DENTAL WORLD

– The plan of treatment
– The concept of work
– Tools
– The stages of the preparation of the teeth in front department
– The stages of the preparation of the teeth side departments
– Insights

Nothing can replace the sense of professional fulfilment and personal reward that comes from successfully restoring a patient’s smile. This lecture, which serves as a complete primer on aesthetic dentistry, is aimed at that precise reward. Informed by the latest scientific research and clinical evidence, the author will provide the listeners with keen insight into the artistic aspects essential to achieving a truly aesthetic outcome. The lecture covers aesthetic analysis, effective treatment planning, use of digital dental photography, and the importance of interdisciplinary collaboration. Further, outline effective treatment protocols, including the principles of ultraconservative restoration, in-office CAD/CAM technology, and the usage of minimally invasive procedures.

Aims:
– To outline the ideal proportions of white and pink aesthetics
– Material choices in the anterior and posterior full ceramic restorations
– To show the differences in perception between professionals and lay people to altered
dental aesthetics
– To give an understanding to the use of double veneer technique: when, how, why
– To outline the advantages of minimal invasive prosthetic procedure (MIPP)
– To show step by step the luting protocol of all ceramic restorations
– To give an understanding of the benefits and limitations of conventional and CAD/CAM
technology

Learning outcomes:
– To have a broader understanding of the fundamentals of aesthetic dentistry, its importance
in treatment planning and clinical management of a patient
– To have the knowledge to adopt a structured approach to the delivery of complex
interdisciplinary treatments
– To avoid failures in full mouth rehabilitation
– To clarify the limits of CAD/CAM technology versus conventional treatment in minimal
invasive dentistry  

There are a number of variables that must be mastered and implemented in order to achieve an esthetic result.
This lecture will provide attendees with the foundation necessary to objectively evaluate dental esthetics and immediately implement these principles to daily practice utilizing direct composite resin.

– Applying principles of smile design and analysis of proportions
– Examination of anterior morphology
– Importance of the mid-line “Critical Zone”
– Material selection – which composites to choose and where to use them
– Understanding the components of the polychromatic incisal edge
– Utilizing hue, value and chroma to determine color
– The application of the palatal stent
– Opacity vs translucency – the what and the when
– Effectively masking fracture lines
– Finishing and Polishing techniques
– Discussion of texture and its impact on shape

Modern dentistry is distinguished from that of the past by being able to solve complex and highly aesthetic cases through minimally invasive but resolutive and valid interventions. On the anterior teeth in particular, thanks to the evolution of techniques and ceramic materials, it is possible to obtain aesthetic and functional results, once not achievable, that today, however are more and more requested by our patients. The feather edge tooth preparation applied to new biological approaches (BOPT) and to the new translucent zirconia crowns open new horizons in the complete coronal treatment, with a simplification of the clinical steps and an improvement of the final aesthetic result.

Dentistry has never been more exciting than today. The development of new materials such as ceramics and composites and new concepts such as minimal dentistry or micro dentistry have pushed a number of practitioners to use magnification in their daily practice. The use of magnification by dental clinicians is becoming more commonplace. The best instrument for this purpose is the operating microscope which has been shown to enhance quality, longevity and outcome of clinical work as well as facilitating better ergonomics. My lecture explores the potential of the operating microscope, especially in cosmetic dentistry, and discusses the interest of microscope in the precision of anterior dental preparation and restorations. 

Due to the increasing available restorative surfaces, clinicians must have a clear understanding on the differences amongst them. These differences will; have an impact on the applicable bonding protocols during the cementation procedure. From mechanical retention to chemical interaction with specific primers, each restorative material will behave differently, requiring unique bonding protocols. The purpose of this lecture is to describe each surface’s optimized bonding protocol in order to have a positive clinical outcome. 

In our daily practice we have different demands from the patients and clinical situations. Different composite resin systems has been developed to solve this challenges in a way to try to simplify the procedures to anterior and posterior teeth.
In the anteriors the layering techniques with composite resins was described some years ago and we used often in our clinical practice. Some of these techniques use several different opacities and increments of composites, leading to the dentist get confused in deciding which one to choose. The clinical reality of most dental clinics are based on simple procedures, easy to perform with suitable aesthetic and long-lasting results. Some simple layering techniques and simpler restorative materials makes the dentist daily work simple and predictable, enabling make direct aesthetic and invisible composite resin restorations.

In the restorative procedure one detail that can make the difference in aesthetics and longevity of our restoration is the way we polishing and finishing it. For this last restorative step we can have more detailed texture in young teeth and smoother texture in teeth with more age. At our disposal we have various materials to accomplish these results, depending on the sequence and the technique.

Also for posterior teeth, the new composite resins allow us to have at same time simplicity, fast application and an easy modelling technique.
The Upgrade Dentistry will bring you nowadays different simple aesthetic solutions to work every day with direct composite resins. 

A lot of factors contribute to the final outcome of implant supported reconstructions in esthetic zone. Accurate implant position and orientation are essential ones among all those factors. An ideal implant position could be influenced by the implant site, the location of the transmucosal point, and the orientation of the implant. When free hand surgery could no longer meet the need for the accuracy of the implant placement, guided surgery supported by digital technologies could help us a lot achieving a precise placement. This lecture would cover immediate implant placement and restoration facilitated by digital template guide under normal conditions. And then implant placement and bone augmentation guided by digital template under difficult conditions would be presented. Finally, a precise implant placement guided real time digital navigation would be presented.

The three-dimensional printing of metal and plastic allows an incredible precision and freedom of planning to dentists and dental technicians. We need to understand the possibilities and limitations of this new technology, to give our patients the best and hopefully less expensive options. Raw materials, digital impression, printed models, monolithic crowns, relation of implant and abutment, insertion of bar systems and attachments – precision in micron size. Get to understand, what the dentist has to know, to be able to order and hand the planned prosthetics over to the patient.

Guided endodontics could be the future tool for even the general practitioners to carry out more conservative endodontic treatments in a feasible way. In this presentation i would like to share my own experience about guided endodontics, regarding to the latest literature. Showing successful cases and failures, pointing out the possibilites and limitations of this procedure.

Ultrasonics and their use in combination with magnification systems (Operative Microscope) allowed a minimally invasive approach in dentistry and with even more significant benefits in endodontics. The microultrasonics ensure better control and visibility intra-operative.

Advantages of Microultrasonics in endodontics are many:
*Minimally Invasive Access Cavity.
*Finishing of access cavity.
*Broken files, Fiber Posts, Screw post removal.
*Identification and shaping of coronal Isthmus.
*Calcification removal.
*Adaptation of MTA
*3D Cleaning
*Surgical Microendodontics.

Nowadays the use of operating microscope and ultrasonics is indispensable in order to perform endodontics in a safe and predictable way. 

The factors that affects the quality of documentation will be discussed:

– subject
– mirrors
– lights
– camera adaptors
– camera settings
– post processing

Endo problems and successful solutions!
– Problem solving during everyday endodontic treatment, starting from creating access, up to negotiation of the canal space!
– Techniques concerning removing of fracture instruments, metal and fiber posts, closing perforations and passing ledges.
– Planning proper restoration for long term results!

Each procedure with step by step basing on clinical cases. 

‘Endorestodontics’ is a concept supporting the idea of symbiosis between two dental procedures in which both benefit from the association. The concept was developed in aim of general practitioners to improve their ‘endo’, and endodontists to improve their ‘resto’ having the accent put on the importance of ‘pre- endodontic’ build up, analyzed through clinical cases.

A badly broken-down tooth, or one with a deep destruction, often makes it impossible to retain the rubber dam for endodontic treatment. Looked from both, practical and functional perspective, having pre endodontic build up prior endodontic treatment would guarantee a better isolation during the treatment as well as easier and faster final build up. Endorestodontics it’s a patient- oriented treatment usually performed in a single visit. Single-visit root canal treatment requires fewer visits and reduces treatment time and material use compared with multiple-visit treatment. In addition, a single-visit regimen does not require repeated local anaesthetics and the use of leaky intermediary restorations.

Procedures such as pre- endodontic build up, quality of the root canal treatment and the design of final post- endo restoration are crucial steps in long term prognosis of the endo-restorative treatment. They provide better coronal seal and better comfort through and after the treatment for both the patient and the dentist. 

The main goal of endodontics is to treat apical periodontitis and prevent recurrence of infection of the root canal system. Endodontic therapy has reached limitations in its ability to fully disinfect and debride the entire root canal system, due to the challenges of intricate anatomy. For that reason is very important to follow-up our clinical cases to assess the long-term success of our therapies. Periapical lesions may fail to heal after primary root canal treatment due to different mechanical or biological causes. Decision making regarding the clinical options once the initial root canal treatment has failed is both difficult and challenging.   

Prosthetic rehabilitation in atrophic jaws using dental implants represents a challenge for any clinicians. Factors that are potential sources of complications are bone quality, soft tissue management and anatomical variables. In order to have a long‐term outcome and benefit for the patient, the treatment plan should consider all these difficulties and variables. With the introduction of three dimensional (3D) diagnostic imaging and treatment planning technologies in implant dentistry, the preparation and placement of dental implants has become the norm in quality patient care, especially in patients with severe atrophies. Guided implant surgery has helped facilitate, simplify, and overcome the most common challenges in dental implant therapy. Modern implant softwares are able to reconstruct anatomical areas in 3D allowing clinicians to virtually plan implant placement from CT or cone beam computed tomography (CBCT) scan.

In today’s practice, CAD/CAM technology is frequently a foundational element of an integrated digital workflow for dental implant placement and restoration. This technology includes an intraoral scanning system, cone beam computed tomography (CBCT), implant planning software, and CAD/CAM design and milling software and hardware.

The convenience, time saving and efficiency of designing and fabricating a solution that can quickly and easily be modified or replicated on site are just a few of the advantages of using CAD/CAM dentistry. Specifically, this type of approach enables clinicians to operate difficult cases with a minimally invasive approach, with a prosthetic restoration, that has a predictable success rate.

Prosthetic rehabilitation in atrophic jaws using dental implants represents a challenge for any clinicians. Factors that are potential sources of complications are bone quality, soft tissue management and anatomical variables. In order to have a long‐term outcome and benefit for the patient, the treatment plan should consider all these difficulties and variables. With the introduction of three dimensional (3D) diagnostic imaging and treatment planning technologies in implant dentistry, the preparation and placement of dental implants has become the norm in quality patient care, especially in patients with severe atrophies. Guided implant surgery has helped facilitate, simplify, and overcome the most common challenges in dental implant therapy. Modern implant softwares are able to reconstruct anatomical areas in 3D allowing clinicians to virtually plan implant placement from CT or cone beam computed tomography (CBCT) scan.

In today’s practice, CAD/CAM technology is frequently a foundational element of an integrated digital workflow for dental implant placement and restoration. This technology includes an intraoral scanning system, cone beam computed tomography (CBCT), implant planning software, and CAD/CAM design and milling software and hardware.

The convenience, time saving and efficiency of designing and fabricating a solution that can quickly and easily be modified or replicated on site are just a few of the advantages of using CAD/CAM dentistry. Specifically, this type of approach enables clinicians to operate difficult cases with a minimally invasive approach, with a prosthetic restoration, that has a predictable success rate.

In modern Implantology, like in Orthopedics and Regenerative Medicine, our aim is to restore the form and function of the lost bone, so that we can give back to our patients exactly the same tissue, a healthy bone tissue which can remodel and adapt to the transmitting occlusal forces.

A new generation of novel alloplastic materials may elicit a controlled action and reaction to the host tissue environment, whilst exhibiting controlled chemical breakdown and resorption with an ultimate replacement by new bone. As surgeons, if bone regeneration is the aim of our treatment, a fully resorbable material should be used so that the newly formed bone will be in identical to the lost host bone and no residual graft should be present in the long term. Long-term incorporation of non-resorbable graft particles in the augmented bone leads to incomplete regeneration, so in these cases repair or bone augmentation are more appropriate terms.

Novel synthetic biomaterials are designed to be not only osteoconductive but also osteoinductive, i.e. to stimulate the differentiation of multipotent cells towards osteoblasts capable of depositing bone matrix, and there are currently numerous medical research papers showing this. All this medical research can teach us how to engineer functional bone in Dentistry and Implantology, we can learn and understand the role of periosteum, the importance of angiogenesis and biomechanics, so that we translate this knowledge into clinical applications for the benefit of our patients.

The aim of this course is to discuss these concepts and developments, and to present new minimally invasive protocols in order to optimize the host regeneration.

Learning Objectives:
– To understand the importance of bone as the foundation for successful implant restorations.
– To be aware of the various types of bone grafting materials and the modern techniques available for alveolar ridge preservation and augmentation in everyday clinical practice.
– To discuss the key role of bone quality on the long-term stability and function of dental implants. 

Severe bone resorption of maxillary crest occurs mostly by patients with chronical untreated periodontitis, traumatic extractions, prosthetic or implant maltherapy or combination of those . As a consequence we observe total resorption of alveolar ridge, both in frontal and lateral area up to nasal spine and paranasal sinuses. Total prosthesis is often not satisfactory solution or even impossible in this patient group. Rehabilitation with dental implants in these cases is very challenging from different points of view. At first bone reconstruction both in vertical and horizontal aspect is needed as a first step followed by implant placement and management of soft tissues. Prosthetic solution is mostly difficult due to huge vertical dimensions between upper and lower jaw and retro-position of maxilla. This can be a problem by choosing the right materials and prosthetic concept for long term function. As a prosthetic concept we tend to use opened (potentially removable – hybrid or fixed) prosthesis, to be able to react to any possible complication in sense of periimplantitis or mechanical complication of prosthesis. As a prevention of severe bone resorption flappless immediate augmentation is described and documented, which is recommended to be performed in case of deep periodontal socket extraction site or in case of every explantation.

Immediate loading procedures has being described in the literature of oral implants for about 30 years. There are already clinical evidence about this procedure, with reasonable clinical advantages, that motived our clinical team to start this procedure since 1999. The aim of this presentation is to share the science behind this procedure, the clinical step by step for successful results of clinical cases from single to full arch restorations, with an minimum number of implants. All important details as treatment planning, surgical cares and prosthetic solutions will be exemplified with clinical cases and its follow ups. Also, there will be presented similar solutions and suggestions for doctors that would like to combine more traditional protocols with the advantages of this new solution (immediate loading) in order to maintain living tissue in the long term. 

Orthopedic rehabilitation of children with congenital absence of teeth, especially with certain edentia, is an urgent and ultimately unresolved problem. According to the literature, about 5-5.5% of all children are born with hereditary pathology. One of the most commonly encoded syndromes is the Christ-Siemens-Touraine syndrome, 26.64%. The frequency of ectodermal dysplasia in different countries ranges from 0.15 to 10.4%, or 1-7 children per 100,000 healthy newborns. Such children need orthopedic (prosthetic) rehabilitation at the age of 6 or 7. Implants can be an effective treatment in such patients.

Aim: to study functional and aesthetic aspects of the use of dental implants in children with HED (hypodigous form of ectodermal dysplasia) with complete congenital absence of teeth at an early age, starting from 6-7 years, who had fixed irremovable prosthetic structures on the lower jaw. The work substantiates and presents more than 15 years experience of dental implantation in children with HED who had full congenital adentia and their effect on function and aesthetic results. 

The aim of this lecture is to present experiences with extraoral cortico-basal implants as a part of strategic implantology. Maxillofacial prosthodontics department of Clinic of Maxillofacial surgery, School of Dentistry in Belgrade was established 1965 and have a long tradition. However, in this presentation we will focus to philosophy of strategic implantology and use in maxillofacial implantology and prosthodontics. The main problem in maxillofacial prosthodontic is retention of prosthesis. In order to achieve some improvements in the quality of life of these patients the modern concept of maxillofacial prosthodontic was established. This concept considers introducing of maxillofacial implants as an anchorage for prosthesis, which significantly improves their stability. However, there are some specifics of maxillofacial implantology: explicit anatomical relation to the intracranial structures; less bone quality and quantity; more compact bone and irradiated tissues.

Lack of the bone sometimes limits use of conventional screw like implants. Also, implant survival in irradiated tissues is much lower. Implantation during the primary surgical procedure is not recommended in patients who will undergo postoperative irradiation. According to the literature, there is no type of implant which could be considered as superior for the implantation in the irradiated bone. The various implant systems for those purposes are in use. Using of basal osseointegration concept on “disk” implants will be emphasised, particularly because this is, to our knowledge, firs time used. Basally osseointegrated (BOI) implants present an excellent solution for maxillofacial prostheses anchorage, particularly in irradiated patients.

It is approved that regardless to the disadvantages, implementation of implants as anchorage for maxillofacial prostheses contribute to: significantly improvement of retention and stabilisation of prosthesis; faster adaption of patients to the prosthesis; prosthesis`s comfort; better aesthetic; easier maintaining of hygiene. Patients with extraoral maxillofacial prosthesis will be presented. Using of basal osseointegration concept on “disk” implants will be emphasised, particularly because this is, to our knowledge, firs time used at our department. 

The modern prosthetic dentistry currently uses techniques and materials that are increasingly conservative and respectful to the biology of dental tissues, with the goal of a predictable result in the long term. Today a prosthesis increasingly based on Cad- Cam technologies, intraoral scanners, and digital management of functionality. The prosthetic techniques are adhesive and mini-invasive, but they require always more appropriate protocols in tooth shortening.

In fact, with the advent of minimally invasive techniques, the modern esthetic dentistry is basically new, especially with regard to the requests of the patients for treatments of increasing value in terms of quality and oriented towards a rapid and optimal solution also of large and complex cases 

Why and how to use the microscope in each specialist branch of dentistry what the meaning is and what the results are. How to do better every day for the new expectations of our patients and the new quality standards of modern dentistry.

Nowadays we are going, from a side to extreme aesthetics request from patients for dental restorations and on the other side for minimally invasive techniques. Our quest is to find a way, a compromise that be able to satisfy both this needs.
But this requires very rigid protocols, a very detailed workflow planning, and no compromises in procedures. Microdentistry help us in this hard commitment, giving us the possibility to reach the desired result for patient and for clinicians.
A walkthrough, step by step in a new approach to reach the maximum of result. 

Retention is arguably the most important part of any orthodontic treatment plan, but traditionally it has been a topic that has been neglected in orthodontics. In recent years, we have developed a much better understanding of retention and stability, and Simon
Littlewood has a keen interest in this field. He is the lead author on the Cochrane review looking at orthodontic retention & has undertaken his own research in this field as well as appearing in educational videos about retention.
Dr Littlewood will also share the most up-to-date scientific evidence to support the use of different types of retainers, both removable and fixed, and additional techniques to increase stability that can be done during treatment. Responsibilities in retention in a much-neglected
area in orthodontics. The responsibilities of the patient, the orthodontist and the general dentist will be discussed, along with the British Orthodontic Society’s national “Hold That Smile” campaign, which was led by Dr Littlewood. Finally, Dr Littlewood will also look at different ways we may address relapse in the future, including applied use of technology, biology and education, and in particular the use of
personalized retention protocols.

Class III treatment – when should we treat and how

Is it appropriate, realistic and achievable to intercept a developing Class III skeletal pattern in a young child? Simon Littlewood is part of a UK research team that has undertaken the world’s longest running multi-centre, randomized controlled clinical trial into the use of
protraction facemask to treat developing Class III malocclusions. Dr Littlewood will share his experiences of this award-winning clinical trial run by Dr Nicky Mandall in Manchester, providing clear clinical and laboratory advice about when, and how to use this approach, and
what is really achievable with the technique. He will also look at the evidence to support additional techniques and indications, using bone-anchored approaches to treatment of children with developing Class III malocclusions.

Enhancement of facial beauty is one of the primary elective goals of patients seeking orthodontic care. The goal of contemporary orthodontic treatment should be the attainment of the best possible esthetic and occlusal results. Diagnosis and treatment planning for Facially Driven Orthodontics and the optimal position of the upper central incisor in all spacial plans, are of primordial importance for achieving excellence in esthetic outcomes of our orthodontic treatment.

“Begin with the end in mind” a sentence used frequently by Dr.Thomas Pitts is always worth repeating. Finishing off an orthodontic treatment case begins even before the appliance is placed, with solid diagnosis and treatment planning. Cephalometric standards should not be the main goal of the orthodontist.They must serve as a general guideline and as a complement of esthetic based diagnosis.

Good facial harmony can exist within a wide range of cephalometric values and even well treated orthodontic cases that meet every criteria of the ABO for successful treatment outcomes, may not produce an esthetic smile. In contemporary orthodontic treatment we need to assess the patients needs, perform soft tissue tissue based diagnosis (as opposed to only hard tissue diagnosis) and execute a complete smile analysis defined in terms of tooth shape and proportions, gingival esthetic characteristics and the relationship between both.

The 4th dimension – time – must also be considered.Patients want to look great not only after treatment but also 20, 30 and 40 years later.The anticipation of the ageing effects brought upon the face and peri-oral tissues have to be taken into account in our treatment planning. Esthetic considerations are paramount in planning appropriate orthodontic and orthognathic treatment, and, rigid rules cannot be applied to this process. Treatment plans based on the upper incisor and soft tissue relations, help create balanced faces and dentitions that age more gracefully.

The Pitts21 System with PSL, square slots, square wire finishing & light forces enables all trained, contemporary orthodontists to attain effective and extraordinary esthetic & occlusal results. Soft tissue based diagnosis can de done by using Dr. David Sarver’s, “Classification of Appearance and Esthetics” which we should systematically use when assessing treatment needs:
Macroesthetics – the face in all three planes of space(long face, short face, etc.);
Miniesthetics – focuses on the smile framework and structure (gengival and incisor display on smile, buccal corridors, smile arc, etc.)
Microesthetics – assessment of teeth and gums (tooth shape, proportions and colour, gingival shape and contour, black triangles, etc.