Primary Dental Journal

Dental therapists have a vital role to play in the provision of dentistry in the UK. This article examines the role of dental therapists in carrying out aesthetic dentistry in the UK dental practice setting. Patient access through collaborative working, especially through a shared care model, referral, and direct access will be discussed. In addition, two clinical cases are presented to demonstrate the provision of aesthetic anterior dental restorations by dental therapists.

The ideal smile is one where there is harmony between the ‘white’ (tooth) and ‘pink’ (periodontal) aesthetics. The developments in the field of periodontology have enhanced aesthetic outcomes when managing excessive gingival exposure in a ‘gummy’ smile or excessive tooth exposure in gingival recession cases. This paper aims to outline the aetiology, classification, and management of both a ‘gummy’ smile and gingival recession, putting a spotlight on aesthetics.

The burgeoning public interest in techniques to enhance a smile has led to demand on clinicians that require important steps in the pre-treatment approval process. Digital dentistry provides a new level of planning and visualisation, improving clinical risk assessment and patient engagement. Dentists must acquire a sound understanding of aesthetic design parameters, including physiologic limitations, and must match patient expectations with clinical reality. Digital design offers flexibility not obtainable with the conventional analogue wax up. Multiple versions of a design can be viewed in a 2D or 3D simulation and accommodated efficiently in CAD software, with 3D printed models generated from each design. The ability to use a test drive or mock-up based on a 3D digital analysis and design, has created a new standard of care for treatment planning, providing an accurate and reversible preview before any definitive dentistry is done. It also places the responsibility for understanding biologic limitations of care on the general dentist, with the risk that digital planning may over-promise if not matched with underlying hard and soft tissue conditions. It improves interdisciplinary and laboratory communication and increases the predictability of the proposed treatment. The result is greater patient satisfaction and an improved informed consent process.

The aim of this article is to describe a method for correcting bone deficiencies which may compromise aesthetic, functional or oral hygiene maintenance of implant supported restorations. The generic causes of these deficiencies are mentioned. The use of autogenous block bone grafts is described alongside methods for managing the hard and soft tissues at both the recipient and donor sites. The biomechanical advantage conferred with the use of grafts in reducing the crown:implant ratio is emphasised. The sources of intraoral bone grafts are identified and the risks of damage to adjacent anatomical structures and their avoidance are addressed.

The principles of healing are briefly described with an emphasis on the increasing predictability of contact healing, as opposed to gap healing.

The impact and inherent risks associated with the supplementary use of membranes for containment is also addressed.

Clinical cases have been used to illustrate procedures and outcomes. Previously published data is referenced.

The bedrock of delivering cosmetic dentistry remains good communication underpinned by a clear and transparent consent process. This article looks at this while exploring the ethical and risk management issues that have started to challenge the profession. While patients’ demand for cosmetic dentistry has exploded, this article explores the ethical conundrums faced by these treatments against the backdrop of whether their happiness is affected by their image.

Orthodontic treatment with the Invisalign® appliance (and other clear aligners) may be more aesthetically appealing to most adult patients when compared with conventional fixed appliances. When the first clear aligner systems were introduced into the market some 20 years ago, they were very basic in their mode of force delivery. In the last ten years, the Invisalign® system has undergone some remarkable changes and refinements in order to deliver more predictable treatment outcomes and allow for the treatment of more complex malocclusions. However, there remains an issue in terms of differences between the predicted and achieved tooth movements. Some tooth movements are more difficult to achieve than others. This article aims to examine the evidence of effectiveness and predictability of Invisalign® appliances for the correction of different tooth movements.

It is the aim of this paper to present data on the survival of direct and indirect restorations in anterior teeth. Two sources of information are used: previously-published analysis of data from 1990 to 2006 from a 13 million restoration dataset from England and Wales; and evidence from published literature from 2011 to the time of writing (March 2022). The findings suggest that: (1) directly-placed resin composite materials may provide satisfactory survival of restorations in anterior teeth; (2) crowns provide better survival to re-intervention: however, crowning an incisor or canine tooth, as opposed to placement of a direct restoration, will lead to an earlier time to extraction of the restored tooth; (3) veneers perform more favourably than other restorations in terms of time to extraction of the restored tooth, but may have a less favourable time to re-intervention than crowns; (4) lithium disilicate crowns may be considered to perform satisfactorily with regard to time to re-intervention when placed in anterior teeth, but less satisfactorily in posterior teeth; and (5) operator factors influence survival of restorations.