Quo vadis, esthetic dentistry? Part II: Composite resin overtreatment and social media appeal.

OBJECTIVES: This article presents case reports highlighting over-treatments with resin composites, often misconceived as minimally invasive procedures. CLINICAL CONSIDERATIONS: Tooth-colored restorative materials, such as ceramics and composites, have found widespread application to correct problems related to tooth color, shape, and alignment. When composite resin is used, these procedures can be done in a very conservative, cost-effective, and timely fashion. However, it is noteworthy that contemporary dental esthetic expectations are based on standards propagated by social media and other marketing and communications platforms. The abuse of and addiction to social media impacts can lead to unrealistic esthetic expectations and standards for both patients and dentists. CONCLUSIONS: After a critical discussion on ceramic veneers published in part I of this 2-part series, this article directs attention towards what has become a trendy fashion, i.e., the use of direct composite resins as "non-prep" veneers in clinical situations that arguably required no restorative intervention at all. We further explore how social media influences the decision-making processes of both professionals and patients.

Quo vadis, esthetic dentistry? Ceramic veneers and overtreatment-A cautionary tale.

The increased emphasis on orofacial esthetics, experienced both by dental professionals and the lay public, results in an environment where overtreatment can easily occur. Patients on the one hand feel pressure from esthetic norms that are often unrealistic, while dental professionals are compelled to deliver immediate results many times without considering what is best for the ill-informed patient. This article is an illustrated cautionary tale against overtreatment disguised as esthetic dentistry. Representative clinical examples illustrate how porcelain veneers are used without following sound operatory principles, as well as how these cases have been resolved.

Surface treatments on CAD/CAM glass-ceramics: Influence on roughness, topography, and bond strength.

OBJECTIVE: To evaluate the influence of surface treatment on roughness (SA), topography, and shear bond strength (SBS) of computer-aided designer and manufacture (CAD/CAM) zirconia-reinforced lithium silicate (ZLS) and feldspathic (FEL) glass-ceramics. MATERIALS AND METHODS: FEL and ZLS specimens were submitted to 5% or 10% hydrofluoric acid (HF) or self-etching ceramic primer (MEP) and different application times (20, 40, and 60 s), or to sandblasting (Control, 20 s). Resin cement cylinders were bonded to the specimens and tested in shear (n = 10) after 24 h and 16-months of water storage. SA and topography were evaluated by atomic force (AFM, n = 10) and scanning electron microscopy. Data were analyzed by ANOVA and Bonferroni test (α = 0.05). RESULTS: Sandblasting promoted the highest SA for ZLS, but 10% HF (40, 60 s) promoted higher SBS at 16 months. 10% HF produced the highest SA for FEL, but sandblasting and 5% HF (20 s) maintained SBS after 16 months, without differences from 10% HF (20 s) (p > 0.05). Overall, MEP produced lower SA and SBS among groups (p < 0.05). HF displayed greater morphological changes on FEL. CONCLUSION: 10% HF (40 s) provided better results for ZLS, while 5% or 10% HF (20 s) was suitable for FEL. CLINICAL SIGNIFICANCE: Surface treatments influenced SA, topography, and SBS of materials. HF etching is the surface treatment of choice for both CAD/CAM glass-ceramics.

Seeing is believing? When scanning electron microscopy (SEM) meets clinical dentistry: The replica technique.

In restorative dentistry, the in situ replication of intra-oral situations, is based on a non-invasive and non-destructive scanning electron microscopy (SEM) evaluation method. The technique is suitable for investigation restorative materials and dental hard- and soft-tissues, and its interfaces. Surface characteristics, integrity of interfaces (margins), or fracture analysis (chipping, cracks, etc.) with reliable resolution and under high magnification (from ×50 to ×5,000). Overall the current study aims to share detailed and reproducible information about the replica technique. Specific goals are: (a) to describe detailed each step involved in producing a replica of an intra-oral situation, (b) to validate an integrated workflow based on a rational sequence from visual examination, to macrophotography and SEM analysis using the replica technique; (c) to present three clinical cases documented using the technique. A compilation of three clinical situations/cases were analyzed here by means the replica technique showing a wide range of possibilities that can be reached and explored with the described technique. This guidance document will contribute to a more accurate use of the replica technique and help researchers and clinicians to understand and identify issues related to restorative procedures under high magnification.

Periodontal considerations for adhesive ceramic dental restorations: key points to avoid gingival problems.

The stability and health of the periodontal tissues should be a common goal for all dental care providers with regard to natural or restored teeth as well as implant-supported restorations or any other type of prosthesis. The objective of this study was to address the key aspects to be respected when executing adhesive oral rehabilitations involving ceramic restorations, regardless of their thickness, and to reinforce the importance of each step to ensure the success and longevity of the treatment from a periodontal standpoint. This article reviews the fundamentals of the periodontics that relate directly or indirectly to adhesive ceramic dental restorations, and also addresses their clinical relevance.

Bulk Fill Composites: An Anatomic Sculpting Technique.

UNLABELLED: Composite resins have been routinely used for posterior cavities due to a phasedown on amalgam as a restorative option. However, clinical problems related to polymerization shrinkage demands careful and specific techniques for placement of the composite layers. New low shrinkage composites are now marketed for bulk filling of cavities without the need of a traditional layering. With this new concept, the restoration can be built in one or two layers, depending on the classification of the bulk fill material. This article discusses and presents two alternative techniques using the low shrinkage composites, suggesting a called "amalgam-like sculpting technique," one using a flowable bulk fill and other a regular bulk fill material. Clinical cases illustrate these two alternatives compared with the layered technique. CLINICAL SIGNIFICANCE: New techniques using low shrinkage composites for bulk filling can provide a simpler technical approach for the clinician in sculpting and generating highly esthetic posterior composites.

Esthetic and functional rehabilitation of crowded mandibular anterior teeth using ceramic veneers: a case report.

The use of ceramic veneers to restore crowded teeth in the maxilla has been widely discussed in the literature. However, the use of this technique in the mandible has received little attention. Therefore, this case report describes the treatment of crowded mandibular anterior teeth using ceramic veneers. The primary treatment challenge in this region is the reduced tooth structure available for rehabilitation. Proper communication between the clinician and dental technician is required to achieve clinical success. This article presents a straightforward treatment plan and restorative technique that includes both the clinical and laboratory sequences necessary for predictable and stable postoperative outcomes.

Ultimate ceramic veneer: a laboratory-guided preparation technique for minimally invasive laminate veneers.

Clinical success of ceramic laminate veneers depends on material selection, bonding procedures, controlled laboratory steps, and enamel preservation. Enamel preservation is the most critical because excessive tooth preparation can expose dentin reducing bond strength, which is a factor that can cause a decrease in long-term clinical success. The proposed technique based on carefully treatment planning developed between clinician and dental technician helps to maximize enamel preservation, which is an important element for clinical success.

All-ceramic inlay-retained fixed partial bridge using a CAD-CAM produced Y-TZP framework and fluoroapatite veneering ceramic: a clinical report.

All-ceramic materials have become an excellent option for both anterior and posterior fixed partial dentures (FPDs) due to advances in esthetic and mechanical properties. This clinical report describes the use of an all-ceramic inlay-retained three-unit FPD for replacement of a maxillary second premolar. Prosthetic restorative materials consisted of a CAD-CAM processed presintered yttrium stabilized zirconium oxide (Y-TZP) framework and a fluoroapatite veneering ceramic. The minimally invasive preparation technique and advantages of this highly esthetic and resistant treatment option are discussed.