2001-1-Editorial - Saudi Dental Journal

ISSN (Print) 1013-9052
EISSN 1658-3558

The Saudi Dental Journal,
P.O. Box 52500,
Riyadh 11563,
Kingdom of Saudi Arabia

Tel.	966-1-467-7328
Fax.	933-1-467-7308 / 966-1-467-7534
Email	saudidj@ksu.edu.sa

Editorial

Developing a commitment to Esthetic Dentistry

The 11th Saudi International Dental Meeting was convened in Riyadh, Saudi Arabia from February 28 to March 1, 2000 and I had the distinct privilege of being able to participate as a guest speaker at the meeting. Needless to say, Saudi Arabia is a long way from the United States but I have never felt more at home in any other place that I have visited. Having been born in Lebanon and working with so many wonderful Saudi Arabian students at the University of Michigan prepared me somewhat for the visit. The city of Riyadh was certainly more beautiful than I had envisioned, particularly the architecture which is well represented on arrival at the airport terminal with the graceful stonework, fountains and landscaping which are breathtaking. But the most important resource of any country is its people, and the people of Saudi Arabia are to be commended for their hard work, friendliness and hospitality. The hard work is exemplified by the advancements that have been made in the dental profession in the past twenty-five years. That King Saud University College of Dentistry has progressed to such a high level of excellence in a relatively short period of time is testimony to the hard work of the people that have been guiding the development of dental education in Saudi Arabia. The dental school is as impressive as the quality of care that is being provided and research that is being conducted. The focus of the 11th international meeting was "Esthetics for the new millenium" and that certainly is a very timely topic. The meeting was well organized, very professional with an attentive and inquisitive audience.

Esthetic dentistry is having a tremendous impact on the practice of dentistry not only in the United States but also worldwide. Appearance related dentistry is not just confined to the young and wealthy but is sought after by older patients exploring not only functional but esthetic solutions to oral health. Many dentists are investing time and money in continuing education to become familiar with the optimal aids and techniques for utilizing today's advanced materials. This impact on esthetics began with the ability to effectively bond composite in a quick, painless and predictable manner. The ability to bond predictably has also created new techniques and challenges for conservative dental treatment. In one visit, not only could a dramatic change be made in a smile but in a lifestyle. However to perform any esthetic treatment, sufficient time must be allotted for the procedure. Excellent esthetic dentistry is impossible to accomplish quickly.

Contemporary dentistry has embraced the bonding process for direct composite restorations which in many cases have replaced amalgam where esthetics is a primary concern and sound tooth structure remains. When more extensive treatment is necessary, indirect restorations processed with composite or porcelain might be selected. Laminates have been clinically proven to successfully function as minimal facial covering or to be extended into the interproximal and lingual surfaces when less conservative treatment is indicated. All ceramic systems have become increasingly popular replacing traditional metal or metal ceramic restorations. The newer systems exhibit excellent esthetics and increased fracture resistance. Ceramics are brittle and can break easily when unsupported, however they become quite strong when laminated to an underlying material. Bonding ceramic or composite restorations to tooth structure essentially forms the supporting foundation needed to give the ceramic added strength under functional stresses. Another added advantage is that less tooth reduction is required because the all-ceramic restorations can be thinner than the porcelain fused to metal crowns since no additional space is needed for metal.

Irrespective of the restorative material chosen, the bonding sequence requires excellent clinical technique or the results will be compromised. Potential problems with inadequate bonding may include microleakage, post-operative sensitivity, recurrent caries and possible debonding of the restoration. Careful attention to technique, isolation and moisture control and adequate light curing are essential even with the more simplified one bottle adhesives. There are no shortcuts when performing esthetic dentistry or bonding procedures. Tooth preparation is many times overlooked with bonded restorations but it is a very critical part of the procedure. The teeth must be adequately reduced and have some resistance and retention form, particularly for larger restorations. The adhesion of materials should and cannot be the only means of retention. Preparations for indirect procedures must be followed by an accurate registration in an impression and of course, a qualified and experienced laboratory technician is an integral and crucial part of the team. They are talented people on whom we rely to produce the desired quality and esthetics in the restorations and often, they do not receive the credit they deserve.The patient and the dentist must have realistic goals and expectations when considering esthetic treatment. There can be no guarantees and this must be candidly addressed with the patient prior to commencing treatment. This is particularly important with patients that are perfectionists or whose expectations cannot be met. Although esthetic procedures are challenging and demanding, they have become an important aspect of our profession. The rewards, happy and satisfied patients and our satisfaction in a job well done are certainly worth the effort to master the skills required for esthetic treatment.

Peter Yaman, DDS, MS
Clinical Professor & Director,
Graduate Program in Restorative Dentistry, School of Dentistry,
University of Michigan, Michigan, USA