When Esthetic Becomes Challenging
This case report shows the successful change of a young lady smile, by following standard dental esthetic guide lines. With careful, detailed examination and diagnosis, we could reach our goal toward providing a high esthetic smile change.

Treating Two Adjacent Missing Teeth in the Esthetic Zone - Part 1: The Pink Hybrid Restoration & the Unilateral Versus Bilateral Defect Concept
This article, the first of a planned three-part series, outlines a new surgical & prosthetic approach for treating cases involving two missing adjacent teeth in the esthetic zone. These type of cases, particularly when combined with a three-dimensional ridge deficiency, represent one of esthetic dentistry's most challenging dilemmas. A Clear understanding of the unilateral and bilateral defect concept is necessary to properly evaluate each particular case, understand surgical limitations, perform a better risk assessment, establish an esthetic prognosis, develop the best clinical-laboratory strategy, and adjust patients' expectations. While not recommended for every case, represents a useful, economical, and predictable alternative that decreases the umber and complexity of interventions.

The “Scalloped Guide”: A Proof-of-Concept Technique for a Digitally Streamlined, Pink-Free Full-Arch Implant Protocol
Inadequate restorative space can result in mechanical, biologic, and esthetic complications with full-arch fixed implant-supported prosthetics. As such, clinicians often reduce bone to create clearance. The aim of this paper was to present a protocol using stacking computer-aided design/computerassisted manufacturing (CAD/CAM) guides to minimize and accurately obtain the desired bone reduction, immediately place prosthetically guided implants, and load a provisional that replicates predetermined tissue contour. This protocol can help clinicians minimize bone reduction and place the implants in an ideal position that allows them to emerge from the soft tissue interface with a natural, pink-free zirconia fixed dental prostheses.

Surgical Veneer Grafting - Compensation for Natural Labial Plate Remodeling After Immediate Implant Placement
Contemporary implant therapy aims to provide highly esthetic and predictable treatment outcomes while decreasing treatment duration and complexity. The clinician must therefore be cognizant of circumstances with a predisposition toward esthetic outcomes and treatment plan accordingly. Preservation of the surrounding hard and soft tissues associated with an immediate postextraction socket implant to replace a nonrestorable tooth in the esthetic zone is one of the greatest challenges facing the dental team. A case report of a hopeless maxillary left central incisor in a patient with a thin periodontal phenotype illustrates this new surgical and prosthetic approach. Clinical, radiological, and esthetic parameters were recorded to evaluate primary treatment outcomes.

CAD/CAM Solutions for Minimally Invasive All-Ceramic Rehabilitation of Extended Erosive Lesions
Dental erosion is a global health problem that can lead to significant functional and esthetic impairments of the affected patients. Treatment of sever cases with augmented loss of the vertical dimension of occlusion (VDO) represents a challenge for both the dental team and the patient. CAD/CAM technology was used in the presented case to analyze the inter-occlusal space. The case report documents a practical, digital approach and discusses the advantages related to treatment time, ease of treatment, and predictability.

Retrospective Analysis of 26 Complete-Arch Implant-Supported Monolithic Zirconia Prostheses with Feldspathic Porcelain Veneering Limited to the Facial Surface
The purpose of this retrospective study was to evaluate the clinical performances of 26 implant-supported, complete-arch, monolithic zirconia restorations with facial feldspathic porcelain veneers for the rehabilitation of completely edentulous patients. Eighteen patients were treated with a total of 26 complete-arch fixed prostheses. The mean follow-up time was 20.9 months. In total, 154 implants were placed supporting 309 retainers and pontics. The results of this retrospective evaluation showed that monolithic zirconia restorations with facial porcelain veneer provided satisfactory clinical performance and suggest that these rehabilitations are a viable treatment option for completely edentulous patients.

The "Hybrid Abutment": A New Design for Implant Cemented Restorations in the Esthetic Zones
Cemented implant restorations are widely used by many dentists. The traditional abutment design resembles a natural tooth prepared for a crown with a similar taper and a chamfer finish line. A frequent complication associated with implant restorations in the esthetic zones is the recession of buccal gingiva over time. Abutment morphology, among several other prosthetic factors, may play an important role in the stability of gingival margin in esthetically sensitive areas, but this has never been thoroughly analyzed. With many considerations in mind and recent techniques released, this article proposes the "hybrid abutment: design (HAD), a new design that includes a combination of the two types of features - a feather edge on the buccal side, and a chamfer finish line on the lingual side. This article also presents a rationale for the use of different abutment designs for different situations.

Advanced Esthetic Management of Dental Implants: Surgical and Restorative Considerations to Improve Outcomes
This article demonstrates the importance of proper surgical and prosthetic principles in achieving esthetic implant results.Successful dental implant therapy in the maxillary anterior dentition requires meticulous attention to surgical and prosthodontic measures. Proper diagnosis, extraction technique, implant selection, and placement significantly impact outcomes. Respect of hard and soft tissue physiology following tooth loss and implant placement requires specific steps be taken. Management tissue contours properly, via regenerative therapy, results in successful framing of the restoration. Provisionalization and definitive restorative therapy also impacts the level of esthetic success.The contours of the temporary abutment and crown develop soft tissue contours for the final restoration. Overcontouring can lead to soft tissue recession and mucosal asymmetry. Design of the definitive crown(s) is crucial for long-term maintenance of esthetically acceptable results.

Enhancing Esthetics with a Fixed Prosthesis Utilizing an Innovative Pontic Design and Periodontal Plastic Surgery
During the past two decades, significant advancements with the integration of periodontal plastic surgery into esthetic restorative dental procedures have received increased attention. While ovate pontics have traditionally been used as a restorative design following augmentation procedures to enhance esthetics, an alternate E-pontic design aims to predictably support and maintain the gingival architecture between a single missing anterior tooth adjacent to a natural tooth or an implant that is in harmony with the lip line and face. In addition, the E-pontic design promotes the gingival facial tissue to coronally migrate over the pontic, creating a gingival sulcus. This article describes an innovative new technique and a pontic design that predictably will develop, support, and maintain the gingival architecture to provide a long-term esthetic and functional outcome.

Effect of Different Cementation Techniques on Retained Excess Cement and Uniaxial Retention of the Implant-Supported Prosthesis
The aim of the study was to identify the different techniques of cementation (half filling, practice abutment, and venting) that will reduce the amount of retained cement and the effect of these techniques on retention of implant supported prostheses. The venting and practice abutment techniques are suitable methods of reducing retained excess cement with optimal retention values.

Complex Case Rehabilitation in Light of New Technologies
This case report describes a step-by-step full arch restoration (upper and lower), rehabilitated utilizing new technologies in dentistry. CAD/CAM technology has changed not only the technician's working process, but also the clinician's, offering new benefits to clinical workflow.For example the possibility of using zirconia and its characteristics as a restorative material. The clinician's and technician's professional backgrounds and relationships are critical to achieving optimal aesthetic and functional results; while prosthetic success depends upon an in-depth knowledge of the materials and their properties and on carefully performed clinical procedures, which are still of utmost importance to obtain satisfactory results.

Esthetic and Functional Rehabilitation: A Case Report
In this article, esthetic case planning and a new complete protocol of tooth preparation for full crowns will be highlighted utilizing modified enamel chisels and the dental microscope. Multimedia will be utilized for optimal visual learning using magnification photography and videos to focus on specific details required to improve your dental skills. The important role of magnification in dentistry will be further discussed.

Surgical Crown Lengthening in a Population With Human Immunodeficiency Virus: A Retrospective Analysis
This report investigates the outcome of CLS procedures performed at an urban dental school in a population of individuals with HIV. Specifically, this retrospective clinical analysis evaluates the healing response after crown lengthening surgery (CLS). Of the 21 patients with HIV examined after CLS, none had postoperative complications, such as delayed healing, infection, or prolonged bleeding. Variations in viral load, CD4 cell count, smoking, platelets, and neutrophils did not impact surgical healing. In addition, variations in medication regimens (highly active anti-retroviral therapy; on pro-tease inhibitors; no medications had an impact. The results of this retrospective analysis show the absence of postoperative complications after CLS in this population with HIV. Additional investigation into this area will help health care practitioners increase the range of surgical services provided to this group of patients.

Bonding Lithium Disilicate Ceramic to Feather-Edge Tooth Preparations: A Minimally Invasive Treatment Concept
The purpose of this study is to report short-term clinical outcome of a new minimally invasive prosthetic approach utilizing monolithic lithium-disilicate full crowns bonded to feather-edge tooth preparations. This procedure can be considered a further option for the conservative restorative treatment of single elements where a full crown is required.

Significance of Crown Shape in the Replacement of a Central Incisor with a Single Implant-Supported Crown
When utilizing a single implant-supported crown to replace a central incisor, understanding the final shape of the implant restoration is an important factor to help achieve a successful esthetic outcome. In today's dentistry, tooth shape is a critical factor when dental implant prosthesis are considered in the esthetic zone. The goal of this study was to objectively analyze the significance of natural crown shape when replacing a central incisor with a single implant-supported crown. Data analysis revealed that is there is a "black triangle", a diastema, or presence of dental or gingival asymmetry, an additional restoration on the adjacent central incisor is often required in order to fulfill esthetic goals. The additional restoration is highly recommended in situations with a triangular crown shape, while it is suggested in cases of square/tapered and square tooth shapes in the presence of a dental diastema.

A Multi-faceted Treatment Approach for Anterior Reconstructions Using Current Ceramics, Implants and Adhesive Systems
Of all developments in dental technology, fulfilling the esthetic and functional demands of a patient is still a challenge for both dentists and dental technicians. This becomes more difficult for patients with a previous treatment history that is not ideal. This case presentation demonstrates reconstruction of an anterior zirconia resin-bonded fixed dental prosthesis (RBFDP) for the mandible with a combined treatment approach utilizing veneers for harmonized space distribution on the abutment teeth and an implant-supported zirconia fixed dental prosthesis in the anterior segment of the maxilla. Adhesive cementation if the restorations is also presented in a step-by-step approach based on the current state of the art.

Vertical and Horizontal Dimensions of Implant Dentistry: Numbers Every Dentist Should Know
This article will review the most common vertical and horizontal measurements that the general dentist placing and restoring implants should know, and illustrate how using these parameters will provide more reliable outcomes.

A retrospective analysis of 102 zirconia single crowns with knife-edge margins
In this retrospective evaluation, feldspathic porcelain veneered-zirconia crowns with knife-edge margins provided clinical performance similar to that reported with other margin designs.

Interdisciplinary management of anterior dental esthetics
This article describes an interdisciplinary approach to the diagnosis and management of anterior dental esthetics.

CAD/CAM Anterior and Posterior Implant Restorations - Ceramics, Abutments and Design
The use of in-office CAD/CAM techniques will be highlighted to fabricate implant posterior and anterior implant crowns.

Long-Term Outcome of Cemented Versus Screw-Retained Implant-Supported Partial Restorations
The present study was designed to compare the long-term outcome and complications of cemented versus screw-retained implant restorations in partially edentulous patients. The long-term outcome of cemented implant-supported restorations was superior to that of screw-retained restorations, both clinically and biologically.

Consideraciones de los materiales disponibles en América Latina para la fabricación de coronas cerámicas libres de metal
El siguiente artículo es una revisión de la literatura odontológica el cual se ha redactado con la intención de llevar al clínico a través de una actualización de los materiales dentales cerámicos libres de metal disponibles en América Latina.

Splints Are Not Just for TMD Therapy
Properly made and well-adjusted occlusal splints can help control parafunctional stresses that are applied by the patient to their natural teeth and the restorations that dentists fabricate for them.

Predictable Cementation of All Ceramic Dental Restorations - The "Noah" Technique
Creation of an ideally prepared tooth and its detail being "captured" in a master impression are critical steps in the indirect dental restorative process.

Diagnostic Waxing Transfer From Diagnostic Casts to Soft Tissue Definitive Casts
Fabricating quality anterior esthetic restorations, such as porcelain veneers and crowns, requires the fabrication of a soft tissue definitive cast with removable dies and a hard stone gingiva. This cast is essential to the integration of the definitive restoration with the architecture of the gingiva.

Adhesive Dentistry - A Full Time Practitioner’s Perspective
Adhesive dentistry has provided techniques and materials for conservative and esthetic options in every restorative practice. The understanding of the process of etching to form microscopic undercuts and infiltrating these gaps with resin to create an adhesive interface between tooth and restorative material has demonstrated long-term durable and well-sealed interfaces, resulting in excellent clinical results.

Sectional Impressions and Simplified Folding Complete Denture for Severe Microstomia
A patient presenting with severe microstomia (PDI Class IV) was unable to insert a maxillary complete denture.

Minimally Invasive Reconstruction in Implant Therapy - The Prosthetic Gingival Restoration
This article presents a reliable and consistent alternative to prosthetically restore cases with an uncertain surgical outcome or for those patients who do not want to undergo regenerative surgical procedures.

Proximal Contact Areas of the Maxillary Anterior Dentition
The goal of this study was to quantify the apicoincisal extent of the proximal contact area (PCA) between the eight maxillary anterior teeth. PCAPs should be taken into consideration for clinical anterior restorations since they determine the papillary and incisal embrasures.

Creating Physiologic Contours Using a Modified Geller Cast Technique
This article will discuss how to control the gingival contours of the final restorations in the laboratory.

CAD/CAM Update - Technologies and Materials and Clinical Perspectives
Because of the growing confusion as to what these technologies are, what they will do, and, more importantly, what the clinical and laboratory guidelines for using these materials and techniques are, this article will address the important points of the CAD/CAM market and technology.

Communicating Digitally with the Laboratory: Design, Impressions, Shade, and the Digital Laboratory Slip
This article will review and explore some of the digital opportunities and rationales for digital communication of all forms of clinical information from the dentist to the laboratory.

A Systematic Approach to Full-Mouth Reconstruction of the Severely Worn Dentition
Jay Lerner demonstrates a procedure that allows the clinician to obtain the space required for the restoration of severely worn dentition.

Treatment of Excessive Gingival Display and Anterior Overeruption: Rehabilitation and Restoration
In order to develop a normal physiologic relationship between the osseous crest and correct the incisal positioning of the gingival margin as related to the CEJ, surgical correction of the patient’s excessive gingival display was required.

Prosthetic Gingival Reconstruction in a Fixed Partial Restoration - Part 1: Introduction to Artificial Gingiva as an Alternative Therapy
The Class III defect environment entails a vertical and horizontal deficiency in the endentulous ridge. Often, bone and soft tissue surgical procedures fall short of achieving a natural esthetic result. Alternative surgical and restorative protocols for these types of prosthetic gingival restorations are presented in this three-part series, which highlights the diagnostic and treatment aspects as well as the lab and maintenance challenges involved.

Prosthetic Gingival Reconstruction in the Fixed Partial Restorations
“Originally published in Inside Dentistry, 2008. Copyright 2008. AEGIS Communications. Reprinted with permission.”

Aesthetic Enhancement of Pontic Sites for Fixed Partial Dentures
An adequate alveolar bone base is the prerequisite for functional and aesthetically optimal reconstruction of the soft tissue architecture for a fixed partial denture pontic site or dental implant site. If the horizontal and vertical dimensions of the ridge deficiency are within 3 mm of their original contour, acceptable results can he achieved by soft tissue augmentation procedure only, ie, connective tissue grafts, onlay grafts, or an inlay rolled graft. These procedures are usually performed…

A Biometric Approach To Aesthetic Crown Lengthening: Part 1 - Midfacial Considerations
Although human dental anatomy is taught in university curricula, clinicians often witness restorations that are not proportional to one another. Dental restorations should also be proportional to periodontal supporting tissues as an essential aspect of dental anatomy. Measurements can be performed directly on a patient’s teeth with aesthetic gauges used to confirm the correct position of the supporting osseous topography. This article demonstrates a technique using these gauges to objectively determine the correct position of the underlying hard tissues and render predictable, aesthetic treatment.

Restorative Space Management: Treatment Planning & Clinical Considerations for Insufficient Space
In attempting to provide a restorative solution for cases that have been compromised by spatial considerations, clinicians have traditionally opted for an orthodontic approach that did not provide optimal aesthetics due to changes in tooth morphology, specifically tooth size and shape as a result of dental deterioration. With the advent of contemporary aesthetic materials and preparation techniques, clinicians and technicians are now empowered to deliver a penultimate result with minimal compromise to the surrounding dentition. This article presents the clinical and laboratory considerations that must be addressed when providing a prosthetic restoration for crowded teeth.

An Esthetic Alternative in Full-Coverage Restorations
All too often, restorative dentists are faced with the dilemma of not being able to provide the ceramist the optimal space for maximum esthetics. The reasons are numerous, yet the problem still remains. The dental industry, along with the dental laboratory industry, has developed numerous full-coverage restorative options to obtain maximum esthetics. These include, but are not limited to, feldsphatic porcelain crowns or porcelain jacket crowns, In-Ceram (Vita Zahnfabrik; Distributor, Vident) and…

A Multidisciplinary Approach to Single-Tooth Replacement
Over the last several decades, dentistry has focused on more conservative treatment modalities and preventive techniques. This has been possible not only because of improved techniques and materials, but also because of the understanding that tooth preparation, regardless of how conservative it may be, is an irreversible procedure

Biologic Width Demystified
Information from John Kois’s research predicts the final positions of esthetic gingival margins

Quest for the All Ceramic Restoration
The all-ceramic, full-coverage restoration has long been the center of the profession's ardent quest for the consummate esthetic restoration. Over the years, we have come to acknowledge the optimal esthetics of the all-porcelain crown, but its tendency to fracture over time rendered it an "alternative" restoration for specifically selected cases when compared to the "workhorse" of porcelain-fused-to-metal restorations. The initial dental feldspathic porcelains exhibited low shear strength with a…

Tissue Management for Aesthitc Success with Posterior Restorations
Due in part to the positive tissue response to metal-ceramic crowns fabricated with Captek™ substructures, clinicians can now provide an aesthetic restoration with healthy supporting periodontium for their patients. All indirect restorations, however, depend on an accurate impression of the preparation and proper tissue management throughout provisionalization. Even after careful tooth preparation, the restorative site often fills with blood, intracrevicular and intraoral fluids, and the delicate…

Controlled Restorative Treatment of Compromised Anterior Dentition
The aesthetic appearance of the maxillary anterior dentition is determined by the relationship between the shape, contour, color, position, and arrangement of the teeth to the healthy labial gingiva and the interdental papillae. When restoring the anterior dentition, the objective of a harmonious natural appearance of the teeth, surrounded by healthy soft tissue, should be achieved through a controlled predictable treatment protocol. In periodontally compromised teeth, the prognosis of each tooth…

A Biometric Approach to Predictable Treatment of Clinical Crown Discrepancies
Dental professionals have long been guided by mathematical principles when interpreting aesthetic and tooth proportions for their patients. While many acknowledge that such principles are merely launch points for a smile design or reconstructive procedure, their existence appears to indicate practitioners’ desire for predictable, objective, and reproducible means of achieving success in aesthetic dentistry. This article introduces innovative aesthetic measurement gauges as a means of objectively quantifying tooth size discrepancies and enabling the clinician to perform aesthetic restorative dentistry with success and predictability.

Recommended Shade Matching Protocol
Following much research and clinical evaluation, this chapter outlines the authors’ recommendations for an ideal approach to shade matching: a combination of conventional techniques with new technologies.