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Surface Texture: A Systematic Approach for Accurate and Effective Communication/Alan V. Sulikowski, Aki Yoshida
A Comprehensive Approach for Restoring Esthetics and Function in Fixed Prosthodontics/Walter Gebhard
Adhesive Cementation of High-Strength Ceramic Restorations: Clinical and Laboratory Guideline/Markus B. Blatz, Avishai Sadan, Matthias Kern
The Lava System For CAD/CAM Production of High-Strength Precision Fixed Prosthodontics/John A. Sorensen
Material Testing and Layering Techniques of a New Two-Phase All-Glass Veneering Porcelain for Bonded Porcelain and High-Alumina Frameworks/Edward A. McLaren, Russell A. Giordano, Richard Pober, Basem Abozenada
Direct vs Semidirect vs Indirect Restorations: Establishing Criteria for Clinical Decision-Making/Interview with Roberto Spreafico by Avishai Sadan
Selected Case Presentations
Spinell Crown with Vitadur Alpha for Single-Tooth Restoration/Pinhas Adar
Crown Lengthening and Restoration Using the Pressable Authentic System/Pinhas Adar
Anterior Restoration with Procera Crowns and Vitadur Alpha Veneers/Pinhas Adar
Techniques and Technologies
Predictable Tooth Preparation for Porcelain Laminate Veneers in Complicated Cases/Galip GŁrel
Fabrication of a Full-Arch Acrylic Resin Diagnostic Provisional from a Diagnostic Waxup for Communication of Esthetic and Functional Requirements to the Laboratory/Brian S. Vence
Direct and Indirect Composite Restorations in the Anterior Area: A Comparison Between the Procedures/Valter Devoto
The Encapsulated Bridge: An Esthetic Alternative for Partially Edentulous Patients/Thomas Trinkner, Matt Roberts
Provisional Restorations as a Guide to Complex Treatment of the Anterior Dentition/Basil Mizrahi
Natural Color Concept: A Systematic Approach to Visual Shade Selection/Bernhard Egger
Single-Tooth Replacement with a New Zirconia Titanium Cylinder Implant Abutment: A Case Report/JŲrg R. Strub, Frank Butz, Rainer Semsch
Assembly of Screw-Retained Implant Prostheses/Ira D. Zinner, Mitchell S. Pines, Francis V. Panno, Patrick E. Reid, Curtis E. Jansen
Maxillary Rehabilitation with a Fixed Implant-Supported Prosthesis: Design and Technical Steps/Alexander Shor, Harold Heindl
Editorial: Less Is Much More
The number of completely elective restorative cases has increased manyfold in recent years. In these cases, healthy teeth are treated and restored to satisfy the patientís desire for a more pleasing appearance. To treat the diseased tooth or teeth, we have some acceptable general guidelines that enable the restorative team to form a treatment plan that, from a conceptual standpoint, will be acceptable almost globally. However, such uniform guidelines do not exist for a purely elective treatment plan, and, unfortunately, it is highly unlikely that such criteria will be available soon. The nature of the completely elective treatment is that the same dentition, smile, and overall esthetics that may be considered pleasing and youthful in one culture may be considered unattractive in another. Compound the cultural differences by the fact that market trends and public perceptions can constantly change in the same culture, and you start realizing that we will not have a universal foundation to use as a building block for elective procedures anytime soon.
With no basic universal guidelines or universally accepted treatment plans, one has to establish oneís own philosophy regarding elective procedures. One has to look first at both fringes of the spectrum. At one fringe, one can decide to do little to no elective procedures, while, at the other fringe, one may decide that to satisfy patient demands no treatment plan is too aggressive. The extremely conservative restorative team may claim that because perceptions are constantly changing and dental materials and techniques are constantly improving, they are not comfortable operating on healthy dentition to satisfy trendy desires. The extremely aggressive clinician will claim that the significance of a youthful smile to the patientís well-being outweighs all other considerations; thus, even the smallest of patient concerns will be addressed by placing restorations on almost all of the patientís teeth.
Of course, it is almost needless to say that both approaches lack a full understanding of the current status of our profession. The staunch conservative approach assumes that nothing durable or predictable is available. However, ever-increasing data, both in vitro and in vivo, are saying otherwise; for example, bonding porcelain laminate veneers to enamel seems to provide a predictable and long-lasting restoration. Therefore, incorporating them in an elective treatment plan, to the exact extent that they are needed in a specific case, is a legitimate approach. On the other hand, the overaggressive approach assumes that every type of tooth-colored restoration placed on a healthy tooth anywhere in the dental arch is predictable and durable. We must remember that since no sufficient data are currently available, the restorative team cannot promise the patient that an elective restoration will provide an esthetic and functional service that will last for the lifetime of the patient. Thus, every restoration placed may be a candidate for future replacement, many times just due to changes in a societyís perception of esthetics. As long as the case is carefully planned to include only the minimum number of required abutments, then fewer restorations may need to be replaced. It is hard to justify preparing eight teeth instead of four just to make shade matching easier. Also, if some restorations may need replacement in the future, the first set placed should be as conservative as possible, leaving all restorative options open for re-treatment. Clinicians must make every possible effort to preserve as much enamel as possible knowing that the laboratory has a variety of ways to fabricate beautiful yet thin ceramic restorations.
Proper elective treatment planning will remain controversial and elusive in years to come. However, as long as one uses the approach that less is more, he is standing on solid ground. The key is still to create a custom-made treatment plan, rather than to use the same treatment plan for all elective cases. Informing patients, rather than making promises that may be unattainable, restoring the minimal number of abutments needed to address the patientís concerns, and reducing the least amount of tooth structure necessary will minimize the risk of failure and will keep all options open for future re-treatments that may arise as our perception of what constitutes a beautiful smile keeps changing.