cosmetic dentistry - beauty & science

I 11 special topic _ minimally invasive cosmetic dentistry I cosmeticdentistry 3_2012 MCCF.Therearefiveareasoftheocclusalscheme in which clinicians can affect the force compo- nents (Fig. 5). The force-finishing component of MCCF re- quirestheuseofdigitalocclusaltechnologythat can measure precisely and objectively clinical occlusalforcedata,whiledisplayingthefindings for clinical interpretation and treatment. The objective and precise clinical data helps clinicians to achieve tooth-contact forces and tooth-contacttimingsequencesthatarepreser- vational, rather than destructive, regarding the final case result. However, in cosmetic dentistry, the role of force finishing is generally over- looked, minimised or ignored. The following are some of the clinical prob- lems that clinicians encounter when they ignore or are unable to harmonise occlusal forces after treatment: _damaged restorations (veneers, onlays, crowns, bridges); _fractured teeth; _tooth mobility; _abnormal tooth wear and sensitivity; _pain in the teeth, muscles and jaw joints; and _increased neck pain, ear pain and headache. In order to achieve the quality force-finishing results in dentistry, the following clinical condi- tionsmustbefulfilledduringtheforce-finishing process: _even and simultaneous contacts of all teeth during mandibular closure; _distribution of nearly equal force percentage between the right and left arch halves; _distribution of more tooth-contact forces on posterior teeth, less on premolar teeth, with only light anterior contacts; _the centre of force (COF) should be in the middle of the distribution of all contacting teeth; _the anterior teeth should immediately disclude the posterior teeth during excursive move- ments.13–16 Optimally, after proper force finishing, all teethshouldcomeintocontactwithoneanother at about the same time and with harmonised occlusal forces and measurably short disclusion timing. When this does not occur, the clinical case is considered to be unbalanced and poorly force finished. Force-finishing clinical facts are shown in Figure 6. _Aesthetic finishing The aesthetic outcome is one of the major concerns of all patients seeking cosmetic dental treatment. The aesthetic-finishing process in cosmetic dentistry involves establishing high surface gloss and creating proper micro-smile aesthetic characteristics. These include proper tooth-size ratio, axial inclination, open incisal embrasures, proper connector location, proper contact-point progression, surface micro-tex- ture, surface gloss or lustre, inciso-gingival shade progression, and special surface effects on the facial surfaces. Additionally, gingival aesthetic characteris- tics to incorporate during case finishing are the control of tissue contour, embrasure heights, gingival zenith, and the establishment of uni- form height (position or level) of the tissue around all the restorations. In order to improve the practicality of clinical aesthetic case-finishing procedures, the proce- dures are divided into four clinical steps: _Aestheticcontouring:Therestorationisgrossly reduced for the reproduction of the natural size, shape and other details of the tooth form.53 Re-establishing the contact with ad- Table I_Type I MiCD case-finishing protocol. Clinical steps Finishing tools Guiding tools Step I: Aesthetic finishing Aesthetic-finishing kit _Dental loupe Aesthetic contouring: Digital images 1. Reproduce natural size, shape and _Digital X-ray other details of the tooth form. (to check restoration 2. Re-establish normal and functional marginal fit, finishing contact with adjacent and opposing teeth. and overhangs) Finishing: 1. Establish an even, well-adapted junction between the tooth surface and the restorations. Aesthetic touch-up: 1. Achieve natural surface details through texture, grooves, pits and other special surface effects. Polishing: 1. Pre-polishing: Remove the remaining surface scratches after the aesthetic touch-up process. 2. Polishing: Establish a blemish-free and smooth surface with no visible scratches on the restoration. 3. Super polishing: Polish restoration to enamel-like lustre. Step II: Finishing evaluation Aesthetic-finishing kit _Dental loupe 1. Evaluate aesthetics, health (dental and gingival) _Digital images and comfort status. 2. Document the final case-finishing results digitally. Table I