Preserve and protect, esthetics will come
ANAHEIM, Ca? There is an intrinsic beauty to natural teeth and the mission of the dental professional is the preservation and protection of that element, according to Pascal Magne, DMD, PHD, a speaker at CDA Presents in Anaheim.
ANAHEIM, Ca? There is an intrinsic beauty to natural teeth and the mission of the dental professional is the preservation and protection of that element, according to Pascal Magne, DMD, PHD, a speaker at CDA Presents in Anaheim. The message of his lecture, said Dr. Magne, is ?emulate nature.? He presented ways to approach restorations based on the reproduction of nature. However, he cautioned the audience that the focus was not on ?esthetic dentistry,? adding that he does not like that term. Preserving biology is first, said Dr. Magne, adding that the function and the mechanics of the teeth should be fixed next. ?Esthetics is the outcome,? he said.
Following a brief discussion of biomaterial research, he added that the biologic solution is not here yet. Instead, clinicians must choose from current mechanical solutions, said Dr. Magne, emphasizing the need for science to mimic nature.
The Biomimetic Principle
Turning his attention to available materials, Dr. Magne said amalgam is likely to disappear because of ecological problems and disposal, adding that compromised esthetics and biomechanics are some additional reasons why. He posed the question: Is gold the gold standard? And because of composite?s ability to provide conservative restorations he also asked, ?Is composite resin the ?new? gold??
The driving force, according to Dr. Magne, is the biomimetic principle, which is the clinician?s ?mission statement.? Regarding the biomimetic principle, Dr. Magne said, ?The pulp is queen?The pulp is the pilot of the tooth. [Clinicians] want the pulp to give information on the state of the tooth.? Function and mechanics also come into play, and according to Dr. Magne, when you have vital pulp, ?You can compete in the Olympic Games of restorative dentistry.? He re-emphasized, ?esthetics are the result.?
Dr. Magne further discussed available materials that copy nature, more specifically, materials that copy enamel and dentin. He said the closest match to enamel is feldspathic porcelain, while the closest to dentin is composite resin. Dr. Magne also said he believes that, for socio-economic reasons, the future might lie with a single material that can be used for both dentin and enamel.
Presenting different clinical techniques (direct, semi-direct, and indirect), Dr. Magne offered insight into the different restorative options and materials. For direct techniques, Dr. Magne said composite resin is key in this restorative option. With many of the new composite resin materials, the manufacturers are trying to emulate the optical properties of teeth, according to Dr. Magne. ?Our fun is to make totally invisible restorations,? he said. In addition, he said another big development is manufacturers realize that clinicians do not need 35 shades. ?Composite resin has a beautiful chameleon effect,? said Dr. Magne. He mentioned VOCO?s Amaris as an example, calling it a ?simplified product.? He added that simple shade guides improve predictability.
Moving on to semi-direct techniques, Dr. Magne said that this is used for large restorations in which direct techniques would cause a lot of shrinkage stress. He cited direct intraoral inlay and extraoral inlay as 2 examples. However, Dr. Magne warned that direct inlay may not be very practical as it conflicts with immediate dentin sealing (IDS). He also said that extraoral inlay provides the clinician with a way to fabricate a little piece of composite resin in an efficient way. One system that provides clinicians with a big advantage in regard to extraoral semi-direct, according to Dr. Magne, is CAD/CAM. ?I think CAD/CAM systems are not mainstream yet?We are getting there,? said Dr. Magne who used Sirona?s CEREC and D4D Technologies? E4D as examples of CAD/CAM systems. Dr. Magne also discussed materials for CAD/CAM systems, saying that composite resin, such as 3M ESPE?s Paradigm composite resin blocks, is a better material for CAD/CAM than porcelain due to the composite material?s fatigue strength, millability and blending.
Dr. Magne also believes there is room for indirect cases. He said that published studies show no difference between indirect composite resin and indirect ceramic. However, Dr. Magne cautioned that there are problems with clinical studies in comparing the 2 and said if existing data were updated with more recent laboratory materials, one might see composite resin outperform ceramic.
Continuing to build on the biomimetic principle, Dr. Magne said the best gift a clinician can give to the patient is the preservation of remaining tooth structure. He added that the beauty of adhesion dentistry is that repair is possible with ceramic and especially with composite resin restorations.
Dr. Magne then turned his attention to immediate dentin sealing, calling it a ?wonderful technology.? According to Dr. Magne, some of the many advantages of IDS include improved bond strength, biomechanics, and clinical simplification. He also addressed the disadvantages of IDS; he said provisionals stick so clinicians will want to use a separation layer such as an insulating gel. He also said impression inhibition is another disadvantage and clinicians want to make sure that there is no oxygen inhibition layer left before taking an impression.
Driving his point home, Dr. Magne concluded by saying that the focus of the lecture was not about esthetic dentistry, rather it was about conservation. Materials are available that can help dental professionals achieve the kind of conservation that results in esthetic dentistry. ?Elyse Fetherman
Dr. Pascal Magne is an Associate Professor with Tenure and the Don and Sybil Harrington Foundation Professor of Esthetic Dentistry in the Division of Restorative Sciences, University of Southern California, Herman Ostrow School of Dentistry of USC, Los Angeles, CA. He has received multiple awards from the Swiss Science Foundation and the Swiss Found for Medical Biological Grants, and is the author of many clinical and research publications on esthetic and adhesive dentistry. Dr. Magne authored the book Bonded Porcelain Restorations in the Anterior Dentition ? A Biomimetic Approach.