Essay III: Adhesive restorative options for restorative space management in the anterior zone with or without orthodontic pretreatment: some clinical considerations and case presentations.

An unfavorable relationship between the form and dimension of the dental arch and the number, dimension, and shape of the existing teeth can pose several esthetic, biologic, and functional problems. In this article, the various restorative options are discussed based on clinical and scientific evidence: Gap closure and substitution of missing teeth: restorative transformation of substituted teeth into homologous teeth with odontoplasty, direct composite, etched pieces or porcelain veneers. Gap opening and tooth replacement with all-ceramic adhesive bridges, including pontic site development. Gap distribution and restorative compensation with direct composite restorations, etched pieces or porcelain veneers. Gap shifting and restorative compensation with all-ceramic adhesive bridges, composite, etched pieces or veneers. Gap compensation by reconstructive compensation without orthodontics. The reconstructive tools including composite restorations, ceramic veneers, and adhesive bridges are discussed, and numerous cases are presented to illustrate the concepts.

Treatment decisions regarding caries and dental developmental defects in children - a questionnaire-based study among Norwegian dentists.

BACKGROUND: Current knowledge on treatment strategies and choice of restorative materials when treating deep caries or severe dental developmental defects (DDDs) in young individuals is scarce. Therefore, the aim was to investigate Norwegian dentists´ treatment decisions and reasons for treatment choice when treating deep caries in primary teeth and severe DDDs in permanent teeth in children. METHODS: A pre-coded questionnaire was sent electronically to all dentists employed in the Public Dental Service (PDS) in Norway (n = 1294). The clinicians were asked about their background characteristics and how often they registered DDDs. Three clinical cases were presented to the dentists and asked to prioritize treatment options and reasons for their choice. RESULTS: After three reminders, 45.8% of the dentists answered. Most clinicians were general practitioners (96.3%), females (77.9%), under 41 year-olds (59.4%), graduated in 2001 or later (61.1%), and representing all regions of Norway. The respondents registered molar incisor hypomineralisation (MIH), other DDDs and dental fluorosis (DF) frequently, 523 (91.1%), 257 (44.8%) and 158 (27.5%), respectively. In case 1a with severe dental caries in a primary molar, the preferred treatment was resin-modified glass ionomer cement (RMGIC) (58.3%), followed by glass ionomer cement (GIC) (17.9%) and zinc oxide-eugenol (ZOE) (13.2%). Extraction, compomer or stainless steel crowns (SSC) were preferred by 0.9, 0.7 and 0.4%, respectively. In case 1b, which was identical to case 1a, but treated under general anaesthesia, the preferred treatment alternatives were RMGIC (37.1%), resin composite (RC) (17.6%) and GIC (17.2%). Extraction and SSC were chosen by 15.1 and 7.2%, respectively. In case 2, showing a severely hypomineralised and symptomatic first permanent molar, the dentists preferred RC (38.4%), followed by RMGIC (26.6%) and GIC (19.0%). Extraction and SSC were chosen by 8.7 and 5.4%, respectively. The treatment choices were not significantly affected by the dentists' background characteristics. The reasons for dentists' treatment decisions varied for each patient case; patient cooperation, prognosis of the tooth and own experience were the dominant reasons. CONCLUSIONS: A notable disparity in treatment choices was shown indicating that Norwegian dentists evaluate each case individually and base their decisions on what they consider best for the individual patient.