Survey of patient attitudes toward current esthetic procedures

The Components of Smile Design: New York University Smile Evaluation Form Revisited, Update 2015

This article updates a simple checklist of foundational knowledge in aesthetic dental concepts that allows clinicians to organize their thoughts, to record the concerns of the patient, and to map out those improvements that must be addressed. This adjunct is called a Smile Evaluation Form. Along with other adjuncts such as radiographs, study casts, and diagnostic wax-ups, the Smile Evaluation Form allows clinicians to form a conceptual visualization of the expected end point. It provides a checklist for discussions with other disciplines in the team, to provide a logical sequence of treatment with a mutually agreed-on end point.

Evaluation of the effect of a home bleaching agent on surface characteristics of indirect esthetic restorative materials--part II microhardness

BACKGROUND

The exponential usage of esthetic restorative materials is beholden to society needs and desires. Interaction between the bleaching agents and the esthetic restorative materials is of critical importance.

AIM

This in vitro study has been conducted to evaluate the effect of a home bleaching agent, carbamide peroxide (CP) 38%, on the microhardness of the fiber reinforced composite (FRC), overglazed, autoglazed, or polished porcelain specimens.

MATERIALS AND METHODS

For overglazed, autoglazed, polished ceramics and also FRC cylindrical specimens (n = 20 per group) were prepared. The specimens were stored in distilled water at 37°C for 48 hours prior to testing. Six samples from each group were selected randomly as negative controls which were stored in distilled water at 37°C that was changed daily. CP 38% was applied on the test specimens for 15 minutes, twice a day for 14 days. By using Knoop-microhardness tester microhardness testing for baseline, control and test specimens was conducted. Data were statistically analyzed using paired t-test, Mann-Whitney test, and Kruskal-Wallis test.

RESULTS

Home bleaching significantly decreased the surface microhardness of all the test samples (p < 0.05), whereas the control groups did not show statistically significant changes after 2 weeks. The polished porcelain and polished composite specimens showed the most significant change in microhard-ness after bleaching process (p < 0.05).

CONCLUSION

Although the type of surface preparation affects the susceptibility of the porcelain surface to the bleaching agent, no special preparation can preclude such adverse effects.

CLINICAL SIGNIFICANCE

The contact of home bleaching agents with esthetic restorative materials is unavoidable. Therefore protecting these restorations from bleaching agents and reglazing or at least polishing the restorations after bleaching is recommended.

Color stability of denture teeth and acrylic base resin subjected daily to various consumer cleansers

OBJECTIVE

This study evaluated color stability of acrylic denture teeth and base resins after 48 weeks of commercial denture cleanser simulation.

MATERIALS AND METHODS

Two brands of denture teeth (Trubyte Portrait IPN, TP; SR Vivodent DCL, SR) in shades A1, B1, and C1 and three acrylic base resins (Lucitone, LU; Paragon, PA; Valplast, VA) prepared to manufacturer's specifications were exposed 10 hours daily to four cleansers (Clorox Bleach, CB; Polident 3 minute, PO3; Efferdent, EF; and Kleenite, KL) and distilled water control, approximating consumer overnight use. Color measurements used the standard Commision International de l'Eclairage (International Commission on Illumination, CIE L*a*b*) color space (0, 4, 12, 24, 36, and 48 weeks.) Color differences (ΔE*) at 48 weeks were subjected to four-way analysis of variance (ANOVA). Mean values were compared with Fisher's (protected least significant difference) intervals (0.05 significance level).

RESULTS

Mean color differences (ΔE*) demonstrated color changes in each material. ANOVA-indicated color changes in teeth were significantly affected by both cleansers and teeth brand (p < 0.05), but not shade. Color changes in base resins were significantly affected by cleansers (p < 0.05), but not brand alone. Overall, KL produced the least color change while CB and PO3 produced the most for all materials.

CONCLUSIONS

After 48 weeks of daily simulation, TP teeth were more color stable than SR in all cleansers except EF (p < 0.0001). Base resin VA was less color stable than LU and PA. Cleanser KL resulted in the lowest color changes.

CLINICAL SIGNIFICANCE

All tested materials yield clinically acceptable color changes (ΔE* < 3.5); all cleansing methods tested can be recommended, although Kleenite demonstrated the least change after 48 weeks.

In vitro fracture resistance of mandibular incisors restored with modified partial-coverage ceramic restorations

BACKGROUND/AIM

The aim of this in vitro study was to investigate the impact fracture resistance of anterior teeth that had been fractured and restored with modified partial-coverage ceramics using the edge-up technique.

MATERIAL AND METHODS

A total of 178 extracted human mandibular central and lateral incisors were included in this study. The incisors were randomly divided into two groups. Group 1 (n = 89) teeth were cleaved and restored with modified partial-coverage ceramics using the edge-up technique; Group 2 (n = 89) consisted of intact teeth that served as control. Impact strength was tested in a modified impact testing machine (pendulum type), and the severity of crown fracture after fracture resistance test was registered.

RESULTS

Impact strength was insignificantly lower in restored teeth (median 5.39 and range 0.81-14.12 kJ m(-2) ) than in intact teeth (median 5.45 and range 0.31-16.47 kJ m(-2) ), although no statistically significant differences were observed. Regarding the severity of crown fracture, restored teeth showed a lower rate of severe fractures (20.22%) compared to intact teeth (25.84%), but no statistically significant differences were observed.

CONCLUSIONS

Restoration of cleaved mandibular incisors with modified partial-coverage ceramics using the edge-up technique shows fracture resistance and severity of crown fracture following traumatism similar to intact teeth. In this way, this technique can be used successfully for the treatment of fractured anterior teeth.

Smile design and treatment planning with the help of a comprehensive esthetic evaluation form

Even if a clinician possesses basic knowledge in esthetic dentistry and clinical skills, many cases presenting in modern dental practices simply cannot be restored to both the clinician's and the patient's expectations without incorporating the perspectives and assistance of several dental disciplines. Besides listening carefully to chief complaints, clinicians must also be able to evaluate the patient's physical, biologic, and esthetic needs. This article demonstrates the use of a smile evaluation form designed at New York University that assists in developing esthetic treatment plans that might incorporate any and all dental specialties in a simple and organized fashion.

Risk management in clinical practice. Part 5. Ethical considerations for dental enhancement procedures

After the demise of the Industrial Age, we currently live in an 'Information Age' fuelled mainly by the Internet, with an ever-increasing medically and dentally literate population. The media has played its role by reporting scientific advances, as well as securitising medical and dental practices. Reality television such as 'Extreme makeovers' has also raised public awareness of body enhancements, with a greater number of people seeking such procedures. To satiate this growing demand, the dental industry has flourished by introducing novel cosmetic products such as bleaching kits, tooth coloured filling materials and a variety of dental ceramics. In addition, one only has to browse through a dental journal to notice innumerable courses and lectures on techniques for providing cosmetic dentistry. The incessant public interest, combined with unrelenting marketing by companies is gradually shifting the balance of dental care from a healing to an enhancement profession. The purpose of this article is to endeavour to answer questions such as, What is aesthetic or cosmetic dentistry? Why do patients seek cosmetic dentistry? Are enhancement procedures a part of dental practice? What, if any, ethical guidelines and constraints apply to elective enhancement procedures? What is the role of the dentist in providing or encouraging this type of 'therapy'? What treatment modalities are available for aesthetic dental treatment?

Evaluation of the Relationship between Subjects? Perception and Professional Assessment of Esthetic Treatment Needs

PURPOSE

The purposes of the present study were to (1) evaluate the esthetic dental treatment need by means of two special questionnaires, (2) determine the reliability and the construct validity of the measurement scales derived from these questionnaires, and (3) investigate the relationship between Greek subjects' perception and a professional examiner's assessment regarding the esthetic treatment need.

MATERIALS AND METHODS

Participants in this survey consisted of 132 subjects (48 males with mean age 39.0 +/- 14.5 years old, 84 females with mean age 41.7 +/- 14.5 years old) with natural teeth and fixed restorations. Subjects were asked to complete a special self-evaluation questionnaire consisting of 12 items. During the next stage, all participants were clinically examined by an experienced examiner and the data collected were used to fill out a second special professional assessment questionnaire consisting of 20 items. The forms structure used were in accordance with well-established indices used in orthodontics for assessing esthetic treatment need.

RESULTS

The reliability of the multiple correspondence analysis (MCA) analysis-derived scales was very satisfactory (Cronbach's a coefficient: a =0.82) for the total scale of the self-evaluation measurement. For the professional assessment scale, the reliability of the total scale was almost perfect (a=0.92). The MCA revealed one reliable factorial construct for the self-evaluation measurement scale and two reliable constructs for the professional measurement scale. Pearson's correlation coefficient indicated a very low agreement between self-evaluation and professional measurement scales.

CONCLUSION

The findings of this survey suggest that there was a relative disagreement between subjects' perception and professional assessment regarding the need for esthetic dental treatment. CLINICAL SIGNIFICANCE In the present survey, the agreement between subjects' perception and clinical assessment of esthetic dental treatment need was found to be very low, which highlighted the discrepancies between patients' and dentists' perceptions of esthetic needs.

Intraoral determination of the tolerance of dentists for perceptibility and acceptability of shade mismatch

STATEMENT OF PROBLEM

There is little agreement in the dental literature as to how much color difference constitutes an acceptable shade mismatch or how much color difference is considered perceivable to observers. Most studies attempting to determine perceptibility and acceptability of tolerances for shade mismatches have been conducted under in vitro conditions that are not applicable to clinical scenarios.

PURPOSE

The goal of this study was to determine valid acceptability and perceptibility tolerances for shade mismatch in an actual clinical scenario using spectroradiometric instrumentation.

MATERIAL AND METHODS

A test denture was fabricated that allowed 10 maxillary left central incisors of varying shade mismatch with the right central incisor to be interchanged within the denture base. A spectroradiometer was used to determine the CIELAB coordinates and color differences (DeltaE) between the right central incisor and the interchangeable left central incisor denture teeth. The interchangeable denture teeth ranged uniformly from 1 DeltaE unit (visually undetectable) to greater than 10 DeltaE units (an obvious shade mismatch). The test denture with each of the interchangeable teeth was modeled by a subject to 28 dentists in a clinical setting. For each of the interchangeable teeth, dentist observers were asked if they could see a difference between the central incisors and, if so, whether the difference was acceptable. A Probit regression analysis was used to predict acceptability and perceptibility tolerances with 95% confidence limits.

RESULTS

The predicted color difference at which 50% of the dentist observers could perceive a color difference (50/50 perceptibility) was 2.6 DeltaE units. The predicted color difference at which 50% of the subjects would remake the restoration due to color mismatch (clinically unacceptable color match) was 5.5 DeltaE. Acceptability and perceptibility color tolerances at the 50/50 level were significantly different (P<.05), as their 95% confidence limits did not overlap.

CONCLUSIONS

Tolerances for perceptibility were significantly lower than tolerances for acceptability for shade mismatch between 2 denture teeth.

Effect of an antibacterial adhesive on the bond strength of three different luting resin composites

OBJECTIVES

Effect of a dentin adhesive system containing antibacterial monomer-MDPB (Clearfil Protect Bond) on the shear bond strength of all-ceramic-IPS Empress 2 restorations luted with three different dual-polymerizing systems (Variolink 2, RelyX ARC and Panavia F 2.0) to dentin was investigated.

METHODS

One hundred and eight all-ceramic discs (2 x 3mm; IPS Empress 2) were fabricated and ultrasonically cleaned. The buccal surfaces of 108 non-carious extracted human premolars were flattened to expose dentin and subsequently polished with 600-grit wet silicon carbide paper. Three dual-polymerizing luting systems had test groups and control groups consisting of 18 samples each. For the test groups Clearfil Protect Bond was applied to the exposed dentin surfaces. Control groups received the original bonding procedures of each adhesive system. After the all-ceramic samples were luted to the teeth, thermocycling was performed 5000 times. Shear bond strengths were tested using Shimadzu Universal Testing Machine until failure. Analysis of fractured dentin surfaces were performed using Optical Microscope at x10 and x1000 magnifications and the images were analyzed with Image Analyzer. Data was analyzed with one-way ANOVA and Bonferroni test at a significance level of p<0.05.

RESULTS

Mean shear bond strength data of the groups in MPa were; Variolink: 20.45+/-4.75, Variolink+Clearfil Protect Bond:29.32+/-2.37, RelyX ARC:18.82+/-3.19, RelyX ARC+Clearfil Protect Bond:25.58+/-4.05, Panavia F 2.0:17.11+/-2.98, Panavia F 2.0+Clearfil Protect Bond:24.40+/-7.46. Application of the antibacterial adhesive increased the shear bond strengths of all three dual-polymerizing systems to dentin (p=0.00). The surface analysis showed that most of the specimens showed the adhesive failure mode between the dentin and the composite luting agent interface.

CONCLUSION

The antibacterial adhesive system Clearfil Protect Bond can be safely used to prevent the potential risk of complications resulting from bacterial activity regardless of affecting the bond strength of IPS Empress 2 restorations luted with the dual-polimerizing systems used in this study.

In vitro fracture strength of teeth restored with different all-ceramic crown systems

STATEMENT OF PROBLEM

There is insufficient knowledge of the strength of all-ceramic crowns bonded to natural teeth to warrant the use of all-ceramic crowns in place of metal-ceramic crowns.

PURPOSE

The purpose of this study was to evaluate and compare fracture resistance of crowns made of 3 different types of 2 all-ceramic crown systems-0.4-mm and 0.6-mm aluminum oxide coping crowns and zirconia ceramic coping crowns-and metal-ceramic crowns.

MATERIAL AND METHODS

Forty intact, noncarious human maxillary central incisors were divided into 4 groups (n=10): Group MCC (control), metal-ceramic crown (JRVT High Noble Alloy); Group AC4, crown with 0.4-mm aluminum oxide coping (Procera AllCeram); Group AC6, crown with 0.6-mm aluminum oxide coping (Procera AllCeram); and Group ZC6, crown with 0.6-mm zirconia ceramic coping (Procera AllZirkon). Teeth were prepared for complete-coverage all-ceramic crowns so that a final dimension of 5.5 +/- 0.5 mm was achieved incisocervically, mesiodistally, and faciolingually. A 1.0-mm deep shoulder finish line was used with a rounded internal line angle. All restorations were treated with bonding agent (Clearfil SE Bond) and luted with phosphate-monomer-modified adhesive cement (Panavia 21). Fracture strength was tested with a universal testing machine at a crosshead speed of 2 mm per minute with an angle of 30 degrees to the long axis of the tooth after restorations were stored in 100% relative humidity of a normal saline solution for 7 days. The mode of fracture was examined visually. Means were calculated and analyzed with 1-way ANOVA and Tukey's HSD (alpha=.05).

RESULTS

The means of fracture strength were: Group MCC, 405 +/- 130 N; Group AC4, 447 +/- 123 N; Group AC6, 476 +/- 174 N; and Group ZC6, 381 +/- 166 N. There was no significant difference between groups ( P =.501). The mode of failure for all specimens was fracture of the natural tooth.

CONCLUSIONS

There was no significant difference in the fracture strength of the teeth restored with all-ceramic crowns with 0.4- and 0.6-mm aluminum oxide copings, 0.6-mm zirconia ceramic copings, and metal ceramic crowns.

The effect of esthetic consultation methods on acceptance of diastema-closure treatment plan: a pilot study

BACKGROUND

The authors conducted a study to determine which of four consultation methods helped patients best understand a proposed treatment plan for maxillary anterior diastema closure.

METHODS

The authors presented 24 subjects with four types of consultation in random order: before-and-after photographs of other patients, diagnostic models with wax setups, resin-based composite/esthetic preview/mock-ups and computer-imaging simulations. After viewing each method, the authors asked the subjects about treatment acceptability. At the end of the demonstrations of all four methods, the authors asked the subjects which consultation method helped them best understand the proposed treatment plan.

RESULTS

A total of 87.5 percent of the subjects indicated that they would accept the proposed treatment plan after they were shown the computer-imaging simulation, 50 percent said they would after they were shown the resin-based composite/esthetic preview/mock-up, 41.7 percent said they would after they were shown photographs of other patients, and 25 percent said they would after they were shown diagnostic models with wax setups. When asked which method helped them best understand the proposed treatment, 54.2 percent of the subjects selected computer-imaging simulation, 33.3 percent selected resin-based composite/esthetic preview/mock-ups, and 12.5 percent selected before-and-after photographs of other patients. None of the subjects selected diagnostic models with wax setups. A chi2 test for goodness of fit indicated that these differences were statistically significant.

CONCLUSION

Subjects preferred computer-imaging simulation to the other three consultation methods, and they indicated that computer-imaging simulation provided a better understanding of the proposed treatment plan for diastema closure.

CLINICAL IMPLICATIONS

The use of computer-imaging simulation enhances the patient's understanding of a proposed treatment plan concerning maxillary anterior diastema closure.

Diagnostic and technical approach to esthetic rehabilitations

The success of an esthetic rehabilitation depends on the understanding of the patient's needs and on effective communication among the entire dental team. The involvement of the dental technician since the beginning of the treatment plan is one of the keys for success. This article describes a systematic approach to oral rehabilitations involving esthetic areas. Technical suggestions for the construction of the diagnostic wax-up, the provisional, and the final ceramic restorations are illustrated in a logical sequence.

Simulated shape design. Helping patients decide their esthetic ideal

BACKGROUND

Esthetic care is changing dentistry from a need-based to a want-based practice. Patients are asking for esthetic treatment, and clinicians are retooling their practices to satisfy this need. One important part of providing esthetic dentistry is ensuring that the patient is as well-informed as possible about treatment outcomes.

DESCRIPTION OF TECHNIQUE

This article describes a tool dentists can use to show patients potential tooth sizes, shapes and arrangements before carrying out treatment. Simulated shape design, or SSD, is a reversible method of demonstrating potential esthetic outcomes that involves creating trial restoration shapes and placing them over a patient's teeth. SSD is a simple technique that any dentist can perform. In essence, the technician makes new tooth shapes in wax, the dentist places these in the patient's mouth and the patient evaluates them. The dentist then makes modifications in the SSD, which he or she reports to the technician.

CLINICAL IMPLICATIONS

With the decisions of shape, arrangement and size made at chairside, the whole flow of esthetic treatment can be handled smoothly. Preparations can be cut more accurately to better support the restorative material; decisions can be made to open or not open the contacts; and shapes can be agreed on in the earliest stage of evaluation, then duplicated faithfully in the provisional and final restorations. There are no surprises for the patient, the dentist or the technician. Both the esthetic (smile design) and functional elements (anterior guidance) of the restoration can be checked with SSD. SSD could become the standard in determining whether or not to proceed with esthetic treatment.

Computer imaging versus conventional esthetic consultation: a prospective clinical study

Computer imaging can be helpful in demonstrating to patients the potential outcome of esthetic dental procedures. The current clinical study assesses the effectiveness of computer imaging by comparing the reactions of patient and dentist to conventional consultations versus the use of computer imaging. The responses from 35 subjects show that computer imaging consultations are more effective in helping patients decide to accept treatment. Patient satisfaction was higher (93.75%) with computer consultations than with conventional methods (83.3%). Computer imaging consultations were easier to conduct but significantly (p < .05) more time consuming.

patients' satisfaction with different types of veneer restorations

OBJECTIVES

The aim of this study was to measure the satisfaction of patients with respect to the aesthetics of veneer restorations (VRs) and to identify potential factors influencing their satisfaction.

MATERIALS AND METHODS

One hundred and eighty VRs of three different types (direct composite, indirect composite and porcelain) were placed on anterior teeth. Patients were asked to fill in questionnaires at baseline and at one- and two-year recalls.

RESULTS

At baseline the overall satisfaction was 76%, after two years this was 78%. The variable 'type of VR' was the only factor measured that had a significant influence on the satisfaction of the patient. At the two-year evaluation patients with porcelain VRs were more satisfied than those with direct composite VRs (P < 0.05).

CONCLUSIONS

From the results of this study it is concluded that differences in clinical procedures had no effect on satisfaction. Also the number of VRs had not influenced the level of satisfaction. After two years a significant difference was observed for the variable 'type of VR', with the best results for porcelain.

In-office bleaching: where we came from, where we are today

Discolored teeth are the primary aesthetic concern among dental patients. While many seek professional advice and treatment, an alarming number opt for non-professional quick-fix solutions. The in-office bleaching modality often is overlooked in favor of at-home vital bleaching. But this option has been proven to be effective, quick and safe-either alone or in combination with other aesthetic treatments-as a method of brightening and enhancing a patient's smile.

Esthetics: patients' perceptions of dental attractiveness

PURPOSE

The importance of dentofacial attractiveness to the psychosocial well-being of an individual has been well established. Very little information is available regarding dental patient perceptions of a pleasing esthetic image. The purpose of this study was to identify factors distinctive to attractive smiles versus unattractive smiles, as perceived by patients.

MATERIALS AND METHODS

Standardized format photographs (5 x 7 in, matte finish, at f-32 and 1:2 magnification) of eight male and eight female smiles, framing only lips and teeth, were viewed by 297 subjects. The smiles exhibited differences in symmetry, tooth shade, number of teeth displayed, and height of maxillary lip line, and included both restored and unrestored teeth. Respondents ranked the photographs in order from most to least appealing appearance. Respondents viewed each series of photographs in a similar lighting and time period. A questionnaire identified the respondent's age, sex, race, education, income, and home town. Twenty-five demographic groups were established from the information in the questionnaire. Data were analyzed using stepwise discriminant analysis to determine the combination of smile characteristics that best predicted the ranking.

RESULTS

The same female smile was chosen as the most attractive by 24 of the 25 demographic groups. This smile is characterized by natural teeth having light shade, high lip line, a large display of teeth, and radiating symmetry. Two female smiles typified by darker shade and asymmetry were rated by all groups as being least attractive. Two male smiles were judged equal as the most pleasing esthetically. Respondents favored those smiles characterized by light shade, a moderate display of teeth, moderate lip line, and a symmetrical arrangement of teeth. One male smile characterized by darker shade was rated as least attractive.

CONCLUSIONS

In all cases, tooth shade was the most important factor, followed in sequence by unrestored natural teeth and number of teeth displayed. No correlation was found to exist between specific demographic groups and smile variables.

Patients' perceptions of the decision-making process leading to extraction of permanent teeth in Norway

Extraction is the final step in a continuous process in which oral health-related factors and psycho-social processes play a role. The purpose of the present study was to investigate the patient's perception of the decision-making process leading to the extraction of permanent teeth and to determine whether and how patient-associated characteristics might influence who made the decision to extract and if the patients felt they had any influence on the dentist's decision. A national random sample of Norwegian dentists (n = 500) recorded reasons for tooth extraction during a period of 2 weeks in 1988. A total of 437 patients responded (73%), of whom 54% were women. Nearly 33% of the respondents stated that it was their own decision to extract, while about two thirds said that the dentist had suggested extraction. Whether the dentist or the patient made the decision to extract teeth was significantly influenced by the patient's dental attendance pattern, place of residence, number of teeth and belief in retention of his/her own teeth for life (P < 0.05). There was no significant bivariate effect of patients' age, sex, educational level, or score on Corah's Dental Anxiety Scale on who made the decision to extract. Only 0.4% of patients said that family, friends or colleagues had influenced the decision to have teeth extracted. A logistic regression analysis with: "Was it the dentist or the patient who made the suggestion to extract teeth?" as the dependent variable, and the four bivariately significant independent variables showed for all patients that none had a significant effect.(ABSTRACT TRUNCATED AT 250 WORDS)

Predictability of color matching and the possibilities for enhancement of ceramic laminate veneers

This study investigated the predictability of color (Hue, Value, and Chroma) on three illustrated surfaces of ceramic veneers and the extent to which laminates may be shade-adapted by use of tints and opaquers on the fitting surface. Significant discrepancies were found in the final color match. The dentist should opt for a lighter, more translucent shade, which can be modified before final cementation.

Objective and subjective need for cosmetic dentistry in the Dutch adult population

In order to assess the objective and subjective need for cosmetic dentistry in the Dutch adult population in 1986 a stratified sample of 2784 dentate persons, aged 15-74 yr, participated in the study. The aesthetics of anterior teeth and first premolars in the maxillary mandibular arch were determined by dental examiners as well as by the examinees. According to the dental examiners 16-63% of the people in the age range from 15 to 74 yr were in need of cosmetic dental care. Based on the patient's opinion (subjective need) these percentages varied between 18 and 40% in the different age groups. The discrepancy between the objective and subjective assessment in the percentage of people in need of cosmetic dental care increased with age.

[Initial attitudes to orthodontic treatment--the results of a practical and clinical questionnaire study (I)]

312 patients from one clinic and nine offices, between eight and 15 years of age treated with bionators, their parents and a control group were questioned on various aspects of their treatment. Findings regarding opinions about dentofacial appearance, initial motives and expectations are presented. Aesthetic motives proved preponderant by seeking treatment though the children's ability to verbally differentiate aesthetic concepts was poor. Above all, they expected visible treatment progress, absence of appliance-caused psychosomatic impairment and rather factual information than personal communication with the orthodontist.

Mobile connection of veneer crowns after orthodontic closure of a wide diastema in the maxillae. A clinical report

A new, mobile splint for artificial crowns is suggested after orthodontic closure of a wide diastema mediale. A smooth mandibular movement in all excursions in considered essential. This approach sustains a physiologic load on the periodontium and prevents a recurrence of the diastema. The restorations in Fig. 6 have been stable and comfortable for 2 1/2 years with independent mobility of each tooth. Similar splinted prosthodontic devices inserted have also been successful.

Perception and significance of dental appearance: the case of missing teeth

The perception and significance of dental appearance was investigated in three groups of patients. One group had a missing front tooth replaced by partial dentures, which were taken out during the tests. A second group had some missing (pre-)molars. A third group had a complete natural dentition and they acted as control group. Color photographs of the teeth were made and a clinical examination was carried out. The psychological impact of dental appearance was measured by way of a scale of words with affective connotations. Social impact was assessed by way of changes in daily activities. Dentists and lay-persons were asked to give an opinion of the dental appearance on the basis of the pictures. It was found that a missing front tooth resulted in less positive feelings and more negative feelings and also that this condition affected daily life activities strongly. Missing (pre-)molars caused less of an aesthetic problem. Dentists and lay-persons were quite alike in their appreciation of dental appearance, whereas the respondents themselves had different opinions. An explanation for these differences and their implications for dentists are discussed.

Dental esthetic satisfaction in adults

This study determined the influence of teeth, mouth, and face on self-image and personal esthetic satisfaction in adults. A random sample of 125 patients completed a five-item questionnaire about personal esthetic satisfaction and oral self-image. As a group, general dental variables were stronger predictors of esthetic satisfaction than orthodontic variables (P less than .01). Discrepancies between clinical findings and patterns of self-perception and satisfaction suggest the dentist and patient should plan together for esthetic dental treatment.

Dentin bonding vs. enamel bonding of composite restorations: a clinical evaluation

The effect of dentinal bonding of composite resins was compared with that of enamel bonding. Two operators placed 192 composite resin restorations using enamel bonding or dentinal bonding on the two types of resin chosen for the study. Patients were recalled at the end of one year and two years. The restorations were evaluated clinically in the following categories: color match, cavo-surface discoloration, anatomical form, marginal adaptation, and recurrent caries. It was concluded for the evaluations that dentin bonding is not as effective as enamel bonding in protecting the composite restoration against cavo-surface discoloration and deterioration in marginal adaptation.

The teaching of posterior composites: views of recent UK graduates

The views of recent UK graduates have been surveyed to determine the extent and adequacy of the teaching they received as undergraduates in respect of posterior composites. It is concluded that most recent graduates believe that they acquired sufficient knowledge of posterior composites at dental school, but that they would benefit from attendance at hands-on postgraduate courses on these materials.

Composite laminate veneers: a clinical study

A 2-year clinical trial of a composite laminate veneer system for masking discoloration or hypoplasia on the anterior teeth of patients has been undertaken. Three hundred and twenty restorations were placed in seventy-nine patients, of these 273 restorations in sixty-eight patients have been followed over a 2-year period. The technique produced an acceptable improvement in the aesthetics of the patients in the trial. However, the veneers were susceptible to chipping (52% of lateral incisor veneers and 79% of central incisor and canine veneers showed some evidence of material loss after 2 years) and marginal staining (75% of veneers showed some evidence of marginal staining after 2 years) during function. The veneer restorations had a deleterious affect upon the gingival health of the teeth on which they were placed.

Computer-generated diagnostic correction of anterior diastemas

A technique for pretreatment estimation of appearance following cosmetic change to the anterior teeth by using a computer-generated image has been described. Patients should be advised that the generated projection is an estimation. As with a diagnostic set-up, a computer-generated result can only approximate final treatment. The patient must understand that the result could vary for reasons that might include (1) restorative material, (2) functional occlusal needs, (3) gingival tissue irritability, (4) artificial versus outdoor light, and (5) the angle at which the photograph was made. As technology advances, there will undoubtedly be other applications for computer graphics. The authors have successfully estimated outcomes for prosthodontic, orthodontic, and orthognathic surgical treatment. If properly used, color computer estimations can be successfully integrated in a dental office as a communication tool for the dentist, patient, and laboratory technician.

Modern dentistry and the esthetically aware patient

With esthetic dentistry, the profession derives excitement and satisfaction from providing service patients want, not just need. The new materials and techniques rest on a firm foundation of sound restorative and diagnostic principles. Patients who seek esthetic dentistry today are informed consumers who have specific objectives. Esthetic care, more than any other treatment, has psychological aspects, the consideration of which is crucial to treatment success.

The use of a direct bonded microfilled composite resin veneer

This technique creates a direct bonded microfilled composite resin veneer that replicates the complex color distribution and surface texture of the natural tooth structure. Duplicating the complexity of natural tooth color can be repeated by recording the different layers of color used in their sequence of placement.