International Journal of Esthetic Dentistry (EN), 01/2012

Minimally invasive treatment modalities allow for the preservation of sound tooth substance. However, by limiting the preparation to the extent of a defect, the transition between restoration and natural tooth may be moved to more visible areas. The materials available for the restoration of a limited defect in the anterior area are either resin composite materials or porcelain. A patient was presented who asked for the replacement of a discolored filling on the maxillary right central incisor. Tooth preparation was limited to the extent of the old filling, and a porcelain partial veneer restoration was fabricated. Despite the horizontal finish line in the middle of the clinical crown, a result could be achieved that was regarded as a success by the patient. This type of restoration proves to be a suitable alternative to direct composite restorations in the anterior area for the reconstruction of a limited defect, eg, due to a dental trauma.

Interdisciplinary, multidisciplinary and comprehensive treatment plans are now part of everyday practice. The interaction between different specialists can provide patients with better, more conservative and more pleasing results. This case report shows the step by step of a multidisciplinary treatment plan and the rationale for each part of a process where conservative dentistry, periodontics, orthodontics, implant dentistry and prosthetics are involved.

It is currently accepted that success in implant-supported restorations is based not only on osseointegration, but also on achieving the esthetic outcome of natural teeth and healthy soft tissues. The socalled "pink esthetic" has become the main challenge with implant-supported rehabilitations in the anterior area. This is especially difficult in the cases with two adjacent implants. Two components affect the final periimplant gingiva: a correct bone support, and a sufficient quantity and quality of soft tissues. Several papers have emphasized the need to regenerate and preserve the bone after extractions, or after the exposure of the implants to the oral environment. The classical implantation protocol entails entering the working area several times and always involves the surgical manipulation of peri-implant tissues. Careful surgical handling of the soft tissues when exposing the implants and placing the healing abutments (second surgery) helps the clinician to obtain the best possible results, but even so there is a loss of volume of the tissues as they become weaker and more rigid after each procedure. The present study proposes a new protocol that includes the connective tissue graft placement and the soft tissues remodeling technique, which is based on the use of the ovoid pontics. This technique may help to minimize the logical scar reaction after the second surgery and to improve the final emergence profile.

Many treatment options are currently available for single tooth replacement, such as metal-ceramic, all-ceramic, direct or indirect fiber-reinforced composite fixed dental prostheses (FDPs) or implants. Inlay-retained FDPs could be indicated especially when adjacent teeth have preexisting restorations and where implant placement is not possible or not indicated. In such cases, indication of both metal-ceramic and fiber-reinforced composite FDPs has certain disadvantages. This paper describes the use of all-ceramic inlay-retained FDPs with zirconia frameworks, veneered with a press-on technique. The retainer margins were made of pressed ceramic to make adhesive luting possible. In deep cavities, a full contour press-on ceramic all around the retainers increased the available surface area for the adhesive approach.

Background: Research into bleaching focuses on new products in order to minimize undesirable effects. This study evaluated the bleaching effectiveness of a new enzymatic-activated dentifrice. Materials and methods: A total of 20 volunteers were bleached with a dentifrice containing 5% lactoperoxidase and 3% carbamide peroxide applied three times a day for two minutes over 21 days. Color was recorded before and after the treatment using a spectrophotometer. CIELAB differences were calculated before and after treatment using the paired t test (P 0.05). Results: Lightness was significantly higher after treatment (P 0.001), ΔE was 5.14. The maxillary central incisors showed greater lightness than the laterals and canines, both before and after treatment, and a greater tendency towards green and blue; the same occurred in the mandibular central incisors in comparison to the canines and laterals. Conclusions: The use of brush-applied enzyme-activated carbamide peroxide at low concentrations with short exposure time is effective for whitening teeth. Clinical implications: Enzymatic dental bleaching is able to increase the efficiency of low concentration peroxides, reducing the potential risk of peroxides on oral tissues.

The aim of the study was to characterize the surface chemistry, hydration capacity, topography and roughness of the root part of a hydrophilic sandblasted and acid-etched titanium dental implant (SLActive). Implants as received (SAR), after water rinsing (SAW) and after ultrasonication in water (SAU) were subjected to x-ray photoelectron spectroscopy (XPS) elemental and binding state analysis. Scanning electron microscopy plus energy dispersive x-ray microanalysis (SEM/EDX), reflection Fourier transform infrared microspectroscopy (RFTIRM) and hydration/ dehydration cycling by environmental scanning electron microscopy (ESEM), were performed in SAR, whereas SAU implants were subjected to 3D-optical profilometry and SEM. For all the experiments, a conventional sandblasted and acid-etched implant (SLA ) of the same manufacturer was used as control. XPS showed lower mean C content in SAR than SLA, but not significantly different. In SAW, the C and O contents were increased. Significantly reduced C and increased Ti and O contents were found in SAU. Residual Na phases, other than NaCl, were traced in all SLActive groups. SAR demonstrated higher [-OH]/O2- ratio than SLA . EDX documented higher O, Na, Cl and lower Ti content in SAR. More -OH contributions were probed on SAR in comparison with SLA by RFTI RM. Ti-O peaks assigned to anatase, rutile and amorphous phases were found in both implant groups. The ESEM study revealed a full rehydration capacity in SAR, in contrast to SLA. No differences were found in the topography of SAU and SLA implant surfaces under the SEM. However, significantly greater values in spatial and functional roughness parameters were encountered in SAU. The increased surface hydroxylated titanium content and the greater spatial and functional roughness parameters, may explain the enhanced biological activity documented for SLActive in comparison with SLA.