International Journal of Esthetic Dentistry (EN), 03/2006

Porcelain laminate veneers are widely accepted as the treatment of choice to noninvasively restore the esthetics and function of anterior teeth, provided there is a sufficient amount of tooth structure to support the reconstruction. However, there are certain esthetic limitations if the underlying tooth structure is discolored, which may occur in cases of nonvital roots. This article describes how to manage this esthetic challenge. Internal bleaching, tooth-colored internal buildups, and preparation guidelines are discussed via clinical case presentations.

Recently, esthetic implant dentistry has focused on changes in buccal implant mucosal height. The purpose of this article was to investigate the relationship between the height and width of buccal supra-implant mucosa based on the physiologic mucosal form surrounding the implant. Fourteen patients who had buccal supraimplant mucosal heights of more than 1.5 mm and keratinized mucosa 1 year or more after superstructure placement (average period: 3 years 5 months) were studied. Silicone impressions were taken immediately after superstructures and abutments were removed. The study model used for the measurement process was manufactured using improved dental stone. The height and width of the buccal supra-implant mucosa were measured using digital slide calipers, and the ratio of the height and width was investigated. In all cases, the widths were greater than the heights. The average height of the buccal supra-implant mucosa was 2.17 mm, while the average width was 3.44 mm. The average biologic height-width ratio was 1:1.58. The width was larger in the posterior region than in the anterior. There were no differences in the biologic height-width ratio in terms of the diameter of the implant. These findings indicate that peri-implant soft tissue augmentation procedures resulting in an average biologic height-width ratio of 1:1.5 may provide a stable buccal cervical line around the implant superstructure, even for thin periodontal biotypes.

The safety and effectiveness of full-arch implant- supported fixed partial dentures have been established. Thus, clinicians are now focusing on the treatment modalities that can reduce patient discomfort, treatment time, and cost, and that could enhance the esthetic outcome of the restorations. Fullarch implant-supported rehabilitations are used when the patient is edentulous or if the residual dentition has a poor prognosis. In order to improve patients' comfort and avoid the use of a removable prosthesis, some protocols for immediate replacement of hopeless dentitions have been proposed, but there are no data on their outcomes regarding the soft tissues. The aim of this article is to describe the double provisional technique and to show evidence of its efficacy in easily achieving predictable esthetic results when immediately restoring a hopeless dentition with a fixed implant-supported restoration.

Considerable developments in the area of metal-free restorations - in response to increasing esthetic demands from patients - are offering the clinician and dental technician new therapeutic paths to follow when performing restorative treatments. Effective and reliable high-strength ceramic systems, suitable for anterior and posterior sites, may allow the achievement of predictable esthetics and function. Along with the evident indications for the treatment of anterior compromised elements, these types of restorations may be used in a wider variety of clinical cases, including complex prosthetic rehabilitations. Appropriate usage of different materials according to the specific clinical situation is mandatory for long-lasting, functional, and esthetic results. Therefore, a thorough application of metal-free restorations may be considered a "metal-free approach," which includes a specific formulation of treatment planning. In this article, the different materials, selection criteria, clinical indications, and benefits are evaluated, with a particular regard for treatment planning.

In this two-part treatment planning series, the case of a 63-year-old woman with severe attachment loss at the maxillary incisors is presented. In Part 1, pretreatment strategies, occlusal and periodontal status, and the advantages and disadvantages of six treatment options using both conventional and implant therapy were presented. In this follow-up article, the treatment selected for the case is revealed, and the rationale- including indications and contraindications for the different treatment options-is discussed. The treatment sequence is then outlined, and the final outcome is presented.

This two-part treatment series describes the examination, planning, and prosthetic treatment of a 17-year-old female patient whose maxillary central incisors were traumatically lost at the age of 9 years. In this first part, analysis of function and esthetics following previous orthodontic treatment is described. The advantages and disadvantages of the different prosthodontic treatment options are discussed. The second part of the article will reveal the treatment selected, along with the rationale for the decision, the sequence of treatment steps, and the result.