International Journal of Esthetic Dentistry (EN), 04/2011

The esthetic rehabilitation of advanced periodontal cases remains a challenge, despite the numerous advances in treatment of periodontitis and regenerative therapies. Whilst understanding of periodontal diseases deepens with advances in cell biology, cell signaling, and genomic research, the restoration of the gingival tissues to anatomical norms remains a considerable challenge in advanced cases. The improvements in diagnosis and treatment of disease certainly enable successful management of disease and stabilization of the compromised and failing dentition. Nonetheless, effective "esthetic" rehabilitation of patients with advanced disease affecting teeth in the esthetic zone, where significant asymmetrical bone loss and tissue recession are present, still constitutes a significant dilemma. An interdisciplinary approach involving vertical augmentation of bone and soft tissues by means of orthodontic extrusion of severely compromised periodontally involved teeth to reconstitute esthetics, as well as ideal bone and soft tissue volume prior to immediate implant placement and restoration, may be a particularly useful treatment option in patients suffering advanced periodontal disease with asymmetrical bone and tissue loss in the esthetic zone. This paper discusses the concepts and illustrates its use in two complex and demanding cases.

Esthetics is a topic that has become much discussed both in medicine and in dentistry. However, it should be questioned how reliable and reproducible the guidelines and protocols for esthetic procedures really are. This article will describe in detail the interactions between the musculoskeletal and masticatory systems. Dentists are frequently misled by their false interpretation of existing reference lines, without recognizing the true problem. The close relationship between skeletal and dental problems and their impact on the masticatory and musculoskeletal systems will be explained in this paper. Esthetics and function - not only of the teeth - form an entity that needs to be viewed and treated as a whole. Many of these interactions are thought of as "alternative medicine" and are therefore hardly considered at all in conventional mainstream medicine. This holistic approach will be further explained and discussed with a patient case.

Introduction: The objective of this study was to evaluate the intra- and interdevice repeatability in different tooth regions using three color-measuring devices under clinical conditions. Materials and methods: Fifteen shade measurements (cervical, body, incisal) were recorded on 15 patients by one investigator using three color-measuring devices (VITA Easyshade compact, DeguDent Shadepilot, X-Rite ShadeVision). CIE Lab values were determined for all maxillary anterior teeth. Intraclass correlation coefficients (ICCs) were used to statistically analyze intraand inter-device repeatability for different tooth regions. Color differences (ΔE) between measurements were also computed to evaluate the clinical acceptability of repeatability values. The data were evaluated using analysis of variance and Bonferroni's adjustment to control for multiple testing. Differences were deemed significant when P 0.016. Results: The three color-measuring devices generally exhibited high repeatability of color coordinates for all tooth regions (ICC > 0.516-0.986, ΔE 3.03). In contrast, inter-device repeatability was lower for all tooth regions (ICC = 0.010-0.922, ΔE = 4.06-16.04). Conclusions: High intra-device repeatability of color coordinates could be achieved for all tooth regions when the same color-measuring device was used. However, because of low inter-device repeatability, results using different colormeasuring devices are not comparable.

Statement of problem: Studies have measured the effectiveness of tooth bleaching, however there are very few studies that have measured the persistence in color change after a 6-month follow-up. Purpose: This study assessed the efficacy of the laser bleaching process using different regimens, and the persistence of color change over a 6-month period. Method and materials: Sixty patients divided into three equal groups were subjected to bleaching using a diode laser with 34% hydrogen peroxide. Group 1: patients subjected to one session of laser bleaching. Group 2: patients subjected to two sessions of laser bleaching with a 1-week interval. Group 3: the same as Group 2 but followed by home bleaching once a month for 3 months. The color was assessed four times: before bleaching, directly after bleaching, 3 months after bleaching, and 6 months after bleaching. Results: All teeth had a significant color change at 6 months, but all teeth had regressed from the maximum value. There was significantly less regression in color for Group 3, followed by Groups 2 and 1, respectively. Conclusion: The combined technique of in-office laser bleaching for two sessions with a 1-week interval, followed by home bleaching once a month for 3 months gave more persistence in color change. Clinical significance: In-office power bleaching using a laser assisted hydrogen peroxide system repeated after a week, combined with home bleaching once a month for 3 months, is an effective bleaching regimen with less color regression after 6 months compared to a regimen of in-office bleaching alone.

Although supervised night-guard bleaching has proved successful for whitening teeth, both mineral loss and tooth sensitivity are still common problems. The present study introduces a novel remineralizer as well as describes the utilization of a possibly low sensitivity supervised night-guard vital tooth bleaching technique. A 22% carbamide peroxide gel was mixed with the casein phosphopeptide-amorphous calcium phosphate-containing MI Paste. The peroxide/MI Paste mixture was prepared with 1 ml of each material until obtaining a homogeneous paste. Five patients were instructed to follow a home bleaching protocol for 3 weeks. The outcome was assessed visually with a Vitapan scale. All subjects presented reduction of at least two Vitapan scale units after bleaching and no sensitivity was reported. The concomitant use of MI Paste and peroxide might not affect the gel effectiveness and still reduce hypersensitivity levels.

Objectives: The aim of this in vitro study was to evaluate the bleaching efficacy of high concentration bleaching agents activated by chemical or physical catalysts. Materials and methods: This study was divided into two parts. Part 1 evaluated the efficacy of tooth whitening after treatment with 35% hydrogen peroxide (Whiteness HP Maxx) that was activated by different light-curing units: halogen lamp (conventional and bleach mode) (Optilux 501C, Demetron/Kerr), LED first generation (Ultrablue IV, DMC), LED/diode laser (Ultrablue IV, DMC), LED second generation (Bluephase 16i, Ivoclar Vivadent), and no light source (control group). Part 2 provided an analysis of the effect of chemical and physical catalysts on high concentration bleaching agents: 35% hydrogen peroxide (Whiteness HP Maxx) + 20% sodium hydroxide; 35% hydrogen peroxide + 7% sodium bicarbonate; 38% hydrogen peroxide (Opalescence Xtra Boost); 35% hydrogen peroxide + halogen lamp; 35% hydrogen peroxide + 20% sodium hydroxide + halogen lamp; 35% hydrogen peroxide + 7% sodium bicarbonate + halogen lamp; 38% hydrogen peroxide + halogen lamp; and 35% hydrogen peroxide. Blocks obtained from human molars were randomly divided into groups (n = 5) in accordance with bleaching treatments. The efficacy of bleaching was measured using a spectrophotometer. Three bleaching sessions were performed. The results were submitted to ANOVA followed by the Tukey test (5%). Results: For both parts of the study, activated vs. non-activated bleaching did not differ significantly for all sessions tested. Conclusion: Activating systems did not improve the whitening effectiveness of high concentration bleaching agents.