Three-Dimensional (3D) Facially Driven Workflow for Anterior Ridge Defect Evaluation: A Treatment Concept
The esthetic rehabilitation of anterior ridge defects and achieving patient satisfaction have become major clinical challenges for dentists and technicians. Poor diagnosis and treatment planning are frequently associated with multiple surgical procedures that fail to meet patient expectations. The loss of hard and soft tissues in anterior ridges results in an esthetically compromised zone that affects the rehabilitation prognosis. The presence of interdental papilla and papillary configuration play a decisive role in patient satisfaction.

CAD/CAM Solutions for Minimally Invasive All-Ceramic Rehabilitation of Extended Erosive Lesions
Dental erosion is a global health problem that can lead to significant functional and esthetic impairments of the affected patients. Treatment of sever cases with augmented loss of the vertical dimension of occlusion (VDO) represents a challenge for both the dental team and the patient. CAD/CAM technology was used in the presented case to analyze the inter-occlusal space. The case report documents a practical, digital approach and discusses the advantages related to treatment time, ease of treatment, and predictability.

Surface Roughness of Restroation Margin Preparations: A Comparative Analysis of Finishing Techniques
This study compared the margin profile and surface roughness created by the tips of four different finishing instruments: fine diamond, dura white stone, tungsten carbide, and ultrasonic diamond-coated tips (UDTs). The aim was to determine which of these instruments produced the smoothest finish and created the most evenly contoured margin characteristics. It was hypothesized that UDTs would produce a rougher dentin surface than a fine diamond bur, that a tungsten carbide bur would provide a smoother finish than a fine diamond, and that the dura white stone would produce an intermediate finish.

Enhancing Esthetics with a Fixed Prosthesis Utilizing an Innovative Pontic Design and Periodontal Plastic Surgery
During the past two decades, significant advancements with the integration of periodontal plastic surgery into esthetic restorative dental procedures have received increased attention. While ovate pontics have traditionally been used as a restorative design following augmentation procedures to enhance esthetics, an alternate E-pontic design aims to predictably support and maintain the gingival architecture between a single missing anterior tooth adjacent to a natural tooth or an implant that is in harmony with the lip line and face. In addition, the E-pontic design promotes the gingival facial tissue to coronally migrate over the pontic, creating a gingival sulcus. This article describes an innovative new technique and a pontic design that predictably will develop, support, and maintain the gingival architecture to provide a long-term esthetic and functional outcome.

Adhesive Dentistry: Materials & Techniques Simplified
Handout

Visual Esthetic Smile Design: Driving the Restorative Plan
Digital Smile Design is a multipurpose digital tool with clinically relevant advantages: It can strengthen esthetic diagnostic abilities, improve communication between team members, help organize treatment planning, create predictable systems throughout treatment phases, enhance patients’ education and motivation, and increase the effectiveness of case presentation. This article describes the main steps of introducing this practical tool to the clinician’s esthetic restorative practice.

Complex Case Rehabilitation in Light of New Technologies
This case report describes a step-by-step full arch restoration (upper and lower), rehabilitated utilizing new technologies in dentistry. CAD/CAM technology has changed not only the technician's working process, but also the clinician's, offering new benefits to clinical workflow.For example the possibility of using zirconia and its characteristics as a restorative material. The clinician's and technician's professional backgrounds and relationships are critical to achieving optimal aesthetic and functional results; while prosthetic success depends upon an in-depth knowledge of the materials and their properties and on carefully performed clinical procedures, which are still of utmost importance to obtain satisfactory results.

Two Immediate Temporization Methods Exemplified: Flap vs. Punch Technique in Implant Surgery
Protocols and techniques for immediate tooth replacement in the esthetic zone have become more popular and predictable within the past decade. Two different clinical scenarios are presented where immediate temporization of implants placed into healed or augmented ridges is exemplified. The benefits of augmentation prior to implant placement and temporization are that flap elevation is not required; therefore, the blood supply to the labial plate is not compromised, thereby eliminating potential midfacial recession. In addition, the soft tissue subgingival shape of the temporary crown can be non-surgically sculpted at the time of implant placement since the patient is already anesthetized.

Esthetic and Functional Rehabilitation: A Case Report
In this article, esthetic case planning and a new complete protocol of tooth preparation for full crowns will be highlighted utilizing modified enamel chisels and the dental microscope. Multimedia will be utilized for optimal visual learning using magnification photography and videos to focus on specific details required to improve your dental skills. The important role of magnification in dentistry will be further discussed.

Relationships Between Different Tooth Shapes and Patient’s Periodontal Phenotype
The purpose of the present study was to establish whether any correlation exists between tooth shapes and patient-related factors such as gingival and periodontal characteristics. Clinical measurements, including the width and the height of maxillary central incisor crowns, the apico incisal height of the keratinized mucosa, the buccal gingival thickness (GT), the depth of the sulcus, the bone-sounding depth (BS) and the height of the interproximal maxillary central papilla, were investigated in 50 healthy individuals. These individuals were then divided into three groups based on the shape of their maxillary central incisor crowns: triangular; square; or square-tapered. The results of this study indicate that different tooth shapes are associated with significantly different values for the extent of the KM, its bucco-lingual thickness and the height of the interproximal maxillary central papilla.

A Technique for Making Impressions of Deeply Placed Implants
Precise fit between dental implants and the superstructure is important for the long term success of implants and implant-supported prostheses. One factor which may influence the accuracy of the definitive prosthesis is the stability of the impression coping in polymerized impression material. In some circumstances, an implant must be placed well below the gingival margin, meaning that most of the impression coping will also be situated subgingivally with no contact with the impression material. This can result in reduced stability of the impression coping, allowing it to rotate when fastening the implant analog. This article describes a simple technique that involves the use of a roll of composite resin, tray adhesive, and a small amount of occlusal registration material applied around a transfer coping in a direct implant impression.

CAD/CAM Anterior Esthetic Implant Restorations: The BellaTek Encode Healing Abutment and CAD-Block Ceramics
Digital design software programs for teeth and implant restorations have evolved over the past 5 years. Using CBCT scans and digital preoperative scans, the clinician can properly plan the placement of implant fixtures. Various software programs and intraoral scanners offer analysis of proper implant position, angle of implant placement, and depth of tissue and occlusal clearance. The utilization of coded healing abutments (BellaTek®, Encode®, Biomet 3i) may also add to the precision of design and calibration of all tissue contacting points of the emerging abutment. This article will introduce and describe a current model for fabrication of ideal abutments, and fabrication of CAD/ CAM restorations for the anterior esthetic zone.

Smile Analysis - The Photoshop Smile Design Technique: Part 1
Computer design software will become the main communication technology between dentists and ceramists and a useful tool for showing patients the possibilities for enhancing their smiles. By understanding the elements of esthetics and learning how to incorporate technology applications into clinical dentistry, clinicians can predictably plan smile design cases and communicate anticipated results to patients and ceramists alike. This article, the first in a two-part series, introduces elements of smile design and reviews some timeless concepts. It discusses new, step-by step techniques for incorporating digital technology into the smile design process that can be accomplished in approximately three to four minutes.

Anterior Substructure Design Considerations for Lithium Disilicate Crowns
Considering anterior substructure designs for lithium disilicate crowns, a hybrid substructure design that supports a cusp to fossa anterior guidance relationships can increase the strength of the ceramic system without having to compromise the esthetic integrity of the crown. Refractive index values increase when the substructure thickens. Increasing the thickness of the substructure results in a crown of higher value.

Reconstruction of Tooth Form in Various Anatomical Tooth Combinations
The present article describes the variations in form of anterior teeth, which are important in achieving an aesthetic result. Each tooth is shaped according to the task it must perform and that will enable it to blend harmoniously into the oral cavity. The shape of the anterior teeth are very important from the aesthetic point of view, is dealt with from the standpoint of the dental technician. The numerous possibilities for anatomical tooth reproduction, in order to achieve the most suitable form for each particular case, are highlighted.

The Harmony of Pink and White
Advances in technology have created many options in dental therapy. Implant therapy is becoming widely used to improve patients' oral function and make them satisfied. Clinicians are discovering the anatomical relationship of implant and soft tissue with the limitations of implant therapy. On the other hand, patients are demanding more beautiful smiles. Therefore, it is necessary to consider the harmony of pink and white in esthetic and functional restorative therapy.

Dental color matching instruments and systems. Review of clinical and research aspects
Today’s shade-matching technologies have been developed in an effort to increase the success of color matching, communication, reproduction and verification in clinical dentistry, and, ultimately, to increase the efficiency of esthetic restorative work within any practice. The aim of this paper is to provide a comprehensive review of the current state of shade-matching technologies and instrumentation, and their clinical and research application.

Efficacy and Persistence of Tooth Bleaching Using a Diode Laser with Three Different Treatment Regimens
Bleaching is the most conservative esthetic treatment for discolored teeth when compared to resin-bonded composites, porcelain veneers, or crowns. The purpose of this study was to compare the efficacy of power bleaching using a laser assisted hydrogen peroxide system, and to determine the stability of the color change over a 6-month period.

Classification and Treatment of the Anterior Maxillary Dentition Affected by Dental Erosion: The Ace Classification
In modern society, dentinal erosion has become one of the major causes of the loss of mineralized tooth structure. The aim of this articel is to convince clinicians that in the specific case of dental erosion, hesitation in under-taking the adequate treatment will inevitably lead to further degradation of the patients dentition.

Splints Are Not Just for TMJ Therapy Part II: Fabrication Technique
When only the canine or the incisors contact in lateral movement, there is a neurologic feedback mechanism that prevents excessive muscular contraction (the more teeth that contact the greater the possible contractile stress and thus muscular overload).

Laser-Assisted Flapless Crown Lengthening: A Case Series
In medicine, and to a lesser extent in dentistry, evolving technologies have served to expand the indications for minimally invasive procedures. In dentistry, lasers, although currently less integral to advances in minimally invasive procedures, are nevertheless evolving as potentially effective adjunctive tools within the therapeutic arena.

A Simple Technique to Create an Interim Provisional Restoration
It is usually a challenge for a patient to feel immediately comfortable with his or her new smile. One of the best ways to gain patient acceptance of the new smile is to place provisional restorations that mimic the final ceramic restoration in both tooth form and color.

Proximal Contact Areas of the Maxillary Anterior Dentition
The goal of this study was to quantify the apicoincisal extent of the proximal contact area (PCA) between the eight maxillary anterior teeth. PCAPs should be taken into consideration for clinical anterior restorations since they determine the papillary and incisal embrasures.

Papilla Proportions in the Maxillary Anterior Dentition
Interdental papilla heights of maxillary anterior teeth were measured from the gingival zenith, along with clinical crown lengths.

Intraoral Autogenous Block Onlay Bone Grafting for ExtensiveReconstruction of Atrophic Maxillary Alveolar Ridges
Autologous bone grafting used with dental implants was originally described by Bränemarketal in 1975, and is now a well-accepted procedure in oral and maxillofacial rehabilitation.Placement of an endosseous implant requires sufficient bone volume for complete bone coverage. Furthermore, the pattern of ridge resorption contributes to an unfavorable maxillomandibular relationship, requires angulations of the implants and/or angled abutments, and affects the proximity of adjacent facial concavities(maxillary sinus, nasal cavity) and vital structures(mandibular nerve).

Immediate Custom Implant Provisionalization: A Prosthetic Technique
This article outlines a provisionalization technique that can be performed after traditional healing of the implant site. Upon reading this article, the reader should: Realize that this technique is also effective when immediate implant loading is not possible. Become familiar with the benefits of an immediate customized provisional, including duplicating the emergence profile of the extracted tooth.

Utilising a restorative approach to correct an adult skeletal class III malocclusion
Gerard J. Lemongello discusses all the steps taken to correct the malocclusion.

Communicating Digitally with the Laboratory: Design, Impressions, Shade, and the Digital Laboratory Slip
This article will review and explore some of the digital opportunities and rationales for digital communication of all forms of clinical information from the dentist to the laboratory.

Introducing Choukroun’s Platelet Rich Fibrin (PRF) to the Reconstructive Surgery Milieu
Platelet-rich fibrin (PRF), developed in France by Choukroun et al (2001), is a second generation platelet concentrate widely used to accelerate soft and hard tissue healing. Its advantages over the better known platelet-rich plasma (PRP) include ease of preparation/application, minimal expense, and lack of biochemical modification (no bovine thrombin or anticoagulant is required). PRF is a strictly autologous fibrin matrix containing a large quantity of platelet and leukocyte cytokines. This article serves as an introduction to the PRF “concept” and its potential clinical applications.

Prosthetic Gingival Reconstruction in a Fixed Partial Restoration - Part 1: Introduction to Artificial Gingiva as an Alternative Therapy
The Class III defect environment entails a vertical and horizontal deficiency in the endentulous ridge. Often, bone and soft tissue surgical procedures fall short of achieving a natural esthetic result. Alternative surgical and restorative protocols for these types of prosthetic gingival restorations are presented in this three-part series, which highlights the diagnostic and treatment aspects as well as the lab and maintenance challenges involved.

Exceptional Master Impressions
Advanced soft- and hard-tissue management is essential when it comes to making esthetic dental restorations.

Adhesive Dentistry's 'Secret' Weapon
When it comes to bases, bondings, and build-ups, glass ionomer cements are the restorative material of choice to replace dentin.

A Precise Bite Registration Technique
Courtesy of AEGIS & Inside Dentistry

Range & Mean Distribution Frequency of Individual Tooth Width of the Maxillary Anterior Dentition
Proper diagnosis of tooth size for each patient is critical in treatment planning for aesthetic restorative dentistry. The goal of this study was to determine the clinically relevant range and mean distribution frequency of individual tooth width of the maxillary anterior dentition within a given population of patients. Mean values for restoration of tooth size were not interchangeable for the different group size of patients or respective tooth groups. The results of this study suggest that there exists a range value of maxillary anterior tooth width for both males and females. Gender differences are a critical factor in restoring an aesthetically pleasing smile.

Chu's Aesthetic Gauges: Proportion
The Proportion Gauge has the T-bar tip on one end and an In-line tip on the opposite end. The T-bar tip is used on teeth with normal alignment and the In-line tip is used for crooked or crowded teeth where the horizontal arm of the T-bar is obstructed by the rotated teeth. The instrument is used to measure the width and length of maxillary anterior teeth. The tip measurements have a predetermined ratio of about 78% (based on the study results on the average width, length ratio of the maxillary anterior…

Subgingival Technology to Enhance the Theraputic Outcome Smile Reconstruction
As the public becomes more attuned to the esthetic possibilities available for selfimprovement through smile enhancement, dentistry is seeing a significant increase in patients wanting the so-called "Hollywood" smilel This emerging trend is causing the growth of the periodontal plastic aspect of periodontal therapy, which includes procedures such as root coverage, ridge augmentation, site development for implants, soft and hard tissue grafting to correct un esthetic or functionally compromising…

A New View for Restorative Dentistry
The term endoscopy is derived from the Greek language and is literally translated as endon (within) and skopion (to see), hence the meaning, "to see within." Early endoscopists such as Hippocrates in 377 Beused primitive tube-like instruments for endoscopy. Arabs in 900 AD utilized mirrors to illuminate body cavities, and Nitze in the 1870s incorporated lenses with an incandescent platinum wire loop for illumination. All were restricted by the inability to transfer sufficient light distally into…

In Practice Maintenance of Esthetic Restorations
During my career in dentistry, I have seen patients successfully maintain their restorations for more than 40 years. Other patients have needed replacement or repair in less than 5 years. Why is there such a tremendous range? Obviously, the lifespan of a restoration has a strong correlation to its original fabrication quality. But professional dental oral maintenance plus home care by the patient can greatly influence the lifespan of restorations as well. This article addresses the basic elements…

Restoration and Retention of Maxillary Anteriors with Severe Root Resorption
Background: The authors describe the treatment of three patients who had severe apical root resorption of maxillary lateral incisors caused hy ectopically erupting canines. Ectopically erupting canines derive from a normal path of eruption and may cause resorption of the adjacent teeth.

Aesthetic Design Preservation in Multidisciplinary Therapy
Complex perio-prosthetic cases that require multidisciplinary therapy often result in compromised aesthetics. Traditional treatment planning philosophies, as well as existing interdisciplinary relational patterns, do not promote the achievement of predictable aesthetic results. Implementation of a restorative-driven approach requires the development of an aesthetic blueprint that will serve as a guide through treatment. This article illustrates the clinical techniques and sequence for an outcome-based protocol…

Aesthetic Excellence Through Outcome-Based Treatment Rationale
The conceptual basis of restorative-driven implant dentistry is well established among clinicians. Its implementation includes the development of a prosthetic blueprint that will serve as a guide throughout therapy. While these concepts may be applied to prosthetic dentistry in general, their benefits are most compelling in the treatment of the aesthetic zone. This article demonstrates a systematic multidimensional approach for the establishment and incorporation of definitive aesthetic objectives throughout…

Prosthetic Considerations with Periodontal Root Resective Therapy Part 1
Previousiy, the presence of a probable furcation with in a multi rooted tooth was considered an indication for extraction. Loss of attachment in the furcation has traditionally been described as classes I, II , or [ II, depending on the extent of horizontal penetration into the furcation. Tamow and Fletcher subsequently included a vertical component classification with its horizontal counterpart. Interestingly, both of these classifications are based only on periodontal probing depths rather than…

Multipurpose Lasers in Dentistry 1999
Few professions have worked as hard as dentistry to convince the public of the value of its services and especially to make these services as attractive as possible. Of no minor importance is the realization that patients want and appreciate dentistry's efforts to make dental visits more pleasant. Efforts to communicate advancement in dentistry is seen in written advertisements, as well as television coverage of just how painless and high-tech a visit to the dentist has become. Helping improve the…

Predictable Elastomeric Impressions in Advanced Fixed Prosthodontics
Despite advances in dental material technology, the predictable procurement of accurate impressions for the fabrication of complex fixed prosthodontic restorations remains an elusive objective. The technical challenges and potential negative sequelae are exponentially magnified in advanced applications that involve multiple abutments and preparatory phases. A protocol for consistently achieving accurate impressions with the use of polyether impression materials and automatic instrumentation is presented…

Interproximal Height of Bone
A guidepost to predictable aesthetic strategies and contours.

Achieving Optimal Gingival Esthetics
Rationale, Concepts, and Techniques

Aesthetic Dentistry: A European Perspective
The objective of this collaboration is to familiarize the American dental community with the concepts and material applications currently in use throughout the European community.

Using Air-Abrasive Technology to Diagnose
National Institute of Dental Research surveys indicate that the Incidence of pit and fissure caries constitutes a higher proportion of the total caries incidence among U.S. teens and children than in the past. Airabrasive technology may provide a more conservative alternative in the diagnosis and treatment of pit and fissure caries than traditional techniques using handpieces. The authors review characteristics of pit and fissure lesions and discuss methods for diagnosing and treating these lesions…

The Interproximal Height of Bone as a Prognostic Guide to Esthetic Tooth Replacement
Predictable interproximal soft tissue dimensions measured from the most coronal IHB (note: measurements rounded to nearest half millimeter for clinical relevance and utilization).