The prosthodontic management of medication-related osteonecrosis of the jaw: a case report.

Medication-related osteonecrosis of the jaw (MRONJ) has clear staging and management guidance from the American Association of Oral and Maxillofacial Surgeons. There is, however, less guidance on the prosthodontic rehabilitation for this cohort of patients. This paper aims to bring increased understanding on the staging of MRONJ as well as approaches to its prosthodontic management. This case report outlines a removable prosthodontic method that successfully rehabilitated a patient suffering from MRONJ. This case is well documented with the use of clinical photography. The article demonstrates techniques in overcoming the challenges of necrotic bone in the denture-bearing area, and how such methods can improve both tissue health and patient symptoms.

The ovate pontic for fixed bridgework.

UNLABELLED: The provision of fixed prosthodontic restorations that meets the patient's functional and aesthetic demands can be challenging, especially in the anterior maxilla. It requires close communication with the technician and knowledge of the available options. This article will outline the options for pontic design and focus on the ovate pontic, which has the potential to provide the most aesthetic outcome. This should equip the practitioner with the knowledge as to which pontic to prescribe if such a challenge arises. CLINICAL RELEVANCE: Fixed bridgework is a commonly prescribed prosthesis for the replacement of missing teeth. In order for this to be provided successfully, the practitioner should have a working knowledge of the available options for pontic design.This is especially important in cases where aesthetic demands are high.

The orthodontic-restorative interface: 2. Compensating for variations in tooth number and shape.

UNLABELLED: The aim of this second article in this series of two is to outline a variety of methods which may be used to compensate for variations in tooth shape and number using a combination of orthodontic and restorative approaches. It will also provide an overview of other areas of patient care which necessitate a multi-disciplinary orthodontic/restorative approach. The article will highlight the importance of combined planning from the outset and the close relationship between the different specialties, which must be maintained throughout treatment. The methods of compensating for variations in tooth number and shape will often require contributions from both orthodontist and restorative dentist. It is important that both disciplines are involved in the assessment and treatment planning process so that they know what will be expected of them during the patient's care. Treatment planning in isolation may lead to care being delivered which is below the optimum standard which can be achieved. The orthodontist and restorative dentist are likely to liaise with the patient's general dental practitioner so that he/she can provide the restorative treatment in some cases. CLINICAL RELEVANCE: Great improvements in aesthetics and function may be obtained using an interdisciplinary approach for patients who have variations in tooth number and shape.

The orthodontic-restorative interface: 1. Patient assessment.

UNLABELLED: The first article in this series of two aims to outline the assessment of patients for whom a combined orthodontic-restorative approach would be beneficial. In particular, it will concentrate on the assessment of patients who have hypodontia and tooth size discrepancies. The importance of the aesthetic assessment for these cases will be highlighted. Variations in tooth number and tooth size discrepancy often require a combined treatment planning approach from the orthodontist and restorative dentist. The referring general dental practitioner has a key role in recognizing that this approach may be required and highlighting this in the initial patient referral. It is likely in the more straightforward cases that the GDP will be providing the restorative treatment and so an increased understanding of these cases would be beneficial. In the second paper, treatment options will be presented. CLINICAL RELEVANCE: For patients who require a combined orthodontic/restorative approach, it is important that orthodontic and restorative disciplines liaise closely in the assessment and treatment planning process so that optimal care may be planned.

Techniques for restoring worn anterior teeth with direct composite resin.

UNLABELLED: Toothwear is increasing in prevalence. Traditional treatment methods for moderate or advanced toothwear, such as indirect restorations and crown lengthening surgery, are invasive and destructive of remaining tissues. The 'Dahl technique' has been used to obtain space for anterior restorations and has been modified such that direct composite restorations are placed at increased occlusal vertical dimension. These restorations have proved durable and aesthetic, protect tooth structure and posterior occlusal contact is predictably re-established. The authors describe and compare two techniques using composite resin to treat localized anterior toothwear in a general practice setting. CLINICAL RELEVANCE: Toothwear is a significant clinical problem and general dental practitioners and specialists alike must be familiar with the available conservative treatment options.

Conservative aesthetic techniques for discoloured teeth: 1. The use of bleaching.

UNLABELLED: There is an increasing move towards more minimally invasive techniques in restorative dentistry. This series of two articles discusses conservative techniques for the treatment of discoloured teeth. A step-wise approach to treatment is promoted to encourage the most conservative solution to achieve satisfactory aesthetics. The first of these two articles will describe the use of bleaching, whilst part two will go on to describe microabrasion and the use of direct composite resin. CLINICAL RELEVANCE: Discoloured teeth are a common dental problem. Bleaching provides a simple conservative solution in many cases.