International Journal of Esthetic Dentistry (EN), 02/2011

Endodontic and restorative considerations are of primary significance in the treatment of tooth fractures. Since exposed dentinal tubules permit invasion of bacteria into the endodontic system, a protective dressing must be applied as part of the emergency treatment. Provided the dentin wound has been sealed, restorative treatment can also be carried out at a later stage. The fractured tooth fragment can be reattached using adhesive protocols in order to restore function and esthetic appearance. If reattachment is difficult or impossible, eg, in cases of multiple or missing fragments, current composite materials enable excellent esthetic results. Minimally-invasive direct composite restorations are preferred over the more invasive indirect restorations, at least in immature teeth with an extensive coronal pulp dimension. Restorative treatment of crown-root fractures is frequently demanding due to inaccessible subgingival fracture margins. Extrusion of the remaining root is an alternative method to surgical crown lengthening for re-establishing the biological width. This can be carried out either orthodontically (forced eruption), or surgically (intra-alveolar transplantation). Although the treatment of crown-root fractures is one of the most technically sensitive procedures in dental traumatology and is frequently considered as a long-term temporary restoration, tooth conservation up to the age at which implants can be placed may be regarded as a success.

This article proposes a comprehensive and conservative approach to the treatment of tooth wear, based on the application of minimally invasive composite restorations to treat both anterior and posterior decay. Three treatment options were considered, in relation to the severity of tissue loss and size of existing posterior restorations. Posterior tooth status actually will guide the clinician toward the most appropriate restorative option. In the presence of limited tissue loss and small fillings, only direct restorations are considered. With moderate tissue loss and medium size existing restorations, a mix of direct and indirect composite restorations is preferred, and with extensive tissue loss and large restorations, mainly indirect restorations will be chosen. The restoration of anterior guidance and a proper smile line are reestablished using adhesive restorations, including primarily direct composite buildups; in the presence of more severe tissue destruction, loss of facial morphology or discoloration, veneers and possibly crowns can be considered. The driving force behind the concept presented in this article is to intercept tissue destruction and restore proper tooth biomechanics, function, and esthetics using adhesive restorations which do not further invade hard tissues.

Today, physical appearance plays a major role in self-esteem and, as a result, also in the overall satisfaction of the person. Facial esthetics plays a crucial role, with the smile being the protagonist. A multidisciplinary approach, including several specialties of dentistry, is usually needed in order to create a pleasing end result. With the Smile's Aesthetic Evaluation Form (SAEF), the authors propose a new evaluation of the esthetics of the smile. It uses both static (photographs) and dynamic (videos) analysis, followed by several objective and subjective items, thus improving the communication between the different dental specialists and laboratory technicians. The SAEF also provides the patient knowledge of the disharmonies of the smile and increases the patient's comprehension and acceptance of treatment. It is organized in such a way as to provide an understanding of the esthetic parameters of the smile individually, and, simultaneously, evaluate the quality of the smile for the specific case. This form is designed to detect small dental anomalies when the patient is not content with his/her smile, but is unable to pinpoint the parameters that cause this dissatisfaction. This esthetic evaluation form can be a useful additional tool to the clinical diagnostic procedure. In order for the analysis to be fully understood, an example of its use will be presented in a clinical case. Case report: A 28-year-old female patient, dissatisfied with her smile, presented to the Orthodontic Department of Tel Aviv University. She had undergone orthodontic treatment in the past. She presented a relapse in the mandible. The relapse in the mandibular arch was to be corrected with Invisalign. For the maxillary arch, the SAEF was completed in order to improve the communication between the orthodontist, patient, and cosmetic dentist to correct the incorrect parameters highlighted in the analysis.

Veneering anterior teeth is a well-established technique, which was brought to Dentistry by Dr Pincus as early as 1937. From the mid-1970s, boosted by the development of composites and adhesive techniques, various concepts emerged including direct composite restorations, prefabricated composite veneers and of course, individualized porcelain indirect veneers. The prefabricated composite veneer option was however soon abandoned due to former technological limitations. Recently, the creation of a new shade guide comprising enamel shells revitalized this "old idea," and in combination with a high pressure and temperature molding process followed by a laser surface vitrification, a novel, improved composite prefabricated system (Venear, Edelweiss Dentistry) was born. This paper provides an overview of the potential indications and clinical protocol of this original veneering technique.

Prosthetic restoration of the anterior teeth is a major esthetic challenge. Esthetic treatment consists of creating pleasantly proportioned teeth and integrating them harmoniously into the patient's gingiva, lips, and face. The communication of clinical data to the laboratory is critical to the success of any esthetic treatment. The purpose here is to present a straightforward, efficient, and reproducible means of communicating esthetic specifications to ceramists, allowing them to work as though the patient was actually in front of them, with access to all of the major facial esthetic criteria.

Purpose: To evaluate the variability in shade selection for general practitioners (GPs) and postgraduate (MDS) practitioners and to assess if a shade selection bias exists. Materials and Methods: 2070 samples of the chosen shade(s) by 31 GPs and 18 MDS practitioners in the form of work authorization forms and slips were collected from dental laboratories. The mouth was divided into four quadrants: maxillary anteriors and posteriors, and mandibular anteriors and posteriors. The data was grouped and analyzed. Results: The same shade or combination was repeated by the GPs and the MDS practitioners 38% and 35% of the time, respectively. The GP group prescribed a single shade in 84% of cases and a combination of two shades per tooth in 14% of cases, in contrast to the MDS practitioners, who prescribed a single shade in 51% of cases and two shades in 47% of cases. Conclusion: A shade selection bias exists among both general and MDS practitioners, as a particular shade or combination was repeated a significant number of times. However, MDS practitioners use a combination of two shades more frequently than general practitioners, who rely mostly on a single shade for a tooth.