A Case Against the Implant.

It is incumbent upon our profession to reevaluate our preference for routinely replacing a missing single maxillary incisor, especially a maxillary lateral incisor, with a dental implant in a young adult. The dental literature is replete with beautiful restorative results using implants in this area, but there is minimal discussion regarding the long-term consequences of this treatment. The maxillary lateral incisor is one of the most commonly missing teeth due to agenesis, and it is also one of the most common teeth to be lost due to trauma in the developing child.1 Therefore, the decision for replacement must be made with the long-term in mind, as these restorations are commonly placed between ages 18 and 21 and must serve the patient for many decades. There are several reasons that implants can be associated with complications or even fail, including the following: (1) Continued craniofacial growth, which has a predominant anterior and vertical component and has been shown to occur in the maxilla, resulting in the apparent submersion of the implant crown as the natural teeth move incisally in relation to the implant2,3-there is no evidence that this can be predicted, let alone how far into the future it may happen; (2) peri-implantitis, which has a patient-level prevalence estimate of nearly 25% according to the findings of a recent systematic review;4 (3) thinning and recession of the peri-implant mucosa due to poor implant placement, inadequate prosthetic management, and/or poor case selection, often resulting in compromised esthetics and a predisposition for the onset and progression of peri-implant diseases; and (4) mechanical failure of the implant, abutment screw, transmucosal abutment, and/or crown. Clinicians should also keep in mind that, once an implant is placed in the anterior maxilla, it precludes the possibility for palatal expansion in the adult patient because the space created by the expansion cannot be redistributed orthodontically. Canine substitution is one traditional method for replacement of the missing maxillary lateral incisor. It is still a viable option when the canine tooth has an acceptable shape and color, and the occlusion will not be compromised by the substitution.5 Additionally, the bonded single-wing zirconia bridge has become a primary treatment option.6 Zirconia has the strength of metal and beauty of porcelain, which makes it an ideal substrate for a bonded bridge. The literature has demonstrated the long-term success of this replacement option for the missing maxillary incisor.7 There are clearly many potential long-term disadvantages associated with replacing a single missing maxillary incisor with an implant in young adults. We should be prescribing the least-invasive treatment option for the replacement of these teeth. Therefore, when treatment-planning for a missing maxillary incisor in a young adult, alternatives to implant therapy-such as the bonded single-wing zirconia bridge and canine substitution-should be the primary treatment options. The implant should only be considered as a secondary treatment when the other options are not viable or have previously failed.

Restoratively guided orthodontic treatment: The pre-orthodontic bonding concept.

OBJECTIVE: Communication between the orthodontist and the restorative dentist has always been difficult due to the inability of the orthodontist to achieve the desired orthodontic goals with just words in a referral note. CLINICAL CONSIDERATIONS: A better method of communication is for the restorative dentist to create the ideal tooth anatomy either before or during orthodontic treatment to direct the orthodontic tooth movement. CONCLUSION: It is the purpose of this article to present a technique, which makes the pre-restorative orthodontic treatment both more accurate and more efficient. CLINICAL SIGNIFICANCE: It is very difficult for the orthodontist to move teeth into their correct positions when the teeth are anatomically incorrect due to attrition/erosion or due to developmental malformation. When the restorative dentist makes the teeth anatomically correct with either pre-orthodontic or intermediate orthodontic bonding, the orthodontist has the benefit of ideal tooth anatomy to finalize the tooth positions. This then allows the restorative dentist to create final restorations, which are ideal, both functionally and esthetically.

Treatment Options for the Replacement of the Missing Maxillary Lateral Incisor.

The replacement of the missing maxillary lateral incisor continues to be a challenge for the interdisciplinary dental treatment team. Over the past two decades the dental implant has become a primary method of replacement for this tooth. However, while implants offer numerous benefits, some significant potential problems are associated with implant treatment, including the possible need for tissue grafting, the long-term stability of bone and soft tissue overlying the facial surface of the implant, as well as the continued growth of alveolar bone and eruption of teeth adjacent to the implant. This article discusses various treatment options for the replacement of the missing maxillary lateral incisor with an emphasis on the bonded zirconia bridge.

Management of invasive cervical resorption: observations from three private practices and a report of three cases.

Invasive cervical resorption (ICR) is a type of external resorption that is not well understood or well known in the dental community. It is often misdiagnosed, leading to improper treatment or unnecessary loss of the tooth. Treatment may involve the periodontium as well as the tooth and pulp, and management can be complex. Early diagnosis and appropriate treatment are the keys to a successful outcome. This article discusses the decision-making process and management of ICR, with emphasis on the restorative aspects of treatment. Three treatment cases are presented that include nonsurgical and surgical approaches, with recalls of 4, 8, and 9.5 years.

Management of invasive cervical resorption: observations from three private practices and a report of three cases.

Invasive cervical resorption (ICR) is a type of external resorption that is not well understood or well known in the dental community. It is often misdiagnosed, leading to improper treatment or unnecessary loss of the tooth. Treatment may involve the periodontium as well as the tooth and pulp, and management can be complex. Early diagnosis and appropriate treatment are the keys to a successful outcome. This article discusses the decision-making process and management of ICR, with emphasis on the restorative aspects of treatment. Three treatment cases are presented that include nonsurgical and surgical approaches, with recalls of 4, 8, and 9.5 years.

Six-year clinical evaluation of bonded and pin-retained complex amalgam restorations.

This clinical study compared the performance of complex amalgam restorations retained with self-threading pins or bonded with a filled, 4-META-based resin. Sixty amalgam restorations (28 pin-retained and 32 bonded), each replacing at least one cusp, were placed. Self-threading stainless steel pins (Coltene-Whaledent) were used in the pin-retained group. A filled, 4-META-based bonding resin (Amalgambond Plus with HPA powder) was used in the bonded group. For both groups, any retention form remaining after removal of an old restoration was left in place but not enhanced. At six years, 11 restorations had failed; eight of which were pin-retained and three bonded. Using Fisher's exact test to compare the groups at six years, there was no significant difference in failure rate, marginal adaptation, marginal discoloration, secondary caries, tooth sensitivity or tooth vitality. At six years, there was no difference in the performance of pin-retained amalgam restorations and bonded amalgam restorations.

Direct composite bonding in conjunction with surgical tissue management.

This article discussed several issues associated with the intimate relationship between attachment apparatus and the restorative interface. First, it is essential that the restorative dentist have a clear understanding of crest position and its impact on the restorative outcome. Then, the restorative dentist must understand the importance of sequencing and timing when orthodontic therapy, tissue recontouring and restorative dentistry must be accomplished on the same patient.

Restoration of the endodontically treated tooth.

It has been the purpose of this article to provide a rationale for the restoration of endodontically treated teeth. Treatment recommendations have been made in the areas of post design, placement technique, cements, core materials, and definitive restorations, based on a review of the clinical and laboratory data.