Conservative Esthetic Procedures PDF

Conservative Esthetic Procedures Osama Bagabas BDS, MS Restorative Dental Science Department College of Dentistry Taibah University Causes of Esthetic Defects 1. Dental caries 2. Faulty restoration 3. Loss of tooth substance 4. Tooth discoloration 5. Anatomical abnormalities 6. Mi...

Conservative Esthetic Procedures Osama Bagabas BDS, MS Restorative Dental Science Department College of Dentistry Taibah University Causes of Esthetic Defects 1. Dental caries 2. Faulty restoration 3. Loss of tooth substance 4. Tooth discoloration 5. Anatomical abnormalities 6. Missing teeth 1 Dental Caries Cause discoloration of remaining tooth substance. Can cause change in tooth translucency if the pulp involved. Cause loss of tooth structure and form. Can create tooth movement such as over eruption of opposing and drifting of adjacent teeth. 2 Faulty Restoration including direct, indirect or implant supported restorations: Improper size or shape of the restoration Restoration with inaccurate color match Marginal discoloration and recession Restoration with recurrent caries 3 Loss of Tooth Substance Traumatic fracture Erosion Abrasion Attrition Abfraction 4 Extrinsic Stains - Stains located on outer surfaces of teeth. - Stains may be related to poor oral hygiene, existing restorations, plaque accumulation or eating/drinking habits. - Most surface stains can be removed by routine prophylactic procedures such as polishing or microabrasion. 5 Intrinsic Stains - Intrinsic discolorations are caused by deeper (not superficial) internal stains or enamel defects.  - Causative factors include hereditary disorders, medications (particularly tetracycline), excess fluoride, high fevers associated with early childhood illnesses, and other types of trauma. - Mostly more difficult to treat and require more advanced procedures. 6 Anatomical Abnormalities Anatomical abnormalities in teeth size, form and position such as midline diastema, crowding or peg shaped incisors can cause problems to dental esthetics. 7 Missing Teeth Loosing one or more teeth due to extraction, trauma, or congenital anomalies can cause significant damage to the esthetic of the face and smile. Limiting Problems in Restoring Esthetics Dentists may face some difficulties when restoring anterior dental esthetics. This includes: 1. Exact color matching 2. Gingival & periodontal health 3. Establishment of adequate retention 4. Abnormal occlusion or biting habits 1 Exact Color Matching - Exact duplication of color of a particular tooth is a very difficult step because it requires duplicating the combined color of two optically different tissues, enamel and dentin, in one restorative material. Each of the three substances has different optical characteristics. - The surrounding background and the observer’s eye are significant variable factors, which may affect color selection. - The type and intensity of illumination used for color determination can affect shade selection. Color determination should be done under natural or neutral light illumination. - Metamerism a phenomena in which tooth appear color matched under one type of light source and different under another type of light. - The restoration in the mouth will be subjected to discoloration influences (e.g. food, drinks, smoking) which may affect its color and complicate shade selection. - Lab technician may not reproduce the exact color blending determined by the operator in case of ceramic restoration. This is because a technician did not examined the patient or evaluated shade features. - Detailed shade analysis and proper communication (e.g. photographs, shade prescription sheet) between the operator and technician is very important to the outcome of anterior esthetic restorations.  2 Gingival & Periodontal Health Gingival Inflammation & Periodontal Disease - Gingival inflammation and associated periodontal destruction are leading factors that can reverse the esthetic outcome in the long term. - Establishing definitive restorations when inflammatory periodontal problems are present not only restrains esthetic success, but also accelerates the rate of periodontal destruction. - Elimination of gingival inflammation and periodontal disease is mandatory before initiation of any restorative treatment. Restoration Margin and Finish Line - The position of the restoration finish line is a crucial step to the health and integrity of the gingiva. - For better esthetic outcomes, margins of crown or veneer restorations in the esthetic zone should be placed subgingivally without violating the biological width. (BW is the distance from the junctional epithelium and connective tissue attachment to the root surface= 2.04 mm) - The standard today is to prepare the finish lines of the restorations slightly below gingival margin (0.5 mm below the marginal gingiva if the sulcus depth is 1 mm, 0.5 to 1 mm if the sulcus depth is exceeding 1.5 mm) 3 Establishment of Adequate Retention - Establishment of adequate retention may present a problem if the tooth is extensively damaged and the remaining tooth substance becomes inadequate to provide enough retention for the restoration. - Procedures such as full coverage preparation and intra radicular retention may be indicated for both retention and support for extensively damaged or endodontically treated anterior teeth. 4 Abnormal Occlusion or Biting Habits - Excessive occlusal forces cause wear of the tooth structure and put a tremendous amount of forces to teeth and restorations. - Abnormal occlusal habits such a burxism, clenching and habitual biting on hard objects can cause fracture of esthetic restoration. - Esthetic restoration such as laminate veneers are contraindicated in case of abnormal occlusal forces is present till the condition is controlled. 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