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1/3. Restoring esthetics and anterior guidance in worn anterior teeth. A conservative multidisciplinary approach.

    BACKGROUND: Developments in adhesive dentistry have given the dental profession new restorative materials and technology to restore esthetics and function to the worn anterior dentition. This article illustrates, through a clinical case study, the clinical requirements for restoring esthetic harmony and functional stability to the worn anterior dentition. CASE DESCRIPTION: The author presents the case of a 24-year-old man who sought esthetic dental treatment because he was unhappy with the appearance of his maxillary anterior teeth. The review of his dental history revealed that he ground his teeth at night. The author performed a complete evaluation of the causes of the patient's bruxism and created a diagnostic preview to, among other things, develop the relationship between the condylar and anterior guidance and to establish the esthetic requirements for the final restorations. Treatment included periodontal recontouring, tooth preparation and placement of temporary and then permanent restorations; the patient also was given an occlusal guard to protect the restorations against future bruxing. CLINICAL IMPLICATIONS: Whatever the cause of occlusal instability, it is important that the restorative dentist be able to recognize its signs--such as tooth hypermobility, tooth wear, periodontal breakdown, occlusal dimpling, stress fractures, exostosis, muscle enlargement and loss of posterior disclusion. When restoring the worn dentition, the clinician should bear in mind the five P's: proper planning prevents poor performance.
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ranking = 1
keywords = dentistry
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2/3. Restorative and Invisalign: a new approach.

    This case report describes an interdisciplinary treatment approach using the Invisalign System (Align technology, Inc., Santa Clara, california) for orthodontics in combination with restorative dentistry. This combined approach was selected for an optimum esthetic and functional result. This case report demonstrates how a restorative case can be improved with prerestorative orthodontic alignment. The Invisalign System was used for opening the bite anteriorly, space distribution, and midline correction. The restorative dentistry procedures involved veneering to enhance the maxillary incisor length-to-width ratio and provide anterior guidance. The cosmetic alternative treatment modality to conventional fixed orthodontics allowed the clinician to accomplish the prerestorative orthodontic goals to help meet the desires of an esthetically conscientious patient.
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ranking = 2
keywords = dentistry
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3/3. Post-traumatic stress disorder: considerations for dentistry.

    A dental patient with post-traumatic stress disorder (PTSD) may present with greater dental and behavioral challenges than most dental patients. The background review of PTSD's initiating factors, diagnostic criteria, and medical management should help practitioners better understand and manage these challenges. Many of the challenges the clinician may encounter and managing recommendations are described. A case report of a PTSD patient complaining of constant bilateral tooth pain of the maxillary and mandibular bicuspids and molars is presented. Recommended techniques for identifying the tooth pain source and contributing factors are provided. The primary contributing factor for the patient's tooth pain was determined to be his severe tooth clenching activity. A maxillary acrylic appliance provided some pain reduction and a subsequent mandibular soft occlusal appliance worn opposing the maxillary appliance provided additional relief.
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ranking = 4
keywords = dentistry
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