Determining color for the direct restorative approach.

When implementing a direct composite resin (CR) restoration, the determination of color can be a challenging step. The reproduction of tooth shade is often a source of frustration for the practitioner. Dental color can be complex, and its accurate reproduction requires not only a good understanding of color by the practitioner but also the use of appropriate methods to achieve it. It is important to remember what tooth color parameters one is able to mimic with CRs. The purpose of this article is to demystify the errors attributable to standard tools, ie, shade guides, and above all to suggest a number of measures to avoid such errors.

Effective Protocol for Daily High-quality Direct Posterior Composite Restorations: Layering and Finishing.

Currently, there is a trend towards simplification of materials and clinical procedures. Simplification and quality can go together if the dentist works with materials and techniques that are well proven in vitro and in vivo. The placement of a high-quality class-1/2 direct posterior composite restoration can be time efficient following a standardized layering protocol and using composite materials that adapt well to the tooth surface and are able to mimic the natural tooth. When these materials are applied in a controlled way, finishing and polishing can also be shortened. In this article, an effective layering and finishing/polishing protocol for medium-sized class-1/2 direct posterior composite restorations is presented. Following the histo-anatomic buildup of natural teeth, dentin must be concave, as opposed to convex enamel. An isochromatic, medium-opaque, highly filled flowable composite is used to replace dentin. Enamel is replaced with a medium-translucent small-particle hybrid composite. Enamel is modelled in an anatomical way, following a successive cusp-by-cusp buildup approach. Clinical experience shows that the combination of both materials used according to this so-called bi-laminar histo-anatomical layering approach results in restorations that blend in very well within the surrounding tooth structure. Following a simplified finishing and polishing protocol, the composite restorations will have a correct contour, seamless margins, and a smooth, glossy surface.

[Fototipps: Licht in der dentalen Fotografie].

Nicht nur in der dentalen Fotografie ist die effektive Beleuchtung ein Schlüsselfaktor für ein gutes Bild. Verschiedene Lichtquellen gelangen hierzu zum Einsatz. Es ist wichtig, die Farbeigenschaften der Lichtquellen zu kennen und die Kamera ent- sprechend einzustellen. So lassen sich unerwünschte Farbveränderungen vermeiden. Die Beleuchtung ist ein Schlüsselfaktor für ein erfolgreiches Bild. Sie bestimmt nicht nur die Helligkeit und Dunkelheit, sondern auch Ton, Stimmung und Atmosphäre. Die Manipulation des Lichts, auch durch den Einsatz spezieller Filter, kann als diagnostisches Hilfsmittel bei der Behandlung eingesetzt werden.

eLABor_aid: a new approach to digital shade management.

Contemporary dental patients present with high expectations and demand seamless optical integration of restorative interventions. As a result, clinicians and technicians are required to develop methodologies that remain practical yet increase the accuracy and objectivity of shade analysis and estimation. There have been significant advances in digital technologies over the past 20 years, with digital photography being at the forefront. Digital photography has made an immediate and profound impact on applied clinical dentistry, primarily due to instantaneous image visualization and distribution. However, standardization protocols in terms of image acquisition and objective analysis remain equivocal. By utilizing reflective cross-polarized light digital photography with a standardized white balance gray reference card serving as the known reference, in conjunction with a specific digital single-lens reflex (DSLR) camera profile and digital photographic processing software working in the CIE L*a*b* (1976) color space, one can achieve standardized image acquisition and subsequent objective image analysis. The goal of this systematic approach is to identify the most efficient and effective means to generate consistent and optimum visual integration and restorative outcomes through numerical quantification, in order to enable clinicians and technicians to work predictably even when they are in different geographic locations.

Lip Lifting: Unveiling Dental Beauty.

The focus for the achievement of complete success in the esthetic zone has traditionally been on addressing deficiencies of intraoral hard and soft tissue. Often, these deficiencies are accompanied by esthetic concerns regarding the lips that are routinely neglected by the dental team. A predictable plastic surgery technique - the lip lift - has been used for decades to enhance lip esthetics by shortening the senile upper lip to achieve a more youthful appearance. Over the years, this technique has been refined and used in many different ways, allowing its routine incorporation into full facial esthetic planning. Through restoration of the upper lip to its optimal position, the artistry of the dentist and dental technician can truly be appreciated in the rejuvenated smile. By the introduction of this minimally invasive surgical technique to the dental community, patients stand to benefit from a comprehensive orofacial approach to anterior dental esthetic planning.

Ceramic adhesive restorations and biomimetic dentistry: tissue preservation and adhesion.

Thanks to sophisticated adhesive techniques in contemporary dentistry, and the development of composite and ceramic materials, it is possible to reproduce a biomimetic match between substitution materials and natural teeth substrates. Biomimetics or bio-emulation allows for the association of two fundamental parameters at the heart of current therapeutic treatments: tissue preservation and adhesion. This contemporary concept makes the retention of the integrity of the maximum amount of dental tissue possible, while offering exceptional clinical longevity, and maximum esthetic results. It permits the conservation of the biological, esthetic, biomechanical and functional properties of enamel and dentin. Today, it is clearly possible to develop preparations allowing for the conservation of the enamel and dentin in order to bond partial restorations in the anterior and posterior sectors therefore limiting, as Professor Urs Belser from Geneva indicates, "the replacement of previous deficient crowns and devitalized teeth whose conservation are justified but whose residual structural state are insufficient for reliable bonding."1 This article not only addresses ceramic adhesive restoration in the anterior area, the ambassadors of biomimetic dentistry, but also highlights the possibility of occasionally integrating one or two restorations at the heart of the smile as a complement to extensive rehabilitations that require more invasive treatment.

Bio-Emulation: biomimetically emulating nature utilizing a histoanatomic approach; visual synthesis.

A thorough understanding of the spatial distribution pertaining to the histo-anatomic coronal structures and dynamic light interaction of the natural dentition provides the dental team with the ultimate strategic advantage with regards to optical integration of the final restoration. The second part of this two-part article will attempt to provide insight on the illumination interactivity and the spatial arrangement of the coronal elements of natural teeth through the utilization of this knowledge in the clinical and technical restorative approach. The main goals for this article are to cognize histo-anatomic visualization by introducing: (1) Dynamic light interaction, (2) the 9 elements of visual synthesis, (3) dynamic infinite optical thickness, and (4) amplified visual perception effect of the hard dental tissues. Furthermore, a diversification of photographic illumination techniques will be illustrated in order to juxtapose optical associations between the enamel/dentinoenamel complex/dentin nexus.

Bio-emulation: biomimetically emulating nature utilizing a histo-anatomic approach; structural analysis.

A thorough understanding of the histoanatomic structures and dynamic light interaction of the natural dentition provides dental practitioners with the ultimate strategic advantage with regard to optical integration of the final restoration. The first part of this article will attempt to provide insight on the threedimensional coronal configuration of natural teeth and on the utilization of this knowledge in the clinical and technical restorative approach. The main goals for this article are to identify and reveal previously unreported histo-anatomic interrelationships and to explain existing ones: the sigmoid curve distribution (convex enamel/concave dentin), the distinction between dentinoenamel "junction" (DEJ, visual interface) and dentinoenamel "complex" (DEC, functional interphase), and the structural significance of DEC preservation.

The parallel stratification masking technique: an analytical approach to predictably mask discolored dental substrate.

Discolored dental substrates continue to challenge the restorative team when ultraconservative treatment modalities are chosen. An innovative laboratory concept--the parallel stratification masking technique--has been developed in order to achieve maximum preservation of dental hard tissues and predictably accomplish a desirable esthetic outcome. The major advantages of this technique are that the ceramist is able to: a)identify and map the discolored dental substrate, b)predictably mask the discolored dental substrate, and c) assess the appropriate masking efficacy of the fabricated restoration prior to laboratory delivery to the dentist in cases of bonded porcelain restorations.

Direct dentin bonding technique sensitivity when using air/suction drying steps.

STATEMENT OF PROBLEM: Moisture control before and after application of the primer/adhesive components of etch-and-rinse dentin bonding agents is usually achieved using a stream of air delivered by an air syringe. Suction drying with a suction tip is a common alternative for moisture control, but data about the use of suction drying instead of the air syringe is scarce or nonexistent. PURPOSE: The purpose of this study was to compare the dentin microtensile bond strength (MTBS) using either the air syringe or the suction tip to control the amount of moisture. MATERIALS AND METHODS: Fifteen freshly extracted human molars were divided randomly into three groups of five. A three-step etch-and-rinse dentin bonding agent (OptiBond FL) was used. Group 1 was the control group and utilized air drying alone (with an air syringe) during the placement of the dentin adhesive on the ground-flat occlusal dentin surface. Group 2 also used air drying alone, but teeth were prepared with a standardized MOD cavity. Group 3 utilized suction drying alone in the standardized MOD cavity. All teeth were restored with 1.5-mm-thick horizontal increments of composite resin (Filtek Z100). Specimens were stored in water for 24 hours, then prepared for a nontrimming MTBS test. Bond strength data were analyzed with a Kruskal-Wallis test at p < 0.05. Specimens were also evaluated for mode of fracture and interface characterization using scanning electron microscope (SEM) analysis. RESULTS: The mean MTBSs were not statistically different from one another (p = 0.54) at 54.0 MPa (air-drying, flat dentin), 53.4 MPa (air-drying, MOD), and 49.2 MPa (suction drying, MOD). Microscopic evaluation of failure modes indicated that most failures were interfacial. Failed interfaces, when analyzed under SEM, appeared typically mixed with areas of failed adhesive resin and areas of cohesively failed dentin. CONCLUSIONS: There are no differences in MTBS to human dentin using either the air syringe or the suction tip to control the amount of moisture. The conventional three-step dentin bonding agent used in the present study not only proved insensitive to the moisture-control method but also to the effect of increased polymerization shrinkage stress (ground-flat versus MOD preparation). CLINICAL SIGNIFICANCE: Although the effect of common errors on the performance of total-etch adhesives has been investigated, data about the use of suction drying instead of an air syringe is scarce or nonexistent. The present study demonstrated that both the air syringe and the suction tip can be used to control moisture when using etch-and-rinse dentin bonding agents. The conventional three-step dentin bonding agent tested, OptiBond FL, demonstrated low technique sensitivity.