Maximizing esthetic results in posterior restorations using composite opaquers

After removal of caries or a faulty existing restoration in a posterior tooth, frequently the pulpal floor is a dark substrate. Composites are translucent by nature, and even the more opaque shades transmit nearly 60% of visible light, meaning that composites require a certain thickness to maintain their intended shade, especially if the underlying substrate is particularly dark. Depending on the intensity of the dark substrate, even relatively thick composite restorations may not be capable of disguising the discolored dentin underneath. The substrate absorbs a significant part of the light that would otherwise reflect toward the occlusal surface, and the restoration has a nonvital monochromatic grayish color. Opaquers and tints (color modifiers) may be extremely useful to overcome this situation. In this study, composite restorations were placed in extracted teeth to demonstrate that the final esthetic results rely upon the optical properties of the background as well as those of the composite material itself. Preparations with simulated dark pulpal floors were restored without the use of opaquers and tint modifiers. After tooth hydration, the final shade was recorded with photographs. The restoration was removed and a new restoration was placed, but this time with a technique involving opaquer and tints. This article compares and discusses the outcomes of these two procedures.
CLINICAL SIGNIFICANCE
This demonstration shows a simple technique that can help dentists obtain predictable esthetic results in their daily practice with posterior composite restorations.     

Current status of zirconia-based fixed restorations

Zirconium dioxide (zirconia) ceramics are currently used for fixed restorations as a framework material due to their mechanical and optical properties. This review article describes the current status of zirconia-based fixed restorations, including results of current in vitro studies and the clinical performance of these restorations. Adaptation of zirconia-based restorations fabricated with CAD/CAM technology is within an acceptable range to meet clinical requirements. In terms of fracture resistance, zirconia-based fixed partial dentures (FPDs) have the potential to withstand physiological occlusal forces applied in the posterior region, and therefore provide interesting alternatives to metal-ceramic restorations. Clinical evaluations have indicated an excellent clinical survival of zirconia-based FPDs and crown restorations. However, some clinical studies have revealed a high incidence of chipping of veneered porcelain. Full-coverage zirconia-based restorations with adequate retention do not require resin bonding for definitive cementation. Resin bonding, however, may be advantageous in certain clinical situations and is a necessity for bonded restorations, such as resin-bonded FPDs. Combined surface treatment using airborne particle abrasion and specific adhesives with a hydrophobic phosphate monomer are currently reliable for bonding to zirconia ceramics. Further clinical and in vitro studies are needed to obtain long-term clinical information on zirconia-based restorations.     

Patient maintenance of esthetic restorations.

There are probably as many ways to maintain esthetic restorations as there are restorations. After esthetic treatment is completed, schedule a mandatory postoperative appointment to make certain that whatever technique the patient uses is effective. At the postoperative visit, it should be apparent that the patient's tissue is healthy. If the tissue has not healed, some change in home care or additional periodontal or restorative treatment may be necessary. There are virtually hundreds, perhaps even thousands of home plaque removal devices. The ones mentioned here have worked for us and are therefore discussed. It isn't the type of device that is critical, however, but patient compliance. The described regimens have worked effectively for us in overcoming this obstacle of compliance. Appropriate recall visits with the hygienist should be made at one- to six-month intervals. In the final analysis, your success with esthetic restorations may well depend on your patients' success with esthetic maintenance.     

Preparation of teeth for esthetic restorations

Preparation details have been described for a porcelain veneer restoration on the most commonly used teeth. With operator knowledge of the preparation, sharp instrumentation, and, most of all, patience, it is possible to place a restoration that may last as long as any others outside of those made of cast or direct gold. It is imperative to remember that this type of conservative "esthetic" dentistry should be performed only on canine-guided occlusions after equilibration (if necessary) (Fig. 13). Even then, it still is possible to fracture a veneer accidentally (Fig. 14). Prior to beginning treatment, it is prudent to inform the patient of the pros and cons of using porcelain veneers, including a warning of possible failure.     

Custom shade tabs for esthetic provisional restorations

A technique for fabrication of custom shade tabs in tooth form has been presented. The finished product will be a series of custom shade tabs. Any temporary (provisional) resin material can be used.     

Cervical margin design with contemporary esthetic restorations

The contemporary dentist has a wide variety of options to use in the restoration of extensively damaged or previously restored teeth. Metal-ceramic and all-ceramic crowns are frequently used to restore esthetics and function. One of the essentials for success with either option is proper tooth preparation, which includes proper selection and preparation of the cervical margin of the preparation.     

The material science of minimally invasive esthetic restorations

The term esthetic dentistry usually conjures up mental images of porcelain crowns and veneers. To some dentists, the term minimally invasive dentistry evokes thoughts of observing early lesions, and postponing treatment until lesions are closer to the pulp. (The World Congress of Minimally Invasive Dentistry defines minimally invasive dentistry as those techniques which respect health, function, and esthetics of oral tissue by preventing disease from occurring, or intercepting its progress with minimal tissue loss.) It would seem these two niches within dentistry are on opposite ends of the spectrum; however, composite resin and glass ionomer restorative materials unite these two ideologies. Understanding the limitations, benefits, and science behind each material allows clinicians to produce highly esthetic restorations that can resist future decay, internally remineralize the tooth, and help protect adjacent teeth from cariogenic attack.     

一步一步做好美学临时修复

美学设计、美学表达和美学实现是口腔美学修复诊疗的3个阶段。临时修复体是美学表达的重要手段,是美学设计和美学实现的桥梁和纽带。临时修复体的功能包括美学诊断、功能诊断和软组织美学处理。本文重点讨论口腔美学修复中临时修复体的功能、类型和临床应用。     

Clinical evaluation of direct esthetic restorations in cervical abrasion/erosion lesions: one-year results.

One hundred sixteen cervical abrasion/erosion lesions were restored with one of the following techniques: (1) glass-ionomer cement, (2) composite resin with a dentinal bonding agent, or (3) composite resin with a glass-ionomer cement liner and a dentinal bonding agent. The restorations were assessed at baseline and at 6 months and 1 year postrestoration for retention, caries, color match, marginal staining, and surface texture. No statistically significant differences were found in retention, caries, color match, or marginal staining. A statistically significant difference was found with regard to surface texture: glass-ionomer cement restorations demonstrated a rougher surface than did the composite resin restorations. A substantial number of restorations composed of composite resin with a dentinal bonding agent demonstrated a color shift towards mismatch when evaluated at 6 months. This difference was not significant at the 1-year followup.