This book introduces a unique approach to esthetic restoration of the anterior dentition. Guided by the philosophy of biomimetics, the authors combine sound biologic principles with an overriding respect for the natural intact tooth to achieve esthetic satisfaction with bonded porcelain restorations. Unlike traditional veneers, the approach described here draws upon the ideal hues, the subtle shades, and especially the intracoronal anatomy of the intact tooth to serve as a guide to reconstruction and as a measurement of success. From this perspective, a checklist of fundamental esthetic criteria is presented, and treatment planning, diagnostics, tooth preparation, laboratory procedures, adhesive luting procedures, and maintenance protocols are carefully detailed. The reader will find all the information and step-by-step instruction needed to obtain the authors superior results, which are showcased throughout the book.
ISBN: 0-86715-422-5
978-0-86715-422-1
406 pp; 1,037 illus (mostly color)
Table of Contents
Foreword
Preface
Chapter 1: Understanding the Intact Tooth and the Biomimetic Principle
Biology, Mechanics, Function, and Esthetics
Optimal Compliance and Flexibility
Rationalized Anterior Tooth Shape
Mechanics and Geometry During Function
Physiologic Enamel Cracking and the DEJ
Natural Tooth Aging and Enamel Thinning
Biomimetics Applied to Mechanics
Chapter 2: Natural Oral Esthetics
General Considerations
Fundamental Criteria
Esthetic Integration
Chapter 3: Ultraconservative Treatment Options
Chemical Treatments and Biomimetics
Nightguard Vital Bleaching
Microabrasion and Megabrasion
Nonvital Walking Bleach Technique
Reattachment of a Tooth Fragment
Simplified Direct Composites
Chapter 4: Evolution of Indications for Anterior Bonded Porcelain Restorations
Historic Perspective
Type I: Teeth Resistant to Bleaching
Type II: Major Morphologic Modifications
Type III: Extensive Restoration in the Adult
Combined Indications
Biologic Considerations
Perspectives for Veneering Posterior Teeth
Chapter 5: Initial Treatment Planning and Diagnostic Approach
Interactive Patient-Operatory-Laboratory Relationships
Patient Management by the Operatory Team
Patient Management by the Laboratory Team
Treatment Planning and Initial Therapy
Diagnostic Waxup
Diagnostic Mock-up
Peculiar Cases
Summary of Diagnostic Approaches
Clinical Photography
Shade Documentation
Chapter 6: Tooth Preparation, Impression, and Provisionalization
General Considerations
Tissue Reduction
Margin Configuration and Localization
Peculiar Situations
Immediate Dentin Bonding
Definitive Impressions
Direct Provisionals and Provisional Bonding
Chapter 7: Laboratory Procedures
Choice of Restorative Material and Technique
Master Casts in the Refractory Die Technique
Ceramic Layering and Finishing
Special Effects
Configuration of the Ceramic Workpiece
Chapter 8: Try-In and Adhesive Luting Procedures
Choice of Luting Composite Resin
Try-in and Preparatory Steps
Conditioning of the Ceramic Surface
Conditioning of the Tooth Surface
Placement of the Ceramic Restoration
Final Adjustments and Occlusal Control
Special Considerations
Chapter 9: Maintenance and Repairs
Maximum Performance, Reduced Maintenance
Routine Professional Hygiene
Complications and Repairs
Replacement of Class 3 Composite
Guide to Clinical Cases
Index
Preface
The most exciting developments in dentistry have emerged within the past decade. Oral implant dentistry, guided tissue regeneration, and adhesive restorative dentistry are strategic growth areas both in research and in clinical practice. However, the many advances in dental materials and technology have generated a plethora of dental products in the marketplace. Clinicians and dental technicians are faced with difficult choices as the number of treatment modalities continues to grow. Further, changes in technology do not always simplify technique or decrease treatment costs. Prudence and wisdom need to be combined with knowledge and progress when it comes to improving our patients welfare.
In this perplexing context, no one will contest the need for less expensive, satisfactory, and rational substitutes for current treatments. The answer might come from an emerging interdisciplinary biomaterial science called biomimetics.1 This concept of medical research involves the investigation of the structure and physical function of biologic composites and the design of new and improved substitutes. Biomimetics in dental medicine has increasing relevance. The primary meaning for dentistry refers to processing material in a manner similar to that by the oral cavity, such as the calcification of a soft tissue precursor. The secondary meaning refers to the mimicking or recovery of the biomechanics of the original tooth by the restoration. This, of course, is the goal of restorative dentistry.
Several research disciplines in dental medicine have evolved with the purpose to mimic oral structures. However, this nascent principle is applied mostly at a molecular level, with the aim to enhance wound healing, repair, and regeneration of soft and hard tissues.2,3 When extended to a macrostructural level, biomimetics can trigger innovative applications in restorative dentistry. Restoring or mimicking the biomechanical, structural, and esthetic integrity of teeth is the driving force of this process. Therefore, the objective of this book is to propose new criteria for esthetic restorative dentistry based on biomimetics.
Biomimetics in restorative dentistry starts with an understanding of hard tissue structure and related stress distribution within the intact tooth, which is the focus of the opening chapter of this book. It is immediately followed by a systematic review of parameters related to natural oral esthetics. Because the driving forces of restorative dentistry are maintenance of tooth vitality and maximum conservation of intact hard tissues, a brief chapter describes the ultraconservative treatment options that can precede a more sophisticated treatment. The core of the book centers on the application of the biomimetic principle in the form of bonded porcelain restorations (BPRs). The broad spectrum of indications for BPRs is described, followed by detailed instruction on the treatment planning and diagnostic approach, which is the first step in learning this technique. The treatment is then described step-by-step, including tooth preparation and impression, laboratory procedures related to the fabrication of the ceramic workpiece, and its final insertion through adhesive luting procedures. The book ends with discussion of the follow-up, maintenance, and repair of BPRs.
I would have been unable to achieve this work without the valued collaboration of other dentists, dental technicians, specialists, and researchers. We should always remember that a key element for successful and predictable restoration is teamwork and an essential ingredient for teamwork is humility, to consider others better than oneself. We must try to serve each other rather than expect to be served.
I am fortunate to have studied under Prof Urs Belser; his teaching and guidance have been invaluable to me.
Special thanks goes to Drs William Douglas, Ralph DeLong, Maria Pintado, Antheunis Versluis, and Thomas Korioth at the University of Minnesota for their help and friendship during my 2-year research scholarship there. They expanded my vision and knowledge of scientific research in biomaterials and biomechanics.
I extend appreciation to Michel Magne, CDT, for his significant contributions to the chapter on laboratory procedures and for his skills in fabricating the ceramic restorations for all of the cases in this book. I also acknowledge my patients, who indirectly contributed to the realization of this book, and the private practitioners who donated extracted teeth for the studies and illustrations. Special thanks in this regard goes to Drs Rosa Serrano of Geneva, Switzerland, and Josι de Souza Negrγo of Sγo Paulo, Brazil.
Finally, I give honor and glory to my Lord and Savior, Jesus Christ, who has made all of my projects possible through his gracious love.
Pascal Magne, PD, DR MED DENT
Senior Lecturer
Department of Fixed Prosthodontics and Occlusion
University of Geneva
School of Dentistry
Geneva, Switzerland
Urs Belser, PROF, DR MED DENT
Professor and Head
Department of Fixed Prosthodontics and Occlusion
University of Geneva
School of Dentistry
Geneva, Switzerland
