Demolition experts: management of the parafunctional patient: 2. Restorative management strategies.

UNLABELLED: The second part of this paper discusses strategies for providing restorative dental care for the parafunctional patient. These include direct composite resin restorations, cast metal resin-retained restorations and dentine-bonded crowns, design features for porcelain fused to metal crowns and denture design. Specific features can help enhance predictability in the hostile environment of increased occlusal loading and parafunction. CLINICAL RELEVANCE: Appropriate planning, design and execution of restorative procedures can reduce the chance of failure. Patients may have to accept a compromise between appearance and restoration survival/maintenance.

Demolition experts: management of the parafunctional patient: 1. Diagnosis and prevention.

UNLABELLED: The first part of this paper discusses the clinical problems associated with providing predictable restorative dental care for parafunctional patients. The identification of patients with this problem is important, as is patient understanding and the optimization of preventive approaches, all of which are considered. In the second part, restorative strategies will be presented. CLINICAL RELEVANCE: Parafunctional patients need to understand the difficulties associated with managing their problem. The preservation of tooth tissue is of paramount importance to ensure long-term success.

Self-inflicted dental injury presenting as localized anterior tooth surface loss.

UNLABELLED: A case of localized anterior tooth surface loss (TSL) with an unusual aetiology is reported. Whilst suffering from a bout of acute depression and anxiety, a 29-year-old female caused significant trauma to her anterior dentition with a pair of fabric scissors. The presentation and management of this case is described. CLINICAL RELEVANCE: Although tooth surface loss is a common clinical finding in many patient groups, practitioners should be aware of possible unusual aetiologies which may be involved.

Medicinal erosion: a case report.

Patients, healthcare professionals, and health product manufacturers focus on the benefits that the use of a medicine or health product will bring rather than the potential side effects. A case of erosive tooth surface loss caused by the repeated and prolonged use of an acidic mouthrinse is reported. The adverse effects of health care products on the dentition and methods to minimise potential damage are discussed.

The Dycal try-in technique for Resin-bonded bridges.

The resin-bonded bridge (RBB) is a predictable technique that has a useful place in modern day dentistry. Practitioners' main concerns, regarding this technique, are a lower survival rate when compared with conventional prostheses, and unpredictable aesthetics. Unfortunately, the minimal preparation and adhesive concepts used with RBBs complicates provisional cementation. Ideally, the RBB should be assessed as if it were the definitively bonded prosthesis. It is possible to achieve a good final aesthetic result as the grey shine-through of the metal wing can be eliminated by the use of opaque resin cements such as Panavia 21 OP. Ideally, the restoration should be assessed with an identical opaque try-in paste but, unfortunately, such a proprietary paste is not available. This paper describes the use of Dycal as a try-in paste for provisionally cementing a resin-bonded bridge and the benefits this offers.

A modern day application of the Rochette bridge.

A restoration that is frequently prescribed to provisionally restore the single unit edentulous space is the removable acrylic partial prosthesis. The Rochette bridge design provides an effective alternative when confronted with this clinical situation. The adaptable nature of this technique means that it can be utilised in a variety of clinical situations with success. The greatest benefits are seen in clinical situations where simple and aesthetic alteration of the pontic dimensions during treatment is necessary. It can also be used in long-term provisional situations where, if a removable acrylic partial prosthesis was used, multiple adjustments or remakes would be necessary. This paper presents three case reports where this technique has been utilised with distinctive advantages over a provisional removable partial acrylic prosthesis.

Managing discoloured non-vital teeth: the inside/outside bleaching technique.

The discoloured, non-vital anterior tooth is a common aesthetic concern for many patients. It can have a profound effect on their self-esteem, interaction with others and employability. Discoloured non-vital teeth are frequently compromised owing to previous trauma, caries, endodontic therapy and failed restorations. Destructive invasive treatment options are likely to weaken the residual structure of the tooth. This can reduce the prognosis and challenge the long-term viability of the tooth, thereby initiating further prosthetic predicaments. This paper discusses modern approaches to the treatment of discoloured teeth. The importance of preventing and eliminating the potential for discoloration will be highlighted. The paper will include a detailed technical account on the application of the inside/outside bleaching technique, with several clinical examples.

The clinical application of posterior resin-bonded cast metal restorations.

There has been much interest in the development of adhesive dentistry over recent years. Greater understanding of materials and bonding methods have improved the clinical predictability of restorations. Resin-bonded cast metal restorations can now provide a genuine alternative to conventional fixed restorations for both premolar and molar teeth. This paper illustrates the clinical application of such restorations.