Functional and Esthetic Comparison of Metal-Ceramic and All-Ceramic Posterior Three-Unit Fixed Dental Prostheses.

PURPOSE: The aim of this study was to assess functional and esthetic satisfaction plus evaluate changes in oral health-related quality of life (OHRQoL) using the Oral Health Impact Profile (OHIP-14) after insertion of a metal-ceramic (MC-FDP) or a veneered zirconia all-ceramic (AC-FDP) posterior three-unit fixed dental prosthesis (FDP). Additionally, patients' and professionals' esthetic evaluations were compared. MATERIALS AND METHODS: A convenience sample of 34 patients was randomized to receive a MC-FDP (n = 17) or an AC-FDP (n = 17). Patients were assessed using the OHIP-14 and also answered a questionnaire regarding satisfaction with function and esthetics using visual analog scales (VAS) before treatment and after 2 weeks, after 3 months, and after 1, 2, and 3 years. A fully dentate control group (n = 20) was also assessed using the OHIP-14. The operator and another observer evaluated the esthetics of the FDPs using VAS. RESULTS: The patients assessed the two FDP types similarly for all parameters. In contrast, there was a statistically significant difference in OHIP-14 results between the treated patients and the control group before treatment. After treatment, a statistically significant improvement in OHIP-14 was observed at all examinations. Patients were highly satisfied with the function and esthetics of the FDPs. The overall satisfaction with esthetics was statistically significantly higher among the patients than among the professionals at three out of five examinations. CONCLUSION: The patients experienced improved OHRQoL and increased satisfaction with function and esthetics after receiving a posterior three-unit FDP. No important differences were observed between the two types of FDPs when evaluated by the patient or the professionals.

Perception of dental esthetics: influence of restoration type, symmetry, and color in four different countries.

In this study, the influence of restoration type, symmetry, and color on the perception of dental appearance was evaluated. An esthetic questionnaire was completed by 29 patients before and after esthetic rehabilitation. In addition, 94 dentists from four countries (Germany, the United Kingdom [UK], China, and Switzerland) evaluated the influence of the above factors using before-and-after rehabilitation pictures. The most invasive treatment was recommended by Chinese dentists, while German, Swiss, and UK dentists recommended comparable treatment options. As for restorative symmetry, restoration type, and color, significant differences could be found among and within the dentists of the four countries (P ± .05).

Perception of dental esthetics in different cultures.

PURPOSE: The purpose of this study was to compare patients' and dentists' perception of dental appearance. MATERIALS AND METHODS: Based on internationally accepted guidelines about dental esthetics, a questionnaire was developed to measure "dental appearance" (QDA). Eleven items defined a QDA score (0 = "absolutely dissatisfied" to 100 = "absolutely satisfied"). The QDA was completed by 29 patients (21 women, 8 men) before and after a complete oral rehabilitation that included restoration of the maxillary anterior teeth. Overall, 94 dentists from four countries (Germany, the United Kingdom, China, and Switzerland) evaluated the esthetics before and after rehabilitation on a visual analog scale (VAS: 0 = "absolutely unesthetic" to 100 = "absolutely esthetic"). RESULTS: Patients and dentists of all countries found a significant esthetic improvement after treatment (P ≤ .0001). Significant differences could be found when comparing the evaluation of the dentists from the various countries among one another and with the patients' self-evaluation (P ≤ .05). With the exception of the professional rating of the initial situation, no gender-related differences could be found in any of the test groups. CONCLUSIONS: In daily practice, it seems of utmost importance for dentists to incorporate the patients' feedback in order to avoid esthetic treatment failures.

Impact of aesthetic restorative treatment on anterior teeth with fluorosis among residents of an endemic area in Brazil: intervention study.

BACKGROUND: Endemic dental fluorosis has already been described in some regions of the world. The aim of this study was to evaluate the functional and psychosocial impact of direct aesthetic restorative treatments in endemic fluorosis patients in the northern state of Minas Gerais, Brazil. Was a quasi-experimental intervention study. METHODS: The reference population consisted of individuals between 9 and 27 years of age that were served by a project intended to recover the smiles of patients with severe fluorosis. The questionnaires were administered on two occasions, 24 months apart (before and after dental treatment). Initially, descriptive analyses were conducted. Prevalence and severity, as well as the extent of the functional and psychosocial impact of oral disorders were estimated based on the Oral Health Impact Profile instrument (OHIP-14). Comparisons between baseline and follow-up and between treatment techniques were carried out using the McNemar, Wilcoxon, and Mann-Whitney tests. RESULTS: The study involved 53 individuals, with a mean age of 15.9 years, treated with microabrasion, dental composite, or a combination of both techniques. The treatments performed proved to be competent for reducing the functional and psychosocial impact of oral disorders as measured by the OHIP-14, pointing to the possibility of establishing protocols to be used in programs aimed at restoring the aesthetics and functionality of the anterior teeth in large populations. CONCLUSIONS: After performing the direct aesthetic restorative treatments in patients with endemic fluorosis, a significant improvement was observed in the prevalence and severity, as well as the extent of the functional and psychosocial impact of oral disorders.

Fears and concerns of individuals contemplating esthetic restorative dentistry.

Questionnaires that focus on the fear of dental treatment typically include a narrow list of previous treatment-related factors. By omitting items concerned with psychologic, emotional, and interpersonal traits that impact treatment, practitioners often fail to gain additional valuable information on related anxiety issues. This study was undertaken to identify previously unrecognized or poorly discussed sources of fear and anxiety in patients seeking esthetic dental treatment. The Esthetic Clinic at Tufts University School of Dental Medicine recruited 62 participants who were asked to score their level of anxieties and concerns based on 24 different items on a 0 to 5 Likert scale. In addition, age, gender, and type of procedure in consideration were the only other variables recorded. The item that elicited the highest level of anxiety was "not feeling happy with my new smile." Thirty-eight respondents (61.3%) said they feel "markedly anxious"or "severely anxious" or answered "avoid completely." Concerns "that the outcome might look false and unnatural" or "that the dentist might not redo it if I am not satisfied with the outcome" both received 37 out of 62 (59.7%) similar responses. These results suggest obstacles to treatment exist not only in areas typically investigated but also in factors rarely discussed during the patient-practitioner encounter. The practitioner needs to consider a broader range of issues when addressing the patient's concerns.

The effect of veneers on cosmetic improvement.

OBJECTIVES: This clinical study was designed to compare the patient's opinion of the cosmetic improvement after the placement of direct composite and indirect porcelain veneers. METHODS: This retrospective study involved a survey of 145 patients (96 responses) each treated with 10 direct composite (Vitalescence) or 10 porcelain (Fortress) veneers. Patients subjectively evaluated multiple aspects of their smile using visual analogue scales before and after treatment for colour, shape, size, smile line and overall facial appearance. RESULTS: There were no statistical differences between the cosmetic improvement achieved for porcelain and composite (p > or = 0.05). Cost factors were not significant. Significant factors were: tooth conservation (p < or = 0.021), time (p < or = 0.012), repair costs (p < or = 0.009) and replacement costs (p < or = 0.024) and favoured the direct composite veneers over the porcelain veneers. Correlation findings relating to what patients feel as the key components of the smile for overall cosmetic improvement showed medium to high correlations (0.301 < or = r < or = 0.718) with tooth shape, colour and level of tooth display, gingival level, gingival symmetry and tooth whiteness. CONCLUSION: The choice of material (direct composite resin vs porcelain) when constructing maxillary anterior veneers does not significantly affect the patient's perception of cosmetic improvement. However, there was a preference towards accepting the composite veneer option. Overall aesthetic satisfaction is multifactorial. The results support the opinion that the more conservative composite veneers are justified and that, given the choice and information, patients may prefer this option.

Psychological effects of aesthetic dental treatment.

OBJECTIVE: To demonstrate that aesthetic restorative dental treatment, using the porcelain laminate veneer, has a positive effect on the self-esteem of a patient. METHODS: A study group of 17 patients, unhappy with their dental appearance, were assessed psychologically at the pre-operative, immediate post operative and 6 month review stages. Porcelain laminate veneer restorations were used to improve the dental aesthetics for the patients in the study group. A comparison group of 27 subjects, without a dental appearance problem, were also psychologically assessed at comparable intervals. The assessments included Cattell's 16PF Personality Inventory, a Body-Esteem index, a computer administered version of the Repertory Grid technique and semi-structured interviews. RESULTS: The results showed that there were no significant differences between the study and comparison groups on any first or second-order factor of the 16PF. However, highly significant changes in a positive direction (p < 0.005) were observed in the study group in responses to a Body-Esteem questionnaire at each stage in the procedure. Comparison group changes were not significant. Repertory Grid analyses showed a significant overall convergence in the study group compared with the comparison group. There were also significant positive shifts amongst the study group in the normalised ratings of "self' on several of the constructs. Interviews confirmed the Repertory Grid findings. CONCLUSIONS: The study shows that aesthetic restorative treatment has a positive effect on patients' self-esteem.

Avoiding patient disappointment with trial veneer utilization.

The type of communication described makes up a kind of three-dimensional pretreatment communication that leads to greater patient satisfaction and helps to reduce the likelihood of lawsuits from patients who feel that they were promised results that were not met. The method of try-in veneers allows the patient be a part of the outcome in the pretreatment stages. This can lead to a happier, more satisfied patient, which is what all practitioners strive to obtain.

patients' satisfaction with different types of veneer restorations.

OBJECTIVES: The aim of this study was to measure the satisfaction of patients with respect to the aesthetics of veneer restorations (VRs) and to identify potential factors influencing their satisfaction. MATERIALS AND METHODS: One hundred and eighty VRs of three different types (direct composite, indirect composite and porcelain) were placed on anterior teeth. Patients were asked to fill in questionnaires at baseline and at one- and two-year recalls. RESULTS: At baseline the overall satisfaction was 76%, after two years this was 78%. The variable 'type of VR' was the only factor measured that had a significant influence on the satisfaction of the patient. At the two-year evaluation patients with porcelain VRs were more satisfied than those with direct composite VRs (P < 0.05). CONCLUSIONS: From the results of this study it is concluded that differences in clinical procedures had no effect on satisfaction. Also the number of VRs had not influenced the level of satisfaction. After two years a significant difference was observed for the variable 'type of VR', with the best results for porcelain.

Cosmetic dental treatment in an adult Dutch population.

In 1992 a follow-up to the Dutch national dental survey of 1986 (DNDS) was performed. The main objective was to analyse changes in oral self care, dental attendance, and oral health status. A postal questionnaire was used: 936 persons (44 per cent response) participated in the study. This paper will focus on the results concerning cosmetic dental treatment. Stepwise regression analyses were used to study the effect of dental and social variables. Relative risks (RR) were computed to clarify the effect of these variables. Of the group of respondents, 90 persons reported having been treated with veneers on their anterior teeth. The variables indicating cosmetic dental treatment needs established during the DNDS clinical dental examination, showed a statistically significant influence. 'Objective need': RR = 2.6; 'Subjective need': RR = 2.1. Out of 877 respondents with restorations present in 1986, 19 per cent reported having one or more of them replaced by composite or porcelain. Four variables were found to have a statistically significant influence: 'Subjective need': RR = 1.7; 'Number of filled tooth surfaces': RR = 1.6; 'Number of decayed tooth surfaces': RR = 1.4; and 'Frequency of toothbrushing': RR = 1.6. Whereas the dentists' opinions had the most influence on having veneer treatments, the patients' opinions had more influence on having amalgam restorations replaced with composite or porcelain.

Cosmetic dentistry: patients' perspectives.

More dentists now are offering cosmetic dentistry to their patients. In this study, patients' perspectives on a variety of cosmetic procedures were surveyed. Women and older respondents seemed most willing to have cosmetic treatment. Perception of fees and discomfort level of these procedures also were examined. Many practitioners report an increase in office productivity with cosmetic dentistry, and an increase in personal satisfaction from performing esthetic procedures that their patients appreciate.