Simplifying and improving soft-tissue management for fixed-prosthodontic impressions.

It is apparent that conventional impressions, usually made in vinyl polysiloxane or polyether material, could be better. One of the significant reasons for impressions' inadequacy is incomplete inclusion of the tooth preparation margins in the impression. There are numerous reasons for this challenge, some of which could be overcome by implementing the technique changes I have described in this column.

Helping patients understand and accept the best treatment plans.

The global recession has brought a significant reduction in the number of patients seeking dental treatment. Dentists have reported anecdotally that many patients are not accepting treatment plans in spite of needing or wanting the treatment and being able to afford it. With proper education, patients who can afford treatment can be motivated to accept it. Education generally is necessary to stimulate behavior change, which in the context of this article is acceptance of treatment plans. Avoiding patient education leads only to patients' requests for minimal, urgent treatment. In-depth patient education usually leads to acceptance of at least a portion of the proposed treatment plan. It is suggested that dentists and their staff members plan and carry out diagnostic data collection together; that dentists present honest, thorough treatment plans or, if necessary, develop sequential treatment plans; and importantly, that dentists charge moderate, reasonable fees that they would pay themselves for the suggested treatment. Such activities will increase treatment plan acceptance, motivate new patients to stay in practices and help ensure a practice's financial viability and success.

New technology: mandatory, elective, or hype?

If you were to buy all of the technologies that are currently advertised as being important, it would be financially stressful. In addition, you may not find that you would use all of them with equal enthusiasm. In our opinion, some new technologies are mandatory for current practice, while others are primarily elective. Only you can decide which technology is desirable to better treat your patients and make dentistry more enjoyable for you and your staff. Incorporation of the right new technology into your practice will excite you, your staff, and your patients, stimulate your interest in dentistry, and potentially provide higher quality dentistry. The money you spend on the technology of your choice will be well spent if you evaluate each concept carefully and thoroughly before buying it.

Fixed prosthodontics: time to change the status quo?

The majority of indirect restorations placed in the United States are currently made by conventional procedures in 2 or more appointments, including standard impressions using VPS or polyether, use of dental laboratory technicians to make the restorations, and conventional cementation procedures. The likelihood of rapid change to digital impressions and/or in-office milling is not predicted. However, some dentists have changed to making digital impressions and sending the information to specific dental laboratories to have the crowns fabricated. In general, they are satisfied with the concept and the restorations thus produced. It is anticipated that digital impressions will slowly continue to grow until the concept eventually dominates the market. In-office milling of restorations by CEREC or E4D is now a reliable clinical process in spite of an arduous and long period of development. It is anticipated that this concept will continue to grow. At this time, any of the 3 concepts discussed in this article--conventional procedures, digital impressions sent to a laboratory, or digital impressions followed by in-office milling--are acceptable depending on the preferences of practitioners.

Has resin-based composite replaced amalgam?

The major health organizations in the world continue to accept amalgam use, but the "amalgam war" of the 1800s is still going on. The end is not in sight. There is little disagreement that amalgam serves well and, although controversial, it appears to have minimal to no health hazards. There is a wide variation in the relative amount of amalgam placed in developed countries, and many dentists in North America do not use it. However, amalgam is still being used at least some of the time by the majority of practitioners in North America, and most of those practitioners also place resin-based composite in Class II locations. The evolution from amalgam to tooth-colored restorations has been a slow and tumultuous journey. The acceptability of resin-based composite in Class II locations continues to be a question for some dentists, while others have concluded that amalgam is "dead." It would be highly desirable if some of dentists using the alleged poisonous properties of amalgam as a "practice building" ploy would find more legitimate methods to increase their practice activity.

The truth about small-diameter implants.

SDIs that are treatment planned correctly, placed and loaded properly, and are within a well-adjusted occlusion, are working in an excellent manner for the patients described in this article. It is time for those practitioners unfamiliar with SDIs and their uses to discontinue their discouragement of this technique. SDIs are easily placed, minimally invasive, and a true service to those patients described. They do not replace conventional diameter implants; however, they are a significant and important augmentation to the original root-form implant concept. There is obvious evidence of the growing acceptance of small-diameter implants by both general practitioners and specialists.

Why use resin cements?

RMGI is the most popular cement in North America, but several other cement types also are used for routine cementation of the most commonly placed indirect dental restorations. After many years of dominant use, RMGI appears to possess most of the characteristics desired by most dentists. When additional cement strength, translucence or a choice of cement colors is required, resin cements can fulfill those needs. However, RMGI still is an excellent choice for routine cementation of most indirect restorations.

Selecting new products, techniques, and concepts for your practice.

Practitioner evaluation of products is an extremely difficult task, in view of the enormous amount of both reliable and questionable product information available, variable interpretation of research projects, support of correct or incorrect information in the literature, the funding for research projects, the money that changes hands for some positive product recommendations, and the half-truths that are often used as "hype" to sell a product. On the positive, the products available today are far better than the products of even a few years ago. Practitioners need to seek information from a variety of trusted sources described in this article to make correct decisions. The sources of information identified in this article have not been prioritized. They vary in usefulness depending on the type of product, the geographic area in which you live, the speakers to whom you listen, your relationships with peers, manufacturers, retailers, and your own ability to sort out information. Use the most unbiased, up-to-date information available from the sources you find most appropriate for your practice, and remember, clinical success is the final test!

Ensuring accuracy and predictability with double-arch impressions.

The described double-arch impression technique provides an accurate and stable impression, accurate dies and the ability to make one or two crowns with minimal or no adjustments. Both scientific evidence and clinical observation attest to the adequacy of the double-arch impression concept, when it is accomplished in accordance with the requirements enumerated in this column.

Esthetic dentistry-2008.

The many procedures included in esthetic dentistry are dominant in many dental practices. The trend will continue until many dental practices will be primarily oriented toward esthetic procedures. Overall, the movement toward major involvement with esthetic dentistry has been good. Caution is advised to ensure that patients are provided with informed consent before proceeding with esthetic procedures and that they are not overtreated.

High-tech dentistry: what is necessary and what is not.

Many new high-tech concepts and devices for dentistry have been introduced in recent years, and corresponding advertisements are predominant throughout the dental profession. Most high-tech devices and concepts are useful, some more than others. It would be difficult and costly to incorporate into dental practice every new technology that comes out on the market. It is common knowledge among most dentists that some dental procedures can be accomplished faster, easier and better with well-known, time-proven techniques, whereas other tasks are better accomplished with today's newest technologies. Dentists must weigh technology's perceived value to patients, as well as the relative efficiency of clinical techniques accomplished by conventional versus high-tech concepts when deciding whether to incorporate technology into their practices. This article has expressed my opinions about various high-tech concepts as I perceive them, and from my experience as I see them being accepted and used by the practicing profession.

Esthetic dentistry: state of the art.

Over the past 30 years, the dental profession has changed from being mainly a pain-driven service orientation to including procedures that enhance the appearance of patients and improve their self-esteem and enjoyment of life. It has been estimated that approximately 50% of a typical American dentist's revenue is related to esthetic/ cosmetic procedures; it is predicted that this trend will continue. However, caution must be used to honestly provide all treatment possibilities, including expected treatment longevity, and to receive patient consent before providing irreversible esthetic procedures.

Caries management by risk assessment: implementation guidelines.

ACT This consensus statement supports implementation of caries management by risk assessment in clinical practice by using the following principles: modification of the oral flora, patient education, remineralization, and minimal operative intervention. The statement includes a list of supporters.

Current paradigm shifts in dentistry.

It is a time of revolution and innovation in dentistry. Many of the ongoing changes are significant, while others are less influential. I have discussed numerous observable and inevitable paradigm shifts. Dentists are advised to note the ongoing trends, become educated about them, evaluate the importance of the changes in their individual practices and to their patients, and to integrate these changes into practice.

The 'new' operative dentistry.

During the past few decades, life expectancy has increased significantly. As a result, mature patients often have receding gingival tissues, physical and mental debilitation, less energy and motivation, and the resultant Class V carious lesions. In this article, I suggest the use of high-level fluoride in toothpastes, remineralizing pastes and high-level fluoride gels for topical application in trays to reduce the progression of caries. To accompany fluoride therapy, high-fluoride-releasing restorative materials are indicated for Class V carious lesions. Adequate caries-preventive and restorative concepts for mature patients require planning, patient education and close patient supervision.

Making fixed prostheses that are not too high.

It has been observed that a high percentage of multiple crowns or FPDs arrive from laboratories too "high." This article suggests methods to create accurate alginate impressions, opposing casts and IORs. If dentists use these techniques, it is anticipated that fewer FPDs will be too high as dentists attempt to seat them in the mouth.

Is now the time to purchase an in-office CAD/CAM device?

In-office CAD/CAM is a reality. It allows fabrication of tooth-colored inlays and onlays, crowns and veneers in one appointment. It is especially well-suited to dentists who accomplish many single-tooth or single-quadrant restorations. As with any new technology, its cost is high, but using it can be financially feasible. Clinical and basic science investigations have resulted in positive findings on the concept. There are some significant advantages and several disadvantages. In-office CAD/CAM works well for many dentists, but practitioners should evaluate it carefully before accepting it, as it is not for everybody.

The 'mini'-implant has arrived.

There is no question that dental implants have been the most influential change in dentistry during the last half-century. In general, they are well-proven and highly useful. However, the diameter of standard implants (approximately 3.75 mm), along with the frequent need to graft bone to allow for their placement, have limited their use for those who most need implants. The introduction, approval and continuing observation of success of smaller-diameter mini-implants have stimulated use of implants in situations in which standard-sized implants could not have been used without grafting. The result has been more patients who have been served successfully at reduced cost with minimized pain and trauma--patients who could not have been treated with implants otherwise. Continuing research is needed for further verification of the acceptability of mini-implants.