Protocols for Predictable Aesthetic Dental Restorations

Irfan Ahmad has a private dental practice on the outskirts of London, UK. He is an active member of the European Academy of Esthetic Dentistry. He writes extensively on the topic of aesthetic restorations and is a popular invited speaker at dental conferences across the world. His publications number over 120 in peer reviewed international dental journals, and he is the sole author of two books, Digital and Conventional Photography: A Practical Clinical Manual and A Clinical Guide to Anterior Dental Aesthetics.

• Dedication viiiForeword by Ronald E. Goldstein ixPreface xi1 Treatment planning – assessment, planning and treatment 1Assessment 1Planning 3Diagnosis 3Risk assessment 3Evidence-based decision making and treatment 6Presenting treatment plan proposals to the patient 9Treatment 11Clinical case study 12Assessment 12Planning 13Treatment 162 The health, function and aesthetic triad 21Health 21The periodontium 22Restorative implications 29Implants 29Function 30Occlusion 30Phonetics 36Aesthetics 37Facial composition 38Dentofacial composition 41Dental composition 45Gingival composition 483 Choice of all-ceramic systems 55Scientific rationale 55Rationale for all-ceramic restorations 55Physical and mechanical properties of ceramic 58Uni-layer and bi-layer all-ceramic systems 58Aetiology of fractures 59Dental ceramics 60Silica-based ceramics 61Alumina-based ceramics 65Zirconia-based ceramics 68Longevity 69Metal–ceramic 69Dicor and Cerestore 70IPS-Empress 1 70In-Ceram Alumina 70Procera 70Ceramic bridges (FPDs) 70Clinical practice 734 Colour and shade analysis 77Scientific rationale 77The stimulus for colour 78The illuminant 78The object 79Sensation (the detector) 81Synopsis of the stimulus for colour 83Perception 83Tooth colour determination 85Physical variables 85Physiological variables 86Psychological variables 86Dental variables 87Other optical variables influencing colour 89Shade guides 90Types of shade guide 91Limitations of shade guides 93Instrumental assessment 93Spectrophotometer 94Colorimeter 94Digital camera and red, green, blue (RGB) devices 94Clinical practice 94Ocular shade assessment 95Instrumental shade assessment 965 Foundations and intra-radicular support 98Introduction 98Vital teeth – scientific rationale 98Vital teeth 98Retention 99Vital teeth – clinical practice 102Pre-assessment for cores on vital teeth 102Radiographic evaluation 102Intra-oral evaluation 102Clinical sequalae for cores on vital teeth 102Non-vital teeth – scientific rationale 103Post materials 103Casting alloys 103Prefabricated metal 103Ceramics 104Fibre 104Criteria for intra-radicular post selection 106Coronal dentine and the ferrule effect 106Tapered vs. parallel 106Smooth vs. serrated 107Passive vs. active 107Direct vs. indirect technique 107Single- vs. multi-rooted teeth 109Choice of luting agents 109Aesthetics 110Types of cores 113Modes of failure 114Loss of retention 115Post fractures 115Root fractures 116Pre-post placement assessment 117Endodontic factors 117Periodontal factors 117Choice of definitive restoration 118Remaining coronal dentine 118Tooth location 118Summary 118Non-vital teeth – clinical practice 1186 Tooth preparation 125Scientific rationale 125Reasons for extra-coronal restorations 125Biologic width 127Margin location 128Margin geometry 130Preparation design 131Maintenance of dental hard tissue integrity 133Cutting efficiency 135Clinical practice 135Anterior tooth preparation 135Assessment 136Planning 136Treatment 137Posterior tooth preparation 140Assessment 140Planning 140Treatment 1417 Therapeutic temporary restorations 145Introduction 145Scientific rationale 145Health 145Function 147Aesthetics 147Biocompatibility 151Strength 151Palliative 151Marginal integrity 152Preventing plaque accumulation 153Chromatic stability 155Handling characteristics and ease of fabrication 155Material selection 155Polymethyl methacrylate (PMMA) 156Polyvinyl ethylmethacrylate (PVEMA) 156Bis-GMA resin 157Bis-acryl resin composite 157Urethane dimethacrylate (UDMA) resin 157Clinical practice 157Fabrication 157Matrices 158Existing anatomical form 158Proposed anatomical form 158Preformed metal and plastic crown forms 159Techniques 159Direct technique 160Indirect technique 162Direct–indirect technique 1628 Biological impressions 165Introduction 165Scientific rationale 165Secondary determinants 166Stock vs. custom trays 166Inter- vs. intra-arch 166Closed vs. open tray 167One vs. two stages 167Passive vs. non-passive 168Warm vs. cold environment 168Manual vs. automated mixing 168Physical vs. chemical gingival retraction 168Impression materials 169Primary determinant 172Patient factors (risk assessment) 173Operator factors 174Clinical practice 177Dental biological impressions 177Gingival biological impressions 1799 Try-in procedures 185Clinical practice 186Extra-oral evaluation 186Inspection of restoration on trimmed die 187Inspection of restoration on untrimmed die 188Intra-oral evaluation 18910 Cementation and dentine bonding agents 191Scientific rationale 191Types and properties of luting agents 191Zinc oxide eugenol (ZOE) 191Zinc phosphate (ZP) 192Polycarboxylate (PC) 192Glass ionomer (GI) 192Resin-modified glass ionomer (RGI) 192Dual-polymerisation resins (DR) 192Self-adhesive, dual-polymerisation resins (SADR) 192Self adhesive, auto-polymerisation resins (SAAR) 193Ceramic primers (CP) 193Efficacy of cementing agents 193Adhesion 193Occlusal stresses 194Marginal integrity and leakage 195Retention 196Pre-treatment of abutment 197Dentine bonding agents 197Efficacy 201Pre-treatment of intaglio surface 202Clinical practice 203Index 211

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