W12-Treatment planning in esthetic dentistry Flashcards
1
Q
Degradation of interface:
hydrolytic degradation of components of hybrid layer within time, includes:
A
hydrolytic degradation of components of hybrid layer within time, includes:
- Hydrolytic Degradation of Adhesives.
- Hydrolytic Degradation of Collagen by enzymes (matrix metalloproteinases and cysteine cathepsins).
2
Q
Esthetic VS cosmetic:
A
- The terms ‘cosmetic’ and ‘esthetic’ dentistry (‘esthetic’ being used more widely on the international stage than the ‘aesthetic’ spelling) have been and continue to be employed interchangeably, causing much confusion in the profession and the population in general.
- The situation is compounded by the overlap between various esthetic and cosmetic treatments and by the fact that all esthetic and cosmetic procedures in medicine and surgery are considered to fall under the single umbrella of ‘cosmetic practice’.
3
Q
The origin of “cosmetic”
A
- As a noun, the word ‘cosmetic’ comes from Greek ‘kosmetike’, which is ‘the art of dress and ornament’.
- As an adjective, ‘cosmetic’ derives from the Greek word ‘kosmetikos’, ‘skilled in adornment or arrangement’ or ‘used or done superficially to make something look better, more attractive, or more impressive’.
- The word ‘esthetic’ comes from Greek ‘aisthetikos’, meaning ‘sensitive and perceptive’
4
Q
Simple definition of “esthetic” and “cosmetic:
A
- The Collins Concise English Dictionary provides the following definitions for ‘esthetic’: “relating to pure beauty rather than to other considerations’ and ‘relating to good taste or artistic”.
- The same dictionary defines ‘cosmetic’ as ‘having no other function than to beautify’ and ‘designed to cover up a greater flaw or deficiency; superficial’.
5
Q
esthetic vs cosmetic
Differences between them..
A
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.
6
Q
Cosmetic vs Esthetic
More precise definition of both terms..
A
Winkler and Orloff describe the terms, as they pertain to the treatment of patients, as follows:
- Cosmetic: This encompasses reversible procedures to attain a so- called optimal appearance that is sociological, cultural, geographic and time-dependent. Trends are time-dependent; what is acceptable and fashionable today can and will oftentimes be considered unacceptable and old-fashioned tomorrow.
- Esthetic: This demands tailoring and customisation to individual preference. It is a fluid and dynamic entity, but it is based on the patients’ expectations, psychology and subjective criteria.
7
Q
The goals of esthetic dental care include the need to:
A
- meet the realistic expectations of the patient
- attain long-term functional and esthetic stability
- achieve the treatment goals through the application of minimal intervention approaches.
8
Q
Cariology and its relevance to esthetic dentistry
A
- Dental caries is a transmissible infectious bacterial disease, a biofilm disease of the teeth that leads to decay and ultimate loss of the teeth. It is not corrected by eliminating a patient’s cavities, but requires diagnosis and treatment of the biofilm disease to correct the infection.
- Patients who undergo major restorative dentistry (often esthetic dentistry) are generally patients who have had a lifelong, chronic experience with dental caries. Unless the infection is diagnosed and treated, they remain in a diseased state, putting all of their expensive restorative dentistry at high risk for recurrent decay and loss
- Dental caries has multifactorial causation, with environmental risk factors, individual risk factors, and behavioral and dietary influences as well as the biofilm component.
- Literally any saccharolytic, acidogenic, and aciduric bacteria could contribute to the caries biofilm and lead to dental caries.
9
Q
Essential history, briefly..
A
- Historically dentistry has treated dental decay with a surgical model, drilling the decayed tooth structure away and replacing it with a restorative material. Dental caries has been recognized for over 100 years as a disease that contributes to decay. Early pioneers—G.V. Black, Leon Williams, and others—recognized the relationship of dental plaque to decay.
- Over a period of decades, several bacteria have been identified and connected to the decay process. These bacteria include primarily Streptococcus mutans and Lactobacillus.
Both of these types of bacteria are saccharolytic (metabolize carbohydrates), acidogenic (produce small molecular organic acids from the carbohydrate metabolism), aciduric (survive in acidic or low pH environments, pH ranges that dissolve the calcium and phosphate minerals from the teeth), and cariogenic (contribute to the decay process as a result of these characteristics).
10
Q
Caries risk assessment
A
- Today dental caries necessitates a caries risk assessment with a validated questionnaire to evaluate and correct the modifiable risk factors for an individual patient.
- It necessitates diagnosis of the bacterial infection using bacterial metric testing or culture.
- Finally, it necessitates specific targeted antimicrobial therapy of the biofilm infection to predictably and effectively treat the disease. Simply, preparations and restorations of the cavities, a surgical approach to treating a bacterial infection, does not diagnose or treat the disease and is no longer acceptable as a standard of care.
11
Q
Caries risk assessment
What is it related to?
A
- Caries risk assessment is related to function and esthetics in that “drilling and filling” restorative dentistry has little to do with treating the infection, although it does restore the teeth to function and eliminates pain in the short term.
- For predictable long-term success with regard to function and esthetics in restorative dentistry, the dental caries biofilm disease must be assessed, diagnosed, and treated as the disease process it is.
- Unless this is done, most restorative dentistry is destined to fail with “recurrent decay” (although the disease process is actually left in place). About 70% of all restorative dentistry is the replacement of previous restorations.
12
Q
caries risk assessment
Indications-Contraindications
A
- The goal of caries risk assessment is to identify patients at risk for the disease and treat them before cavities appear.
- Caries risk assessment is indicated and should be performed at least annually on every patient.
- Although a patient may be in a low risk category and not have any signs or symptoms of the disease, risk factors change over time.
- A patient may become at high risk for dental caries at any point of life.
There are no contraindications to caries risk assessment, because all of the benefits outweigh any risks.
- However, there is little benefit to providing caries risk assessment for people who are edentulous, although they may benefit if they also have xerostomia and are experiencing problems. Candida albicans is acidogenic and aciduric and may be a problem for these patients. C. albicans can be treated with pH- elevating or pH-neutralizing products.
13
Q
Treatment strategies
A
- 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:
- First in most treatment considerations are the reparative procedures required to correct the physical damage to the teeth.
- The second strategies are focused on the therapeutic approach to correcting the bacterial biofilm component of the disease.
- The third strategies are behavioral changes to improve the oral environment to favor a healthy biofilm.
14
Q
Treatment strategies
What does each procedure include?
A
- Reparative procedures to correct the physical damage: This includes remineralization of lesions that have not cavitated and still have an intact enamel surface with fluoride and calcium phosphate or hydroxyapatite, plus minimally invasive restorations using biomimetic materials for lesions that have cavitation and decay present.
-
Therapeutic approach to control bacterial biofilm
These procedures include antimicrobial agents, pH corrections, and metabolic agents (xylitol). - Behavioral change for healthier biofilm: Typically this involves oral hygiene instructions for improved home care and plaque control plus dietary counselling.
15
Q
Three strategies to overcome this problem..
A
- Remineralization..
- Minimally invasive restorative procedures.
- Therapeutic caries strategies.
23
Q
icdas
A
26
Q
The correct pathway from the
first visit to finalizing the clinical case
A
