Dental Tribune Indian Edition

15Dental Tribune Indian Edition - July 2013 Cosmetic Jost P. Prestin MDT André di Mauro, DDS Die Zahnärzte am alten Park Hegau- straße 3 78315 Radolfzell Germany prestin@dzaap.de www.dzaap.de www.jostprestin.com Contact Info Figure 25–30: An overview of the finished crowns on the control model.Figure 24: Controlling the approximal areas. Figure 31–33: Close-up image of the papillae directly after seating of the new crowns.Figure 29–30: An overview of the finished crowns on the control model. Figure38:Thesituationfivemonthsafterseating.Figure 34–37: Final check-up one week after seating. Figure 39: A small black triangle appeared between the central incisors when the sali- va was blown away. Figure 40 a–b: Close-up image pre- and post-treatment. etching (Fig. 13). Afterwards, we applied layers of IPS e.max Ceram (Ivoclar Vivadent). The layering technique is not part of this article (Figs. 14 & 15). The sha- de and appearance of the tooth textu- re were copied from the mandibular anterior teeth (Fig. 16). For the first try-in, the crowns were in their final form and size (Figs. 17–19). The pa- tient was more than satisfied with the result so far. We did not have to chan- ge anything. Even the colour was a perfect match (Fig. 20). Sufficient space was left in the ap- proximal areas to allow the papillae to regenerate (Figs. 21–23). We disli- ke long areas of contact that make the teeth appear square. On the maxillary left side, the papillae were almost per- fect at the try-in (Fig. 24). After that, we adjusted the surface texture and performed the glaze firing using Glaze Paste FLUO (Ivoclar Vi- vadent). Finally, the crowns were po- lished by hand with a diamond paste to obtain the highest plaque resistan- ce possible. For the finishing, photo- graphs are a great help. Today, captu- ring photographs of the teeth should be common practice because, espe- cially for a case like this, no patient has the time to sit in the laboratory for hours (Figs. 25–30). About three weeks after prepa- ration, the crowns were seated with Syntac and Tetric Flow in shade A2 (both Ivoclar Vivadent). Little black triangles were still visible between teeth 11 and 12, and 11 and 21 (Figs. 31–33). One week later, we performed the final fit (Figs. 34–37), and we re- checked the situation five months la- ter (in October). The patient showed a grey-free smile with perfectly formed papillae in all approximal areas (Fig. 38). At a recent follow-up, a small black triangle appeared between the central incisors when the saliva was blown away (Fig. 39). Final result Six months after the start of tre- atment, our patient was more than satisfied with the final result (Figs. 40–42). Her request for a healthy- looking gingiva and natural-looking crowns had been fulfilled. It is al- most impossible to detect artificial dentition in her new smile, even for a dentist or dental technician. Owing to the extraor - dinary translucency of the IPS e.max crowns, the roots receive the same amount of light that would pass through a natural tooth (Figs. 43a & b). The soft tissue is then lit up naturally and the grey gingiva is completely gone. Also, it is intere- sting how well the papillae are able to regenerate (Figs. 44a & b). It may even appear that the gingival margin on PFM crowns is moving by itself to escape the metal-ion infiltration. The appearance of the papillae was impro- ved after the all-ceramic crowns had been seated (Figs. 45a & b). Finally, it could be said that becau- se of the drawbacks of PFM and even zirconia we should consider using true all-ceramic crowns for such ca- ses. Reference 1. P. Magne & U. Belser, Adhäsiv befestigte Keramikres-taurationen (Berlin: Quintessenz, 2002). DT Figure 41: The patient with the old PFM crowns before the treatment. Figure 42: The patient after restoration seating. Figure 44 a–b: Regeneration of the approxi- mal papillae immediately (a) and five months after seating of the new restorations (b). Figure 43 a–b: Close-up image of the gingival margin, showing the dark tooth necks due to blocked light (a), and the correct shade and translucency of the restorations (b). This result would not have been possible with zirconia crowns, for which subgingival preparation would have been required (no bleaching was involved). DTI NEW YORK CITY, NY, USA: The results of a study conducted at the New York University College of Dentistry seem to confirm the hypo- thesis that the use of oral bisphospho- nate is connected to dental implant failure. In the case-control study, more than 300 middle-aged female patients with failed dental implants were compared with woman from the same age group whose implants were still intact. Clinical evaluations at the De- partment of Periodontology and Implant Dentistry were conducted between 1997 and late 2004. Accor- ding to the researchers, the clinical data gathered from these examina- tions showed that in women whose implants had failed the odds of ha- ving taken bisphosphonate orally were almost three times higher. Den- tal implant failure related to the use of oral bisphosphonate also seemed to be more likely to occur in the ma- xilla. Neither the quantity nor the dura- tion of bisphosphonate use was eva- luated. Although the risk of implant failure is low, the researchers concluded that oral bisphosphonate could pose a risk to the success of dental implant the- rapy and should be prescribed with caution. Earlier research on the association remains ambiguous, as results from Sweden and Australia have not found increased risks for implant failure when bisphosphonate was taken by patients before or after implant place- ment. However, the majority of clinical organisations still recommend that long-term users stop taking bispho- sphonate before undergoing dental implant procedures to avoid compli- cations. DT Implant failure may be related to bisphosphonate use