Quintessence Roundup: January

Monthly Special


Contemporary Restoration of Endodontically Treated Teeth: Evidence-Based Diagnosis and Treatment Planning

Edited by Nadim Z. Baba

This much-needed book has a wealth of evidence-based information on all facets of the restoration of pulpless teeth. With a better understanding of the factors that can influence the prognosis of severely compromised teeth, the approach to treating these teeth has evolved, and this text offers a well-balanced, contemporary approach to treatment planning. Traditional principles and techniques are reviewed and reinforced, along with modern materials and methods, all with a firm foundation in the best available scientific evidence and with an emphasis on clinical studies. Many of the chapters provide comprehensive, step-by-step descriptions of technical procedures with accompanying illustrations to guide the reader through every stage of restoring pulpless teeth. Preprosthetic adjunctive procedures, such as surgical crown lengthening, repair of perforations, and orthodontic measures, are also described and illustrated. For years to come, this text will remain a definitive reference for specialists involved in the restoration of pulpless teeth or engaged in planning treatment for structurally compromised teeth.

228 pp; 460 illus; ©2012; ISBN 978-0-86715-571-6 (B5716); US $118 Special price! $39

 

New Titles in Books


Esthetic and Restorative Dentistry: Material Selection and Technique, Third Edition

Douglas A. Terry and Willi Geller

Restorative dentistry has seen dramatic advances in recent years, especially with the use of digital technologies, and this book provides the most up-to-date information on enhanced developments, materials, and techniques that have emerged since the publication of the second edition, offering the reader a completely updated, revised, and newly illustrated overview of modern esthetic and restorative dentistry complete with tutorial videos. New topics include web-based communication with the laboratory, indirect composite chairside CAD/CAM restorations, a comparison of digital and conventional techniques, the resin composite injection technique, as well as updated information on composites and ceramic systems, including esthetic zirconia. New cases illustrate the maintenance of esthetic restorative materials, esthetic contouring, immediate dentin sealing, and novel surgical techniques such as lip repositioning, connective tissue grafting, and ridge preservation with collagen membranes. Dr Terry expanded his team of editorial reviewers to include the best minds in research and clinical practice, and the final product is a testament to his dedication to patient satisfaction and treatment success. The techniques demonstrated in this book will no doubt elevate your practice to the next level.

792 pp; 2,584 illus; ©2018; ISBN 978-0-86715-763-5 (B7635); Available February 2018. Reserve your copy today at our special preorder price! $278

 

Introduction to Metal-Ceramic Technology, Third Edition

W. Patrick Naylor

For 25 years, the Introduction to Metal-Ceramic Technology has been an essential textbook, and this revised edition underscores its import to the discipline. The author expertly outlines the history and theory behind metal-ceramic restorations and then guides readers through each step of the fabrication process. Although many students do not realize the esthetic possibilities of metal-ceramic technology, this book illustrates how to achieve esthetic results to rival those of all-ceramic materials through treatment planning, clinical procedures, and dental laboratory steps executed at their highest levels. New to this edition are an expanded illustrated glossary, a simplified four-step buttonless technique, fresh analysis of bonding mechanisms, and a full chapter on the esthetic porcelain-margin restoration. Written specifically for dental technology students, dental students, and residents in advanced technical courses.

240 pp; 617 illus;  ISBN 978-0-86715-752-9 (B7529); Now available! US $98

Read more about the Introduction to Metal-Ceramic Technology, Third Edition here!

How to Make Metal-Ceramic Technology Look Good and Why You Should Still Be Using It

 

Essentials of Maxillary Sinus Augmentation

Francis Louise and Oana Dragan

Sinus augmentation has become a routine surgical procedure to increase the height of the edentulous atrophied posterior maxilla. Numerous techniques have been developed and perfected, allowing for a high survival rate of implants placed after sinus elevation. This book highlights pertinent anatomical landmarks and uses comprehensive clinical presentations to demonstrate the use of the latest ultrasonic devices for both lateral and crestal approaches as well as to discuss the management of possible complications. The goal of this book is to help clinicians understand each surgival step of the illustrated maxillary sinus augmentation procedures and the evidence-based rationale behind the decision making. The authors have clearly succeeded in their goal and created an up-to-date and accessible resource that every dentist performing sinus augmentation should have on hand for clinical guidance.

128 pp; 360 illus; ISBN 978-1-78698-018-2 (B9101); Now available! US $88

 

RBFDPs: Resin-Bonded Fixed Dental Prostheses

Matthias Kern

Nowadays single-retainer metal-ceramic and all-ceramic resin-bonded fixed dental prostheses (RBFDPs) often present a minimally invasive alternative to single-tooth implants or other conventional prosthetic methods. With a growing body of evidence showing that implants placed in the esthetic zone of younger patients present a high risk of esthetic problems in later years, RBFDPs made from zirconia ceramics are experiencing a great renaissance. This book details the protocols necessary to achieve success when replacing incisors with single-retainer RBFDPs. Although the method is technically sensitive, it is simple and extremely reliable when the correct procedures are implemented. The principles outlined in the text can also be used to replace canines and premolars. Numerous high-quality figures detail the procedures for metal-ceramic and all-ceramic RBFDPs, and case presentations—some with 20 years and more of follow-up—document the development of the success model for RBFDPs. This comprehensive text will benefit practitioners who want to expand their minimally invasive treatment options for esthetic single-tooth replacement.

264 pp; 888 illus; ISBN 978-1-78698-020-5 (B9102); Now available! US $148

Read more about RBFDPs: Resin-Bonded Fixed Dental Prostheses here!

Minimally Invasive Single-Tooth Replacement Without Implants

 

New Issues in Journals


prd_banner

Featured article: Late Dental Implant Failures Associated with Retained Root Fragments: Case Reports with Histologic and SEM Analysis
Marc L. Nevins, Laureen Langer, and Peter Schupbach

Immediate Placement of Ultrawide-Diameter Implants in Molar Sockets: Description of a Recommended Technique
André C. Hattingh, Hugo De Bruyn, Andrew Ackermann, and Stefan Vandeweghe

Coronally Advanced Flap with Site-Specific Application of Connective Tissue Graft for the Treatment of Multiple Adjacent Gingival Recessions: A 3-Year Follow-Up Case Series
Martina Stefanini, Giovanni Zucchelli, Matteo Marzadori, and Massimo de Sanctis

ijp_banner

Two-Implant–Supported Mandibular Overdentures: Do Clinical Denture Quality and Inter-Implant Distance Affect Patient Satisfaction?
Sara A. Alfadda, Mohammad D. Al Amri, Amal Al-Ohali, Arwa Al-Hakami, and Noura Al-Madhi

Preload, Coefficient of Friction, and Thread Friction in an Implant-Abutment-Screw Complex
Stefan Wentaschek, Sven Tomalla, Irene Schmidtmann, and Karl Martin Lehmann

Comparative Evaluation of a Four-Implant–Supported Polyetherketoneketone Framework Prosthesis: A Three-Dimensional Finite Element Analysis Based on Cone Beam Computed Tomography and Computer-Aided Design
Ki-Sun Lee, Sang-Wan Shin, Sang-Pyo Lee, Jong-Eun Kim, Jee-Hwan Kim, and Jeong-Yol Lee

jomi_banner

Featured Article: Implant Mandibular Overdentures Retained by Immediately Loaded Implants: A 1-Year Randomized Trial Comparing the Clinical and Radiographic Outcomes Between Mini Dental Implants and Standard-Sized Implants
Kostas Zygogiannis, Irene H.A. Aartman, Azin Parsa, Ali Tahmaseb, and Daniel Wismeijer

Thematic Abstract Review: The Lucky Fibula
Martin Osswald

Evaluating Maxillary Sinus Septa Using Cone Beam Computed Tomography: Is There a Difference in Frequency and Type Between the Dentate and Edentulous Posterior Maxilla?
Martina Schriber, Thomas von Arx, Pedram Sendi, Reinhilde Jacobs, Valerie G.A. Suter, and Michael M. Bornstein

banner_ofph

Interaction Between Awake and Sleep Bruxism Is Associated with Increased Presence of Painful Temporomandibular Disorder
Daniel R. Reissmann, Mike T. John, Annette Aigner, Gerhard Schön, Ira Sierwald, and Eric L. Schiffman

Subjective Sleep Quality in Temporomandibular Disorder Patients and Association with Disease Characteristics and Oral Health–Related Quality of Life
Rafael Benoliel, Avraham Zini, Avraham Zakuto, Hulio Slutzky, Yaron Haviv, Yair Sharav, and Galit Almoznino

Systematic Mapping of Pressure Pain Thresholds of the Masseter and Temporalis Muscles and Assessment of Their Diversity Through the Novel Application of Entropy
Ana M. Álvarez-Méndez, Fernando G. Exposto, Eduardo E. Castrillon, and Peter Svensson

Dental Meetings Quintessence Will Attend in January


GNYAP Meeting: Booth #9
hosted by the Greater New York Academy of Prosthodontics, January 5–6 in New York, New York

Seattle Study Club 25th Anniversary Symposium
hosted by the Seattle Study Club, January 15–20 in La Quinta, California

Rocky Mountain Dental Convention: Booth #452
hosted by the Metro Denver Dental Society, January 18–20 in Denver, Colorado

Yankee Dental Congress: Booth #1003
hosted by the Massachusetts Dental Society, January 25–27 in Boston, Massachusetts

USC 43rd Annual International Periodontal and Implant Symposium
hosted by the Herman Ostrow School of Dentistry of USC, January 26–27 in Los Angeles, California

 

Upcoming Quintessence Events


Posted in Books, Roundup, Special Offer, What's New | Tagged , , , , , | Leave a comment

Showing Gratitude: The Value of Support Staff in Dentistry

Whether in clinical practice or research and education, every great dentist is held up by great support staff. While not often in the spotlight, these individuals represent the oil that keeps the gears of the dental industry turning smoothly. Quintessence Publishing recognizes the value these men and women bring to our industry, so we’re giving our authors the opportunity to share what value their support staff contributes—and to imagine what dentistry would look like without them.


Brooke Blicher, DMD
Coauthor of Endodontics Review: A Study Guide (Quintessence, 2016)

“Our team is incredibly valuable. As the face of our practice, they have much more direct interaction with our patients than the doctors. Their enthusiasm and positive attitudes are what make our patients feel comfortable and assured that they will be well taken care of every step of the way. Without them, my practice could not offer the exceptional care that we do. Just today, my staff spent countless hours behind the scenes getting our malfunctioning software back up and running. Without that, I would not have been able to treat any patients at all! Because of their efforts, I barely knew there was an issue, and my patients were clueless. My team is constantly doing things like this to keep the practice running smoothly. The absence of my team and the incredible support they provide to their colleagues and our patients would result in a clunky system of bumbling doctors trying to make sense of too many areas that are not our expertise!

“I am so grateful to get to work every day with such an incredible group of smart, talented, and passionate colleagues who share my vision of providing exceptional endodontic care. Their engagement in our office and with the patients that we treat makes coming to work a joy and takes (almost!) all the stress out of treating patients in pain. Without my team I’d be toast!”

Practice info:
Upper Valley Endodontics
205 Billings Farm Road, Suite 6A
White River Junction, Vermont 05001

 

Robert E. Marx, DDS
Author of Oral Pathology in Clinical Dental Practice (Quintessence, 2017) and Oral and Intravenous Bisphosphonate–Induced Osteonecrosis of the Jaws: History, Etiology, Prevention, and Treatment, Second Edition (Quintessence, 2011); coauthor of Oral and Maxillofacial Pathology: A Rationale for Diagnosis and Treatment, Second Edition (Quintessence, 2012) and Atlas of Oral and Extraoral Bone Harvesting (Quintessence, 2009)

“My support staff consists of a nurse coordinator, four dental assistants, and my secretary, Maria. Their value is so great I cannot even express it completely. Some of it is referral letters, calling and talking to patients, taking radiographs and CBCT scans, putting up with over-bureaucracy in both the medical and dental industries, and more—not to mention the tortuous insurance game that must be played. My practice would fold if not for them. In a way they are more important than me. Their absence would diminish the quantity and quality of our care here at a major academic institution. If they were not here, I would be out fishing every day instead of working.

“To all of my staff: You already know how much I appreciate not only your work but also your creation of a friendly and familial atmosphere in the workplace. Thank you.”

Academic affiliation:
Division of Oral and Maxillofacial Surgery
Miller School of Medicine
University of Miami
Miami, Florida

 

George A. Zarb, MS, DDS, MS, PhD, DSc, MD
Editor-in-Chief of The International Journal of Prosthodontics

“In addition to my academic work, my staff has supported my Quintessence-related activities, which have spanned several decades and involved books, journals, and symposia. The value of my support staff in all of these endeavors can be summed up with one word: invaluable. My work’s impact results from diverse levels of partnership. Flying solo would be disastrous, and the effectiveness of my educational mandate would be significantly compromised.

“To my staff I would say this: Please do not change. Your integrity of commitment and warm camaraderie are indispensable.”

Academic affiliation:
Faculty of Dentistry
University of Toronto
Toronto, Ontario

 

Douglas A. Terry, DDS
Author of Restoring with Flowables (Quintessence, 2016), Smile! Your Guide to Esthetic Dental Treatment (Quintessence, 2014), What’s in Your Mouth? Your Guide to a Lifelong Smile (Quintessence, 2014), and What’s in Your Mouth? What’s in Your Child’s Mouth? (Quintessence, 2013); coauthor of Esthetic and Restorative Dentistry: Material Selection and Technique, Third Edition (Quintessence, 2018)

“We call our team the A-team, and their participation in the interdisciplinary process is of utmost importance in sustaining the correct sequence of events. Many interdisciplinary offices can put the cart before the horse, leading to an improper sequence and wasted time during treatment planning as well as restorative and surgical treatment. Our team reinforces our practice’s core values during every interaction with every patient: to prevent the need for that first restoration or surgical procedure, to preserve hard and soft tissue during any operative or surgical procedure, and to increase the longevity of a given restoration or surgical procedure. We consider the patient to be part of our A-team, and my staff helps integrate them into our team so that they can be part of the restorative solution.

“Without my staff, there would be no coordination between the interdisciplinary team and the patient. Additionally, the patients would not receive the necessary instruction and reinforcement for optimal oral health. The quality of care would diminish, and this would be reflected in the value of the patients’ oral care. So, to both my patients and my staff, I would like to say this: Thank you for making this journey not a job, but a lifestyle.”

Practice info:
Institute of Esthetics and Restorative Dentistry
12050 Beamer Road
Houston, Texas 77089

 

John A. Khademi, DDS, MS
Author of Advanced CBCT for Endodontics: Technical Considerations, Perception, and Decision-Making (Quintessence, 2017)

“The most important value my staff brings to my practice is trust. I trust my staff to insulate me from all of the tasks required to really run the office. They are the friendly faces who represent our office. They manage the appointment schedule, record keeping, radiography, and report generation. There are many aspects of running the practice that I don’t actually know how to do anymore, and they do all of these things quickly, accurately, and better than I would be able to do. My chairsides are also intimately involved in treatment—we practice using a microscope 100% of the time, and my chairsides stand at the microscope as well.

“I trust that my staff will always act in the best interests of our patients and our practice. This year, that trust became even more important to me because of the distractions of a busy travel schedule and writing a book. My staff has covered for me and put up with their absentminded and sometimes grumpy boss, which is why they are included in the dedication of my book.

“Ana, Amelia, Ashlee, and Jen: You are the best team I have ever had. We are busier now than we have ever been, and you have stepped up to the plate day after day and delivered. You never complain about staying late to fit in emergency patients or about the volume of work that needs to get done every day. When I walk into the room, you’re ready, the patient is ready, and if I’m not ready, you’re so on the ball that you get me ready! Thank you for always trying to do what I want, regardless of what I actually say.”

Practice info:
Four Corners Endodontics
1570 E 2nd Avenue
Durango, Colorado 81301

 

Matthew Mizukawa, DDS
Coeditor of Anesthesia Considerations for the Oral and Maxillofacial Surgeon (Quintessence, 2017)

“Having a knowledgeable, well-trained support staff is invaluable, and treating patients from day to day would be impossible without them. Without adequate, competent staff by my side, the patient’s safety would largely be jeopardized—from both a surgical standpoint and especially from an anesthesia standpoint, as the staff monitors and maintains the patient’s safety during surgery.

“The support staff in my office is incredible, and I want to publicly express my gratitude to them. Whatever capacity they work in, they are all vital components to the overall practice. They make the patient experience: They are with the patient from the moment they walk in the door all the way through the procedure and recovery. They are the ones who discuss sensitive financial information with the patient, and they act with professionalism at every step. They come to work day in and day out—and sometimes afterhours for emergencies—and continue to put forth their best effort for me, my partner, and more importantly for our patients. They truly make it a pleasure to come to work.”

Practice info:
Dixie Oral Maxillofacial & Implant Surgery
1308 East 900 South, Suite A
St. George, Utah 84790

 

Richard Rubinstein, DDS, MS, FACD
Coauthor of The Art and Science of Contemporary Surgical Endodontics (Quintessence, 2017) and Practical Lessons in Endodontic Surgery (Quintessence, 1998)

“I have been practicing endodontics for 42 years, first in a solo practice and later in a large group practice. I have been blessed with an office manager, Jan Betts, who has been by my side from the very beginning. It would be fair to say she runs my professional life. My two senior assistants, Stacy Hammonds and Jenny McDonough, have been with me for 22 and 18 years, respectively. They are right there with me when I travel to give hands-on courses. I am only as good as my assistants, and without my staff I would be lost. Through the years I have been quite successful in helping them to develop into mini-endodontists, and we are always learning together in order to deliver the best results possible for our patients. Whether we are performing conventional endodontics or microsurgery, they assist and observe the field through assistant binoculars. We truly work as a team, and every day when I leave the office the last thing I say to them is ‘thank you.’ They are more than just my staff—they are lifelong professional colleagues and friends.”

Practice info:
Endodontic Associates
Farmington Hills—West Bloomfield
31410 Northwestern Highway, Suite C
Farmington Hills, Michigan 48334


Quintessence readers: What value does your support staff bring? What would your practice or academic work look like without them, and how would their absence affect the quality of care and education you are able to provide? Share this article with your staff and include some words of your own for them!

“Gratitude can transform common days into thanksgivings, turn routine jobs into joy and change ordinary opportunities into blessings.”

William Arthur Ward


Books for Your Practice

 

Posted in Books, Endodontics, Esthetic Dentistry, Feature, Implant Dentistry, Journals, Misc, Multidisciplinary, Oral and Maxillofacial Surgery, Practice Management, Prosthodontics, Restorative Dentistry, The International Journal of Prosthodontics | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Quintessence Roundup: December

Quintessence 2017 Catalog

Monthly Special


Early-Age Orthodontic Treatment

Aliakbar Bahreman

This book presents readers with the information necessary to understand the morphogenesis of orthodontic problems, to differentiate among various conditions, and to apply early intervention approaches to optimal effect. Through integration of basic science and clinical practice, detailed case reports, and abundant illustrations, the author provides an overview of dental development, from tooth formation to permanent occlusion; emphasizes the developmental stages that must be recognized during patient examination to facilitate differential diagnosis; presents clear, step-by-step instructions for different treatment options; and demonstrates the benefits achieved by intervention in developing malocclusions and guidance of eruption. The discussions in part 1 of the concept of early-age treatment and the basic foundation of occlusal development empower practitioners to detect anomalies and intervene as necessary. Part 2 consists of chapters explaining the ontogeny, diagnosis, and early detection of, as well as the proper intervention for, nonskeletal problems. Part 3 includes chapters on early intervention for dentoskeletal problems in the sagittal, transverse, and vertical dimensions. This book cuts through the controversy surrounding early versus late treatment and shows that clinicians must decide on a case-by-case basis when to provide orthodontic treatment.

436 pp; 1,534 illus; ©2013; ISBN 978-0-86715-566-2 (B5662); US $142 Special price! US $46

 

New Titles in Books


Esthetic and Restorative Dentistry: Material Selection and Technique, Third Edition

Douglas A. Terry and Willi Geller

Restorative dentistry has seen dramatic advances in recent years, especially with the use of digital technologies, and this book provides the most up-to-date information on enhanced developments, materials, and techniques that have emerged since the publication of the second edition, offering the reader a completely updated, revised, and newly illustrated overview of modern esthetic and restorative dentistry complete with tutorial videos. New topics include web-based communication with the laboratory, indirect composite chairside CAD/CAM restorations, a comparison of digital and conventional techniques, the resin composite injection technique, as well as updated information on composites and ceramic systems, including esthetic zirconia. New cases illustrate the maintenance of esthetic restorative materials, esthetic contouring, immediate dentin sealing, and novel surgical techniques such as lip repositioning, connective tissue grafting, and ridge preservation with collagen membranes. Dr Terry expanded his team of editorial reviewers to include the best minds in research and clinical practice, and the final product is a testament to his dedication to patient satisfaction and treatment success. The techniques demonstrated in this book will no doubt elevate your practice to the next level.

792 pp; 2,584 illus; ©2018; ISBN 978-0-86715-763-5 (B7635); Available February 2018. Reserve your copy today at our special preorder price! $278

 

Introduction to Metal-Ceramic Technology, Third Edition

W. Patrick Naylor

For 25 years, the Introduction to Metal-Ceramic Technology has been an essential textbook, and this revised edition underscores its import to the discipline. The author expertly outlines the history and theory behind metal-ceramic restorations and then guides readers through each step of the fabrication process. Although many students do not realize the esthetic possibilities of metal-ceramic technology, this book illustrates how to achieve esthetic results to rival those of all-ceramic materials through treatment planning, clinical procedures, and dental laboratory steps executed at their highest levels. New to this edition are an expanded illustrated glossary, a simplified four-step buttonless technique, fresh analysis of bonding mechanisms, and a full chapter on the esthetic porcelain-margin restoration. Written specifically for dental technology students, dental students, and residents in advanced technical courses.

240 pp; 617 illus;  ISBN 978-0-86715-752-9 (B7529); Now available! US $98

Read more about the Introduction to Metal-Ceramic Technology, Third Edition here!

How to Make Metal-Ceramic Technology Look Good and Why You Should Still Be Using It

 

Essentials of Maxillary Sinus Augmentation

Francis Louise and Oana Dragan

Sinus augmentation has become a routine surgical procedure to increase the height of the edentulous atrophied posterior maxilla. Numerous techniques have been developed and perfected, allowing for a high survival rate of implants placed after sinus elevation. This book highlights pertinent anatomical landmarks and uses comprehensive clinical presentations to demonstrate the use of the latest ultrasonic devices for both lateral and crestal approaches as well as to discuss the management of possible complications. The goal of this book is to help clinicians understand each surgival step of the illustrated maxillary sinus augmentation procedures and the evidence-based rationale behind the decision making. The authors have clearly succeeded in their goal and created an up-to-date and accessible resource that every dentist performing sinus augmentation should have on hand for clinical guidance.

128 pp; 360 illus; ISBN 978-1-78698-018-2 (B9101); Now available! US $88

 

RBFDPs: Resin-Bonded Fixed Dental Prostheses

Matthias Kern

Nowadays single-retainer metal-ceramic and all-ceramic resin-bonded fixed dental prostheses (RBFDPs) often present a minimally invasive alternative to single-tooth implants or other conventional prosthetic methods. With a growing body of evidence showing that implants placed in the esthetic zone of younger patients present a high risk of esthetic problems in later years, RBFDPs made from zirconia ceramics are experiencing a great renaissance. This book details the protocols necessary to achieve success when replacing incisors with single-retainer RBFDPs. Although the method is technically sensitive, it is simple and extremely reliable when the correct procedures are implemented. The principles outlined in the text can also be used to replace canines and premolars. Numerous high-quality figures detail the procedures for metal-ceramic and all-ceramic RBFDPs, and case presentations—some with 20 years and more of follow-up—document the development of the success model for RBFDPs. This comprehensive text will benefit practitioners who want to expand their minimally invasive treatment options for esthetic single-tooth replacement.

264 pp; 888 illus; ISBN 978-1-78698-020-5 (B9102); Now available! US $148

Read more about RBFDPs: Resin-Bonded Fixed Dental Prostheses here!

Minimally Invasive Single-Tooth Replacement Without Implants

 

New Issues in Journals


prd_banner

Featured article: Reconstruction of Atrophied Posterior Mandible with an Inlay Technique and Allograft Block: Technical Description and Histologic Case Reports
Vittorio Checchi, Annalisa Mazzoni, Giovanni Zucchelli, Lorenzo Breschi, and Pietro Felice

The Management of Peri-implant Mucosa Deficiencies in Esthetic Sites: Case Report of a Combined Surgical-Prosthetic Approach
Karolina Jurczyk, Urs C. Belser, and Anton Sculean

Socket Shield Technique for Implant Placement in the Esthetic Zone: A Case Report
Matthias Petsch, Benedikt Spies, and Ralf-Joachim Kohal

ijp_banner

Two-Implant–Supported Mandibular Overdentures: Do Clinical Denture Quality and Inter-Implant Distance Affect Patient Satisfaction?
Sara A. Alfadda, Mohammad D. Al Amri, Amal Al-Ohali, Arwa Al-Hakami, and Noura Al-Madhi

Preload, Coefficient of Friction, and Thread Friction in an Implant-Abutment-Screw Complex
Stefan Wentaschek, Sven Tomalla, Irene Schmidtmann, and Karl Martin Lehmann

Comparative Evaluation of a Four-Implant–Supported Polyetherketoneketone Framework Prosthesis: A Three-Dimensional Finite Element Analysis Based on Cone Beam Computed Tomography and Computer-Aided Design
Ki-Sun Lee, Sang-Wan Shin, Sang-Pyo Lee, Jong-Eun Kim, Jee-Hwan Kim, and Jeong-Yol Lee

jomi_banner

Featured Article: Implant Mandibular Overdentures Retained by Immediately Loaded Implants: A 1-Year Randomized Trial Comparing the Clinical and Radiographic Outcomes Between Mini Dental Implants and Standard-Sized Implants
Kostas Zygogiannis, Irene H.A. Aartman, Azin Parsa, Ali Tahmaseb, and Daniel Wismeijer

Thematic Abstract Review: The Lucky Fibula
Martin Osswald

Evaluating Maxillary Sinus Septa Using Cone Beam Computed Tomography: Is There a Difference in Frequency and Type Between the Dentate and Edentulous Posterior Maxilla?
Martina Schriber, Thomas von Arx, Pedram Sendi, Reinhilde Jacobs, Valerie G.A. Suter, and Michael M. Bornstein

banner_ofph

Interaction Between Awake and Sleep Bruxism Is Associated with Increased Presence of Painful Temporomandibular Disorder
Daniel R. Reissmann, Mike T. John, Annette Aigner, Gerhard Schön, Ira Sierwald, and Eric L. Schiffman

Subjective Sleep Quality in Temporomandibular Disorder Patients and Association with Disease Characteristics and Oral Health–Related Quality of Life
Rafael Benoliel, Avraham Zini, Avraham Zakuto, Hulio Slutzky, Yaron Haviv, Yair Sharav, and Galit Almoznino

Systematic Mapping of Pressure Pain Thresholds of the Masseter and Temporalis Muscles and Assessment of Their Diversity Through the Novel Application of Entropy
Ana M. Álvarez-Méndez, Fernando G. Exposto, Eduardo E. Castrillon, and Peter Svensson

Dental Meetings Quintessence Will Attend in December


AAOMS Dental Implant Conference: Booth #202
hosted by the American Association of Oral and Maxillofacial Surgeons, November 30–December 1 in Chicago, Illinois

 

Upcoming Quintessence Events


Posted in Books, Dental Technology, Esthetic Dentistry, Feature, Implant Dentistry, Journal of Oral & Facial Pain and Headache, Journals, Misc, Multidisciplinary, Occlusion & TMD, Oral and Maxillofacial Surgery, Orthodontics, Periodontics, Promotions, Prosthodontics, Research, Restorative Dentistry, Roundup, Special Offer, The International Journal of Oral & Maxillofacial Implants, The International Journal of Periodontics & Restorative Dentistry, The International Journal of Prosthodontics, What's New | Tagged , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Minimally Invasive Single-Tooth Replacement Without Implants

The following was published in Volume 30, Issue 5 of The International Journal of Prosthodontics.


Editorial: A Provocative New Text

George A. Zarb, Editor-in-Chief

My dental education exposed me to several assertively proposed clinical rituals, professional rites of passage that would guarantee excellence of my technical performance and optimal treatment outcomes, even if the scientific backing could be far from compelling. It took a few years of independent clinical practice and coping with my career’s teaching responsibilities to recognize that a great deal of what I had learned—and indeed, subsequently taught—lacked an ecological intraoral context; and that treating an absent or missing single anterior tooth with a fixed three-unit prosthesis ignored the plain fact that enamel is not a renewable resource. The operational rationale was that while time-dependent concerns regarding pulpal and gingival responses to the recruited abutment teeth were not readily predictable, one could always revise the original treatment as needed.

The arrival of the adhesive dentistry era provided an exciting scope for alternative and more ecologically prudent ways to restore teeth and facilitate provision of replacements. However, osseointegration and its apparent ease at providing a tooth root analog quickly eclipsed serious reliance on the adhesive approach. This preprosthetic surgical intervention rapidly embraced by sister specialty groups was enthusiastically advanced as a quasi-panacea, irrespective of the fact that proposed host bone sites were not always ideal candidates for implant location. Numerous ingenious techniques were developed to go on justifying routine implant management, even in young patients whose age-determined morphologic features needed thorough consideration. It became clear that a populist assignment of implant management to the top of a hierarchical treatment list for the missing single tooth was misleading, and that a far more measured and ultimately prudent way of offering patients a best treatment choice, especially in an age-dependent context, was required.

Matthias Kern has undertaken this challenge very convincingly in his new text, and the Journal is pleased to offer this Invited Commentary to describe why he wrote his book.


Invited Commentary: Minimally Invasive Single-Tooth Replacement Without Implants—A True Alternative?

Matthias Kern

Resin-bonded fixed dental prostheses (RBFDPs) were introduced in the early 1970s. Researchers at the University of Maryland redefined aspects of restoration design, and their described “Maryland bridge” quickly gained popularity. Regardless, RBFDPs never became a standard treatment procedure in general dental care, and their ongoing development was curtailed by the potential and versatility of the osseointegration technique.

RBFDPs are considered by most dentists as long-term provisional restorations placed until a single-implant restoration can be provided. However, there is now a growing body of evidence that single implants inserted for single-tooth replacement in the esthetic zone often result in esthetic problems in later years. Although orthodontic literature has long underscored the fact that craniofacial growth continues during adulthood, it appears that morphologic consequences have often been ignored when placing single implants in the esthetic zone. This oversight might be due partially to the perception of many dentists that true long-term and lasting alternative treatment options were missing when adjacent teeth were caries free and should not be cut down for crowns to retain a conventional fixed dental prosthesis. Osseointegrated implants behave like ankylosed teeth roots, and after some years with craniofacial growth and eruption of the anterior teeth, the implants end up as infra-positioned. While the incisal edge might be adapted by providing a new crown, the gingival position of the implant-retained crown will show adverse change, especially in patients with a high lip line. Regrettably, repositioning the now vertically malpositioned implant is possible only to a very limited extent.

Therefore, in the light of recently published clinical studies revealing excellent long-term outcomes of single-retainer RBFDPs, which compare well with the success and survival rates of single-tooth implants in the esthetic zone, the standard of care for the replacement of missing incisors in the esthetic zone should be reconsidered. In RBFDPs, the pontic “erupts” together with its abutment tooth, and no incisal infrapositioning will occur, even over the course of decades. In addition, the popular view that replacing single teeth with implants will result in better preservation of bone and soft tissue than the use of (RB)FDPs is questioned by clinical observations showing no clinically relevant tissue resorption beneath pontics, even after many years. Recently published clinical studies using digital measuring techniques over 5 and 10 years confirm these results.

RBFDP cases treated and clinically observed by the author for more than two decades are presented in the book RBFDPs: Resin-Bonded Fixed Dental Prostheses—Minimally Invasive—Esthetic—Reliable. These numerous case histories reveal that when using an adequately designed ovate pontic with a concave soft tissue contact area, no clinically relevant tissue resorption occurs in the area beneath the pontic for up to 20 years. It might be speculated that an adequately designed pontic is able to transfer some physiologic stimulation to the edentulous ridge through its basal contact area, which results in its long-term preservation.

The author’s clinical experience over the past two decades indicates that a rarely encountered adverse event for a single-retainer, all-ceramic RBFDP is fracture or debonding. In case of the first complication, the RBFDP must be renewed; in the second, the RBFDP can be rebonded. Long-term complications of single-tooth implants are much more severe and include vertical malpositioning, recession of the soft tissue, gingivitis with or without marginal bone resorption, and implant fracture. Consequently, the preference for the use of implants over RBFDPs by most dentists is difficult to understand, given the clear ecological advantages of the latter’s protocol and treatment outcomes.

The question must be posed—why are single-retainer RBFDPs still not used as standard of care when indication(s) are explicit? One reason seems to be the technique sensitivity of bonding methods and associated bad experiences of many dentists. Moreover, there are still clinical rumors that bonding zirconia ceramic would not be reliable. As a series of surveys in Northern Germany showed, there is still a considerable lack of knowledge when it comes to understanding the principles of reliable ceramic bonding among dental practitioners. However, these principles are already well known and have been con rmed in various clinical studies with nonretentive RBFDPs. The most recent clinical study on zirconia ceramic single-retainer RBFDPs showed a survival rate of 98.2% after 10 years. Overall, 8.0% of the RBFDPs debonded, but it must be kept in mind that they could always be rebonded.

It might be time to reconsider the standard of care for single-tooth replacement of incisors in the esthetic zone. Zirconia ceramic single-retainer RBFDPs are not only minimally invasive and esthetic, but also very reliable—and they do not bear the long-term risks of anterior implant protocols. A compelling concern now is whether the profession is prepared to reconsider the best way to replace the missing single tooth.

Recommended Reading

Bienz SP, Sailer I, Sanz-Martín I, Jung RE, Hämmerle CH, Thoma DS. Volumetric changes at pontic sites with or without soft tissue grafting. A controlled clinical study with a 10-year follow-up. J Clin Periodontol 2017;44:178–184.

Botelho MG, Chan AW, Leung NC, Lam WY. Long-term evaluation of cantilevered versus fixed-fixed resin-bonded fixed partial dentures for missing maxillary incisors. J Dent 2016;45:59–66.

Kern M. Fifteen-year survival of anterior all-ceramic cantilever resin-bonded fixed dental prostheses. J Dent 2017;56:133–135.

Kern M. Resin bonding to oxide ceramics for dental restorations. J Adhes Sci Technol 2009;23:1097–1111.

Kern M, Passia N, Sasse M, Yazigi C. Ten-year outcome of zirconia ceramic cantilever resin-bonded fixed dental prostheses and the influence of the reasons for missing incisors [epub ahead of print 5 July 2017]. J Dent doi: 10.1016/j.jdent.2017.07.003.

Klosa K, Meyer G, Kern M. Clinically used adhesive ceramic bonding methods: A survey in 2007, 2011, and in 2015. Clin Oral Investig 2016;20:1691–1698.


RBFDPs: Resin-Bonded Fixed Dental Prostheses

Matthias Kern

Nowadays single-retainer metal-ceramic and all-ceramic resin-bonded fixed dental prostheses (RBFDPs) often present a minimally invasive alternative to single-tooth implants or other conventional prosthetic methods. With a growing body of evidence showing that implants placed in the esthetic zone of younger patients present a high risk of esthetic problems in later years, RBFDPs made from zirconia ceramics are experiencing a great renaissance. This book details the protocols necessary to achieve success when replacing incisors with single-retainer RBFDPs. Although the method is technically sensitive, it is simple and extremely reliable when the correct procedures are implemented. The principles outlined in the text can also be used to replace canines and premolars. Numerous high-quality figures detail the procedures for metal-ceramic and all-ceramic RBFDPs, and case presentations—some with 20 years and more of follow-up—document the development of the success model for RBFDPs. This comprehensive text will benefit practitioners who want to expand their minimally invasive treatment options for esthetic single-tooth replacement.

264 pp; 888 illus; ISBN 978-1-78698-020-5 (B9102); Available now! US $148

Posted in Books, Implant Dentistry, Misc, Prosthodontics, The International Journal of Prosthodontics, What's New | Tagged , , , , , , , | 1 Comment

How to Make Metal-Ceramic Technology Look Good and Why You Should Still Be Using It

Metal-ceramic restorations have long represented a reliable tooth-replacement option; however, they have begun to fall out of favor as all-ceramics systems have improved by leaps and bounds and patients continue to request tooth-colored restorative materials. As these changes have occurred within the industry, some clinicians are questioning the continued relevance of metal-ceramic technology and whether it is compatible with the current demand for esthetics. But according to prosthodontists W. Patrick Naylor and Charles J. Goodacre and master dental technician Satoshi Sakamoto, esthetics and metal-ceramic restorations can be a perfect fit.

Material Choice: A Generational Shift

Even as the dental industry’s overall preference shifts toward all-ceramic restorations, metal-ceramic restorations still occupy a significant niche within restorative dentistry: posterior restorations. According to a 2016 study on material selection for single-unit crowns, clinicians were almost equally likely to restore a first molar with an all-zirconia restoration as with a metal-ceramic restoration. This study also cautioned that “decisions for crown material may be influenced by factors unrelated to tooth and patient variables” and that clinicians should be cognizant of these factors. Perhaps most strikingly, one of the indirect factors significantly influencing material choice was how recently a clinician had graduated, with newer clinicians preferring all-ceramic over metal-ceramic.

Dr Naylor, author of the Introduction to Metal-Ceramic Technology (Quintessence, 2018), explains this shift: “Once these recent graduates get out of dental school, they get bombarded with literature and advertising promoting these inexpensive all-ceramic materials. Metal-ceramics are still a part of dental education but not the way they used to be. One of the biggest changes is that dental students and even graduate dentists in advanced training programs are receiving less and less technical training in the fabrication process for metal-ceramic restorations. More procedures are given to the laboratory to perform, whereas historically those procedures were taught to and performed by dentists. The theory now is that the clinician does the clinical work, and the laboratory technician does the laboratory work—but unless you’ve gone through the process of fabricating a metal-ceramic restoration, you really don’t have the same depth of knowledge and insight as someone who has. You haven’t seen how the technical work is affected when you underprepare a tooth or don’t provide two-plane reduction, or how the esthetic result is compromised when you only take off one millimeter of tooth structure on the occlusal surface and now can’t create secondary anatomy because there’s no depth. Because of the educational deficits, newer clinicians don’t have that experience in the laboratory that they can call upon in the clinic.”

“And that’s a handicap for them,” Dr Goodacre adds. “If you’ve never made something, you don’t know what someone else is going to need to make it.”

Mr Sakamoto, who works with Dr Goodacre at the Loma Linda University School of Dentistry, commiserates: “I work with many dentists who send me impressions, bite records, and shade and facial information. Almost none of them send perfect information. But Dr Goodacre actually knows how to make a crown, so he knows what I need in order to do my job well.”

(left) By any measure, the metal-ceramic restoration on the maxillary left central incisor was not treatment planned properly or executed well clinically. The dental laboratory outcome was also flawed in many respects: shade, length, outline form, surface texture, and level of glaze. Outcomes such as this warrant criticism of metal-ceramic restorations. Take a moment to critique this restoration, and note what changes should be made when replacing this crown. (right) Thanks to retreatment with proper treatment planning, improved execution of clinical procedures, and a high-quality laboratory outcome, the restoration on the maxillary left central incisor now blends well with the adjacent natural tooth. This is a metal-ceramic crown with a porcelain margin. (Courtesy of Dr Charles Goodacre and Mr Satoshi Sakamoto.)

“Most dentists today haven’t made many crowns,” Dr Goodacre emphasizes. “I’m from the old school where we made a lot of them, and I made hundreds for myself in the early years of practicing. Of course, I could never make them look as good as Satoshi does, but I did learn what was important in terms of tooth preparation and the records you need to make. I was shocked when I read a recent JADA article where they went to different laboratories and looked at 1,157 different impressions to determine whether they were adequate or not; 86% of those impressions had at least one detectable error, and 55% of those were critical errors related to the finish line. The impression is a really key portion of the fabrication process because you rely on the impression to get a good fit, and fit is a difficult thing to achieve.”

But with the changing landscape of education and material preference in dentistry, should newer generations even continue with metal-ceramics? Drs Naylor and Goodacre think they should.

“A lot of people have turned to all-ceramics because it’s simpler in some respects and it’s inexpensive compared with metal-ceramics,” Dr Naylor explains. “But if you talk to the people who are doing a lot of high-quality dentistry, they’re still using metal-ceramics.”

“In over 45 years of practice,” Dr Goodacre adds, “I have seen limited complications with metal-ceramic restorations. We have nowhere near that track record so far with all-ceramic systems—we don’t even have 20 years of data yet.”

“In metal-ceramics, we have a number of very high-quality alloys with very predictable behavior,” Dr Naylor says, “and technicians generally have a porcelain system they like to use for each metal alloy and have perfected the application process. And the restorations last for years if not decades. I’m not the only one doing this, and Dr Goodacre and Mr Sakamoto aren’t either. Dr Irena Sailer has some metal-ceramic restorations in Color in Dentistry (Quintessence, 2017). There are a lot of good clinicians doing metal-ceramics and doing them well.”

Drs Naylor and Goodacre stress that neither all-ceramic nor metal-ceramic is perfect for every situation. “The main disadvantage of a metal-ceramic crown is that light doesn’t pass all the way through it,” Dr Goodacre explains. “You have the metal substructure, which you have to block out with opaque porcelain. So all-ceramic has the advantage when you have a tooth that is very thin or translucent. If the color of the dentin is normal, then that color will pass through an all-ceramic crown and give you an optimal esthetic result. But that opaqueness can be an advantage in other situations. If the tooth is discolored, you’ll have a better result with a metal-ceramic crown than you would with all-ceramic because that dark discoloration will show through the all-ceramic.”

In Color in Dentistry, the authors describe a case involving the replacement of two crowns on both the patient’s maxillary central incisors where the left tooth was nonvital and discolored and the right was vital and nondiscolored. Complicating the treatment planning and material selection was the patient’s insistence on all-ceramic restorations rather than metal-ceramic—the two original 20- to 30-year-old metal-ceramic crowns were opaque and not natural-looking, not to mention unsuccessful at masking the cervical discoloration of the tooth root. However, even after placing opaque zirconia frameworks, the technician was not able to fully mask the discolored left central incisor. Luckily, the technician had also made a pair of metal-ceramic crowns that the team compared at try-in, and the patient ended up agreeing with the team that the metal-ceramic crowns were better after all. The metal-ceramic crowns allowed the technician to start with the same gray framework color on both teeth, while also allowing for a thinner framework with a stronger value of opacity and larger ceramic shoulders to better reflect the veneering ceramic. (Case rehabilitation performed in collaboration with Walter Gebhardt, DT.)

“Most clinicians will have a conversation with the patient and explain which material they think is best for each clinical situation,” Dr Naylor says. “The problem is that there are some clinicians who feel all-ceramic is appropriate for every situation. They’ve got the system in their office so they try to adjust their cases to use that material wherever possible. But a good clinician will choose the type of restoration for each patient based on what they feel is appropriate functionally and will also meet the esthetic expectations of the patient. Different patients have different priorities. Material choice is an individual decision that has to be achieved through a very enlightening conversation between the patient and the clinician, and good clinicians will have an armamentarium and select different types of restorations for different patients. It’s complex, and there are no simple answers.”

So how do we maintain this technology? To solve the education dilemma, we don’t necessarily have to turn back the clock on how education curricula have evolved. Expert knowledge of metal-ceramic fabrication still exists, and if clinicians want to reclaim that technical knowledge and make quality metal-ceramic restorations a treatment option for their patients, it’s only a phone call away—to the laboratory technician.

From the Clinic to the Lab: An Important Partnership

A good relationship between the clinician and the laboratory technician can have a profound effect on the esthetic success of a metal-ceramic restoration. Dr Naylor advises that clinicians hoping to elevate the esthetic quality of their metal-ceramic restorations, especially newer clinicians, should forge a collaborative working relationship with laboratory technicians.

“Spend some time with the dental laboratory you use,” he says. “Some clinicians have to mail their work out to laboratories far from their practice if they’re in a rural setting, but there are still tools you can use to facilitate open communication in that situation. Develop a relationship with your dental laboratory. Go there, look at their work, talk to the laboratory technician, and ask what they need from you as far as records and tooth preparation go. The conversation will flow. When you’re doing fixed prosthodontics or making prostheses, you have to realize that you are partnering with someone in the laboratory. That person is your colleague—your partner. Once you know the challenges they face and how those challenges can be addressed clinically, you can be the client they want to do great work for because you don’t send them work with the limitations that other clients do. We have to team up with our dental technician colleagues and work together, and it’s an educational process. The benefits of this kind of partnership will roll over to the patient and improve the quality of care you are able to provide.”

Dr Goodacre and Mr Sakamoto have a distinct camaraderie. When discussing specific cases, each man tries to defer full credit for a successful result to the other. In truth, their work is an equal partnership—one that was built with purpose by two professionals who recognize that a successful result relies on careful collaboration.

The mandibular left first molar was restored using a metal-ceramic crown with a porcelain margin. Both the overall form and appearance are remarkably like a natural tooth but recreated with dental porcelain veneering a metal substructure. Note how Mr Sakamoto has harmonized the appearance with the adjacent natural tooth (mandibular left second premolar). When viewing the intaglio surface, the form of the porcelain margin is visible. The ceramic margin was positioned well past the mesial proximal contact area to hide the metal substructure from view. (Courtesy of Dr Charles Goodacre and Mr Satoshi Sakamoto.)

“I’ll have Satoshi come up and we’ll look at the patient together,” Dr Goodacre says. “Satoshi will take some pictures and study them to determine, based on his experiences, which material will provide the most esthetic result based on each individual tooth.” Dr Goodacre admits that their geographic proximity facilitates a closer partnership than a traditional situation would. “When he was working at Ultimate Styles in Irvine, California and couldn’t come in personally, we communicated using a lot of photos and written information and that worked well. It’s perfectly appropriate to have a patient go to a dental laboratory for a consultation, but if that’s not available you can work it out through a lot of photos and personal contact, back and forth. The key to having a good relationship between the technician and the clinician is two-way communication. I also always send Satoshi photos of the completed treatment so he can see the results of his work, and that’s something a lot of dentists don’t take the time to do. It’s a team effort, and you need to take the time to show your technician when they’ve done a nice job.”

This positive feedback can be seen as sharing credit where credit is due, but Dr Goodacre also emphasizes how important contact at the end of treatment can be if the result is less than optimal. “If something isn’t quite right and you have to do it again,” he says, “you want documentation that you can evaluate and learn from for the next one. We’ve had a few of those over the years—the first restoration doesn’t work out, so you do another one and get a better result with that one.”

“Actually,” Mr Sakamoto interjects, “I have done many metal-ceramic crowns for Dr Goodacre but hardly any redos, because the records Dr Goodacre sends are correct. If I can start with good information, I can do my best work. That is why we can get such good results in most cases.”

“Colleagues I know,” Dr Naylor adds, “they have a rapport with their lab. Clinicians should pick up the phone and talk to their laboratory technician and collaborate, so the laboratory can feel like they can converse with the clinician without fear of losing the client if they say something critical. You have to be able to accept criticism from anybody, and that person needs to be able to tell you things like, ‘Well, Doc, to be honest the impression wasn’t that great, and we couldn’t read the margins,’ or ‘We tried our best, but you didn’t have enough occlusal reduction, so that’s the best we could do for the occlusal anatomy.’ And the dentist should say, ‘Well gosh, next time call me if you see a problem, and then I’ll decide based on the patient whether I can re-prepare the tooth or if we need to change the design of the restoration.’ We have to rely on our colleagues in the field of dental technology because this is their area of expertise, so let’s facilitate that kind of dialogue. This communication is especially important in metal-ceramic cases because so many clinicians just don’t have that technical experience anymore.”

Examples of Success

One of the most complicated yet esthetically rewarding types of metal-ceramic restorations is the porcelain-margin restoration, which can satisfy the esthetic requirements needed to restore teeth in the anterior region. Mr Sakamoto describes the technical considerations involved in making these highly esthetic restorations.

Direct and mirrored views of the intaglio and occlusal surfaces of a metal-ceramic restoration with a 360-degree porcelain margin created for a maxillary right first premolar. The restoration presents with lifelike dental morphology and no externally visible metal. (Courtesy of Dr Charles J. Goodacre and Mr Satoshi Sakamoto.)

“These restorations have a 360-degree porcelain margin,” he explains, “and the porcelain margin needs to be perfect. I bake the porcelain margin four or five times to eliminate all shrinkage. Timewise, I can spend up to 2 hours just baking the porcelain margin. Then I can start on the opacious body, the regular body, and the incisal body. The weak point for metal-ceramic restorations is the opaqueness, so the most important part of making these restorations esthetic is the gradation from that opaque layer using opaque modifier. It’s kind of like how you see a drawing or picture that looks like it’s three-dimensional, when in reality it is a two-dimensional image—that’s the same thing as what I do with the opaque layer. The body of the tooth should be warmer, while the incisal layer should be bluish or grayish. Then I create the internal structure and use an internal stain to characterize the tooth. The final porcelain stage is a clear porcelain over the incisal structure to mimic natural tooth enamel. After this bakes and I finish grinding and adjustment, I polish, glaze, and polish again—it is important to polish after the glaze so you can achieve a natural luster that matches with the adjacent teeth, otherwise the result will not be esthetic.”

Here are a few more examples that represent the high level of esthetics that can be achieved using porcelain-margin restorations:

(left) Facial view of a defective metal-ceramic crown on the maxillary right central incisor. Note the high value of the ceramic, absence of surface texture and incisal translucency, facial overlap, gingival recession, and the display of metal at the cervical margin. (right) The defective restoration was replaced with a metal-ceramic porcelain-margin restoration. Note the corrections made to the outline form (no overlap needed), color, surface texture, incisal translucency, and the gingival margin placement. The soft tissue responded positively to the highly glazed porcelain. (Courtesy of Dr Charles J. Goodacre and Mr Satoshi Sakamoto.)

The mandibular right first molar was restored with a metal-ceramic porcelain-margin restoration next to an all-ceramic crown on the second premolar. Note the positive soft tissue response to both restorations and the harmony of the esthetic outcomes. The metal coping was designed to extend the porcelain margin lingual to the proximal contacts for maximum esthetics. Courtesy of Dr Charles J. Goodacre and Mr Satoshi Sakamoto.)

(left) Facial view of a metal-ceramic restoration for a maxillary premolar. (right) Direct and mirror view of the occlusal surface with its excellent characterization and esthetic occlusal morphology. (Courtesy of Dr Charles Goodacre and Mr Satoshi Sakamoto.)

The Future of Metal-Ceramic Technology

So with new all-ceramic systems cropping up every year and education programs that are unlikely to revert back to old ways, what does the future have in store for metal-ceramic technology?

“I don’t have a crystal ball,” Dr Naylor says, “however, I do see that while the trend in some commercial laboratories is an increase in all-ceramic technology and a decrease in metal-ceramic technology, we have to bear in mind that the patient population is ever increasing—even though the percentage and proportion may decrease, if you look at the number of individual patients there is still a huge demand for metal-ceramics. And I think we’ll see continued demand because the parameters of the mouth are not going to change: there will always be short crowns, there will always be bruxers, there will always be patients who may not be the best candidates for all-ceramic systems. We need to have both all-ceramic and metal-ceramic in our armamentarium. A master ceramist like Mr Sakamoto can layer a metal-ceramic restoration internally to develop a very lifelike restoration, whereas with all-ceramic you have a core, you have a veneer, you have to worry about compatibility between the core and the veneer, and then you have to color it externally. Will that be just as attractive and have the longevity of a metal-ceramic restoration? We’ll find out in time. With metal-ceramic technology, we already have a good thing—we just have to maintain it. With all-ceramic systems, we’re learning as we go how to improve them, identifying their weaknesses so we can try to overcome them, and improving their predictability. That’s what we have to look forward to.

Whatever you’re using, just use it well,” Dr Naylor concludes. “Make sure it’s appropriate for the environment in which it’s being placed. One of the main things we’re hoping to achieve with this edition of the Introduction to Metal-Ceramic Technology is to show people that metal-ceramic technology has an esthetic range that is greater than they realize, but neither metal-ceramics or all-ceramics is absolute or good for every situation. I believe in relying on the good professional judgment of the clinician to identify which material has the greatest likelihood of providing the outcome that the patient is expecting and that the clinician hopes to achieve. You have to judge each clinical case on its merits and limitations, then prescribe the most appropriate treatment. We just want to show that if you plan properly and take these clinical steps, and if your laboratory has a talented ceramist following some very exacting procedures, you can achieve an esthetic outcome with metal-ceramics—probably one that you didn’t think was possible outside of all-ceramic systems. You don’t have to settle for a material that will look good but won’t perform properly, nor do you have to settle for a material that will work well but won’t look good. With the instructions in this book, you can make the material that works look great.”

The Introduction to Metal-Ceramic Technology, Third Edition, which includes several stunning cases contributed by Dr Goodacre and Mr Sakamoto, puts technical concerns into a clinical perspective and can be used to create valuable common ground between clinicians in the dental practice and technicians in the dental lab. Whether you’re a clinician looking to expand your material options by improving the esthetic quality of your metal-ceramic restorations or a technician hoping to master both the science and art of metal-ceramic technology, Dr Naylor’s book provides the detailed instructions and expert tips necessary to succeed. The rest is up to you.


Introduction to Metal-Ceramic Technology, Third Edition

W. Patrick Naylor

For 25 years, the Introduction to Metal-Ceramic Technology has been an essential textbook, and this revised edition underscores its import to the discipline. The author expertly outlines the history and theory behind metal-ceramic restorations and then guides readers through each step of the fabrication process. Although many students do not realize the esthetic possibilities of metal-ceramic technology, this book illustrates how to achieve esthetic results to rival those of all-ceramic materials through treatment planning, clinical procedures, and dental laboratory steps executed at their highest levels. New to this edition are an expanded illustrated glossary, a simplified four-step buttonless technique, fresh analysis of bonding mechanisms, and a full chapter on the esthetic porcelain-margin restoration. Whether you are providing patients with esthetic fixed prosthodontics or are responsible for fabricating lifelike restorations in the dental laboratory, this book can serve as a valuable resource.

Also, for those we who wish to use the buttonless casting technique as described in the textbook, check out the Wax Pattern Alloy Converter App. This easy to use, well-designed app is available through Apple.

240 pp; 617 illus; ©2018; ISBN 978-0-86715-752-9 (B7529); US $98

 

W. Patrick Naylor, DDS, MPH, MS, is Adjunct Professor of Restorative Dentistry and former Associate Dean for Advanced Dental Education at the Loma Linda University School of Dentistry in Loma Linda, California. He completed advanced education programs in prosthodontics, dental public health, and dental materials. In 2000, Dr Naylor retired from the United States Air Force, having served as a prosthodontist (1981 to 2000) and linguist (1968 to 1972). Dr Naylor has written several books, book chapters, and scientific articles, including the Introduction to Metal-Ceramic Technology (Quintessence, 2018). He maintains membership in numerous dental organizations and societies and lectures on topics pertaining to prosthodontics, dental technology, and practice management.

Charles J. Goodacre, DDS, MSD, is Distinguished Professor of Restorative Dentistry at the Loma Londa University School of Dentistry. He received his DDS from the Loma Linda University School of Dentistry in 1971 and his MSD in prosthodontics and dental materials from Indiana University School of Dentistry in 1974. He served as Chairman of the Department of Prosthodontics at Indiana University, and as Dean of the Loma Linda University School of Dentistry from 1994 to 2013. He has received numerous awards throughout his career, including the Distinguished Service Award from the Academy of Prosthodontics and the Dan Gordon Lifetime Achievement Award from the American College of Prosthodontics in 2014. He has authored over 200 publications, textbooks, and textbook chapters, and contributed numerous cases to the Introduction to Metal-Ceramic Technology, Third Edition (Quintessence, 2018). Dr Goodacre maintains a part-time private practice limited to prosthodontics and has given more than 500 invited presentations.

Satoshi Sakamoto, MDT, studied dental technology at the Osaka Dental University School of Dental Technology in Japan. He started his career as the technical manager at the Sakamoto Dental Technology Training Center in Japan before moving to the United States in 2002, where he served as the technical manager at Ultimate Styles Dental Laboratory in Irvine, California, from 2002 to 2010. In 2010, he joined the Loma Linda University School of Dentistry as Master Dental Technician. Mr Sakamoto contributed numerous cases to the Introduction to Metal-Ceramic Technology, Third Edition (Quintessence, 2018) and lectures on topics pertaining to dental technology.

 

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