[Root resection: tooth preservation by targeting the root of the problem]. / Wortelresectie: tandbehoud door problemen bij de wortel aan te pakken.

When problems occur in multirooted teeth, such as persistent endodontic problems following endodontic treatment, problems involving fracture or furcation, extraction may be decided on. However, removal of the tooth will result in loss of occlusal units and the alveolar process. By removing the compromised root and preserving the healthy part, the tooth can remain functional, but only after restorative treatment. A correct indication or diagnosis, a properly performed endodontic, restorative and surgical treatment and proper follow-up are mandatory for a successful treatment outcome.

[Effectivity and durability of telescopic dentures on abutment teeth]. / Doelmatigheid en duurzaamheid van telescoopprothesen op pijlerelementen.

In a study, the effectivity and durability of telescopic dentures on abutment teeth provided with telescope crowns were investigated. The prognosis for the prosthetic structure and for the abutment teeth were both investigated. The survival rate of 234 telescopic dentures (886 abutment teeth) in 147 patients in a general dental practice were retrospectively evaluated on the basis of a status study. The mean survival rate was calculated. This is the moment when 50% of the telescopic dentures had failed. For telescopic dentures in the maxilla, this was 22.3±2.8 years, which did not represent a statistically significant difference from the mandible (20.9±1.9 years). Of the 886 abutment teeth that were used, 127 (14.3%) were extracted after an average period of 11.7 years. Periodontal complications were the primary reason for extraction. Based on this investigation, one could conclude that telescopic dentures are also a durable and sustainable solution in the long term. Loss of abutment teeth is relatively rare and has limited influence on the survival of the prosthetic structure.

[Considerations in the treatment of tooth wear]. / Overwegingen bij de behandeling van gebitsslijtage.

Since the origin of tooth wear (attrition, abrasion and erosion) is multi-factorial, its diagnosis is complicated but vital. The so-called Tooth Wear Evaluation System, introduced earlier, makes a systematic diagnostic approach possible. The system consists of various modules, which can be used by the practitioner depending on the goal. Two new modules have been added to the Tooth Wear Evaluation System. The Therapy Start Module can be used to determine which one of the possible treatment modalities (counseling, monitoring, or restorative treatment) should be chosen. The Level of Difficulty Module gives the practitioner indications of the level of difficulty that may be encountered during a restorative treatment.

[Full crown preparation of a vital tooth is outdated]. / De volledige omslijping van een (vitaal) frontelement is niet meer van deze tijd.

The restorative solutions for esthetic problems are becoming minimal invasive. Adhesive technology and materials as composite luting cements are biocompatible and therefor less harmfull for vital pulps. Necrosis of vital pulps hardly occurs and the survival of porcelain veneers is very good. The esthetic result is also quite impressive, although marginal discoloration is frequently reported. Full crown preparations can be avoided, but replacement of failing crowns is not banned out in dental practice. Full ceramic crowns however can also be luted with adhesive cements and the amount of hard tissue that has to be removed for optimal esthetic results is much less than for porcelain fused to metal crowns. Saving hard and soft tooth tissues is promoted and advocated as a quality standard. Longevity of treatment outcome has been reported and should be an evidence-based decision in the future.

[Restoration of occlusal structure by direct tooth coating materials]. / Occlusieopbouw met directe tandkleurige materialen.

For the restoration of occlusal anatomy partial gold restorations are preferred. Adhesive techniques in combination with plastic materials can also be used and are less invasive than indirect restorations. Occlusal tooth wear is becoming a major problem all over the world. This paper describes minimal invasive techniques to restore tooth wear.

[Preparation with air abrasion]. / Prepareren met 'air abrasion'.

Air abrasive technology has re-emerged in dentistry. The history, characteristics and clinical application of this approach are reviewed, including advantages and limitations for the removal of enamel, dentin and decay. Air-abrasive technology may be especially suited for use in bonded restorations as well as for repair of all types of restorations. The factors affecting adequate bond strength are discussed.

[Composite inlays]. / Composietinlays.

Composite restorations shrink most during curing. In large cavities more shrinkage may be expected. The composite inlay is especially developed to overcome these disadvantages. After curing of the composite inlay causes secondary polymerization increasing several material properties such as wear resistance and stress relaxation. Clinical results are reviewed and the benefits of the composite inlay technique discussed.

[Ceramic inlays and onlays]. / Keramische inlays en onlays.

Large direct composite restorations can induce shrinkage related postoperative sensitivity. Indirect resin-bonded (tooth colored) restorations may perhaps prevent these complaints. Indirect bonded ceramics are especially attractive because of their biocompatibility and esthetic performance. Several procedures and techniques are currently available for the fabrication of ceramic restorations: firing, casting, heat-pressing and milling. In this article the different systems are described. Advantages, disadvantages and clinical performance of ceramic inlays are compared and discussed.

[Composite (etched) bridge]. / Composiet-(ets)bruggen.

An adhesive or resin-bonded bridge is a tooth saving construction for the replacement of a lost tooth, especially when the abutment teeth are relatively sound. In this article an overview is presented of the different types of resin-bonded bridges, their advantages and disadvantages and their indications. The direct methods are very suited for the immediate replacement of a lost anterior tooth. The all composite adhesive bridge has a survival rate that is surprisingly good.

[Occlusion-building with tooth-colored restoration materials]. / Occlusie-opbouw met tandkleurige restauratiematerialen.

Severe localized or generalized tooth wear will result in loss of vertical dimension. Rehabilitation of the dimensional height is often required. A causal approach is the choice of preference to prevent progression of destructive processes. However, the etiology of pathological wear is not yet clarified, so reversible and non-destructive tooth saving restorative procedures are essential. For adjustment and stabilization of the occlusion of CMD problems the philosophy and treatment approach are similar. Tooth coloured adhesive restorations can be fabricated in different manners, directly and indirectly. In this article treatment objectives for occlusal rehabilitation are described and two cases presented where tooth coloured restorations are used.

[The transmandibular implant. From bone loss to bone growth--an investigation of 116 patients]. / Het transmandibulaire implantaat. Van botverlies tot botgroei--een onderzoek bij 116 patiënten.

In a prospective study 116 consecutive patients were treated according to a revised protocol to induce and control bone growth. Revisions included: 1. lengthening of the transosseous posts and cortical screws between the mental foramina so that two threads extended beyond the alveolar crest of the mandible without protruding through the mucosa; and 2. fabricating an implant borne prosthesis with a gap of 2 mm between the denture base and the mucosal tissues in the saddle areas and loading only the retromolar pads. The gap was re-opened every 8 weeks until further bone growth would prevent proper oral hygiene. Measurements of the height of the mandible were made using a digital millimeter caliper and standardized radiographs. The radiographic enlargement was calculated per radiograph for the sites to be measured. The follow-up varied from 15 up to 39 months. Bone growth had occurred in 104 of the 116 patients, while the resorption of bone had ceased in the remaining patients. The increase of bone height varied from 9 mm in patients with severe mandibular atrophy down to 2 mm for patients with mild atrophy. The revised protocol for TMI insertion and rehabilitation is advocated to promote bone growth and to cease further resorption in the atrophic mandible.

[Bleaching of teeth: a review]. / Het bleken van frontelementen.

Bleaching of vital and non-vital teeth is becoming a routine procedure in esthetic dentistry. In a relative safe way many types of discoloration can be treated. Four treatment systems are available at present. For an appropriate choice it is essential to know the cause of the discoloration. Long term results are still scarce. Most treatment systems show slight to moderate side-effects, varying from demineralisation of enamel to soft tissue problems.

[Cosmetic dentistry and adhesive prosthodontics]. / Kosmetische tandheelkunde en adhesieve prothetiek.

A better chemical bonding to metals offers the opportunity to bind composites onto metal and metals onto tooth structures. This may lead to an increase of adhesive prosthetic and cosmetic treatments. In this article some applications of this modern treatment method are described, anterior and posterior, in solitary elements as well as multiple bridge constructions.

[Bleaching of vital teeth]. / Het bleken van vitale gebitselementen.

In this paper the development of techniques to remove intrinsic vital stains are summarized. The mechanism of chemical agents is described as well as the nature of the stain and its treatment. Finally a rationale for selecting patients for treatment and its prognosis is presented and discussed.