Cosmetics, health, function, and long-term prognosis all depend upon accurately assessing how a patient presents and then determining how to proceed. Individual patient considerations include oral hygiene, the presence of removable prostheses, the status and contouring of restorations, gingival anatomy, long-span fixed prostheses and caries. Attention should be given to the periodontal-restorative dynamic throughout all the stages of treatment from diagnosis and treatment planning to final insertion.

Dentistry uses a wide range of cements to retain crowns, posts and fixed partial dentures to tooth structure. Dental practitioners should have a good understanding of the properties and categories of dental cements to ensure the long-term clinical performance of cemented restorations. Classes of dental cements have evolved from zinc phosphate to glass ionomers, resin modified glass ionomers, resin cements and lastly to self-adhesive resin cements. Self-adhesive resin cements require no bonding agents and simplify the cementation procedure. Since metal, porcelain-fused-to-metal, resin and all-ceramic restorations are used today, an understanding of cement performance is needed before selecting a material to use in a particular situation. This article gives a brief review of cement performance and introduces a new material to the class of self-adhesive resin cements.

Currently, two genres of CAD/CAM systems exist. One is used only in-office, while the other genre is a combination of in-office scanning and image transmission and milling of restorations or pouring of models in the laboratory. All systems start with scanning of the preparation, the method depending on the specific system. CAD/CAM systems have developed considerably, offering accuracy and more options than previously. It can be envisioned that CAD/CAM technology developments will continue to offer dentistry more options for its use, including further CAD/CAM integration of procedures and imaging enhancements.

Upon completing this course, the reader should be able to do the following: Understand the key factors involved in achieving an ideal impression, be knowledgeable about techniques available for soft tissue retraction and hemostasis, understand the factors involved in tray and impression material selection, and be knowledgeable about techniques and materials available that will enhance impression material flow

The increased use of direct composite restorations can be mainly attributed to patient demand for esthetic restorations and the availability of composites with high strength and excellent esthetics. While early composites were weak and suitable only for anterior restorations, current composites are highly esthetic and offer high strength for their intended purposes. Techniques have also evolved, with sophisticated bonding techniques and single-shade, dual-shade, and multilayering techniques to optimize esthetics. It is important to consider not only the individual case, relative strength, and esthetics of different types of composites but also the technique to be used when selecting a restorative material.

Temporization has become an increasingly common procedure, and may be required short-term or as an interim medium-term step. Excellent provisional restorations are a key component for the clinical success of definitive fixed restorations. Temporization requires consideration of the complexity of the case, length of time the provisional restoration is required, and esthetics. Indirect techniques offer reduced chairside time in comparison to direct techniques. Options for direct temporization have increased in recent years with the introduction of new materials and techniques.

Dentinal hypersensitivity has been referred to as one of the most painful and chronic dental conditions, with a reported prevalence of between 4% and 57% in the general population and a higher prevalence in periodontal patients. It may also occur as a result of, or during, dental treatment. Clinicians must screen for dentinal hypersensitivity and diagnose by exclusion, determine appropriate treatment, and provide treatment and preventive recommendations. Consideration should also be given to treating dentinal hypersensitivity associated with dental treatment. Traditional treatments have included adhesive resins, fluoride varnishes, HEMA,iontophoresis, gingival grafts and desensitizing dentifrices. Other technologies include the use of bioglass particles,ACP, as well as 8% arginine and calcium carbonate paste.

Upon completion of this course, the clinician will be able to do the following: Be knowledgeable about posterior crossbites and the numerous appliances available to treat this problem. Be knowledgeable about the three types of anterior crossbites and the appliances used to treat them. Increase your knowledge of Class III skeletal and dental diagnosis and treatment planning, and the appliances available to aid in their correction. Be knowledgeable about the different philosophies that exist regarding how to treat Class II malocclusions.

The long-term success of endodontic therapy requires the provision of a clinically-acceptable restoration. Restorative considerations include whether or not a post is required and preparation design, as well as the materials used for posts, cores, and bonding agents.

Computer Aided Design/Computer Aided Manufacturing (CAD/CAM) was first introduced to dentistry in the mid-1980s. Both chairside and chairside—laboratory integrated procedures are available for CAD/CAM restoration fabrication. In selecting which procedure to follow, consideration should be given to esthetic demands, chairside time, laboratory costs, number of visits and convenience and return on investment associated with CAD/CAM equipment. Depending on the method selected, CAD/CAM ceramic blocks available for restoration fabrication include leucite-reinforced ceramics, lithium disilicate, zirconia,and composite resin. In order to determine which type of ceramic to use, the practitioner must take into account esthetics, strength,and ease of customizing milled restorations. CAD/CAM gives both the dentist and the laboratory technician an opportunity to automate fixed restoration fabrication and to offer patients highly esthetic restorations in just one or two visits.

The posterior restorative material of choice depends on the individual clinical situation and patient. Amalgam has a long history of use and clinical success. Esthetic restorations are increasingly in demand, and include glass ionomers, compomers and composite resins. Fluoride release is a desirable attribute in a restorative material, as are wear resistance, low polymerization shrinkage and low polymerization stress. Recently, technologies have been incorporated into composite resins that lower polymerization shrinkage and stress.

The clinical success and longevity of restorations depend on a number of factors. Although recurrent or secondary caries has been found to be a major reason for the replacement of existing restorations,1 the materials and techniques employed at the time of restoration are key considerations in determining longevity and clinical success for both direct and indirect restorations. Factors attributed to restoration accuracy, depending on the type of restoration (direct or indirect), have included the degree of clinical expertise; properties of impression, stone and die, and restorative materials; and the conditions under which impressions are taken and restorations completed.

With the increase in cosmetic dental procedures being performed clinically, provisional restorations have become more of a diagnostic tool than simply a space maintainer. Properly contoured provisional restorations assist in maintaining the gingival health, protecting the pulpal tissue, and serving as a blueprint for the laboratory when fabricating the fi nal restorations. This article discusses why provisionals are as important as the final restorations, how to fabricate provisionals, and techniques to simplify those procedures chairside.

There has been dramatic progression in the adhesion of dental adhesives and resins to enamel and dentin in the 40 years since Buonocore1 introduced the technique of etching enamel with phosphoric acid to improve adhesion to enamel. The first dental adhesives bonded resins to enamel only, with little or no dentin adhesion. Subsequent generations have dramatically improved bond strength to dentin and the sealing of dentin margins while retaining a strong bond to enamel. With more patients demanding metal-free dentistry, the use of dental resins as cements as well as direct and indirect restorations will continue to increase. This article discusses the progression of dental adhesives up to the most recent generation, in which all components are contained in a single bottle or unit-dose container and applied using a one-step technique that requires no mixing.

Tooth whitening removes intrinsic and extrinsic staining. Many tooth-whitening options are currently available, including in-office treatments and home-use products that can be office-dispensed or purchased over the counter. Each type of treatment has its own advantages and disadvantages. Management of potential side effects such as tooth sensitivity and gingival irritation must be considered and managed if necessary. Tooth whitening is safe, effective and desired by patients in our esthetically conscious society.

Professionally dispensed vital tooth bleaching techniques include a variety of concentrations of hydrogen and carbamide peroxide, in-office techniques with and without light or heat enhancement, professionally dispensed whitening strips and tray bleaching. A predictable technique that does not require wearing of trays for long periods of time improves patient compliance. Tooth whitening with the latest generation of vital bleaching products is effective, safe and relatively long lasting. Bleaching can be maintained through the use of whitening toothpastes and bleaching toothpastes or with yearly touch-up bleaching using the patient’s custom fitted tray. Vital tooth bleaching is a viable, esthetic treatment for the discolored dentition.