A Novel Concept for Developing a Precise and Predictable Post and Core Complex Using the Injectable Resin Technique (Part 2).

Post and core systems have long been used in dentistry for the purposes of replacing missing coronal tooth structure, retaining the core, and providing sufficient retention and resistance form to the final restoration to re-establish original form and function. While Part 1 of this two-part article provided a history of post and core systems and materials and discussed empirical data regarding fiber-reinforced post systems, this second part of the article focuses on an alternative approach for developing a fiber-reinforced post and core system using a monoblock system via the injectable resin technique and a recently developed fiber-optic post. The present article explains the concept of a ferrule effect and demonstrates the novel restorative procedure.

A Novel Concept for Developing a Precise and Predictable Post and Core Complex Using the Injectable Resin Technique.

Post systems have long been used in the roots of teeth to retain dental restorations. The primary objectives of current post and core systems are to replace missing coronal tooth structure, retain the core, and provide sufficient retention and resistance form to the final restoration to restore original form and function. Many varieties of user-friendly post and core systems are available today for different endodontic, restorative, and esthetic requirements. The present article provides a history of post and core usage in dentistry, describes various systems and materials for this purpose, and discusses empirical data regarding fiber-reinforced post systems.

Achieving excellence using an advanced biomaterial: part 1.

Advancements in material research and adhesive technology have enabled the development of freehand bonding techniques that allow the preservation of remaining tooth structure and conservation of tooth structure during preparation-all while reinforcing the remaining tooth structure and improving the longevity and aesthetics of the restoration. In this article, the clinical concepts discussed were utilized with a recently developed composite resin material to restore the maxillary anterior dentition. Although the long-term benefits of this material remain to be determined, the utilization of this nanohybrid composite in this clinical presentation demonstrated an optimal functional and natural aesthetic result in the anterior region. Part 2 of this article will address the principles, techniques, and other considerations for achieving clinical success with direct posterior composite resin restorations.

Contemporary dental photography: selection and application.

Technological developments in photography have continued to facilitate and enhance the practice of dentistry. This evolution to a contemporary photographic process is revolutionizing the way clinicians diagnose, treat, and communicate with patients and colleagues. In this technologically progressing profession, clinicians should consider using an objective strategy for the selection and application of a reliable camera system that best suits the needs of their practice. This article provides clinicians with an overview of the function and basic components of a professional digital single lens reflex camera system, the criteria for evaluating and selecting a digital camera system, and the clinical applications for dental photography, as well as presents guidelines for obtaining a quality dental image.

A nonmechanical etiology: The adhesive design concept.

Advances in restorative material formulations and adhesive technology have expanded and created new treatment possibilities for dental practitioners. Due to this evolution, composite resins are being used with increasing frequency in posterior restorations. In order to successfully place these restorations, the clinician must understand the rationale for restorative material selection, preparation design, adhesive protocol, and composite resin placement. This article illustrates these considerations for placing a Class I posterior composite restoration.

Restoring the interproximal zone using the proximal adaptation technique--Part 2.

In this era of modern adhesive dentistry, clinicians are still faced with challenges from microleakage, recurrent decay, and sensitivity. Many of the challenges are a result of using yesterday's restorative techniques and principles with the new formulations of biomaterials. Procedures such as the proximal adaptation and the oblique layering techniques offer modifications to the nonadhesive principles discussed in Part I (The Compendium, December 2004), while providing the patient and clinician with the 3 primary objectives of restorative dentistry: prevention, preservation, and conservation. Using stratification techniques and thorough adhesive protocol as illustrated in this article allows clinicians to provide restorations that have improved physical characteristics while reducing the effects of polymerization shrinkage. Other benefits of these adhesive procedures include enhanced chromatic integration, ideal anatomical form and function, optimal proximal contact, improved marginal integrity, and longer lasting directly placed composite restorations.

Developing form, function, and natural aesthetics with laboratory-processed composite resin--part II.

UNLABELLED: Although the literature has provided clinicians with some awareness of restorative material alternatives, such as laboratory-processed composite resin, these systems are not yet fully understood and implemented in daily practice, despite their benefits to dental patients. Whereas part I highlights treatment planning, preparation design, and impression making for an indirect resin onlay, this article emphasizes the laboratory fabrication as well as the involved adhesive bonding and finishing protocols. Additionally, it presents considerations for the selection of either indirect resin- or porcelain-based materials. LEARNING OBJECTIVES: This article emphasizes the laboratory fabrication and adhesive bonding and finishing protocols. Upon reading this article, the reader should: * Gain an understanding of the development of a posterior onlay fabricated of an indirect composite resin system. * Define the factors for selection of restorative materials for intracoronal restorations (porcelain and processed composite resin).

Developing form, function, and natural aesthetics with laboratory-processed composite resin--Part I.

The metallic restorative materials of the past required the dentist to focus on function and form because metal had no tooth-colored properties. The development of tooth-colored restorative materials has introduced a new element in the restorative equation--color. Unfortunately, many clinicians continue to apply a "metallic mentality" to restorative techniques with the newer adhesive restorative materials that can produce a tooth-colored appearance. With advances in material sciences and adhesive technology, the restorative concept now includes aesthetics as a variable in the restorative equation as well.

Restoring the incisal edge.

Restorative dentistry evolves with each development of new material and innovative technique. Selection of improved restorative materials that simulate the physical properties and other characteristics of natural teeth, in combination with restorative techniques such as the proximal adaptation and incremental layering, provide the framework that ensures the optimal development of an esthetic restoration. These advanced placement techniques offer benefits such as enhanced chromatic integration, polychromatism, ideal anatomical form and function, optimal proximal contact, improved marginal integrity and longer lasting directly placed composite restorations. The purpose of this article is to give the reader a better understanding of the complex restorative challenge in achieving true harmonization of the primary parameters in esthetics (that is, color, shape and texture) represented by the replacement of a single anterior tooth. The case presented demonstrates the restoration of a Class IV fracture integrating basic adhesive principles with these placement techniques and a recently developed nanoparticle hybrid composite resin system (Premise, Kerr/Sybron, Orange, CA). The clinical presentation describes preoperative considerations, tooth preparation, development of the body layer, internal characterization with tints, development of the artificial enamel layer, shaping and contouring, and polishing of a Class IV composite restoration. The clinical significance is that anterior tooth fractures can be predictably restored using contemporary small particle hybrid composite resin systems with the aforementioned restorative techniques. These placement techniques when used with proper attention to preparation design, adhesive protocol and finishing and polishing procedures, allow the clinician to successfully restore form, function and esthetics to the single anterior tooth replacement.

Restoring the interproximal zone using the proximal adaptation technique--part 1.

The concepts of the preadhesive era sanctioned the mechanical removal of healthy, sound tooth structure to perform restorative procedures. This mechanical systematic approach to enhance the retention of the restoration by modifying the cavity form included 6 principles: outline form, resistance form, retention form, convenience form, removal of caries, and finish of the enamel walls, margins, and toilet of the cavity. This philosophy was challenged during the adhesive era with a biologic approach. Dramatic changes in the understanding and control of caries, with a reduction in the incidence and severity of caries, and even the process of detecting decay with chemical agents, has forced clinicians to re-think and modify their preparation designs and principles. Some of the mechanical principles are still being used with current adhesive dentistry and clinicians wonder why they continue to have microleakage, recurrent decay, and sensitivity. The effect of this misdirection could be one of the reasons for the relatively short longevity for some adhesively placed restorations. These adhesive design concepts require the clinician to modify nonadhesive techniques when considering preparation design, restorative material selection, adhesive protocol, and placement procedures and techniques. Although the original design principles are outdated by today's standards they are still applicable in the modern dental practice by simply modifying the 6 basic principles. The clinical objectives in the era of minimally invasive adhesive dentistry has become prevention, preservation, and conservation.

Dimensions of color: creating high-diffusion layers with composite resin.

The objective of this article is to provide the clinician with fundamental principles for achieving success with directly placed composite resin restorations in posterior teeth. It describes the adhesive technique and protocol for the development of tooth-colored composite restorations in the posterior dentition by integrating the concepts of function, form, and color. A case presentation demonstrates the anatomical stratification and proper placement of tints and opaquers for the development of the direct posterior composite resin-bonded restoration. Used with an understanding of tooth morphology, restorative material selection, color options, and the physical properties of light, these techniques allow optimally esthetic restorations to be predictably achieved.