Interactions between restorative dentistry and periodontics: preparation and cementation of an onlay in Empress (Part III)

The relentless pursuit by cosmetic dentistry brought the evolution of materials ceramics. The IPS-Empress system was upgrading of indirect restorations based on lithium disilicate. The ceramic restoration posterior allow a new esthetic approach due to its translucency and resistance without any weakening of the remaining dental element, being an option more conservative when compared to conventional prosthetic restorations.

Analyse de l'influence des paramètres esthétiques sur l’attrait du sourire tel que perçu par des non-experts : étude transversale exploratoire

Malgré l’abondance d’information concernant la dentisterie esthétique, les évidences scientifiques à son sujet sont rarissimes. Ainsi, cette recherche a pour premier but d’accroître ces évidences en faisant la lumière sur les paramètres esthétiques et leur influence auprès de l’appréciation générale du sourire, tel que perçu par des sujets non-experts. Une invitation à répondre à un questionnaire autoadministré anonyme a été envoyée à la communauté de l’Université de Montréal par courrier électronique. 467 personnes ont accepté de répondre au questionnaire, toutefois seulement 263 ont terminé l'opération. L’analyse des données démontre que le seul critère esthétique objectif ayant une influence statistiquement significative sur l’appréciation générale est « l’arrangement des dents » (p = .028). Les dents versées diminuent significativement l’attrait général par rapport à des dents droites (p = .012) ou chevauchées (p = .009). Par contre, en corrélant ces données avec les convictions des sujets, « l’angulation de la médiane dentaire supérieure » ainsi que « l’inclinaison du plan incisif » présentent aussi des différences statistiquement significatives. « L’état d’usure des dents » et leur « position » sont les éléments, parmi le vocabulaire suggéré, les plus importants pour l’attrait du sourire aux yeux des patients. Avec les limitations de cette étude, on peut conclure que (1) « l’arrangement des dents », « l’angulation de la médiane dentaire supérieure » et « l’inclinaison du plan incisif » influencent de manière statistiquement significative l’appréciation générale du sourire. (2) Parmi les critères objectifs étudiés, « l'arrangement des dents » a la plus forte influence sur l’appréciation générale d’un sourire. (3) Une corrélation statistiquement significative entre les deux séquences d’évaluation et la faible variance intrasujet indiquent que l’appréciation générale d’un sourire est une action réflexe basée, entre autres, sur des paramètres morphologiques. Application pratique : Les résultats de cette étude insinuent que les traitements visant à corriger l’alignement, l’usure des dents et ceux visant à blanchir les dents d’un individu sont susceptibles d’augmenter l’attrait de son sourire tel que perçu par des sujets non-experts.

Effect of whitening agents on dentin bonding

Background: Several studies have shown a reduction in enamel bond strengths when the bonding procedure is carried out immediately after vital bleaching with peroxides. This reduction in bond strengths has become a concern in cosmetic dentistry with the introduction of new in-office and waiting-room bleaching techniques. The aim of this in vitro study was to evaluate the effect of three bleaching regimens: 35% hydrogen peroxide (HP), 35% carbamide peroxide (CP), and 10% CP, on dentin bond strengths. Materials and Methods: One hundred and twenty fresh bovine incisors were used in this study. The labial surface of each tooth was ground flat to expose dentin and was subsequently polished with 600-grit wet silicon carbide paper. The remaining dentin thickness was monitored and kept at an average of 2 mm. The teeth were randomly assigned to four bleaching regimens (n = 30): (A) control, no bleaching treatment; (B) 35% HP for 30 minutes; (C) 35% CP for 30 minutes; and (D) 10% CP for 6 hours. For each group, half of the specimens (n = 15) were bonded with Single Bond/Z100 immediately after the bleaching treatment, whereas the other half was bonded after the specimens were stored for 1 week in artificial saliva at 37°C. The specimens were fractured in shear using an Instron machine. Results: For the groups bonded immediately after bleaching, one-way analysis of variance (ANOVA) followed by the Duncan's post hoc test revealed a statistically significant reduction in bond strengths in a range from 71% to 76%. For the groups bonded at 1 week, one-way ANOVA showed that group B (35% HP for 30 min) resulted in the highest bond strengths, whereas 10% CP resulted in the lowest bond strengths. Student's t-test showed that delayed bonding resulted in a significant increase in bond strengths for groups B (35% HP) and C (35% CP); whereas the group bleached with 10% CP (group D) remained in the same range obtained for immediate bonding. Storage in artificial saliva also affected the control group, reducing its bond strengths to 53% of the original. ©2000 BC Decker Inc.

Clareamento interno em dentes despolpados como alternativa a procedimentos invasivos: relato de caso

The increasing interest of patients for a better aesthetic appearance of their smile, associated with the development of new materials and techniques, encouraged by media couverage of this concept of beauty, provided an important evolution of cosmetic dentistry. As the darkness of a single anterior tooth or a group of teeth, in most cases, impairs the appearance of the smile and there is growing appreciation of the less invasive procedures, the technique of tooth bleaching is an important option for aesthetic treatment. To have success in the bleaching treatment, it is important to have knowledge of the origin, nature and composition of the stain. Among the causes of color changes acquired post-eruptive, dental trauma, with or without pulp necrosis, is one of the most commonly encountered etiologies, characterized by a reddish-brown color. Current techniques of bleaching for teeth treated endodontically employ oxidative agent hydrogen peroxide. The objective of this paper is to describe the immediate technique of bleaching non-vital tooth by presenting a clinical case.

Sistemas cerámicos puros parte 2: materiales, propiedades ópticas y consideraciones clínicas

While dentistry continues to advance, the aesthetic techniques have evolved in proceedings more effective, functional and biocompatible. Meanwhile, cosmetic dentistry has become a bit more complex and technically difficult. With improvement of the properties (physical and optical) of the ceramics and the establishment of a working protocol, ceramic restorations have become increasingly popular. Currently there are several ceramic systems have excellent optical properties such as opalescence, fluorescence, translucency, chromaticity, which allow the restoration to mimic the tooth structure. From the physical point of view has restored biomechanical integrity and strengthening the remaining tooth structure. All this has led the profession to experience the use of new ceramic systems ranging from conventional feldspathic ceramics to modem ceramic reinforced, injected or computer-aid made. The material selection should be based on clinical need, aesthetic and functional requirements, restoration site, prosthetic design and laboratory techniques. In this article we will deal with the characteristics of the materials, their optical properties and clinical considerations for proper selection.

Influence of spacing in the upper lateral incisor area on the perception of smile esthetics among orthodontists and laypersons

Background: The aim of this study was to determine the perception of smile esthetics among orthodontists and laypeople with respect to the presence of diastemas in the upper lateral incisor in the mesial, distal, and both surfaces using an oblique smile analysis. Methods: Two standardized oblique photos of pleasant smiles from two white women were selected. Images were digitally altered to create diastemas in the lateral incisor, in 0.5-mm increments, in the mesial, distal, or both surfaces. Final images were randomly assembled in a photo album, which was given to 120 judgesd60 orthodontists and 60 laypersons. Each rater was asked to evaluate the attractiveness of the images on a visual analog scale. The data collected were submitted to statistical analysis by the means of one-way ANOVA with the Tukey post hoc test and the unpaired Student’s t test. Results: The most attractive smile was the one without spacing, and the presence of diastemas was considered unattractive by both groups of raters, following a pattern: the greater and the more mesially located, the more unattractive was the smile. Conclusions: The results of this study suggest that diastemas in the upper lateral incisor area were considered unattractive, following a pattern: the greater and the more mesially located, the more unattractive was the smile.

Estado actual del blanqueamiento: sigue siendo un tratamiento seguro? review

The demand for cosmetic dentistry, including teeth whitening, has increased in recent years. The home teeth whitening and in-office, are widely used in dental practice. The mechanism by which it works is by oxidation of the chromogenic existing tooth structure. This is an effective and minimally invasive procedure that achieves tooth lighten the color, however, may cause alterations in the enamel surface, such as a dental permeability increase. Another effect caused by this procedure is tooth sensitivity, being the most common side effect, up to 65% of individuals have had a secondary effect at least once during treatment. This sensitivity and gingival irritation caused by bleaching may vary depending on the patient and used bleaching product

Instrumentación para el registro del color en odontología

Color is an important variable in cosmetic dentistry, and it has traditionally been measured by a visual method, comparing teeth with standard color guides. In recent decades, electronic instruments have been developed to eliminate the subjective factor of visual measurement. This objective method has mainly been performed with colorimeters, spectrophotometers and the analysis of images obtained with digital cameras. These instruments have proven to be reliable with a high degree of precision and accuracy. Its use is recommended as an adjunctive tool to assess color in direct and indirect restorations, in aesthetic treatments like bleaching, and to facilitate communication with the dental laboratory. The spectrophotometer is the device that has reported better “in- vitro “ and “in -vivo” performance, being the “Vita Easyshade “ the one with more reliable results.

Influência de variações das normas estéticas na atratividade do sorriso

The work presented here aims to evaluate how aesthetic norm variations influence the perception of attractiveness of a smile according to dentists and laymen. Methods: The smiles in photographs of a man and a woman were digitally changed. Eleven smiles were created for each one: an ideal, control smile - an ideal smile according to accepted norms - and 10 smiles containing individual variations of each of the following norms: a) 2mm and 3mm deviations from the middle line; b) the contour of the smile - contour of a straight smile and contour of a reverse smile; c) the angle of the lateral incisors - a mesial angle of 10° and a distal angle of 10°; d) 0.5mm and 1mm diastema; and e) dental proportion - Alber’s Proportion and Plato’s Proportion. The photographs were evaluated by two specialists in cosmetic dentistry and two laymen using the visual analogue scale. Results: The ideal smile for both genders was well accepted by both the specialists and the laymen. The opinions on the smiles with aesthetic variations varied, some were more positive than others, some were in agreement and some were in disagreement. Conclusion: The absence of deviations favors the perceived beauty of a smile, but some aesthetic variations seem to be better accepted than others. The success of aesthetic treatments depends on the active participation of dentists and patients in the planning stage.

Cosmetic surgery on children : professional and legal obligations in Australia

Public awareness and concern about cosmetic surgery on children is increasing. Nationally and internationally questions have been raised by the media and government bodies about the appropriateness of children undergoing cosmetic surgery. Considering the rates of cosmetic surgery in comparable Western societies, it seems likely that the number of physicians in Australia who will deal with a request for cosmetic surgery for a child will continue to increase. This is a sensitive issue and it is essential that physicians understand the professional and legal obligations that arise when cosmetic surgery is proposed for a child.

The Australian litigation landscape - Oral and Maxillofacial Surgery and general dentistry (oral surgery procedures): An analysis of litigation cases

Background: There are persistent concerns about litigation in the dental and medical professions. These concerns arise in a setting where general dentists are more frequently undertaking a wider range of oral surgery procedures, potentially increasing legal risk. Methods: Judicial cases dealing with medical negligence in the fields of general dentistry (oral surgery procedure) and Oral and Maxillofacial Surgery were located using the three main legal databases. Relevant cases were analysed to determine the procedures involved, the patients’ claims of injury, findings of negligence, and damages awarded. A thematic analysis of the cases was undertaken to determine trends. Results: Fifteen cases over a twenty-year period were located across almost all Australian jurisdictions (eight cases involved general dentists; seven cases involved Oral and Maxillofacial Surgeons). Eleven of the fifteen cases involved determinations of whether or not the practitioner had failed in their duty of care; negligence was found in six cases. Eleven of the fifteen cases related to molar extractions (eight specifically to third molar). Conclusions: Dental and medical practitioners wanting to manage legal risk should have regard to circumstances arising in judicial cases. Adequate warning of risks is critical, as is offering referral in appropriate cases. Pre-operative radiographs, good medical records, and processes to ensure appropriate follow-up are also important.

Preventive Dentistry and Dental Education in Iran

The present study investigated the preventive orientation of the dental education system in Iran as reflected in the responses of dental school educators and dental students to a questionnaire survey. Two questionnaires, one for dental school educators and one for senior dental students, were designed and piloted. Of the 15 state dental schools in Iran, 7 were selected using a multi-stage sampling approach, and all the dental school educators and senior dental students in these schools were asked to voluntarily fill in the anonymous questionnaires. Totally, 291 educators (80%) and 270 students (82%) participated in the study. In addition to background information, both questionnaires requested information on knowledge of caries prevention, attitudes towards preventive dentistry and oral health behaviour of the respondents. The students' questionnaire also covered items concerning prevention-oriented practice, study motives, and career preferences. Contrary to knowledge and attitudes of the students, those of the educators' were positively associated with some of their academic and personal background characteristics. Women were more likely to report favourable oral self-care habits than men. The other determinants of oral health behaviour were educators' familiarity with the oral public health field, and students' attitudes towards prevention. A higher score on preventive practice among the students was associated with better oral self-care habits and positive attitudes towards prevention. Characteristics of the profession and social status and security were the top-ranked that motivated students to study dentistry, and students mainly preferred to enter postgraduate courses and private practice after graduation. To increase the orientation of Iran's health care system towards prevention, and to cope with current concepts of prevention, corresponding changes should be made in the dental education system. The results of this study support the revision of the dental curriculum by placing more emphasis on prevention-related topics and by integrating prevention-related concepts into all disciplines. Additionally, practicing dentists and dental educators should be provided with opportunities to attend continuing education courses and to conduct seminars and congresses on various aspects of preventive dentistry at home as well as abroad.