Esthetic Dentistry - Science topic

Yes the manufacturer of material is is very important to successful the procedure.

The material is Graphy's Tera Harz material

Composition: Tera hard TC-80 is an LED curing polyurethane based resin suitable for 3D printing characterised by high tensile strength, high abrasion resistance and non toxicity

..https://www.ijdsir.com/issue/page/2872/Aesthetic-reconstruction-of-Ellis-class---fractured-lateral-incisor-using-Partial-bonded-restoration--A-case-report.

Chemical cure GIC is preferred. You’ll be performing the patchwork in steps and increments from the most worn out to the least.

After the first two stops have been placed and contoured by the patient gently closing on the GIC and also performing recursive/chewing movements, the remaining teeth are selectively restored within the confines of this OVD increase (usually 2-3 mm). Even this slight increase causes quite a bit of initial discomfort over the first 24 hours and in spite of post placement immediate adjustments a subsequent sitting after 24 hours is mandatory. If for example the wear and tear of a lower molar has an added dimension of maxillary molar tipping the offending cusp can be identified and selectively adjusted.

After original cuspal prominences and restoration contours have been adjusted the patient uses this ‘mock up’ for 3 to 4 days during which the GIC tends to get further leveled and contoured in accordance to the patient’s chewing habits and comfort instead of a dentist or lab imposed perfect occlusal scheme that may lend for visually spectacular restorations but an unhappy patient.

The end point at one week is used as a guideline and this scenario would very naturally have an occlusal scheme mimicking what would naturally be seen in a 70 year old with a degree of wear and tear that would permit a degree of freedom or laxity in movements.

The chief objective in most of my patients has usually been that the restoration of height allows for better interproximal contacts ( no food getting in), less hypersensitivity(preservation of vitality) & a gentle shift of the chewing from the edges of worn teeth towards restored ‘shallow’ cusps (minimizes cheek & tongue bite)

The initial process is almost reversible in case the elderly patient is unsure or unhappy and the interaction over the first 2 to 3 sittings goes a long way in establishing a degree of trust and allows for a better understanding of the patient’s actual needs much before actual preparations are performed allowing for true consent from the patient

The first step is to get the implant platform at the proper height and angulation relative to the gingival margin and the adjacent teeth. ( see Misch, Contemporary Implant Dentistry). Then after integration use a plastic temporary abutment to "form" the gingival emergence by adding and subtracting composite to the abutment coronal to the platform to achieve the desired profile directly in the mouth.

Here is an interesting paper on expired composites: 

Wax up and double scanning work very well on smile creation.

I wonder if OHQoL and KAP are so conceptually different that it would be unlikely to find a model that links them.   

can you read the followings studies

1-

J Contemp Dent Pract. 2014 Jul 1;15(4):392-8.

Influence of Fluoride Concentration and pH Value of 35% Hydrogen Peroxide on the Hardness, Roughness and Morphology of Bovine Enamel.

Nascimento WC, de Lima Gomes Ydo S1, Alexandrino LD1, Costi HT, Silva JO Jr, Silva CM.

2-

Sichuan Da Xue Xue Bao Yi Xue Ban. 2014 Nov;45(6):933-6, 945.

[Effects of vinegar on tooth bleaching and dental hard tissues in vitro].

[Article in Chinese]

Zheng LW, Li Di-ze, Lu JZ, Hu W, Chen D, Zhou XD

3-

Oper Dent. 2014 Dec 23. [Epub ahead of print]

Effects of the Concentration and Composition of In-office Bleaching Gels on Hydrogen Peroxide Penetration into the Pulp Chamber.

Mena-Serrano A, Parreiras S, Nascimento ED, Borges C, Berger S, Loguercio A, Reis A.

4-

.J Esthet Restor Dent. 2014 Dec 20. doi: 10.1111/jerd.12123. [Epub ahead of print]

Evaluation of Novel Microabrasion Paste as a Dental Bleaching Material and Effects on Enamel Surface.

Bağlar S, Çolak H, Hamidi MM

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J Int Oral Health. 2014 Jul;6(4):18-24.

Microhardness and roughness of enamel bleached with 10% carbamide peroxide and brushed with different toothpastes: an in situ study.

Melo CF, Manfroi FB, Spohr AM

6-

Eur J Dent. 2014 Jul;8(3):320-5. doi: 10.4103/1305-7456.137634.

Effects of a bleaching agent with calcium on bovine enamel.

Alexandrino L, Gomes Y, Alves E, Costi H2, Rogez H, Silva C1.

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BMC Oral Health. 2014 Sep 6;14:113. doi: 10.1186/1472-6831-14-113.

Does post-bleaching fluoridation affect the further demineralization of bleached enamel? An in vitro study.

Kemaloğlu H, Tezel H, Ergücü Z.

8-

 

See comment in PubMed Commons belowOper Dent. 2015 January/February;40(1):96-101. Epub 2014 Aug 19.

Effect of Hydrogen Peroxide Concentration on Enamel Color and Microhardness.

Borges A, Zanatta R, Barros A, Silva L, Pucci C, Torres C.

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See comment in PubMed Commons belowActa Clin Croat. 2013 Dec;52(4):419-29.

Surface changes of enamel and dentin after two different bleaching procedures.

Klarić E, Marcius M, Ristić M, Sever I, Prskalo K, Tarle Z.

One answer is  8-12 microns -Riis and Giddon

Other workers in this field that you should check were were Anderson and Picton

The snap on smile used to be called a Hollywood bridge.  It was used for short term use and mainly as a diagnostic tool to determine if the future cosmetic result would be acceptable to the patient.  Unless it is acceptable , no further treatment is performed. Thus, the patient's mouth is not altered unless it is acceptable using a reversible diagnostic tool.

There are a variety of studies to support the feasibility of implant and tooth supported removable partial dentures

Clinical Outcome of Double Crown-Retained Mandibular Removable Dentures Supported by a Combination of Residual Teeth and Strategic Implants.

Rinke S, Ziebolz D, Ratka-Krüger P, Frisch E.

J Prosthodont. 2014 Sep 14. doi: 10.1111/jopr.12214. [Epub ahead of print

Unsplinted implants and teeth supporting maxillary removable partial dentures retained by telescopic crowns: a retrospective study with >6 years of follow-up.

Frisch E, Ratka-Krüger P, Wenz HJ.

Clin Oral Implants Res. 2014 Apr 16. doi: 10.1111/clr.12407. [Epub ahead of print]

Implant retention and support for distal extension partial removable dental prostheses: satisfaction outcomes.

Gonçalves TM, Campos CH, Garcia RC.

J Prosthet Dent. 2014 Aug;112(2):334-9

Implant Tooth-Supported Removable Partial Denture with at Least 15-Year Long-Term Follow-Up.

Mijiritsky E, Lorean A, Mazor Z, Levin L.

Clin Implant Dent Relat Res. 2013 Dec 27. doi: 10.1111/cid.12190. [Epub ahead of

Prognosis of implants and abutment teeth under combined tooth-implant-supported and solely implant-supported double-crown-retained removable dental prostheses.

Rammelsberg P, Bernhart G, Lorenzo Bermejo J, Schmitter M, Schwarz S.Clin Oral Implants Res. 2014 Jul;25(7):813-8.

Survival of double-crown-retained dentures either tooth-implant or solely implant-supported: an 8-year retrospective study.

Schwarz S, Bernhart G, Hassel AJ, Rammelsberg P.

Clin Implant Dent Relat Res. 2014 Aug;16(4):618-25.

Implant placement under existing removable dental prostheses and its effect on oral health-related quality of life.

Wolfart S, Moll D, Hilgers RD, Wolfart M, Kern M.

Clin Oral Implants Res. 2013 Dec;24(12):1354-9

Dental implants as strategic supplementary abutments for implant-tooth-supported telescopic crown-retained maxillary dentures: a retrospective follow-up study for up to 9 years.

Krennmair G, Krainhöfner M, Waldenberger O, Piehslinger E.

Int J Prosthodont. 2007 Nov-Dec;20(6):617-22.

Removable dentures with implant support in strategic positions followed for up to 8 years.

Kaufmann R, Friedli M, Hug S, Mericske-Stern R.

Int J Prosthodont. 2009 May-Jun;22(3):233-41; discussion 242

Use of dental implants to improve unfavorable removable partial denture design.

Mijiritsky E, Ormianer Z, Klinger A, Mardinger O.

Compend Contin Educ Dent. 2005 Oct;26(10):744-6, 748, 750 passim

A solid statement indeed. May I please respectfully ask:

...based on which solid scientific evidence?

The initial polymerization contraction is 1.5-3.5%, which causes problems with bulk fillings shrinking away from margins, but has little effect on layered build-ups. Wear resistance and flexibility are built into the composite, but do not necessarily directly relate to polymerization shrinkage.

The osteoclast dysfunction define the pathogenesis of this disease. In addition, the whole bone metabolism is affected in the osteopetrosis patient, once the crosstalk between osteblast and osteoclasts is also deficient. The major concern is in fact the osteomyelitis. The orthodontist and the physician should discuss the patient’s risks and benefits of orthodontic treatment according to the severity of the osteopetrosis.

Agreeing with the finding that bonding to enamel is more reliable as bonding to dentin, the question can be refraised as: is it contra-indicated to place a porcelain veneer with cervical part bonded to dentin? I would think that a certain risk for imperfections such as marginal staining would be higher for those situations and should be explained to the patient, but still the veneer can be placed. Alternatives like full crowns also have their risk profiles such as pulp necrosis, fracture etc. Comparing the techniques and possibilities I think the minimal invasive option still has the most advantages.

To make it more complicated: what has a better prognosis: a veneer bonded to enamel in a high caries risk patient or a veneer bonded to dentin in a low risk patient?

These aspects are very suitable to be investigated in practice based, (retrospective) pragmatic controlled trial designs.

Occlusal concepts are still just concepts derived from complete denture practice. To add a little, 99.99% of all clinicians make their first steps having their patients seated comfortably in the dental chair to find the vertical dimension. Also, muscle relaxation is important because most patients lost their oral motor skills (stereognosis) over the years and you will have to manipulate the mandible in centric relation, which takes time.

I think a lot will depend on the patient's compliance and his or her willingness to retain their natural dentition...as far as i am concerned i would definitely try 2 save the natural tooth instead of blindly going 4 implant....surgical crown lengthening, root canal treatment, post and core should be done but ultimately it all depends on the patient's will and whether they would be ready to come for so many appointments for saving a tooth..if the answer is no...definitely implant therapy..provided the periodontium is healthy and we have sufficient sound bone to receive an implant...

To remove the implant and place a new implant at the desired level.

Some probably very helpful papers:

J Prosthet Dent. 2003 Dec;90(6):556-62. Factors determining post selection: a literature review. Fernandes AS1, Shetty S, Coutinho I.

Effect of the crown, post, and remaining coronal dentin on the biomechanical behavior of endodontically treated maxillary central incisors.

Veríssimo C, Simamoto Júnior PC, Soares CJ, Noritomi PY, Santos-Filho PC.

Effect of ferrule height and glass fibre post length on fracture resistance and failure mode of endodontically treated teeth. Abdulrazzak SS, Sulaiman E, Atiya BK, Jamaludin M. Aust Endod J. 2013

In general, I agree. A crown with an insufficient margin should be remade completely. If you want to transfer the insufficiency to the dental technician for adaption, you can use the following approach:

1. Cut back the margin of the crown in the area of the gap 1.0 mm superior to the margin of the preparation. Make sure that there is a pronounced chamfer.

2. Take an impression (e.g. polyether) with the positioned crown.

3. The dental technician should cast the impression with a special resin.

Because of the shrinkage of the ceramics during the firing process, the marginal fit will be tolerable at best. Because of the limited strength of the veneering ceramic (approx. 80 MPa) it should be implemented only in case of small areas with margin insufficiencies, using a special margin ceramics (available e.g. by Vita Zahnfabrik, Bad Saeckingen, Germany).

It depends on each patient self-healing capacity, but it is very important to keep the intaglio surface as much polished as possible and free of plaque. Some inflammation is possible. I recommend you to read two classic articles by John Kois and Joseph Kan on Compendium 2001.

by Public health dentistry. Meaning implementing relevant preventive dental health services to appropriate population groups.