The importance of the lifelike esthetic appearance of all-ceramic restorations on anterior teeth

The success of rehabilitation will not depend on just clinical procedures. A proper dental technique (ceramist) is required as well as the respect for some biomimetic principles to obtain the desired final result. This study has the purpose of describing a prosthetic rehabilitation with laminate veneers and all-ceramic crowns of a patient unsatisfied with a previous esthetic treatment because of the negligence of some biomimetic principles. A 45-year-old female patient was admitted to the dental clinic complaining about the lifelike appearance of her all-ceramic restorations. Before the fabrication of new restorations, a mock-up was conducted to verify the patient's satisfaction. A ceramist conducted all the fabrication process so that surface characterizations could be visually verified and the lifelike appearance of natural tooth could be reproduced. After the cementation procedure, the patient reported being satisfied with the lifelike appearance of the new restorations. Based on the clinical findings of the present case report, it can be concluded that the reproduction of the lifelike esthetic appearance of natural teeth and the visualization of the final results before definitive procedures are essential to obtain the clinical success.

Minimally invasive esthetic therapy: a case report describing the advantages of a multidisciplinary approach

The decision-making process for the treatment of esthetic areas is based on the achievement of a healthy, harmonious, and pleasant smile. These conditions are directly associated with a solid knowledge of tooth anatomy and proportions, as well as the smile line, soft tissue morphology, and osseous architecture. To achieve these objectives, a multidisciplinary approach may be necessary to create long-term harmony between the final restoration and the adjacent teeth, and the health of the surrounding soft and hard tissues. This case report describes the application of a minimally invasive therapy on a 33-year-old woman seeking esthetic treatment. Minimally invasive periodontal plastic surgery associated with porcelain laminate veneers yielded satisfactory esthetics and minimal trauma to dental and periodontal tissues. Such a combined approach may be considered a viable option for the improvement of "white" and "red" esthetics.

Conforto e fonação com a nova geração de bráquetes ortodônticos linguais individualizados

TEMA: recentemente o número de pacientes desejando um tratamento ortodôntico e estético ao mesmo tempo aumentou consideravelmente. A técnica lingual oferece a opção mais estética de tratamento ortodôntico, pois os bráquetes ficam invisíveis colados na superfície lingual dos dentes e os lábios não ficam protuberantes. Apesar da grande vantagem estética, essa terapia possui desvantagens como restrição no conforto oral, na fala, na higiene, irritações na língua, restrição no espaço da língua e dificuldades na alimentação. Para amenizar essas desvantagens uma nova geração de bráquetes linguais otimizados ao máximo através da individualização das bases dos bráquetes, da posição de colagem e dos fios utilizados no tratamento ortodôntico foi desenvolvida recentemente. OBJETIVO: realizar uma revisão sistemática da literatura para verificar a adaptação do paciente a diferentes dispositivos ortodônticos linguais e a influência desses dispositivos no conforto e na fala, principalmente. CONCLUSÃO: atualmente a literatura suporta que os bráquetes linguais de última geração individualizados por computador proporcionam maior conforto e facilidade na fonação quando comparados aos bráquetes tradicionais da técnica lingual. No entanto, o sucesso na terapia requer orientações detalhadas sobre o potencial de restrição do conforto oral, articulação de palavras, mastigação e higiene oral, independente do sistema de bráquetes a ser utilizado.

Concurrence between the maxillary midline and bisector to the interpupillary line

Purpose: Symmetry is one of the factors that contributes to facial harmony, and in oral rehabilitation it determines the success of esthetic treatment. Therefore, the aim of the present study was to analyze the axial symmetry between the bipupillar midline and maxillary central incisors midline of 102 dental students (both genders) distributed across five Brazilian dental schools. Materials and Methods: Students with no teeth missing and who had never been subjected to any dental treatment were selected. Photographs were taken with a Dental Eye III camera with a 100-mm macro objective and ratio of 1 : 10 from natural size, recorded on an Ektachrome ASA/ISO 100 film. The images were developed and applied to Microsoft Office Power Point 2007 software. The results were analyzed by analysis of variance and Student's t-test (= 0.05). Results: There was no significant correlation between bipupillar midline and the maxillary dental midline, irrespective of gender. Conclusion: No significant coincidence was observed between the interpupillary and dental midline. However, the interpupillar distance and its relationship with other anatomic structures may be used as a reference in treatment, but measurements must be assessed individually. CLINICAL SIGNIFICANCE Anatomic measurements and facial proportions can be helpful during the planning of esthetic oral rehabilitation. © 2009 Wiley Periodicals, Inc.

Undesirable effect of cosmetic lip augmentation with autologous fat tissue

Background: Facial cosmetic procedures are commonplace nowadays, especially techniques that aim to increase lip volume. Full lips provide a youthful, healthy, feminine and sensual appearance. There are many techniques and materials used to recover the loss of contour that occurs with age. Case presentation. An unusual case of fat tissue accumulation following cosmetic upper lip augmentation in a 61 year-old female was reported. Surgical treatment was performed for esthetic concerns. Microscopically, the tissue removed was composed of muscle fibers and mature adipocytes. Conclusion: Undesirable effects of esthetic treatment can occur and the clinician should be familiar with such complications to diagnose and manage them. © 2013 Kaminagakura et al.; licensee BioMed Central Ltd.

Efeito protetor da vitima E(ɑ-TOCOFEROL) contra a atividade citotóxica do peróxido de hidrogenênio

Pós-graduação em Reabilitação Oral - FOAR

Enamel microabrasion: an overview of clinical and scientific considerations

Superficial stains and irregularities of the enamel are generally what prompt patients to seek dental intervention to improve their smile. These stains or defects may be due to hypoplasia, amelogenesis imperfecta, mineralized white spots, or fluorosis, for which enamel microabrasion is primarily indicated. Enamel microabrasion involves the use of acidic and abrasive agents, such as with 37% phosphoric acid and pumice or 6% hydrochloric acid and silica, applied to the altered enamel surface with mechanical pressure from a rubber cup coupled to a rotatory mandrel of a low-rotation micromotor. If necessary, this treatment can be safely combined with bleaching for better esthetic results. Recent studies show that microabrasion is a conservative treatment when the enamel wear is minimal and clinically imperceptible. The most important factor contributing to the success of enamel microabrasion is the depth of the defect, as deeper, opaque stains, such as those resulting from hypoplasia, cannot be resolved with microabrasion, and require a restorative approach. Surface enamel alterations that result from microabrasion, such as roughness and microhardness, are easily restored by saliva. Clinical studies support the efficacy and longevity of this safe and minimally invasive treatment. The present article presents the clinical and scientific aspects concerning the microabrasion technique, and discusses the indications for and effects of the treatment, including recent works describing microscopic and clinical evaluations.

Virtual implant planning in the edentulous maxilla: criteria for decision making of prosthesis design

OBJECTIVES To evaluate prosthetic parameters in the edentulous anterior maxilla for decision making between fixed and removable implant prosthesis using virtual planning software. MATERIAL AND METHODS CT- or DVT-scans of 43 patients (mean age 62 ± 8 years) with an edentulous maxilla were analyzed with the NobelGuide software. Implants (≥3.5 mm diameter, ≥10 mm length) were virtually placed in the optimal three-dimensional prosthetic position of all maxillary front teeth. Anatomical and prosthetic landmarks, including the cervical crown point (C-Point), the acrylic flange border (F-Point), and the implant-platform buccal-end (I-Point) were defined in each middle section to determine four measuring parameters: (1) acrylic flange height (FLHeight), (2) mucosal coverage (MucCov), (3) crown-Implant distance (CID) and (4) buccal prosthesis profile (ProsthProfile). Based on these parameters, all patients were assigned to one of three classes: (A) MucCov ≤ 0 mm and ProsthProfile≥45(0) allowing for fixed prosthesis, (B) MucCov = 0-5 mm and/or ProsthProfile = 30(0) -45(0) probably allowing for fixed prosthesis, and (C) MucCov ≥ 5 mm and/or ProsthProfile ≤ 30(0) where removable prosthesis is favorable. Statistical analyses included descriptive methods and non-parametric tests. RESULTS Mean values were for FLHeight 10.0 mm, MucCov 5.6 mm, CID 7.4 mm, and ProsthProfile 39.1(0) . Seventy percent of patients fulfilled class C criteria (removable), 21% class B (probably fixed), and 2% class A (fixed), while in 7% (three patients) bone volume was insufficient for implant planning. CONCLUSIONS The proposed classification and virtual planning procedure simplify the decision-making process regarding type of prosthesis and increase predictability of esthetic treatment outcomes. It was demonstrated that in the majority of cases, the space between the prosthetic crown and implant platform had to be filled with prosthetic materials.

El muro como referencia arquitectónica

Esta investigación parte del interés particular por la manifestación arquitectónica, paisajística o urbanística de aquellos muros construidos que se han erigido para limitar, planteando un enfoque del muro en una vertiente conceptual. Se propone la formulación de distintas interpretaciones para un mismo elemento físico, logrando una propuesta arquitectónica de identificación para diferentes casos de estudio que consideramos paradigmáticos en su concepto. La hipótesis plantea la posibilidad de identificar un muro con la autonomía o identidad conceptual que le hace capaz de condicionar o dirigir la conformación de una obra de arquitectura, sirviendo como instrumento arquitectónico para las acciones de articulación, implantación, referenciación o conformación. El desarrollo de la investigación muestra la aptitud de individualizar el muro como elemento excepcional en el cumplimiento de la síntesis de distintas variables de proyecto. Se elaboran cinco conceptos diferentes del elemento en la función que cumple en el espacio que se basan en una definición compuesta de dos propiedades determinantes que se identifican con la categoría de la “justificación conceptual” combinando, además, valores de las categorías “Relación con el lugar”, “Función estética”, “Función de programa” y “Generación”. Se propone la identificación del muro que presenta las cualidades que lo hacen actuar de forma articuladora en el espacio y que, al cumplir esa función, condiciona y determina parte de la obra de arquitectura en que se encuentra. El muro articulador se entiende como un elemento que soluciona formal y espacialmente distintas situaciones de programa; no responde a un esquema formal predeterminado, sino que lo crea, en la unión coherente entre opuestos: ámbitos opuestos, esquemas formales opuestos, etc. Proponemos la identificación del muro que presenta determinadas cualidades que lo hacen actuar de forma implantadora en el espacio y que, al cumplir esa función, condiciona y determina parte de la obra en que se encuentra. Se considera el muro implantador como el punto de partida del proyecto en que se ha utilizado y como el elemento elegido para hacer la síntesis entre las variables del proyecto - sitio, función constructiva y estructural, estableciendo una regla formal y espacial coherente. Proponemos la identificación del muro referenciador, elemento que se destaca en la edificación como entidad elegida para hacer la síntesis entre las distintas variables del proyecto: significado, función estética y sitio. El muro referenciador se percibe como una entidad autónoma, particular al carácter o programa de la obra y al sitio en que se erige. Se considera el muro-recinto como el punto de partida del proyecto en que se ha utilizado, así como un elemento fundamental que se destaca en el conjunto de la obra - sea por su vertiente constructiva o de tratamiento estético – como entidad elegida para hacer la síntesis entre las variables del proyecto: forma y programa. Al utilizar un esquema formal predeterminado, permite generar espacio coherente con las demandas de un programa específico, entendiéndose como un elemento arquitectónico particular a la obra. Proponemos la identificación del muro habitable como el elemento que presenta las cualidades que lo hacen pasible de generar espacio en su interior, siendo un instrumento útil para cumplir con la variable del proyecto del programa. El concepto de muro habitable, como contrapunto a los otros cuatro tipos, se manifiesta como una entidad más elemental que traduce un instrumento de trabajo todavía más manejable que los restantes muros estudiados. De hecho, su utilización es incluso posible en aquellos muros que ya presentan el concepto de muro articulador, implantador, referenciador o muro-recinto. ABSTRACT This research is based on a particular interest in the architectural, landscape or urban manifestations of those walls that have been erected to limit, considering a conceptual approach. It suggests the formulation of diverse interpretations for the same physical element to achieve an architectural proposal of identification for different case studies that we consider paradigmatic in its concept. The hypothesis considers the possibility to identify a wall with the autonomy or conceptual identity that makes it able to influence or direct the form of an architecture work, serving as an instrument for the actions of articulation, emplacement, referencing or conformation. The development of the research shows the ability to individualize the wall as an outstanding element in the synthesis of different variables of architectural design. It elaborates five different concepts of the wall function in space, based on a definition with two determinant properties which combine values of the categories "Relation with the context", "Aesthetic function", "Program function" and "Generation". We propose the identification of the wall that has the qualities that make it act in an articulating way in space, conditioning and determining part of the architectural work. The “articulating wall” is understood as an element that formally and spatially solves different situations of functional program; it does not respond to a previous formal scheme, it creates it instead, through the coherent combination between opposites: opposing fields, opposing formal schemes, etc. We identify as well the wall that has the qualities that make it able to emplace on site, conditioning and determining part of the architecture work. The “wall that emplaces” is considered the starting point of the architectural design and the chosen element to make the synthesis between the architectural design variables - site, constructive function and structural function - establishing a formal and spatial coherent rule. We propose the identification of the “referencing wall”, element that stands out in the building as an entity chosen to make the synthesis between the project variables: meaning, aesthetic function and site. The referencing wall is perceived as an autonomous entity, particular to the character or the functional program and the site on which it sits. We consider the “precinct wall” as the departure point of the architectural design where it is used as well as a fundamental element that stands out in the whole of the architecture work - either by its constructive aspect or esthetic treatment - as the chosen entity to synthetize form and pro-gram. Since it uses a predetermined formal scheme it will allow to generate consistent space with-in the demands of a specific program, being understood as an element particular to the architectural work. As a fifth concept we identify the “inhabitable wall” as the element that has the qualities that make it predisposed to generate space inside its nucleus, being a useful instrument to comply with the variable of program in the architectural design. The concept of inhabitable wall, as a counterpoint to the other four types, manifests itself as a more elemental entity that translates itself as a more manageable working tool. In fact, its use is even possible in those walls that al-ready present the concept of articulating wall, emplacing wall, referencing wall or precinct wall.

Pre-Prosthetic Orthodontic Treatment Using Personalized Elastic Separators for Optimization of Emergence Profile in Esthetic Crowns: A Clinical Report

Restoring a misaligned tooth with an inadequate contact point is a challenge to the practitioner. In some instances, teeth that could be repositioned and adequately restored are extracted. Thus, the aim of this article was to describe a treatment using orthodontic and prosthetic techniques to restore esthetics and function in a patient with a distally drifted maxillary lateral incisor. The patient's functional and esthetic expectations were successfully met with the outlined treatment.

Gingival recession associated with noncarious cervical lesions: Combined periodontal-restorative approach and the treatment of long-term esthetic complications

The combined periodontalrestorative approach (that is, a connective tissue graft for root coverage and NCCL restoration with RMGI cement) has demonstrated significant root coverage and a good esthetic outcome. In some cases, though, the color of an RMGI restoration can change over time, compromising esthetics. In this situation, applying composite resin over an RMGI restoration can be a conservative approach to satisfy the patient's esthetic complaint. Long-term observation is necessary to evaluate the stability of the results and establish the success of this approach over time.

Perception of the esthetic impact of mandibular incisor extraction treatment on laypersons, dental professionals, and dental students

Objective: To evaluate the degree of perception of laypersons, dental professionals, and dental students regarding dental esthetics in cases with mandibular central incisor extraction. Materials and Methods: Using a smile photograph of a person with normal occlusion and all teeth, modifications were made to reflect the extraction of a mandibular incisor of various compositions and sizes. For this purpose a program specifically for image manipulation (Adobe Photoshop CS3, Adobe Systems Inc) was used. After manipulation the images were printed on photographic paper, attached to a questionnaire and distributed to laypersons, dental professionals, and dental students (n = 90) to evaluate the degree of perception and esthetic using a scale of attractiveness, where 0 = hardly attractive, 5 = attractive, and 10 = very attractive. The differences between examiners were checked by the Mann-Whitney test. All the statistics were performed with a confidence level of 95%. Results: The results demonstrated the skill of the dental professionals and dental students in perceiving the difference between cases of normal occlusion and cases where an incisor was lacking (P < .05). The photograph in which the lateral incisors were shown to be larger than the central incisor was the one that obtained the highest value among the cases of extraction in all groups of evaluators. Conclusions: It can be concluded that dental professionals and dental students are more skillful at identifying deviation from normality. In addition, central incisor extraction should always be discarded when there are other treatment options available. (Angle Orthod. 2012;82:732-738.)

Multidisciplinary treatment approach for crown fracture and crown-root fracture - a case report

The increased incidence of traumatic injuries to anterior teeth is a consequence of leisure activities, where the most common injuries are crown fractures. Treatment of the dental trauma is complex and requires a comprehensive and accurate diagnostic and treatment plan. It is also important to consider the biological, functional, esthetic and economic aspects, as well as the patient's desire. The purpose of this article is to report a case that shows the multidisciplinary approach required to successfully manage the rehabilitation of a maxillary central incisor with a complex crown fracture and a maxillary lateral incisor, that at first presented an oblique crown-root fracture, and after the orthodontic extrusion, suffered a more apical new crown-root fracture.

Multidisciplinary approach for the treatment of a complicated crown-root fracture in a young patient: A case report

Crown-root fractures in permanent teeth cause esthetic and functional problems. This paper reports the case of a complicated crown-root fracture in the maxillary right central inc sor of a young patient who was treated with a multidisciplinary approach in two phases. A modified Widman flap, root canal therapy, glass fiber post cementation, and adhesive tooth fragment reattachment were performed shortly after an accident. Satisfactory esthetic and functional outcomes were obtained. However, the patient did not attend follow-up visits and returned after 7 years. During this second phase, the clinical and radiographic examination showed stability and adaptation of the fragment and good periodontal health conditions, but crown darkening and a radiolucent image associated with the root apex of the fractured tooth were also observed. The periapical lesion was surgically removed by apicoectomy, and the esthetics were recovered with a direct composite res n veneer on the traumatized tooth. (Quintessence Int 2011;42:729-735)