Patients' expectations for oral health care in the 21st century.

BACKGROUND: This article examines trends in patient demographics and dental disease patterns. Data suggest the patient expectations about oral health are increasing, as is their knowledge of oral health services. CLINICAL IMPLICATIONS: Changing patient demographics and technological advances will lead to higher patient expectations and greater demands for oral health care in the 21st century than they had been during most of the 20th century.

The periodontal-restorative interface: enhancement through magnification.

One critical factor associated with aesthetics, periodontal health, and the longevity of restorations is the precision of the margins at the periodontal-restorative interface. Improper margins can cause overhangs and overcontouring that may ultimately result in caries, periodontal inflammation and breakdown, and compromised aesthetics. In order to prevent pathology at the restorative-tooth interface, each phase of the aesthetic treatment must be performed with precision and care. This article presents the utilization of an operating microscope to improve the marginal adaptation of all-porcelain restorations.

The Children's Dental Center--a community resource to meet a community need.

Growing numbers of children of working poor families in California have limited access to dental care. This article presents a unique solution to this problem: the Children's Dental Center. The center, a nonprofit corporation, emphasizes quality multidisciplinary care, aggressive preventive dental practices, and education programs for parent and child. Through behavioral change, coupled with dental care of urgent problems, the family's immediate needs are addressed while creating a future of diminished dental need and greater self-esteem.

Issues in the treatment of root caries in older adults.

Increased life expectancy, improvements in tooth retention, and higher expectations about oral health will continue to result in an increased demand for esthetic restorative dental care. Using demographics as a predictor of future dental treatment needs, root caries may be one of the most significant patient management issues of the next decade. Root caries also can present the clinician with challenging restorative problems. The best treatment option is determined by the lesion, the caries rate, the condition of the patient, and the esthetic requirement or desire. Material selection is critical for successful restoration of root caries. The treatment of root caries also should include methods for the prevention of future lesions. Although caries risk assessment is not a perfected science, models can assist in estimating caries risk and then guide the clinician toward the most suitable preventive approach.

Tooth intrusion in implant-assisted prostheses.

STATEMENT OF PROBLEM: Numerous reports and surveys have been published on natural tooth abutment intrusion with implant-connected fixed partial dentures. The consensus of these publications was that the cause of intrusion was multifactorial, with causative factors such as disuse atrophy, debris impaction, impaired rebound memory, and mechanical binding. It was also believed that the process was irreversible. PURPOSE: In this article, the limitations with these theories are discussed, and two patient reports of tooth intrusion reversal are reviewed. A review of the current literature is discussed, as well as the current theory of tooth movement in response to dynamic mechanical stimulus, a brief discussion of current experimental procedures and results, and the current recommendations for reversal of intrusion.

Postorthodontic restoration of enamel surface characteristics.

Following orthodontic treatment, the mechanical debonding of brackets often results in damage to the enamel surface of teeth. Loss of natural luster, a roughened surface, and scarring may occur. When scarring occurs, a method for re-establishing the enamel luster and surface characteristics can be instituted by either the restorative dentist or the orthodontist. One method of restoring enamel luster and natural surface characteristics following removal of orthodontic fixtures is through a sequence of enamel polishing. This article discusses logical steps for the restoration of enamel through the utilization of polishing burs and progressive pastes (Proxyt), Ivoclar Vivadent, Amherst, NY) for the final aesthetic orthodontic result.

Natural tooth intrusion and reversal in implant-assisted prosthesis: evidence of and a hypothesis for the occurrence.

Based on clinical observation, a hypothesis of the mechanism of intrusion of natural teeth in an implant-assisted prosthesis is suggested. Engineering principles are presented that establish an energy absorption model as it relates to the implant-assisted prosthesis. In addition, in the course of patient treatment it has been discovered that the intrusion of natural teeth can be reversed. Patient histories that demonstrate intrusion reversal are reviewed. The possible mechanisms for the intrusion/reversal phenomenon are presented and preventative recommendations are given.

Psychodynamic factors contributing to esthetic dental failures.

Traditionally, dentistry has focused on biomedical and mechanotechnical approaches to patients' dental health care. Objective and quantifiable measurements, such as tooth form, occlusal function, color, and biological compatibility, are conventional indicators of success or failure. However, unlike most facets of dental practice, the attainment of an enhanced facial and dental appearance is influenced and measured by more abstract, psychological factors such as perception, ideal body image, self-image, and personal motivation. These complex concepts are affected by emotional and personality factors that develop during the life cycle. This article will explore a psychodynamic perspective of patients who are dissatisfied with the esthetics of their dental treatment, although the result may be functionally and esthetically acceptable.

A multidie technique for the fabrication of porcelain laminate veneers.

Porcelain veneers are a challenge for the dentist and dental technician when they are an integral part of complex restorative treatment plans. A multidie technique is described that allows construction of laminate veneers on removable refractory dies in a stone master cast. This system provides flexibility and accuracy with less chair time when used in combination with epoxy resin dies. Multiple restorative techniques can be used simultaneously with one master cast, and emphasis is directed to harmonious working relationships between the dentist, dental technician, and patient.