Kelleher M

Margin design for porcelain fused to metal restorations which extend onto the root

A 90 degree shoulder is probably the most commonly used margin design for porcelain fused to metal (PFM) restorations. However, this design requires the removal of a significant amount of tooth tissue to provide a predictable restoration. This increases the risk of irreversible damage to the pulp, particularly if little tooth tissue is present, for example on exposed roots. In these situations more conservative designs, such as the 135 degree shoulder or deep chamfer, should be considered. Ideally these designs should be used with an all-metal margin since this is associated with the most predictable marginal seal. Where an all metal margin is aesthetically unacceptable a porcelain butt or subgingival margin can be considered. Newer techniques, such as resin bonded crowns, which minimise tooth destruction and provide acceptable aesthetics may be a viable alternative to traditional PFM restorations. Unfortunately, these newer techniques have not been evaluated long-term

Biologically Based Restorative Management of Tooth Wear

The prevalence and severity of tooth wear is increasing in industrialised nations. Yet, there is no high-level evidence to support or refute any therapeutic intervention. In the absence of such evidence, many currently prevailing management strategies for tooth wear may be failing in their duty of care to first and foremost improve the oral health of patients with this disease. This paper promotes biologically sound approaches to the management of tooth wear on the basis of current best evidence of the aetiology and clinical features of this disease. The relative risks and benefits of the varying approaches to managing tooth wear are discussed with reference to long-term follow-up studies. Using reference to ethical standards such as “The Daughter Test”, this paper presents case reports of patients with moderate-to-severe levels of tooth wear managed in line with these biologically sound principles.

Introducing the Concept of Pragmatic Esthetics, with Special Reference to the Treatment of Tooth Wear

The impact of the so-called “cosmetic” dentistry, if assessed by the number of dental makeovers in television programs or in celebrity magazines, has increased substantially in recent years. This is likely to have increased the public’s awareness of their dental appearance,1 and in turn, may have increased the volume of porcelain laminate veneers that have been placed, although quantification of this is difficult. What is quantifiable, however, is that tooth wear (TW) alternatively known as tooth surface loss (TSL) is increasing in incidence,2 especially in younger people, and that the issues around treatment of this are, therefore, becoming increasingly relevant. In the past, treatment of TW was often by means of crowning affected teeth (Figures 1A–C), or by a “full oral rehabilitation.” This involved the crowning of many innocent or bystanding teeth, allegedly with the aim of protecting their surfaces from further TW. The irony, of course, was that the supposed “ideal” treatment plans resulted in either more massive destruction of the affected teeth than the causative factors themselves had produced, or even more curiously, caused significant destruction of other minimally affected teeth in the same arch, or the opposing arch. This could be considered by many people to be a strange way to treat teeth, which were already compromised by wear. More seriously affected cases were (and still are) offered overdentures, or

Restoration of a worn dentition using a double-veneer technique

Restoration of dentitions affected by tooth surface loss has been a problem to the dental profession for many years. This problem is likely to increase as the population ages and retains more teeth into old age. This article describes a method of restoring teeth with non-carious loss of tooth tissue whilst conserving the remaining tooth tissue

Peri-implantitis. Part 1: Scope of the problem

Peri-implantitis is a relatively new disease process that results in gingival inflammation and bone loss around implants. The associated co-morbidities are significant due to the relative financial and biological costs of implant provision. At the current time there is a lack of consensus on the exact aetiology and subsequent pathological process, although this is largely thought to be infective in nature. Unfortunately, due to the relatively new nature of this problem, evidence is continually emerging on diagnosis, prevention, prevalence and incidence. This first part of three reviews will discuss these points and will act as an introduction to part two on prevention and part three on management of this now significant dental pathology.

Restorative complications of orthodontic treatment

The complications of elective orthodontic treatment are numerous. Patients need to be aware, in advance, of possible problems including resorption, instability, caries, recession and failure to deliver optimal tooth position. The investment of time and resources by all concerned is considerable and if there are adverse outcomes these can be biologically costly in the longer term. A frank and full discussion of the possible problems is necessary following the findings of Montgomery vs. Lanarkshire in 2015.