This book introduces a unique approach to esthetic restoration of the anterior dentition. Guided by the philosophy of biomimetics, the authors combine sound biologic principles with an overriding respect for the natural intact tooth to achieve esthetic satisfaction with bonded porcelain restorations. Unlike traditional veneers, the approach described here draws upon the ideal hues, the subtle shades, and especially the intracoronal anatomy of the intact tooth to serve as a guide to reconstruction and as a measurement of success. From this perspective, a checklist of fundamental esthetic criteria is presented, and treatment planning, diagnostics, tooth preparation, laboratory procedures, adhesive luting procedures, and maintenance protocols are carefully detailed. The reader will find all the information and step-by-step instruction needed to obtain the authors� superior results, which are showcased throughout the book.
Table of ContentsForeword
Chapter 1: Understanding the Intact Tooth and the Biomimetic Principle
� Biology, Mechanics, Function, and Esthetics
� Optimal Compliance and Flexibility
� Rationalized Anterior Tooth Shape
� Mechanics and Geometry During Function
� Physiologic Enamel Cracking and the DEJ
� Natural Tooth Aging and Enamel Thinning
� Biomimetics Applied to Mechanics
Chapter 2: Natural Oral Esthetics
� General Considerations
� Fundamental Criteria
� Esthetic Integration
Chapter 3: Ultraconservative Treatment Options
� Chemical Treatments and Biomimetics
� Nightguard Vital Bleaching
� Microabrasion and Megabrasion
� Nonvital Walking Bleach Technique
� Reattachment of a Tooth Fragment
� Simplified Direct Composites
Chapter 4: Evolution of Indications for Anterior Bonded Porcelain Restorations � Historic Perspective
� Type I: Teeth Resistant to Bleaching
� Type II: Major Morphologic Modifications
� Type III: Extensive Restoration in the Adult
� Combined Indications
� Biologic Considerations
� Perspectives for Veneering Posterior Teeth
Chapter 5: Initial Treatment Planning and Diagnostic Approach
� Interactive Patient-Operatory-Laboratory Relationships
� Patient Management by the Operatory Team
� Patient Management by the Laboratory Team
� Treatment Planning and Initial Therapy
� Diagnostic Waxup
� Diagnostic Mock-up
� Peculiar Cases
� Summary of Diagnostic Approaches
� Clinical Photography
� Shade Documentation
Chapter 6: Tooth Preparation, Impression, and Provisionalization
� General Considerations
� Tissue Reduction
� Margin Configuration and Localization
� Peculiar Situations
� Immediate Dentin Bonding
� Definitive Impressions
� Direct Provisionals and Provisional Bonding
Chapter 7: Laboratory Procedures
� Choice of Restorative Material and Technique
� Master Casts in the Refractory Die Technique
� Ceramic Layering and Finishing
� Special Effects
� Configuration of the Ceramic Workpiece
Chapter 8: Try-In and Adhesive Luting Procedures
� Choice of Luting Composite Resin
� Try-in and Preparatory Steps
� Conditioning of the Ceramic Surface
� Conditioning of the Tooth Surface
� Placement of the Ceramic Restoration
� Final Adjustments and Occlusal Control
� Special Considerations
Chapter 9: Maintenance and Repairs
� Maximum Performance, Reduced Maintenance
� Routine Professional Hygiene
� Complications and Repairs
� Replacement of Class 3 Composite
Guide to Clinical Cases
The most exciting developments in dentistry have emerged within the past decade. Oral implant dentistry, guided tissue regeneration, and adhesive restorative dentistry are strategic growth areas both in research and in clinical practice. However, the many advances in dental materials and technology have generated a plethora of dental products in the marketplace. Clinicians and dental technicians are faced with difficult choices as the number of treatment modalities continues to grow. Further, changes in technology do not always simplify technique or decrease treatment costs. Prudence and wisdom need to be combined with knowledge and progress when it comes to improving our patients� welfare.
In this perplexing context, no one will contest the need for less expensive, satisfactory, and rational substitutes for current treatments. The answer might come from an emerging interdisciplinary biomaterial science called biomimetics.1 This concept of medical research involves the investigation of the structure and physical function of biologic �composites� and the design of new and improved substitutes. Biomimetics in dental medicine has increasing relevance. The primary meaning for dentistry refers to processing material in a manner similar to that by the oral cavity, such as the calcification of a soft tissue precursor. The secondary meaning refers to the mimicking or recovery of the biomechanics of the original tooth by the restoration. This, of course, is the goal of restorative dentistry.
Several research disciplines in dental medicine have evolved with the purpose to mimic oral structures. However, this nascent principle is applied mostly at a molecular level, with the aim to enhance wound healing, repair, and regeneration of soft and hard tissues.2,3 When extended to a macrostructural level, biomimetics can trigger innovative applications in restorative dentistry. Restoring or mimicking the biomechanical, structural, and esthetic integrity of teeth is the driving force of this process. Therefore, the objective of this book is to propose new criteria for esthetic restorative dentistry based on biomimetics.
Biomimetics in restorative dentistry starts with an understanding of hard tissue structure and related stress distribution within the intact tooth, which is the focus of the opening chapter of this book. It is immediately followed by a systematic review of parameters related to natural oral esthetics. Because the driving forces of restorative dentistry are maintenance of tooth vitality and maximum conservation of intact hard tissues, a brief chapter describes the ultraconservative treatment options that can precede a more sophisticated treatment. The core of the book centers on the application of the biomimetic principle in the form of bonded porcelain restorations (BPRs). The broad spectrum of indications for BPRs is described, followed by detailed instruction on the treatment planning and diagnostic approach, which is the first step in learning this technique. The treatment is then described step-by-step, including tooth preparation and impression, laboratory procedures related to the fabrication of the ceramic workpiece, and its final insertion through adhesive luting procedures. The book ends with discussion of the follow-up, maintenance, and repair of BPRs.
I would have been unable to achieve this work without the valued collaboration of other dentists, dental technicians, specialists, and researchers. We should always remember that a key element for successful and predictable restoration is teamwork and an essential ingredient for teamwork is humility, to consider others better than oneself. We must try to serve each other rather than expect to be served.
I am fortunate to have studied under Prof Urs Belser; his teaching and guidance have been invaluable to me.
Special thanks goes to Drs William Douglas, Ralph DeLong, Maria Pintado, Antheunis Versluis, and Thomas Korioth at the University of Minnesota for their help and friendship during my 2-year research scholarship there. They expanded my vision and knowledge of scientific research in biomaterials and biomechanics.
I extend appreciation to Michel Magne, CDT, for his significant contributions to the chapter on laboratory procedures and for his skills in fabricating the ceramic restorations for all of the cases in this book. I also acknowledge my patients, who indirectly contributed to the realization of this book, and the private practitioners who donated extracted teeth for the studies and illustrations. Special thanks in this regard goes to Drs Rosa Serrano of Geneva, Switzerland, and Jos� de Souza Negr�o of S�o Paulo, Brazil.
Finally, I give honor and glory to my Lord and Savior, Jesus Christ, who has made all of my projects possible through his gracious love.