Tx in esthetic dentistry key points

Question 1

Differences between cosmetic and esthetic dentistry

Answer 1

In essence, the way to differentiate between the terms ‘cosmetics’ and ‘esthetics’ is to consider esthetics as the theory and philosophy that explore beauty, while cosmetics refers to a preparation designed to beautify the body by direct application.

Question 2

Treatment strategies

What is the most and least important strategy

Answer 2

For all patients, any restorative and biomechanical needs must be addressed. Restoration of the defects may return the teeth to function but have little to do with correcting the dental caries biofilm disease.

The strategies used in treatment of dental caries are divided into:

1. First in most treatment considerations are the reparative procedures required to correct the physical damage to the teeth.
2. The second strategies are focused on the therapeutic approach to correcting the bacterial biofilm component of the disease.
3. The third strategies are behavioral changes to improve the oral environment to favor a healthy biofilm.

Question 3

Three strategies to overcome this problem..

Answer 3

1. Remineralization..
2. Minimally invasive restorative procedures.
3. Therapeutic caries strategies.

• *The 1st strategy is remineralization.
• If there is no possibility of remineralization, the 2nd strategy, if there is demineralization we move to Minimally invasive restorative procedures to remove that small carious tissue (pits and fissures/PRR-protective measure
• 3rd strategy: we have caries, not everywhere but we need to stop progress of caries

Question 4

Minimally invasive procedures

Answer 4

1. Irreversible changes to tooth structure (occlusal, approximal, smooth, or root surface) need action.
2. Initial (early) lesion detection => Chemical remineralization, minimal intervention to arrest or reverse the initial damage (before cavitation).
3. Cavitation is already present => restoration (invasion) with most minimally invasive procedures, maintaining the maximum amount of healthy tissue and structural integrity of the tooth.

Question 5

Therapeutic strategies

Answer 5

1. Antimicrobial therapy: e.g. chlorhexidine, ethyl alcohol and essential oils.
2. pH strategies (rinsing or buffering the oral cavity to promote remineralization).
3. Using Xylitol (is a naturally occurring alcohol sugar not metabolized by mutans streptococci that has effective anticaries activity).

Question 6

Non-invasive options:

Answer 6

1. Tooth-whitening (6% hydrogen peroxide and 10% carbamide peroxide gels in close- fitting trays for home use is a proven and popular technique).
2. Orthodontics (the use of aligners is popular, although fixed appliance therapy remains the gold standard).
3. Adhesive restorations (this includes resin-bonded bridges without tooth preparation).
4. Direct bonding of composite resin to reshape teeth, close spaces and cover defects (this is increasing in popularity as adhesives, composites and techniques improve).
5. Removable prostheses without tooth preparation.

Question 7

•Significant tooth reduction (Conventional esthetic dentistry requires significant tooth reduction).

Answer 7

1. Prepared ceramic veneers.
2. Crowns.
3. Conventional bridges (fixed prostheses).
4. Implant-retained restorations.

Question 8

How to detect cavity?

Sharp explorer?

Answer 8

Traditionally dentists identified cavitated lesions using a sharp explorer tip, visual examination, and/or radiographs. But!

Sharp explorer?

• Numerous studies report that the use of a dental explorer is not adequate for detecting early occlusal lesions at all and not only may lead to a significant number of undetected lesions, including some false positives, but may, if it is sharp, cause traumatic surface defects in teeth.
• Also, radiographs are not useful for early occlusal lesions because of the masking effect of the facial and lingual enamel.

Question 9

Current methods for caries detection:

Answer 9

The current state of lesion detection leaves behind the dental explorer and involves a more scientific approach with the use of ICDAS, DIAGNOdent, digital radiographs, and some interesting new technologies.

Question 10

The importance of diagnosis for patient and dentist

Diagnosis is important to enable the patient to:

Answer 10

1. understand the cause of the condition
2. appreciate the severity of the condition
3. take ownership of the disease
4. take responsibility for preventative measures
5. give informed consent to treatment.

Question 11

The importance of diagnosis for patient and dentist

Diagnosis is important to enable the practitioner to:

Answer 11

1. design a suitable prevention strategy
2. understand the complexity of the treatment** and offer **solutions
3. provide a treatment plan
4. estimate the prognosis
5. cost the treatment accurately
6. answer the patient’s questions.