cosmetic dentistry - beauty & science

I 03 editorial _ cosmetic dentistry I cosmeticdentistry 3_2012 _Do you do force finishing in cosmetic dentistry? I have been practising clinical dentistry for almost 20 years. Now my major clinical workload is shifting towards the management of complex smile defects due to occlusal disharmony. These cases are always difficult to manage because destructive force components are not visible. In the performance of cosmetic dentistry, the force components are frequently neglected or mis- understood. Therefore, the physical strength of tooth-coloured restorative materials is still an impor- tanttopicincosmeticdentistry.Theclinicianhopesthattheselectedrestorativematerialswillovercome potentialfractureoftherestorationsandhencegenerallyselectsmaterialsthataremuchstrongerthan natural teeth. However, it is necessary to understand that the highly concentrated bite-force locations within the occlusal scheme may not always fracture the restorations, but will create other problems with the teeth, muscles and/or joints in some patients. Therefore, if the clinician overcomes potential fracture through material choice, he or she may actually be ignoring the underling force factors. Itisinterestingtonotethat,globally,wecosmeticdentistsspendmoreofourclinicaltimeandeffort onaestheticoutcome.Thisisbecauseaestheticcomponentsarealwaysvisibletoboththeclinicianand patient, and the outcome can be immediately appreciated. However, the force components are invisi- ble, and their negative effects are not easily appreciated clinically until they become chronic. Another reasonthatocclusalforcecanbeoverlookedisthatspecialtoolsandclinicaltechniquesarerequiredto demonstrateandmeasuretheforcefactorsclinically.Therefore,forceisthemostneglectedcomponent in cosmetic dentistry. Last year, I proposed the integration of the concept of force finishing into the conventional case- finishingprotocolofdentistry.Iampleasedtomentionherethattheconcepthasbeenwidelyaccepted indentistry.Ithinkitisbecausetheword“finishing”isgreatlyrelevantindentistry.Theconceptofforce finishing is based on the universal principles of force balance and load timing during dynamic occlu- sion. Optimally, after proper force finishing, all teeth should come into contact with one another 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. In cosmetic dentistry, forces are finished using articulating paper marks, but scientifically speaking such marks can tell the clinician only about the location of tooth contact and the contact area. In order to achieve quality force finishing, the clinician needs to use the proper tools and technology. The fundamental tool for force finishing is a digital force scanner (T-Scan III, Tekscan) that can measure clinical bite-force data precisely and objectively, while displaying the findings for clinical interpreta- tion and treatment. Such clinical data helps the clinician to achieve tooth-contact forces and timing sequences that are preservational, rather than destructive, regarding the final case result. It is to be noted that whatever the theory or concept of occlusal scheme selected during the treat- ment procedure, the role of force finishing is paramount to achieving long-term optimum results in terms of health, function, aesthetics and high patient satisfaction with minimal biological cost. Yours faithfully, Dr Sushil Koirala Editor-in-Chief President Vedic Institute of Smile Aesthetics (VISA) Kathmandu, Nepal Dear Reader, Dr Sushil Koirala Editor-in-Chief