Preventing Porcelain Fractures During Endodontic Treatment.

Attempting endodontic access through ceramic or veneering porcelain can be wrought with challenges. Clinicians must take every precaution to assist patients who are in pain without causing harm through chipping or fracturing the restoration. This article discusses strategies clinicians can consider when facing the task of achieving endodontic access through an all-ceramic crown.

Quo vadis, esthetic dentistry? Ceramic veneers and overtreatment-A cautionary tale.

The increased emphasis on orofacial esthetics, experienced both by dental professionals and the lay public, results in an environment where overtreatment can easily occur. Patients on the one hand feel pressure from esthetic norms that are often unrealistic, while dental professionals are compelled to deliver immediate results many times without considering what is best for the ill-informed patient. This article is an illustrated cautionary tale against overtreatment disguised as esthetic dentistry. Representative clinical examples illustrate how porcelain veneers are used without following sound operatory principles, as well as how these cases have been resolved.

The Photoshop Smile Design Technique.

Esthetic or cosmetic dentistry has become one of the main areas of dental practice emphasis and growth for the past several decades. Many articles have been written and courses taught over the years on concepts of smile design to develop a treatment plan for an esthetic outcome for the patient. The beauty of digital smile design is that patients can see the potential esthetic outcomes of treatment options in minutes. While other dental processes would still need to be completed (ie, generating casts, testing vertical changes and esthetics with a mock-up, etc), using smile design software to visualize the end result is a way to get acceptance by the patient prior to starting the physical processes. This article will show how the authors use Adobe® Photoshop® to edit pre-treatment images of a patient to create digitally enhanced or altered smiles, which could help the dental professional with analysis and treatment planning. It will also help them articulate and present the smile analysis options to the patient.

The clinical management of awake bruxism.

BACKGROUND: Awake bruxism is a common clinical condition that often goes undetected, often leading to pain or damaged teeth and restorations. METHODS: The authors searched electronic databases regarding the treatment and effects of awake bruxism compared with those of sleep bruxism. The authors used the search terms diurnal bruxism and oral parafunction. The authors combined information from relevant literature with clinical experience to establish a recommended protocol for diagnosis and treatment. RESULTS: The authors found articles regarding the diagnosis and treatment of bruxism. The authors combined information from the articles with a review of clinical cases to establish a treatment protocol for awake bruxism. CONCLUSIONS: Literature and clinical experience indicate a lack of patient awareness and, thus, underreporting of awake bruxism. As a result, myriad dental consequences can occur from bruxism. The authors propose a need for increased awareness, for both patients and professionals, particularly of the number of conditions related to awake bruxism. PRACTICAL IMPLICATIONS: Clinicians should look for clinical signs and symptoms of awake bruxism and use minimally invasive treatment modalities.

A Technique Using Calibrated Photography and Photoshop for Accurate Shade Analysis and Communication.

This article reviews the critical aspects of controlling the shade-taking environment and discusses various modalities introduced throughout the years to acquire and communicate shade information. Demonstrating a highly calibrated digital photographic technique for capturing shade information, this article shows how to use Photoshop® to standardize images and extract color information from the tooth and shade tab for use by a ceramist for an accurate shade-matching restoration.

Microleakage around Class V Composite Restorations after Ultrasonic Scaling and Sonic Toothbrushing around their Margin.

OBJECTIVES: To measure microleakage around class V composite restorations after piezoelectric ultrasonic scaling and sonic toothbrushing. METHODS: 3 mm × 2 mm × 1.5 mm boxes were prepared on buccal and lingual surfaces of extracted molars centered on the cementum-enamel junction. Half the preparations were beveled (0.5 mm). Preparations were restored with composite and polished. Restorations on one side of the teeth were either traced with an ultrasonic scaler (60 seconds, n = 16) or brushed in a sonic toothbrushing machine (2 hours, n = 16). After thermocycling (10,000 cycles/5-55°C), specimens were immersed in 5 wt% Fuchsine solution (24 hours). Samples were sectioned and evaluated for percentage of dye penetration. Data were analyzed with an exact Wilcoxon rank-sum test and exact Wilcoxon signed-rank test (alpha = 0.05). RESULTS: Microleakage was observed at the cementum-composite interface but not the enamel-composite interface. There was not a statistically significant effect of the bevel for ultrasonic scaling or for sonic toothbrushing. Data obtained with and without a bevel were combined and a statistically significant difference in microleakage between the treatment and control sides of the tooth were found for ultrasonic scaling (32.5%±44.9%, n = 16; p = 0.016) but not sonic toothbrushing (2.5% ± 41.2%, n = 16; p = 1.0). CONCLUSIONS: Piezoelectric ultrasonic scaling increased microleakage at cementum-composite interface and there was no difference in microleakage with the use of a bevel. CLINICAL SIGNIFICANCE: Piezoelectric sonic scaling around Class V composite restorations with margins in cementum should be avoided. Beveled margins will not reduce the incidence of microleakge resulting from ultrasonic scaling in Class V restorations. Placing the apical margin of the restoration in enamel should be attempted whenever possible to prevent future microleakage. (J Esthet Restor Dent 29:41-48, 2017).

Vonlays: a conservative esthetic alternative to full-coverage crowns.

Porcelain veneers have long been a popular restorative option that have evolved into a well-accepted treatment that can be fabricated in various ways. Onlays are another common treatment modality used in contemporary dentistry to restore large areas of decay and to replace old restorations. With the availability of newer high-strength materials such as lithium disilicate and processing technologies like CAD/CAM and heat pressing, dental professionals are now able to produce highly esthetic, high-strength restorations that blend seamlessly with the natural dentition while also withstanding posterior occlusal forces. This has resulted in innovative methods of providing minimally invasive dentistry. One such approach is a combination restoration the authors call a "vonlay," which, as demonstrated in this case report, can be used as an alternative to coverage crowns to restore damaged posterior teeth.