Interactive treatment planning in toothwear: are we doing it right?

UNLABELLED: Toothwear is now common, especially in younger patients, with high demand for the restoration of the damaged teeth which is likely to increase further over time. Fixed prosthodontic options range from direct composite resin to conventional tooth preparation and cemented indirect restorations. This paper summarizes the views of a variety of clinicians on a plan delivered to a patient with toothwear in secondary care and explores the possible reasons for the variation in decision-making in the treatment of toothwear. CLINICAL RELEVANCE: With levels of toothwear increasing, the clinician needs to be aware of the different treatment modalities which are appropriate.

Bleaching and bonding for the older patient.

UNLABELLED: Older people who remain reasonably well may wish to maintain or enhance their dental and oral appearance, preferably at minimal biologic and financial costs. Bleaching and bonding represents a very good treatment option and a sensible strategy for this group. Bleaching addresses the discoloration, while direct composite bonding can improve the shape of worn, or otherwise unaesthetic, teeth without damaging the structure or health of the residual tooth tissue. This pragmatic treatment is well tolerated by older patients. The visual and functional improvements are greatly appreciated by this group, partly because of the non-destructive and affordable nature of the benefits. CLINICAL RELEVANCE: Bleaching and bonding represents a proven, sensible, pragmatic, affordable and practical approach to managing the aesthetic problems of older patients, and the benefits are achievable without destroying their residual sound tooth tissue.

Medicinal erosion: a case report.

Patients, healthcare professionals, and health product manufacturers focus on the benefits that the use of a medicine or health product will bring rather than the potential side effects. A case of erosive tooth surface loss caused by the repeated and prolonged use of an acidic mouthrinse is reported. The adverse effects of health care products on the dentition and methods to minimise potential damage are discussed.

The Dycal try-in technique for Resin-bonded bridges.

The resin-bonded bridge (RBB) is a predictable technique that has a useful place in modern day dentistry. Practitioners' main concerns, regarding this technique, are a lower survival rate when compared with conventional prostheses, and unpredictable aesthetics. Unfortunately, the minimal preparation and adhesive concepts used with RBBs complicates provisional cementation. Ideally, the RBB should be assessed as if it were the definitively bonded prosthesis. It is possible to achieve a good final aesthetic result as the grey shine-through of the metal wing can be eliminated by the use of opaque resin cements such as Panavia 21 OP. Ideally, the restoration should be assessed with an identical opaque try-in paste but, unfortunately, such a proprietary paste is not available. This paper describes the use of Dycal as a try-in paste for provisionally cementing a resin-bonded bridge and the benefits this offers.

A modern day application of the Rochette bridge.

A restoration that is frequently prescribed to provisionally restore the single unit edentulous space is the removable acrylic partial prosthesis. The Rochette bridge design provides an effective alternative when confronted with this clinical situation. The adaptable nature of this technique means that it can be utilised in a variety of clinical situations with success. The greatest benefits are seen in clinical situations where simple and aesthetic alteration of the pontic dimensions during treatment is necessary. It can also be used in long-term provisional situations where, if a removable acrylic partial prosthesis was used, multiple adjustments or remakes would be necessary. This paper presents three case reports where this technique has been utilised with distinctive advantages over a provisional removable partial acrylic prosthesis.

Managing discoloured non-vital teeth: the inside/outside bleaching technique.

The discoloured, non-vital anterior tooth is a common aesthetic concern for many patients. It can have a profound effect on their self-esteem, interaction with others and employability. Discoloured non-vital teeth are frequently compromised owing to previous trauma, caries, endodontic therapy and failed restorations. Destructive invasive treatment options are likely to weaken the residual structure of the tooth. This can reduce the prognosis and challenge the long-term viability of the tooth, thereby initiating further prosthetic predicaments. This paper discusses modern approaches to the treatment of discoloured teeth. The importance of preventing and eliminating the potential for discoloration will be highlighted. The paper will include a detailed technical account on the application of the inside/outside bleaching technique, with several clinical examples.