Vol.6 No.8 - September 2010
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Continuing Education
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Three-Dimensional Assessment of Dental Occlusion (Occlusal Fencing): A Clinical Technique
Normal occlusion is a product of many structural considerations and physiological processes. To achieve stable occlusion, there must be a confluence of balanced muscle action, proper temporomandibular joint position, and distributed guiding contacts of teeth in the closing stroke. The occlusal fencing concept of 3-dimensional assessment of maxillo-mandibular relationships is presented, which is intended as a clinical technique for the practicing dentist to quickly assess a patient's occlusion. In the occlusal fencing concept, the maxilla acts as a "fence" for the mandibular teeth. If the maxilla is constricted, then the mandibular teeth will crowd to accommodate to the space allowed by the maxillary teeth. The "fence" is composed of 3 sections - anterior/posterior positioning, lateral positioning, and superior/inferior positioning - the purpose of which are described in detail. In addition, symptoms of malocclusion for each section and how these symptoms are produced are provided.
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Managing the Worn Dentition: Part 1
A variety of different clinical challenges can occur because of tooth wear. The purpose of this series of articles is to help clarify what causes teeth to wear, discuss when tooth wear should be treated, present options for how to develop a treatment plan for each patient that addresses both esthetics and occlusion, and highlight methods to minimize the risk of treatment failure in patients with significant tooth wear. Part 1 of this series focuses on when to treat tooth wear, how to present the problem of tooth wear to patients, and what are some of the etiologies of tooth wear. Four erosive etiologies will be discussed-gastric reflux, bulimia, acidic beverages, and citrus fruits-and their dental appearances described.
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Managing Congenitally Missing Lateral Incisors Part 3: Single-Tooth Implants
Three treatment options exist for the replacement of congenitally missing lateral incisors. They include canine substitution, a tooth-supported restoration, and a single-tooth implant. Selecting the appropriate treatment option depends on the malocclusion, anterior relationship, specific space requirements, and condition of the adjacent teeth. The ideal treatment is the most conservative option that satisfies individual esthetic and functional requirements.
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3/31/2010 |
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Managing Congenitally Missing Lateral Incisors Part 2: Tooth-Supported Restorations
Three treatment options exist for the replacement of congenitally missing lateral incisors. They include canine substitution, a tooth-supported restoration, or a single-tooth implant. Selecting the appropriate treatment option depends on the malocclusion, anterior relationship, specific space requirements, and the condition of the adjacent teeth. The ideal treatment is the most conservative alternative that satisfies individual esthetic and functional requirements. This article closely examines the three options when replacing a missing lateral incisor with a tooth-supported restoration. These options are a resin-bonded fixed partial denture, a cantilevered fixed partial denture, or a conventional full-coverage fixed partial denture. The specific criteria that must be evaluated for each option will be addressed to illustrate the importance of interdisciplinary treatment planning to achieve optimal esthetics and long-term predictability. This article is the second of a three-part series discussing the three treatment alternatives for replacing congenitally missing lateral incisors.
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12/1/2009 |
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Managing Congenitally Missing Lateral Incisors Part 1: Canine Substitution
Dentists often encounter patients with missing or malformed teeth. The maxillary lateral incisor is the second most common congenitally absent tooth. There are three treatment options that exist for replacing missing lateral incisors. They include canine substitution, a tooth-supported restoration, or a single-tooth implant. Selecting the appropriate option depends on the malocclusion, specific space requirements, tooth-size relationship, and size and shape of the canine. The ideal treatment is the most conservative alternative that satisfies individual esthetic and functional requirements. Often the ideal option is canine substitution. Although the orthodontist positions the canine in the most esthetic and functional location, the restorative dentist will often need to place a porcelain veneer or crown to re-create normal lateral incisor shape and color. This article closely examines patient selection and illustrates the importance of interdisciplinary treatment planning to achieve optimal esthetics. It is the first of a three-part series discussing the three treatment alternatives for replacing missing lateral incisors.
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Managing Congenitally Missing Mandibular Second Premolars: Clinical Options
Background: Congenital absence of mandibular second premolars affects many orthodontic patients. The orthodontist must make the proper decision at the appropriate time regarding management of the edentulous space. These spaces may be closed or left open.
Implications: If space will be left open for an eventual restoration, the keys during orthodontic treatment are to create the correct amount of space and leave the alveolar ridge in an ideal condition to receive a restoration in the future. If space will be closed, the clinician must avoid altering the occlusion and facial profile in a way that would be detrimental to the patient.
Significance: Some of the decisions that the orthodontist makes early on in the life of a patient who is congenitally missing mandibular second premolars will affect these patients and their dental health for a lifetime. Therefore, the correct decision must be made at the appropriate time.
Purpose: This article will present and discuss a variety of treatment alternatives for managing the orthodontic patient who is congenitally missing one or both mandibular second premolars.
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Restorative Considerations in Deciding Whether to Restore or Remove Endodontically Treated Teeth
The interdisciplinary team is often confronted with the decision of whether to retain or remove questionable teeth that have already been treated endodontically. The purpose of this article is to review the restorative criteria that must be met in order for these teeth to be predictable over the long term. In many instances, the decision of whether to restore or remove a tooth is quite clear. Untreatable periodontal conditions, untreatable endodontic conditions, unmanageable root resorption, or root fractures make the decision to remove a tooth an easy one. For the purpose of this article the author is going to assume that the teeth in question are treatable endodontically as well as periodontally and focus specifically on the issues of restorative predictability.
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Interdisciplinary Management of Anterior Dental Esthetics
Dental esthetics has become a popular topic among all disciplines in dentistry. When a makeover is planned for the esthetic appearance of a patient's teeth, the clinician must have a logical diagnostic approach that results in the appropriate treatment plan. With some patients, the restorative dentist cannot accomplish the correction alone but may require the assistance of other dental disciplines.
Approach. This article describes an interdisciplinary approach to the diagnosis and management of anterior dental esthetics. The authors practice different disciplines in dentistry: restorative care, orthodontics and periodontics. However, for more than 20 years, this team has participated in an interdisciplinary dental study group that focuses on a wide variety of dental problems. One such area has been the analysis of anterior dental esthetic problems requiring interdisciplinary correction. This article will describe a unique approach to interdisciplinary dental diagnosis, beginning with esthetics but encompassing structure, function and biology to achieve an optimal result.
Clinical Implications. If a clinician uses an esthetically based approach to the diagnosis of anterior dental problems, then the outcome of the esthetic treatment plan will be enhanced without sacrificing the structural, functional and biological aspects of the patient's dentition.
Key Words. Interdisciplinary dentistry; anterior dental esthetics; crown length; anterior tooth wear; gingival levels; crown lengthening; orthodontic intrusion; width-to-length ratio; resting lip level; diagnostic wax-up.
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12/31/2008 |
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Approaches to Vertical Dimension
Vertical dimension is a highly debated topic in dentistry. Differences of opinion over how vertical dimension should be established, whether it can be modified, and what the outcome of modification will be can become confusing for those dentists searching for the right treatment for their patients. The fact is that there are multiple different approaches because there are several correct ways to alter vertical dimension. This article will address the most common reasons dentists consider altering vertical dimension, their five top areas of concern, and the methods by which vertical dimension can be established.
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Endodontic Diagnosis: Tools, Science & Intuition
Endodontics is an integral part of daily practice because the intimate relationship between pulp and dentin directly or indirectly affects any restorative procedure. However, diagnosis of pulp and periradicular diseases may be difficult because there is little or no correlation between clinical symptomatology and the histopathologic status of the pulp. Therefore, a systematic approach to data collection is critical for an accurate diagnosis of such conditions. This article reviews classic and current concepts of endodontic diagnosis, describes the current classification of the pulp and periradicular diseases, and presents and discusses the diagnostic tools available today for endodontic diagnosis. Practical topics of endodontic treatment planning are also discussed.
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