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JADA Specialty Scan - Cosmetic/Esthetic
Cosmetic/Esthetic - A Quarterly Newsletter on Dental SpecialtiesJADA

Implant therapy: Improving outcomes in the esthetic zone

The decision-making process for successful implant therapy in the anterior maxilla requires familiarity with current best evidence on far-reaching topics including bone augmentation for implant site development, biologics and prosthetic management.

Authors publishing in the July/August 2015 issue of the Journal of Esthetic and Restorative Dentistry describe key surgical and prosthetic principles in achieving such esthetically successful results. Outlining basic tenets that encourage the framing of final restorations with healthy stable tissues, they warn that if implant placement is not optimal, and the contours of the provisional restorations are not favorable, unacceptable esthetic outcomes impossible to correct after initiation of treatment are possible.

“Not every tooth is a good candidate for immediate implant placement and not every immediate implant is a good candidate for immediate provisionalization,” authors advised. In addition, they stressed that recognizing patient desires and limitations of therapy were paramount to esthetic success.

Among treatment responsibilities, clinicians must determine answers to critical questions about each specific patient. For example: What is the maxillary/mandibular occlusal relationship? What is the quality and quantity of available hard and soft tissue? Can the patient avoid chewing in the operated region for at least six to eight weeks?

Steps to the therapeutic goal, such as case selection, grafting procedures, postoperative management and prosthodontic considerations are covered. Authors noted, “What is often overlooked is the impact the three-dimensional implant position has on the potential of the temporary restoration to provide optimal esthetics.”

Understanding the physiologic changes that occur after tooth loss and appropriately intervening can be the difference between long-term success and failure. Remaining cognizant that the goal of implant therapy is osseointegration is important for insuring that it occurs. Visualizing the outcome of treatment prior to its inception, following specific surgical and restorative guidelines, increases the likelihood of success, they said.

Read the original article.


Dental adhesive and color change

Patients who choose to restore their teeth expect perfectly matching restorations. Clinicians are faced with multiple variables, including the color of the tooth structure and the thickness and translucency of the restoration — all factors that can produce visually perceptible color changes.

Previous research has shown that cement shade can change the final color of porcelain laminate veneers and that dental adhesives may have a similar effect on direct laminate veneers (DLVs). Scientists interested in evaluating the influence of dental adhesive on the final color match of DLVs conducted a study and published their findings in the September 2015 issue of the Journal of Esthetic and Restorative Dentistry.

They prepared 20 uniform discs in each of the three test groups. One group of discs was made up of only the composite material and served as the control group. Another was made up of adhesive and composite material and the third group of discs was made with composite with adhesive that was re-bonded. All discs were incubated in the dark in distilled water at body temperature for 24 hours to complete polymerization reaction.

Scientists used a spectrophotometer to evaluate change in color brightness, hue (red — green) and chroma (yellow — blue).

Among results, differences in laminate veneer color for both hue and chroma exhibited the same pattern among groups. Average change in brightness after curing was significantly less in the samples which were re-bonded as compared with controls and there was no difference between controls and discs made of composite materials with adhesive.
Although color change was small, dental adhesive and re-bonded dental adhesive affected the color of direct composite restorations.

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IPS e.max or zirconia?
Q & A with Archibald and Associates: What do Jed and John really think about zirconia and why do they use IPS e.max?   Read their latest case study with Dr. Gordon J. Christensen in Inside Dental Technology. Learn more.


Perception of smile attractiveness in asymmetric faces

A large body of published research is devoted to the characteristics that make up an attractive smile. However, despite evidence that facial structures influence opinion of smile esthetics, few studies have been published about facial composition in the context of lay peoples’ perception, according to scientists publishing in the Winter 2015 issue of The International Journal of Esthetic Dentistry. The research team was motivated by an interest in factors affecting perception of smile beauty and how various facial structures influence opinion about the dental esthetic. They found that several extraoral facial structures, namely the nose and the chin, affect perception of the dental midline.

Motivated by the increasing importance of acquiring a wider knowledge of the mechanisms comprising the assessment of beauty and the role of facial structures on peoples’ perception of dental esthetics, the team conducted a study. They sought to determine whether certain facial asymmetries of the nose and chin have an impact on perception of the maxillary dental midline shift, long considered an important factor in the appearance of the smile.

To investigate, scientists used a digital photograph of a Caucasian female symmetric facial model (SFM) to create an asymmetric facial model (AFM), in which both the nose and chin deviated three millimeters (mm) to the left. Results from a previous study showed the magnitude of the deviation was below the visual recognition threshold.

Modifications were made to the dental midline shift on the asymmetric facial model in three progressive steps of 1 mm each toward both the left and the right side of the face to create six images. In all, a total of eight images were obtained: the symmetric facial model; the asymmetric facial model; and the six images with modifications to the dental midline shift in the asymmetric model.

A web survey was completed by 112 people (58 females and 54 males) with no dental training ranging in age from 21 to 71. Study participants evaluated each of the eight images created and rated them according to their own esthetic sensibility on a scale of 1 to 4, where 1 was considered least attractive and 4 most attractive.  

Scientists found an inverse response to facial asymmetry such that the greater the shift, the lower the average esthetic rating. In addition, the study results showed that observers were more sensitive toward shifts to the right than they were to the left. Statistical analysis of the data showed no gender- or age-related differences in rating.

Authors concluded:

  1. Nose and chin inclinations have an impact on the perception of dental midline shift.
  2. On asymmetric faces (nose and chin), the direction of the dental midline shift can be a major factor.
  3. A 1mm dental midline shift can have a negative impact on the perception of facial beauty.

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A treatment plan for the non-vital discolored front tooth

Restoring the discolored, endodontically treated maxillary incisor presents a challenge to clinicians, which is further compounded by many treatment choices and a lack of consensus about best approach. Esthetic outcomes, technique or available products often drive treatment selection — ranging from conservative to aggressive.

Scientists publishing in the Winter 2015 issue of The International Journal of Esthetic Dentistry reported a step-by-step plan using traditional porcelain veneers. According to the authors, the approach recovered the original biomechanics of the intact tooth, incorporated the use of an innovative approach to dentin sealing and made use of the masterful skills of an off-site dental technologist.

The case involved a 35-year-old woman who had requested a full-coverage crown restoration on her maxillary right central incisor. The tooth had been traumatized 25 years earlier and she had received a root canal. Unsatisfied with the esthetic results in intervening years, she wanted to ensure good color matching and was willing to have full-coverage crown restoration on both central incisors.

Scientists selected porcelain veneers to reestablish the original stiffness of the crown and thus act as a biomimetic to solve the problem of a stained pulpless tooth and restoration of an extensive coronal fracture. As part of the process, scientists immediately sealed the freshly cut dentin surfaces with a dentin bonding agent prior to taking the impression. Authors referred to previous research demonstrating that this enhanced the potential for adhesion and recreating the dental enamel junction. They also used microsuction to eliminate moisture during dentin sealing.

“Microsuction is one innovative technique that can help clinicians to obtain the precision they require in bonding,” authors also said among conclusions. “Its technical advantages could also be implemented for direct techniques.”

The authors called for additional studies to explore other factors that influence bonding efficacy to dentin.

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The Next Generation Alginate Impression System

Ivoclar Vivadent announces the release of its new AccuDent XD Alginate Impression System. Accudent XD represents the evolution of the time-proven Accudent Impression System. Like the original Accudent, this new and improved system includes two dual-phase alginate materials (tray and syringe) for more accuracy and precision than traditional alginate impression materials. It also includes a thermoplastic heat moldable tray system for both dentate and edentulous impressions.  Watch the video.

Whitening made approachable

To help dental teams explain considerations and techniques for tooth whitening, the ADA offers an educational brochure. “Tooth Whitening for a Better Smile” makes whitening approachable, from whitening toothpastes to home-use whiteners to in-office whitening.

The six-panel brochure shows the benefits of whitening with before and after photos, while managing expectations of patients with disease, decay, crowns or deep stains. The perils of over-whitening are also discussed.

Tooth Whitening for a Better Smile” is sold in packs of 50 brochures. Brochure interior can be viewed here. To order, call 1-800-947-4746 or go to Readers who use the code 15410E before Nov. 27 can save 15 percent on all ADA Catalog products.


Times and Dentistry are Changing
There’s an old adage in business based on three ideas: low cost, fast and good. Experts say you can be two of three, but never all three. Your business can be fast and good, but you have to sacrifice low cost. Your business can be low cost and good, but you have to sacrifice speed. Your business can be low cost and fast, but you have to sacrifice good.  But the times, just like dentistry. . . they’re a changing. And the old adage is just that. . .old.  Learn More.


Editorial and Advertising Policies

Any statements of opinion or fact are those of the authors and do not necessarily reflect the views of the American Dental Association. Neither the ADA nor any of its subsidiaries have any financial interest in any products mentioned in this publication. Any reference to a product or service, whether in advertisements or otherwise, is not intended as an endorsement or as approval by the ADA or any of its affiliated organizations unless accompanied by an authorized statement that such approval or endorsement has been granted.

All matters pertaining to advertising should be addressed to the advertising sales manager, Sales and Marketing Department, American Dental Association, Publishing Division, 211 E. Chicago Ave., Chicago, IL 60611, 1-312-440-2740, fax 1-312-440-2550. All advertising appearing in ADA publications must comply with official published standards of the American Dental Association, a copy of which is available on request.