Esthetic rehabilitation of anterior teeth affected by enamel hypoplasia: a case report

Dentogingival Smile Analysis of Young Adults of Al Qassim Province, Saudi Arabia: A Cross-Sectional Study

Objectives. The present study aims to analyse the smiling components among young adults within Al Qassim region by evaluating typical smile parameters. Methodology. A cross-sectional study was conducted among 324 female and male participants between 18 and 35 years, within Al Qassim Province of Saudi Arabia. The dentogingival macro-aesthetic elements of the smile, the parallelism between the incisal curve and lower lip line, midline, and buccal corridors were determined by using Canon Rebel t7i (Canon, Melville, NY, USA) and evaluated by photo editing software Adobe Photoshop CC2019. The data were analysed using a chi-square test and Spearman’s correlation test for nonparametric data. Results. 62.5% of young adults had no buccal corridors. The nonparallel smile was found in 53.2% of young adults. A high smile line was observed in 33% of participants. 59.3% of young adults lacked a coinciding dental and facial midline. There was a statistically significant difference in the parallelism of the incisal curve and lower lip line as well as in the position of the upper lip line across genders ( $P<0.05$ ). Conclusion. Understanding macro-aesthetic elements of teeth and their interrelation with the surrounding oral structures can be a guide in creating natural and aesthetically pleasing restorative treatment.

Amelogenesis Imperfecta: Case Study

Amelogenesis imperfecta (AI) refers to a group of rare genetic disorders that involve tooth development and that are passed down through families as a dominant trait. This condition is characterized by abnormal enamel formation caused by gene mutations that alter the quality and/or quantity of enamel. This dental problem can impact both primary and permanent dentition, varies among affected individuals, and results in esthetic and functional problems. This condition caused the patient in the current case report to have a lack of confidence when speaking. The treatment for amelogenesis imperfecta depends on the severity of the problem and age of the patient. It is crucial to plan a proper remedy, which requires collaboration among dental specialties to execute comprehensive dental treatment in order to provide a long-term solution with adequate esthetics. The current clinical study presents a patient affected by AI that was diagnosed when the patient was a child. The interdisciplinary treatment continued throughout his childhood and into adult life. The initial treatment consisted of resin composite veneers and stainless-steel crowns to restore the defective tooth structure. The malocclusion of the patient was corrected using a fixed orthodontic appliance that was placed when he had an entire permanent dentition. The treatment plan was eventually intended to include all ceramic crowns and veneers.

Effects of pulsed Nd:YAG laser on tensile bond strength and caries resistance of human enamel

This study aims to evaluate the effects of pulsed Nd:YAG laser on the tensile bond strength (TBS) of resin to human enamel and caries resistance of human enamel. A total of 201 human premolars were used in this in vitro study. A flat enamel surface greater than 4 × 4 mm in area was prepared on each specimen using a low-speed cutting machine under a water coolant. Twenty-one specimens were divided into seven groups for morphology observations with no treatment, 35% phosphoric acid etching (30 seconds), and laser irradiation (30 seconds) of pulsed Nd:YAG laser with five different laser-parameter combinations. Another 100 specimens were used for TBS testing. They were embedded in self-cured acrylic resin and randomly divided into 10 groups. After enamel surface pretreatments according to the group design, resin was applied. The TBS values were tested using a universal testing machine. The other 80 specimens were randomly divided into eight groups for acid resistance evaluation. Scanning electron microscope (SEM) results showed that the enamel surfaces treated with 1.5 W/20 Hz and 2.0 W/20 Hz showed more etching-like appearance than those with other laser-parameter combinations. The laser-parameter combinations of 1.5 W/15 Hz and 1.5 W/20 Hz were found to be efficient for the TBS test. The mean TBS value of 14.45 ± 1.67 MPa in the laser irradiated group was significantly higher than that in the untreated group (3.48 ± 0.35 MPa) but lower than that in the 35% phosphoric acid group (21.50 ± 3.02 MPa). The highest mean TBS value of 26.64 ± 5.22 MPa was identified in the combination group (laser irradiation and then acid etching). Acid resistance evaluation showed that the pulsed Nd:YAG laser was efficient in preventing enamel demineralization. The SEM results of the fractured enamel surfaces, resin/enamel interfaces, and demineralization depths were consistent with those of the TBS test and the acid resistance evaluation. Pulsed Nd:YAG laser as an enamel surface pretreatment method presents a potential clinical application, especially for the caries-susceptible population or individuals with recently bleached teeth.

Functional and esthetic rehabilitation of mutilated dentition associated with amelogenesis imperfecta

This clinical case report describes the oral rehabilitation of an adult female patient diagnosed with hypoplastic amelogenesis imperfecta with inadequate, deteriorated restorations of anterior teeth, inadequate clinical crown heights of posterior teeth due to severe attrition of hypoplastic enamel. Treatment included extraction of teeth with poor prognosis, root canal treatment and crown lengthening of severely worn out teeth & full coverage porcelain-fused-to metal fixed restoration of entire dentition. The main objectives of the selected treatment were to enhance the esthetics, restore masticatory function and eliminate the teeth sensitivity. These treatment objectives were successfully met by sequential fixed prosthodontics treatment using Pankey-Mann-Schuyler philosophy of complete occlusal rehabilitation. Treatment not only restored function and esthetic, but also showed a positive psychological impact and thereby improved perceived quality of life.

Direct restorative treatment of anterior weared teeth after re-establishment of occlusal vertical dimension: a case report

OBJECTIVE

The loss of posterior teeth resulting in a lack of stability may lead to excessive mandibular load on some points of occlusion of the remaining teeth, causing wear. The rehabilitation of these cases must be carefully planned and the treatment requires a period of adaptation with a new vertical dimension.

BACKGROUND

This case report describes the treatment of a patient with a loss of almost all posterior inferior teeth and a consequential loss of occlusal vertical dimension and accentuated wear of anterior elements.

MATERIALS AND METHODS

  Provisional removable partial dentures were manufactured and the patient used them for a period of adaptation prior to restoration of the anterior teeth. After the patient's adaptation with the new occlusal dimension, anterior restorations were made using a mycrohibrid resin composite with different color aspects for an optimal stratification.

RESULTS

The restorations achieved an aesthetic configuration with ideal function as the final result and the occlusion showed a satisfactory stability for a provisional removable partial dentures.

CONCLUSION

This article presents an anterior direct rehabilitation approach not only as an alternative option, but also as viable and less expensive treatment option with an optimally aesthetic and functional result.

A Clinical Study of Direct Composite Full-Coverage Crowns: Long-Term Results

Objective

Long-term assessment of the clinical behavior of direct composite full-coverage crowns using transparent strip crowns as a matrix.

Method

A retrospective observational study without controls of 21 restorations was performed: nine teeth with hypoplasia, six conoid teeth, and six with microdontia. The mean patient age was 22.5 ± 8.2 years. The clinical procedure consisted of cleaning the tooth, acid etching and application of adhesive, after which a transparent strip crown was filled with composite and placed on the tooth. The gingival contour was polished using multifluted burs and interproximal spaces polished with polishing strips. Patients were examined after a period of 12.5 (±4.6) years by two observers who recorded the plaque index and evaluated the restorations in accordance with the modified U. S. Public Health Service (USPHS) criteria.

Results

Except for one case, all the scores obtained on the basis of the USPHS criteria were within the acceptable range. There were no cases of secondary caries. The statistically significant variations were anatomical form, marginal adaptation, marginal discolouration, and surface roughness.

Discussion

This technique is simple and noninvasive. It is a viable long-term treatment option for teeth with amelogenesis or microdonts and is especially suitable for patients still undergoing growth.

Management of fractured permanent incisors: 1 year follow-up

This clinical report describes the treatment of a left maxillary permanent incisor that had a complicated crown-root fracture with multiple fragments and a right maxillary permanent incisor which had an uncomplicated crown fracture. The 17-year-old female patient was presented to Ataturk University's Dentistry Faculty with posttraumatic injuries. The treatment plan included fracture segment reattachment, composite laminate veneer of the left maxillary incisor and composite restoration of the right maxillary incisor. The restorations were successful after 1-year follow-up according to the modified USPHS criteria.

CLINICAL SIGNIFICANCE

The treatment of anterior region's traumas in a single appointment would provide patient's expectation as well as preventive of remaining dental hard tissues.

Influence of method and period of storage on the microtensile bond strength of indirect composite resin restorations to dentine

This study evaluated the influence of the method and period of storage on the adhesive bond strength of indirect composite resin to bovine dentin. Ninety bovine incisors were stored in three different solutions: 0.2% thymol, 10% formalin, and 0.2% sodium azide, during 3 periods of storage: 7 days, 30 days and 6 months, resulting in 9 groups (n = 10). The roots were cut off and the buccal surface was ground with #600-grit silicon carbide paper. The surface was conditioned with 37% phosphoric acid for 15 s and a composite resin restoration (TPH Spectrum) was fixed using a one-bottle adhesive system (Adper Single Bond) and a dual-cured resinous cement (Rely X ARC) under a load of 500 g for 5 minutes. The samples were serially cut perpendicular to the bonded interface to obtain slices of 1.2 mm in thickness. Each slab was trimmed with a cylindrical diamond bur resulting in an hourglass shape with a cross-sectional area of approximately 1 mm(2). The microtensile bond strength (microTBS) testing was performed in a testing machine (EMIC 2000 DL) at a 0.5 mm/minute crosshead-speed until failure. After fracture, the specimens were examined under SEM to analyze the mode of fracture. muTBS Means were expressed in MPa and the data were analyzed by two-way ANOVA (3X3) and the Tukey test (alpha = 0.05). The storage times of 7 and 30 days produced no significant difference irrespective of the solution type. The formalin and thymol solutions, however, did have a negative influence on bond strength when the teeth were stored for 6 months.

Ceramic restoration repair: report of two cases

The esthetic and functional rehabilitation of patients with multiple missing teeth can be performed with several techniques and materials. Ceramic restorations provide reliable masticatory function and good esthetics. However, fracture can occur in some cases due to their brittle behavior. In some cases, the replacement of an extensive prosthesis is a problem due to the high treatment cost. In this paper, two cases are presented, in which fractures occurred in extensive metal-ceramic fixed partial dentures, and their replacement was not possible. Ceramic repair was chosen and the sequences of treatment with and without presence of the ceramic fragment are also discussed. The cases illustrate that, in some situations, fractured metal-ceramic partial dentures can be successfully repaired when prosthetic replacement is not a choice. Prosthodontists must use alternatives that allow a reliable repair to extensive metal-ceramic fixed partial dentures. Surface preparation of the ceramic with hydrofluoric acid in conjunction with a silane coupling agent is essential for a predictable bonding of composite resin. The repair performed with composite resin is an esthetic and functional alternative when extensive fixed partial dentures cannot be replaced.

A transitional overlay partial denture for a young patient: a clinical report

This clinical report describes a noninvasive approach for the treatment of a patient diagnosed with amelogenesis imperfecta (AI) and severe anterior open bite. The patient's functional and esthetic expectations were successfully met with a transitional overlay removable partial denture.

Interdisciplinary approach to treating a patient with amelogenesis imperfecta: a clinical report

Treatment of a patient with amelogenesis imperfecta (AI) presents a real problem from both functional and esthetic points of view. An esthetic result also will result in an improvement in the patient's quality of life. This clinical report illustrates the oral rehabilitation of a 24-year-old man diagnosed with hypomature type of AI. The aim of treatment was to both restore esthetics and improve masticatory function. Esthetic expectations of the patient were successfully attained by placing all-porcelain crowns from canine to canine in each arch, 12 crowns total. Moreover, metal-ceramic three-unit fixed partial dentures for the missing mandibular right first molars were fabricated for the patient's masticatory function. Resin composite restorations were applied to the maxillary premolars, the maxillary right first molar, the mandibular left premolars, and the right first premolar to modify the occlusion. No deterioration in the restorations and no pathology associated with the rehabilitation were found at the 1-year recall, and the patient's esthetic and functional expectations were satisfied. CLINICAL SIGNIFICANCE This article provides an overview of an interdisciplinary approach to treating the difficult condition of AI using a combination of treatments to achieve optimal esthetics and function.

Direct restoration of worn maxillary anterior teeth with a combination of composite resin materials: a case report

Tooth loss, alterations on tooth structure, and reduced vertical dimension are known to severely compromise the stomatognathic system. This case report describes the treatment of a patient who presented with an extremely worn maxillary anterior dentition with a loss of posterior support owing to the loss of almost all the posterior teeth, except the mandibular premolars. Provisional removable partial dentures were used to create an optimum maxillomandibular relationship and to provide restorative space prior to the restoration of the remaining teeth. This restoration was accomplished with a combination of layered hybrid and microfilled composite materials, which restored the maxillary anterior teeth to optimum esthetics and function.