A beautiful smile is one of the main factors in human attractiveness. Unfortunately, however, defects such as gummy smile can add considerable dissonance to the esthetics of the face.
Minimally invasive techniques of esthetic dentistry and esthetic medicine (such as botulinum therapy and contouring plastic surgery) can perfectly correct this esthetic problem. Understanding the polyetiology the of gummy smile is important in understanding the root cause of the defect which can significantly affect the correction strategy and its implementation.
The achievement of esthetics must satisfy patient expectations. Unsatisfying results are not only due to technical or clinical problems often are caused by poor patient communication. An esthetic preview is the only system that can check the function and importantly, the final esthetic outcome before treatment begins. Using this technique tooth preparations will be minimally invasive and less destructive than traditional preparations. Digital and classical techniques will be compared aimed at developing guidelines for a correct clinical procedure.
As restorative dentists our main goal is to provide long lasting restorations to our patients. In a pursuit of long term success we will discuss the sequences used to accomplish the ideal preparation of our dental substrate for a highest bonding performance. We will talk about the importance of the decontamination of the oral cavity, the need of rubber dam isolation and the different preparations of the substrate prior to bonding. For these 3 main topics we will focus on understanding the how and Why and the How of:
In the past 20 years we’ve witnessed an evolution of adhesive systems and restorative materials that have allowed us to use minimally invasive techniques on teeth that have been compromised by caries while attaining a high level of clinical reliability. Whether using direct or indirect approach the proposed solutions have one common denominator, the restoration of esthetics and function.
The prosthetic rehabilitation of patients with fixed restorations traditionally encompassed single crowns and/or bridges, cemented onto prepared abutment teeth with aid of conventional cements. In case of a lack of tooth substance the abutment teeth had to be built- up in order to deliver the geometrically desired shape, conicity and size to retain the restorations. The preparation requirements were mostly material- related, based on the needs of metal- ceramic restorations and later also adapted to the needs of all- ceramic restorations. These traditional treatment concepts are supported by a strong body of evidence, numerous studies were published over the last 20 to 30 years on the outcomes of full crown and bridgework. Recent systematic reviews of the literature demonstrate excellent survival rates of both metal- ceramic and all- ceramic restorations.
Yet, the reviews also highlight that loss of abutment tooth vitality is one predominant biologic complication of the traditional fixed restorations mostly caused by the invasive tooth preparation, hence iatrogenic. Yet, significant improvements of the adhesive cementation technology and the restorative materials composite and ceramics open- up a new less invasive treatment approach. Instead of preparing teeth to deliver retention to restorations, the current minimally- invasive treatment concepts focus on adhesively bonding them to the substrate and enabling defect- oriented restorations. New restoration types such as additive restorations are increasingly being used for prosthetic rehabilitation today. Furthermore, resin-bonded bridges have become a well-documented and accepted treatment means for the replacement of missing anterior teeth.
This lecture will elaborate the actual possibilities of the non- and minimally- invasive restorations for full mouth rehabilitations, and will discuss their indications and current limitations for the rehabilitation of vital and non- vital teeth, and for the replacement of teeth.