International Journal of Esthetic Dentistry (EN), 03/2011

Minimally invasive principles should be the driving force behind rehabilitating young individuals affected by severe dental erosion. The maxillary anterior teeth of a patient, class ACE IV, has been treated following the most conservatory approach, the Sandwich Approach. These teeth, if restored by conventional dentistry (eg, crowns) would have required elective endodontic therapy and crown lengthening. To preserve the pulp vitality, six palatal resin composite veneers and four facial ceramic veneers were delivered instead with minimal, if any, removal of tooth structure. In this article, the details about the treatment are described.

Achieving similar features to those on natural teeth is a common problem with esthetic restorations. Color matching is a fundamental procedure required to perform a predictable composite resin restoration. It is no longer enough to measure these criteria with conventional shade guides, which provide the hue and chroma, but do not take into account other dimensions of the tooth such as value, intensives, opalescence and characterizations. The present article presents a simple and effective technique for color selection using a digital photograph of the tooth and an image-editing program such as Adobe Photoshop or Picture Project. The digital editing of the photograph with two simple steps described in this paper reveals the internal structures of the tooth easily. The modified photographs highlight the opalescence, white spots, shape of the internal mammelons and other features that are not visible at first glance. This procedure provides an accurate color chart with which the clinician can begin an esthetic restoration process.

Bonded porcelain restorations are a predictable and durable treatment option with which not only esthetic appearance but also the strength and function of teeth can be re-established. One of the most important issues of today's dentistry is the preservation of sound enamel. Following biomimetic principles, employing minimally invasive applications and adhesive technologies are of paramount importance for successful restorations. The mock-up technique is advised for delicate removal of the required space for thin porcelain veneers minimally. Besides minimally invasive preparation, long-term success is determined by the adhesive quality of the laminate veneers. This case presentation demonstrates restoration of anterior dentition where the wear of incisal edges posed a negative effect on the smile of the patient. Before bonded porcelain veneers were adhesively cemented, incisal lengthening with direct resin composite and gingival contouring was performed. By using the mock-up technique, minimal preparations were made with the outline ending in enamel only. For cementation of these restorations, step-by-step adhesive procedures are presented.

The "smile line" is commonly used as a parameter to evaluate and categorize a person's smile. This systematic literature review assessed the existing evidence on the validity and universal applicability of this parameter. The latter was evaluated based on studies on smile perception by orthodontists, general clinicians, and laypeople. Methods: A review of the literature published between October 1973 and January 2010 was conducted with the electronic database Pubmed and the search terms "smile," "smile line," "smile arc," and "smile design." Results: The search yielded 309 articles, of which nine studies were included based on the selection criteria. The selected studies typically correlate the smile line with the position of the upper lip during a smile while, on average, 75 to 100% of the maxillary anterior teeth are exposed. A virtual line that connects the incisal edges of the maxillary anterior teeth commonly follows the upper border of the lower lip. Average and parallel smile lines are most common, influenced by the age and gender of a person. Orthodontists, general clinicians, and laypeople have similar preferences and rate average smile lines as most attractive. Conclusions: The smile line is a valid tool to assess the esthetic appearance of a smile. It can be applied universally as clinicians and laypersons perceive and judge it similarly.

This study presents a technique for improving implant placements. As is widely known, a correct positioning is essential in restoration-driven implants, as well as in tilted implants in order to obtain satisfactory final functional and esthetic results. To this end, some authors have emphasized the importance of using a diagnostic and/or surgical guide to plan the exact implant position. In practice, one of the clinical problems faced is how to check the accuracy of the template prior to initiating the surgical phase. A simple method called the "S-Technique" is proposed in order to evaluate and to change, if necessary, the projected position of the implants by way of metal rods as radiopaque markers. This device is easy to produce and is cost-saving to the clinician and, therefore, to the patient. Furthermore, in specific patients, this method could also decrease the need for computerized tomography scans and/or radiographs, thus reducing health risks for the patient.

The aim of this study was to assess the durability of bleaching results achieved with (1) 15% carbamide peroxide home bleaching and (2) 38% hydrogen peroxide in-offi ce bleaching. A total of 231 extracted anterior teeth were randomly divided into three groups (n = 77 in each group) with comparable mean baseline L*-values (68.24 ± 0.8): a non-bleached control group A, a 15% carbamide peroxide group B (5 bleaching intervals of 8 hours), and a 38% hydrogen peroxide group C (3 intervals of 15 minutes). Durability of bleaching was assessed by comparing CIE-L*a*b* data after intervals of 2, 4, 12, and 26 weeks from baseline. Both bleaching regimes initially produced a highly signifi cant increase in lightness parameter L*, with no signifi - cant difference between the respective bleaching regimes (B: 68.23 / 72.48; C: 68.32 / 73.25). Six months after starting the trial, L*-values for group B yielded no signifi cant differences compared to baseline (69.55), whereas L*-values for group C were still signifi cantly raised (69.91), despite a highly signifi cant decrease when compared to initial bleaching results. In both treatment groups, there was a lasting response to bleaching in terms of CIE-a* and -b* value decreases. Results for both home- and in-practice regimes were found to be similar for about 12 weeks. However, in-offi ce results were longer lasting, despite the shorter treatment intervals. Summarized bleaching effects, in terms of delta E values, revealed no signifi cant differences between treatment groups and the control group after 6 months, indicating an abatement of the bleaching results achieved.