Current Opinion in Cosmetic Dentistry

Publications
Advances in adhesive technology offer the dentist the potential to place tooth-reinforcing restorations with more conservative preparations. At the same time, improvements in tooth-colored restorative materials are yielding high levels of durability and esthetics. The combination of these events has led to the development and continued refinement of an entirely new class of restorations for posterior teeth, called esthetic inlays and onlays. This paper summarizes current scientific and clinical opinion regarding this class of dental restorative and presents clinical technique criteria common to all types of esthetic inlays and onlays whether performed directly or indirectly, in resin or in ceramic.
 
Many clinicians have the desire to incorporate cosmetic dentistry into their everyday office procedures. It is often challenging to gain patient acceptance for these procedures. This review explores a way in which two services, tooth whitening and chairside esthetic mockups, can be used to introduce patients to cosmetic dentistry, to educate patients, and to increase happiness in the office while providing worthwhile services.
 
Adhesion has an inseparable association with cosmetic dentistry. The ability to bond well to tooth structure has allowed the placement of countless porcelain veneers and many ceramic inlays and onlays. Improved materials and techniques have offered clinicians the ability to place these restorations with skill and reliability. The past year has seen many developments and additions to the armamentarium of the cosmetic dentist. The compiled data have been placed in different sections to facilitate the learning process. Review of the following material will familiarize the clinician with the current state of the art in the adhesive aspect of cosmetic dentistry. The ability to employ adhesive techniques has revolutionized the practice of dentistry. Clinicians have at their command materials that allow the placement of thin pieces of ceramic onto tooth structure without shattering, the routine placement of composite materials into posterior teeth, the diminishing reliance on liners and bases, and lessened postoperative discomfort with the use of dentin bonding systems. It is, as previously noted, useful to separate the analyses of adhesion to each of the substrates. Advances continue to be made in each of these areas that although not necessarily facilitating treatment ease, improve the reliability of the procedure. This review attempts to highlight the significant literature of the previous year.
 
The outstanding bonds achieved by composite resin luting systems to etched enamel and to etched and silanated porcelain are well documented. These bond strengths, in concert with the excellent and ever-improving dentin bonding systems, encourage the use of porcelain veneers in a continually expanding range of clinical situations and ensure predictable results. Clinicians desiring to offer their patients ultimate cosmetics in conjunction with optimal, conservative restorative techniques will need to monitor scientific and clinical results obtained by leaders in the field of adhesive dentistry and continually update their technique. This review brings the clinician up to date on current research and gives the clinician an understanding of the components of today's adhesive systems technology.
 
Universal Adhesives and Their Basic Chemistries
Advances in adhesive technology have occurred at a remarkable pace over the past few years. It seems as though every month brings a "new" and "better" bonding system onto the market. Clinical protocol is constantly changing. Just when clinicians have mastered one technique, they find it has been supplanted by another. This often creates confusion and suspicion on the part of the dental practitioner. There are, however, some fundamental concepts applicable to almost all adhesive systems. This paper attempts to present a lucid and comprehensible review of some of these concepts. Many of the latest innovations, such as total etch and wet bonding, are discussed. This paper is not intended as a comprehensive review of all aspects of adhesive dentistry. (For example, adhesion to metals is not covered.) It is my hope that readers will come away with a basic understanding of some current concepts and beliefs in the constantly evolving field of adhesive dentistry.
 
The era of bleaching vital teeth has captured the attention of the dental profession, the public, the media, and the government. This method, using a custom-fitted mouthguard and a carbamide peroxide solution, is known as home bleaching, matrix bleaching, nightguard vital bleaching, passive bleaching, and dentist-prescribed-home-applied bleaching. Recent action of the US Food and Drug Administration and continued research and clinical experience in the area have provided favorable and unfavorable information about the variations of the technique. This article discusses these variations, with the general conclusion that the technique of vital tooth bleaching, when administered by a dentist using a custom-fitted mouthguard, is as safe as many other routinely performed dental procedures.
 
The use of orthodontics to correct dental malocclusions and enhance the cosmetic appearance in the adult patient is evaluated. A review of the current literature highlights the latest materials and techniques in adult orthodontics. A categorization of the diagnostic variables involved and the therapeutic options available is presented. Alignment, sagittal, vertical, transverse, and soft-tissue discrepancies, as well as future considerations, are discussed.
 
Ceramics are currently the most widely used material for veneering crowns and bridges. Newer applications, such as bonded inlays, onlays, and veneers, are steadily gaining in popularity. A new generation of metal-free, all-ceramic systems for crowns became available during the 1980s. More recently, other all-ceramic systems with improved mechanical properties affording a variety of uses have been introduced. Also, a computer-assisted design-computer-assisted manufacture method of fabricating ceramic inlays has become a routine treatment entity with favorable 5-year clinical data. Research is leading to a better understanding of conventional ceramic systems as well as providing information on laboratory manipulation and clinical methodology for optimal results.
 
As generations proceed to reinvent themselves in an effort to achieve and maintain youth, cosmetic dentistry faces one of its greatest and most persistent challenges: the restoration of an aging smile. Although the need for this restorative therapy has not yet been adequately studied, the momentum continues to build as aging teeth exhibit physical characteristics that affect their function as well as appearance. This review presents the most common factors influencing the esthetics of anterior tooth aging: coloration; wear and the effects of erosion, attrition, abrasion, and abfraction; and position of teeth relative to each other and surrounding tissues. While dental science seeks to understand how well age-specific restorative procedures can affect patients, the question of the necessity of this therapy remains. Should a healthy smile require treatment? Only time will reveal at what cost and to what extent a younger appearance plays a role in dental science.
 
The aging of the population has put new demands on the range and capabilities of the dentist. Patients are no longer satisfied with the straightforward restoration of their mouths. They are demanding a more youthful appearance as an essential element of therapy. To provide this element, the dentist must have a thorough understanding of the physiology of tooth and facial aging, the treatments available, and the problems and limitations that might be incurred.
 
As computers slowly permeate our dental practices, it becomes obvious that we have a choice: either accept and embrace this technology in order to survive, if not prosper, or we can reject it and sit on the sidelines and get left behind. Using a new patient examination scenario, five different types of computer-aided technology are explored. The clinical application of each piece of equipment is the focus. Extraoral video imaging, intraoral imaging, voice-activated periodontal charting, digital radiographs, and complete office management systems are discussed.
 
The use of ceramic veneers on the facial and incisal surfaces of teeth has become an integral part of our esthetic armamentarium. The success rate on these restorations has led to increased optimism and expanded applications. The full veneer uses bonded ceramic veneers to restore additional tooth surfaces. The result is a highly esthetically pleasing restoration that is functional and very conservative compared with traditional crowns.
 
The challenge of developing a pleasing smile is an artistic venture. A study of how the visual arts have explored the nature of beauty and the elements of artistic composition will enhance our artistic abilities in cosmetic dentistry. This review discusses the perception of beauty and important features of that which we call beautiful. The discussion uses important works of art to demonstrate elements of composition, which are then made relevant in a dental application.
 
Increased patient expectations together with improved diagnostic, material, and surgical advances have expanded the boundaries of esthetic dentistry. To optimize functional and esthetic success, existing techniques are being enhanced through careful patient selection and management of the occlusion. During the period from 1991 to 1992, several areas relating anterior or occlusal compromises to esthetics have been identified. These include: dental and skeletal malocclusion, periodontal esthetic defects, restorative materials and laboratory techniques, tooth arrangement and maxillomandibular relations, and implant dentistry. This paper reviews some of the literature on these areas during this period.
 
The literature is increasingly describing the use of resin-retained porcelain veneers. The dental profession has eagerly adopted this technique and much of this interest has been fueled by the influx of patients seeking to improve the appearance of their smiles. Properly performed, porcelain veneers can provide outstanding esthetics, strength, and longevity. Important restorative applications are beginning to emerge that broaden the scope of ultra-thin bonded ceramic techniques. As with any new procedure, clinical and scientific investigation is required to determine the parameters for efficacy. This review will highlight some of the recently published papers that address important issues associated with the use of porcelain veneers.
 
Patients seeking to improve the appearance of their smiles have driven the profession toward more challenges in esthetic dentistry to answer their needs. Better smiles are being equated with better living. Direct composite veneering has gained tremendous popularity over the past few years because the procedure can be done in one single appointment for a reasonable fee with acceptable results. Materials recently put on the market require stratification build-up techniques to allow for the best natural results. In addition, the procedure gives patients the freedom of live communication and dentists the emotive artistic recreation of a smile composition in which anterior teeth can be designed and redesigned through freehand craftmanship, until both patient and dentist are pleased with the results. This review highlights the benefits of direct composite veneering, a very unique process to investigate more about tooth and smile designs, and suggests more effective communication between patient and dentist in order to achieve predictable results.
 
Edentulous ridge augmentation is a plastic surgical technique that is performed to improve patient esthetics when unsightly, deformed ridges exist. This article describes the etiology of ridge deformities and the many procedures that can be executed to achieve an esthetic, functional result. Historically, soft-tissue mucogingival techniques were described to augment collapsed ridges. Pedicle grafts, free soft-tissue grafts, and subepithelial connective tissue grafts are predictable forms of therapy. More recently, ridge augmentation techniques were developed that regenerate the lost periodontium. These include allografts, bioglasses, guided tissue regenerative procedures, and tissue expansion.
 
Between July 1994 and May 1996, several landmark articles were published concerning the safety and efficacy of vital tooth bleaching with 10% carbamide peroxide in a customfitted tray. The American Dental Association (ADA) published guidelines for ADA acceptance, and three products received approval. Long-term clinical trials on 38 patients indicated 92% successful bleaching after 6 weeks of treatment. Results were stable in 74% of the patients at 1.5 years, and in 62% of the patients at 3-year follow-up with no further treatment. Clinical pulpal studies and periodontal studies indicated no detrimental safety problems, although some laboratory cell studies suggested concerns. The noncarcinogenic potential of 10% carbamide peroxide was established in animal studies. Successful bleaching of tetracycline-stained teeth was achieved after 6 months of treatment, with no tooth problems detected clinically or by scanning electron micrograph. Extended treatment times are effective on other stains from dentinogenesis imperfecta or nicotine. On insertion in the mouth, 10% carbamide peroxide elevated the pH in the tray and saliva. After 4 hours of clinical wear, over 60% of the newer, thicker materials (Opalescence [Ultraclent Products, South Jordon, UT] and Platinum [Colgate Oral Pharmaceuticals, Canton, MA]) was present and active in the tray. Nightguard vital bleaching seems to be the most cost-efficient, user-friendly, patient-accepted method of bleaching teeth available to the profession and is safe and effective. Over-the-counter products can have harmful effects on tooth structure and may not lighten teeth.
 
This year is approximately the fifth year of controlled bleaching of vital teeth administered by the patient, and this practice still generates a great deal of discussion by the American Dental Association, the US Food and Drug Administration, the media, and general practitioners. The placement of a plastic carrier intraorally to hold a carbamide peroxide gel in the mouth is referred to as passive bleaching or dentist-prescribed home bleaching. This article reviews the past year's research, which contains many opposing opinions in both in vitro and in vivo studies with respect to the effect of carbamide peroxide on the hard and soft tissues when they come into contact with this agent for various lengths of time. Above all, the question of safety still arises, although few if any adverse effects have been reported with the use of dentist-prescribed, patient-applied home bleaching. Five years of nonproblematic treatment for millions of patients leads many dentists to believe that this technique, when controlled by the dentist, serves the public well.
 
The use of bonding adhesive techniques in dentistry in general and in esthetic dentistry in particular has expanded significantly. As techniques, materials, and results improve, adhesive procedures are substantially modifying many traditional approaches to treating dental problems. More esthetic and less invasive techniques are becoming routine as adhesive materials and techniques become tested and understood. This paper reviews several important areas that affect our understanding and application of adhesive dentistry. With the many material categories, materials in categories, and varieties of bonding surfaces, the subject is extremely complicated. An attempt has been made to divide the past year's literature into sections and to review each section as a separate component of this complex subject.
 
A review of the literature from 1992 reveals few studies that deal specifically with freehand bonding. Yet freehand bonding is becoming increasingly popular. This contradiction bears in-depth study. How can there be a rise without its being reflected in the literature? The materials have greatly improved, but the techniques are virtually the same, and dentists do not often write articles about techniques that are not new. This paper presents a brief history of resin improvements and reasons that the popularity of freehand bonding is on the rise.
 
Technologic breakthroughs in bonding and ceramics have given us materials and techniques that are more reliable in the long term. Nevertheless, we may still be confronted with fractured composites or porcelain. For reasons of finance, technology, psychology, or time, we may find it difficult to abandon the restoration and redo the job. We are then confronted with the problem of repairing the esthetic material, either temporarily or permanently. This paper reviews the recently published articles on techniques and materials used in the repair of dental restorations.
 
New dental materials and techniques have been introduced in the past few years to fabricate aesthetic ceramic restorations with improved strength, biocompatibility, resistance to wear, and better fit. Aesthetic concerns and increasing demand for tooth-colored posterior restorations have led to a number of all-ceramic restorations such as IPS Empress (Ivoclar-Williams, Amherst, NY). The Empress system offers superior aesthetics and physical properties. New generation ceramics along with the current adhesive techniques have resulted in the ability to provide higher strength, therefore indicating crowns for posterior restorations as well. These materials are being used more frequently and in more extensive oral prosthetic rehabilitations such as the case that will be presented. We discuss the different properties and advantages of IPS Empress.
 
The achievement of successful class II posterior composite restorations depends on very careful technique and the use of materials that allow for reduced wear, prevention of sensitivity, proper anatomic form, accurate and stable color matching, marginal integrity, and surface polish. The intricacies of material science with the burgeoning array of newer, better restoratives are discussed in the context of technique excellence and attention to detail. Today, posterior composite restorations can serve as a reliable functioning part of dentistry's restorative armamentarium.
 
One of the most rewarding experiences for a cosmetic dentist is placing a restoration that harmoniously blends with the surrounding dentition. To obtain this result, one must master the science and art of dental color. Although there have been substantial advances in color teaching during the past few decades, there are still major shortcomings in the development of predictable shades of restorative materials. With the recent influx of new dental materials, and the demand of patients to improve their smiles, the dental profession is finding new solutions to help improve the management of color within the dental profession. This review highlights some important issues in color management from both the clinical and technological points of view.
 
Ideally, a cosmetic restoration should be indistinguishable from the surrounding unrestored dentition. The cosmetic dentist faces the challenging task of creating the restoration using materials that do not possess the light-transmitting properties of natural tooth structures. A thorough knowledge of the physical and physiologic properties of light, color production and perception, and skill in the art of color matching can lead to rewarding success.
 
Laminate veneers have rapidly become the restoration of choice for the conservative esthetic restoration of anterior teeth. The historical development of the process for veneering teeth is presented, and the significant advancements since the introduction of the concept nearly 60 years ago are highlighted. Heat-tempered composite resin laminate veneers are evaluated, including their advantages and disadvantages relative to bonded porcelain veneers. A new technique for the creation of one-appointment heat-tempered hybrid composite resin laminate veneers is discussed. Recent research into the critical features and properties of heat-tempered composite resin inlays and onlays and laminate veneers is reviewed, as are suggestions for technique improvements based on scientific investigations.
 
The evolution of composite and adhesive technology has benefited dentistry significantly. The 1990s have brought us, for the first time in the history of our profession, the ability to restore tooth structure in a conservative and esthetic fashion. The ability to give consistently high-bond strengths to both enamel and dentin and the excellent physical properties of these restorations have made them a permanent part of restorative dentistry. This paper summarizes the authors' current opinion about indirect composite restorations, outlines indications for their use, and describes a clinical technique for their preparation and cementation.
 
Many options are available today for treatment of the cosmetic dentistry patient. Composites, veneers, and porcelain crowns have become an art form, with the gingival tissue serving as the frame. Clinicians providing cosmetic dental services must keep aware of the different techniques available for soft tissue contouring. Only recently has periodontal plastic surgery been presented at dental meetings, and little information exists in the research literature. This review brings the practicing dentist up to date on scientific and clinically relevant articles on soft tissue contouring. By working with the shape and contour of the gingiva, a more complementary esthetic final result is possible.
 
The presentation of proposed dental treatment has been hampered by the absence of visual communication technologies. New high tech dentistry-related tools permit efficient production of case presentations for cosmetic dentistry and restorative dentistry. This review describes how to create computer-based case presentations using Microsoft PowerPoint (Microsoft Corp., Redmond, WA) and visual treatment proposals using Microsoft Word for Windows.
 
Oral and maxillofacial surgery is a specialty of dentistry that may be likened to the proverbial "sleeping giant." From a humble, nascent beginning as a specialty to advance the then modern concept of alveolar surgery to its present state, oral and maxillofacial surgery is today vibrating with excitement. To the credit of dentistry, the profession now has a specialty that not only has the capability to alter the bony facial framework, but also can alter the collateral collagenous and superficial cutaneous structures. Combined with dental alteration of the dentition and gingival apparatus, the profession is nearing its zenith relative to having the capability of changing an entire face.
 
Everyone is marketing their dental practice whether they know it or not. It is far better to design the desired effect than to send mixed messages to your clients. All marketing must be carried out with a plan or mission that is internalized by the doctor and by each member of the staff. The mission coupled with creative talent becomes the proprietary personality of your office and the focus of your marketing efforts. Internal marketing is perhaps the most economical and effective--and most used--method of creating positive results for the practice. External marketing takes your office out to the public most often in print via newsletters, direct mailings, and the yellow pages. Getting the message out through newspapers, radio, and television has and will become increasingly important. This article takes you through the steps we used to identify and market to our cosmetic clients. The results of our demographic and psychographic studies afford unique insight into the type of person attracted by our services. Marketing to this group has to do with diversity in appeal, "the boomers," and experiential motivation.
 
Marketing a cosmetic dental practice is a necessary element of patient education today. A professional relations coordinator is essential for developing integrated strategies that help patients understand the options available to them in cosmetic dentistry. Cosmetic dentistry is an evolving field that can be difficult for patients to fully understand. Only through patient education and marketing will dentists be able to expand their practices to include cosmetic dentistry.
 
The dental laser offers revolutionary advantages over traditional cosmetic dental treatment for our patients. These advantages include precision, hemostasis, sterility, and minimal postoperative pain and swelling. The laser interacts with tissue to vaporize it in a predictable manner that produces predictable results. It is used in periodontal plastic surgery, gingivectomy, soft-tissue crown lengthening, crown and bridge gingival retraction, composite curing, biopsy, frenectomy, stage II implant recovery, and more. Fixed prosthetic impressions can be taken immediately following gingivoplasty and sutures and postoperative dressings are eliminated. This paper presents a case study in cosmetic dentistry to demonstrate many of these applications and summarizes current opinion regarding them. It also briefly describes what a laser is and how it works.
 
This paper reviews the newest advances in and opinions about cosmetic periodontal surgery. It includes a review of basic periodontal anatomy as it relates to restoring ideal health and esthetic gingival and osseous tissues. Treatments for excessive gingival tissue, ridge augmentations, and gingival deficiencies are discussed. These procedures are important in creating the illusion of a natural cosmetic smile in otherwise compromised situations.
 
Appropriate marketing business systems need to be in place to attract and sustain a cosmetic dentistry patient base. Marketing for this sector is most effective when consistently patterned after businesses with high-end consumer services and products. Motivating patients of record and potential new patients to choose cosmetic dental services involves implementing both basic marketing and a series of cosmetic-specific marketing strategies. Consultants are valuable for the process of developing a strategic plan and making recommendations for developing new marketing business systems.
 
It is our obligation to give our patients options so they can make decisions on what treatments they will pursue. Implants certainly provide us with a new set of tools to solve our patients' cosmetic and functional needs. Cosmetic and implant dentistry have both come a long way; the marriage of these two areas has elevated dentistry to a new plateau.
 
With the increased awareness that optimal cosmetic dentistry can have on self-image, self-esteem, and self-confidence, patients are no longer just wanting to close gaps or whiten their smiles. Patients are becoming very conscious of the size, proportion, and position of their teeth as related to their smile and face. By incorporating the art and science of cosmetic dentistry into our enhancement therapy, we are able to create excellent results on a consistent basis. This review explores the impact that cosmetic dentistry can have on creating facial harmony. The discussion demonstrates the importance of a proper esthetic diagnosis as well as a thorough bioesthetic evaluation of each patient. This review also stresses the importance of an objective and subjective assessment and how a detailed evaluation of each patient can help create harmonious and natural smiles.
 
The role that cosmetic dentistry can play in improving one's overall facial esthetics has become increasingly more meaningful to patients, dentists, and physicians as elective cosmetic procedures continue to gain momentum and acceptance in today's Western culture. By incorporating fundamental principals of proper smile design into a total esthetic facial enhancement treatment plan, dramatic improvements may be realized. As cosmetic dentists, maxillofacial surgeons, and orthodontists continue to make successful strides with their physician counterparts, they must continue to emphasize the key role that the smile commands. Although a review of current literature discloses few references to the specific topic of facial enhancements through cosmetic dentistry, it is nonetheless a topic for further discussion.
 
A restoration that captures the elusive qualities of the natural tooth in all its beauty and imperfections has long eluded the dental profession. Recent advancements in tissue manipulation, bonding techniques, dental ceramics, and most importantly, an increase in the skill of the dentist and technician bring dentistry ever closer to achieving the living crown. To duplicate nature we must first be able to see the details that combine to produce beauty. Our powers of observation are our main limiting factor. This article highlights some important factors that, if properly used, can enhance the esthetic result of our dentistry.
 
As dental implants have become an increasingly popular restorative therapy and their stability and functional benefits have become widely acknowledged, newly applied surgical and prosthetic techniques are enabling dentists to approach patients' esthetic expectations. Esthetic results of implant-supported fixed bridges, retrievable bridges, and overdentures are influenced by the amount of soft and bone tissue as well as by the placement of the implants themselves. Tissue augmentation procedures that restore normal tissue contour and allow more ideal implant placement help minimize esthetic compromises. The use of modified abutments that are angulated and placed directly in the implant can offset weak implant placement. Finally, overdentures should be constructed if these techniques cannot be used or if their use still results in compromised esthetic results.
 
The art of designing a new smile often involves more than one cosmetic dental procedure. It is not uncommon to combine media such as tooth whitening with porcelain veneers and crowns to create an entirely new smile. To maintain dental harmony, it is paramount that media are indistinguishable from each other and are consistent with the existing dentition.
 
The 1990s ushered in technologic advances affecting the forefront of dentistry. This technology was the harbinger of a change in dentistry from a need-driven to a want-driven profession. As the twenty-first century approaches, dentistry is embracing these novel advances. Concurrently, the multifarious high-technology equipment brings with it the responsibility for the dentist to educate patients about potential dental benefits that can further enhance their overall health.
 
The need to be aware of and to master techniques in dental photography is increasing as more dentists perform cosmetic procedures. The necessity for photographic records in the areas of legal protection and marketing is only now becoming apparent. The dentist must choose from among a variety of photographic systems depending on the particular requirements of the practice. Visual communication is of vital importance in dentistry, and new modalities for the transfer of this type of information, the clinician link networks, are currently being introduced.
 
The use of dental implants in the oral rehabilitation of partially or fully edentulous patients has become a frequently used treatment modality in everyday practice. The main reason for this development is that critical principles for implant predictability have been established in the last twenty years. Today, researchers and clinicians of all dental subspecialties including cosmetic dentistry are working at refining techniques and extending the limits of the field. This paper is intended to point the reader to interesting publications from 1991 through 1992.
 
The role of interim dental restorations used for indirect restorative and prosthodontic procedures has changed dramatically in the past several years. These restorations are no longer regarded as temporary restorations but rather as provisional restorations with distinct functions and purposes. Provisional restorations have become a vital diagnostic and assessment tool to evaluate function color, shape, contour, occlusion, periodontal response, implant healing, and overall esthetics. An accurate fit and margination is essential to insure and maintain pulpal health of the tooth. With increased demands being placed on provisional restorations, new materials and techniques are being developed and some existing protocols are being refined to accomplish the desired goals. Provisional restorations are often in the oral environment for several months, requiring a well-fabricated and stable restoration. This review is designed to report on current materials, techniques, and concepts in fabricating and maintaining long-term esthetic provisionals.
 
Unimagined only a few years ago, high-technology tools for the dental practice are now widely available. Ranging from video cameras to computer-enhanced diagnostics that fabricate porcelain restorations on site, these new technologies have many applications in esthetic dentistry. Because they make it easier to communicate to patients what can realistically be achieved, high-technology tools tend to involve the patient more in treatment planning and thus may help prevent disappointing outcomes.
 
When implants were first introduced to dentistry, osseointegration was considered the most important factor, with cosmetic considerations not an issue at the time. The possibility of being able to make a foreign body part of the human body was the ultimate goal. With the growing demands for larger than life restorations, dental implantology has entered a new age in which osseointegration is no longer a question but an established fact [1..]. The question has become instead which implant systems and abutments to choose in order to make a superstructure that looks like a natural tooth. This review is intended to bring information to the clinician about the possibilities that exist today to make lifelike teeth on implants.
 
In the past 50 years, advances in restorative dental procedures have made it possible for dentists to achieve better esthetic and functional results for their patients than ever before. Removable prosthodontics has been practiced in much the same way that is has been for many years. Since the introduction of root-form osseointegrated implants, there is a renewed interest in the edentulous and partially edentulous patient. To give the patient all possible treatment options, implants must be considered, but they must not replace sound prosthodontic principles. Presurgical prosthodontics in the form of provisional restorations and stents are necessary for correct implant placement. Overdentures, bar partial dentures, and soft liners are sound treatment alternatives. Review of the work of Dr. Earl Pound is the best source for the development of correct complete dentures.
 
Top-cited authors
Van B Haywood
  • Augusta University
Dennis J Fasbinder
  • University of Michigan
Michael J Noack
  • University of Cologne
J-F Roulet
  • University of Florida
Gary Alex