SUBSTANTIATION FOR PRINCIPLES OF AESTHETIC STOMATOLOGY
A scope of results by global dental practice bears testimony to the fact, that there is an urgent necessity to work out and formulate the basic principles, standards and definitions of aesthetic Stomatology as a study, which in its turn ensures wide implementation of prospective patterns and methods into the healthcare system.
Theoretical knowledge, received form modern literary sources, as well as scientific researches and clinical observations, performed by the author in collaboration with his colleagues, enables us to define the grounding principles for modern aesthetic Stomatology.
The most crucial principle or the cornerstone of aesthetic Stomatology consists in achieving treatment results, which are as close to the natural parameters of a dentition as possible.
The realization of the primary principle is ensured by means of optimum medication practices relying on methods, which cause the minimal damage or no damage at all to intact structures. Different methods of dental bleaching are to be considered as well as minor dissection (microabrasion) and grinding the prismless layer off the enamel surface.
Dissection and especially depulping are to be performed only when no other solutions are deemed viable. Any treatment used must guarantee a high degree of aesthetics, mechanic durability, safe and reliable adhesion between restorations and tooth tissue.
In restorational and orthopeadic Stomatology the optimal treatment presupposes the choice of such a construction, which would secure the maximal protection of both the hard tissue and the pulp of a tooth. Performing a safe minimal dissection under the control of a binocular loupe, the usage of high-quality materials and up-todate technologies ensures that the pulp will remain vital and no complications will follow.
Implantology effectively combines surgical and orthopeadic treatments, preventing bone structure atrophy and preserving the healthy look of the gingiva and restoring the natural shape and color of teeth.
The principle of fully conscious collaboration between patient and dentist presupposes regular and thorough completion of all the procedures prescribed.
As far as the quality of personal hygienic requirements goes, a patient’s role in the preparation for the restoration process becomes dramatically emphasized.
Working with photo-composites and modern ceramics is based on a scope of strictly formulated requirements, which give scientific grounding to the manipulations applied.
The principle of color imitation secures modeling of a restored structure with application of high aesthetic parameters, such as selecting the color of restorative material with utmost precision to match the optical characteristics of dentine and enamel as well as the consecutive color imitation of the lost tissues of a tooth. Layer-by – layer restoration and precise imitation of every single shade of color makes the construction look as natural as ever.
The material used to restore dentine, which is marked as O (opaque) or D (dentine), ought to be chosen in accordance with the color of a given tooth. Colors of the enamel are selected according to the same regulations and are applied so that a restoration has a naturally sparkling and transparent surface.
The principle of reproduction for natural volume parameters consists in planning the size, shape, relief of the surface usually followed by the reproduction of microand macrostructures on a restoration or alveolar sockets. The visual assessment and measurement results make it possible to examine the geometric parameters of a crown based on the interrelations of the side surfaces, to evaluate the expression of characteristics towards the side depending on the correlation between angles, convexity of the crown and inclination of the gingival dome. At this point of research scaled monoculars are normally used to measure linear and angle sizes.
The principle of adhesive preparing stands for the expansion of the contact area between the tooth and the filling with the purpose of sufficient increase in the amount of surface energy, which, in its turn, ensures proper adhesion of the composite to the teeth. The objective can be achieved by means of hard tissue excision down to the intact structures, by creating enamel slant or cavity of a particular shape as well as via etching enamel by acid and the use of the adhesive system.
In case of front teeth the contact area between the enamel and the photo-polymer may be increased by slanting down the cavity combined with the excision of the prismless layer. For molars it is advisable to shape a cavity in a specific way, namely: make a sharp angle between the bottom and the gingival wall, create an additional plateau on the chewing surface and smooth over inner angles.
The minimization principle for the consequences of Polymer shrinkage is based on the characteristic of the material to shrink down when hardening.
If the defect is considerable a filling across the bottom or the side area may “split off” as a result of which a “gap” may appear, followed by many complications.
The risks of a filling splitting off or cracking in a composite-enamel contact zone as well as the risks of hypertension decrease on conditions that chemically hardened filling materials are used. As they get harder, they get “attracted” toward the pulp as a source of heat.
Before the initial level of hardening process the shrinkage of the material is partly compensated for its flowability. The risk of the composite splitting off the enamel is growing as the contact area is increasing and the structural design is becoming more complicated. In case of cavity with a distinctly complex configuration, with a bottom and several sides included, minimization of the negative consequences of polymer shrinkage is achieved through the simultaneous application of one layer of the composite on to no more than two surfaces. One of the methods employed suggests the use of herringbone pattern, another one is the lateral layering.
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