Long-term management of avulsed "hopeless" teeth in the adult dentition.

OBJECTIVE: This case will demonstrate a thoughtful approach to the management of avulsed/replanted teeth in the adult dentition and their long-term maintenance. Often times these teeth are either not replanted, or extracted soon after replantation when resorptive lesions appear and the teeth are deemed "hopeless". The term "hopeless tooth" (HT) has become more popular since the advent of implants. Implants allowed for a simple solution to the HT by extraction and immediate replacement with a fixture and a restoration. However, now that we are realizing that implants do not last forever and also have attendant problems, saving the HT takes on a new light. CLINICAL CONSIDERATIONS: Prolonging the life of the HT can preserve bone and give the patient a functional, esthetic tooth for many years. With each additional year, clinicians garner new skills, and technology improves our future treatment outcomes. This will allow clinicians to improve and extend the life of future replacements. CONCLUSIONS: If there is minimal risk to adjacent structures, retaining the HT has many advantages for the patient and clinician. Clinicians should adopt a policy of thinking ahead and asking "What's Next"? when their prospective treatment fails or needs to be replaced. By prolonging the life of the HT, the "best ultimate treatment" has a greater chance to outlive the patient. CLINICAL SIGNIFICANCE: With the advent of single tooth implants, the term "hopeless tooth" has become more popular. It is easier to justify extraction of a tooth when it is deemed "hopeless". Many of these teeth could be saved. The advantages of this philosophy will be elucidated.

The esthetic management of a severe isolated periodontal defect in the maxillary anterior.

A 30-plus year-old woman presented to the periodontist with a chief complaint concerning the esthetics of the black space between her maxillary right lateral and central incisors (Figure 1). The history of the problem dated back several years when her general dentist noted increased pocket depth in this area. The patient was referred to a periodontist who elected to attempt grafting in this site to improve both the bone and soft tissue. The patient reported that after the initial surgery the defect became significantly worse and a large quantity of gingival tissue was lost. The patient was then referred to a second periodontist who, after evaluation, also chose to attempt both a bone and soft tissue grafting procedure and again the defect became worse. At that point the second periOdontist referred the patient to the periodontist in our group for evaluation and treatment. At her initial consultation the patient indicated she had been managing the defect esthetically by placing pink wax into the large open space every day to minimize the appearance.

The use of implants and ovate pontics in the esthetic zone.

This article will discuss and evaluate the potential conditions that can present in patients who require or already have had multiple anterior tooth extractions; the proper considerations for the use of ovate pontics in the treatment plan also will be discussed. While the ultimate treatment decisions must be determined on a case-by-case basis, it is important to recognize in advance the various potential outcomes to ensure that realistic decisions are made about the best treatment options for each patient. Accordingly, the four most common presentations a clinician is likely to encounter will be examined, as well as how they may be managed and the most likely compromises that might exist in the final result.

A multidisciplinary approach to esthetic dentistry.

Today's dentist does not just repair teeth to make them better for chewing. Increasingly, his or her work involves esthetics. With patients demanding more attractive teeth, dentists now must become more familiar with the formerly independent disciplines of orthodontics, periodontics, restorative dentistry, and maxillofacial surgery. This article provides a systematic method of evaluating dentofacial esthetics in a logical, interdisciplinary manner. In today's interdisciplinary dental world, treatment planning must begin with well-defined esthetic objectives. By beginning with esthetics, and taking into consideration the impact on function, structure, and biology, the clinician will be able to use the various disciplines in dentistry to deliver the highest level of dental care to each patient.

Interdisciplinary management of anterior dental esthetics.

BACKGROUND: Dental esthetics has become a popular topic among all disciplines in dentistry. When a makeover is planned for the esthetic appearance of a patient's teeth, the clinician must have a logical diagnostic approach that results in the appropriate treatment plan. With some patients, the restorative dentist cannot accomplish the correction alone but may require the assistance of other dental disciplines. APPROACH: This article describes an interdisciplinary approach to the diagnosis and management of anterior dental esthetics. The authors practice different disciplines in dentistry: restorative care, orthodontics and periodontics. However, for more than 20 years, this team has participated in an interdisciplinary dental study group that focuses on a wide variety of dental problems. One such area has been the analysis of anterior dental esthetic problems requiring interdisciplinary correction. This article will describe a unique approach to interdisciplinary dental diagnosis, beginning with esthetics but encompassing structure, function and biology to achieve an optimal result. CLINICAL IMPLICATIONS: If a clinician uses an esthetically based approach to the diagnosis of anterior dental problems, then the outcome of the esthetic treatment plan will be enhanced without sacrificing the structural, functional and biological aspects of the patient's dentition.

The esthetic correction of anterior dental mal-alignment conventional vs. instant (restorative) orthodontics.

Creating a flow sheet may assist in the decision whether to use conventional orthodontics and what the limitations of treating the patient will be if treatment is performed without any orthodontics. The decision process can be viewed as a series of questions, and depending upon the answer to the questions, the practitioner and patient can decide on whether to involve orthodontics or not. Questions can create a framework to help separate the patients who would benefit from orthodontic intervention from those we all enjoy treating who can be managed with purely restorative care.

My growing involvement in dental study groups.

The lessons from managing a successful study club are learned over a life-time of practice, just a dentistry is. The author, who has taught numerous participation continuing education courses using the study club model and mentored many study clubs identifies these criteria for success: a respected mentor, open feedback, multiple points, of view, a clear mission and structure, and attention to the changing needs of the participants over time. A study club that has renewed itself effectively over a twenty-year period is described as a possible model.