International Journal of Esthetic Dentistry (EN), 04/2008

Restoration of failing multiple adjacent anterior teeth with dental implants has presented an esthetic challenge. It is commonly accepted that placement of adjacent implants into edentulous sites in the esthetic zone leads to compromised soft tissue esthetics, especially when related to the creation of the inter-implant papillae. On the basis of this it is generally accepted that multiple adjacent implant placement should be avoided in the esthetic zone. However, in this regard, there may be a significant advantage to one-stage immediate implant placement in adjacent sites with respect to maintenance of the interdental (inter-implant) gingival architecture. This is illustrated by a report of ten cases with a 2 to 7 year follow-up. The results presented in this paper highlight the importance of case selection and the need for improved understanding of the biologic response to the placement of implants and their components in different situations. Clearly there are some differences in the remodeling response to implants placed in healed ridges compared with implants placed into extraction sockets. The tissue biotype and labial tissue thickness are also factors that may play a significant role, especially with regard to maintaining the labial tissue contours and esthetics, which further accentuates the need for careful case selection. The diverse nature of the cases illustrated in this paper, all treated by the author in his private practice, would seem to suggest that this approach is a valuable alternative for restoration of failing teeth in the anterior maxilla.

The present possibility of defining a plan for reconstructive treatment taking into consideration metal-free materials and related clinical procedures offers wider therapeutic options for the clinician and the dental technician, establishing function, esthetics and longevity in prosthetic rehabilitation. The metal-free approach may be regarded as a new philosophy of treatment that extends beyond the solution of esthetic and cosmetic shortcomings in the anterior regions and involves a greater variety of complex clinical cases such as periodontal breakdown conditions and edentulous sites requiring implant therapies with varying degrees of difficulty. Nevertheless, as the use of new metal-free materials is such a recent introduction, there is insufficient long-term evaluation and scientific support available for these to be accepted as an established treatment option. This article presents two complex prosthetic rehabilitations showing the applicability of the metal-free approach to different clinical conditions including, as well as healthy sites, various patterns of periodontal disease and edentulism.

Modern operative dentistry provides practitioners of esthetic dentistry the means for performing direct restorations in a virtually imperceptible way. However, this attribute of resin composite can cause difficulties because the absence of contrast between the tooth structure and the restoration can impede visualization of the cavity limits. The purpose of this article is to highlight some operative steps that, when appropriately performed, will facilitate the building of direct resin composite restorations in posterior teeth, significantly reducing the possibility of restorative overextension.

Esthetics is a primary consideration for patients seeking prosthodontic treatment. The alteration of the facial vertical dimension can deteriorate the orofacial harmony. When it is essential to assess dentofacial attractiveness, there is a consensus in the research community that the soft tissue evaluation in digital photographs is much more consistent than the traditional cephalometric analyses. The aim of this study was to compare the lower third of the face with the facial segment (ie, the distance between the outer cantus of the eye and the labial commissural), to verify whether or not there are statistical correlations and significant differences between them. Front-view standardized digital photographs of 84 dentate Brazilian subjects were used to measure all facial segments through an image-processing program. The Student t test showed no significant difference between the left facial segment and the lower third of the face. Pearson's product-moment coefficient showed significant correlations between both facial segments and the lower third of the face. After the regression analysis, two mathematical equations were used to correlate the facial segment to the lower third of the face. The distance between the outer cantus of the eye and the labial commissurae can be a reliable guide to estimate the vertical dimension of the rest position. Moreover, when it is measured on the left side of the face there is a better chance to correctly estimate the appropriate size.

Ceramists may be able to produce excellent results, but none can improve on natural dentition. Natural teeth are always the benchmark to which every ceramist should aspire. To become a better ceramist requires training and application, and one of the best ways of training is to copy natural dentition. The amount of information that can be gained just by examining natural teeth is enormous. Natural dentition is irregular, but it is also in proportion and perfectly balanced. By trying to reproduce natural teeth, the ceramist will appreciate their diversity, and will never stop learning from the experience. This article presents one way of training to better understand the shape, color, and materials of teeth.