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  Health, 2014, 6, 1941-1949 Published Online August 2014 in SciRes.  How to cite this paper: AlJehani, Y.A., Baskaradoss, J.K., Geevarghese, A. and AlShehry, M.A. (2014) Current Trends in Aes- thetic Dentistry. Health , 6 , 1941-1949.  Current Trends in Aesthetic Dentistry Yousef A. AlJehani 1 , Jagan K. Baskaradoss 2 , Amrita Geevarghese 3 , Marey A. AlShehry 3   1 Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh, KSA 2 Department of Dental Public Health, School of Dentistry, Case Western Reserve University, Cleveland, USA 3 College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, KSA Email:  Received 7 June 2014; revised 22 July 2014; accepted 4 August 2014 Copyright © 2014 by authors and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY).   Abstract The level of aesthetic requirement in clinical practice has increased over the past decade, and this has made it necessary for dentist to explore this field in order to satisfy the existing demand in this field. Technology can provide a solution to many of the routine hassles in dental practice. While optimal systems are far from fully realized, technology undeniably has made enormous progress. This review aims to provide an update on some of the recent advances in the field of aesthetic dentistry. MEDLINE (1990 to Jan 2014), PubMed (using medical subject headings), and Google Scholar searched using the following terms “Dental Composites”, “Ceramic Crowns”, “Aes- thetic Posts”, “Ceramic Veneers”, and “Computer-Aided Design/Computer Aided Manufacturing (CAD/CAM)”. This was supplemented by hand-searching in peer-reviewed journals and cross-refer- enced with the articles accessed. Dentist and dental technician alike must be aware of the current technologies in their fields and be able to use it to their and their patient’s advantage. The learn- ing objective of this article is to review the advantages and disadvantages of recent esthetic ma- terials and technology to aid in the proper utilization of the available treatment options with discretion. Keywords Ceramic Crowns, Aesthetic Posts, Ceramic Veneers, Computer-Aided Design/Computer Aided Manufacturing (CAD/CAM) 1. Introduction Dental materials have special requirements. For health reasons, dental materials should be suitable for use in the oral environment. In certain applications, strength and durability of a dental material is important to ensure sa-  Y. A. AlJehani et al  . 1942 tisfactory performance. In some other situations, the esthetic component would be more important. Esthetic dental appearance of teeth is one of the patients’ demands. This helped in the evolution of esthetic restorations, including the use of resin-based composite materials [1]-[7]. Restorative dentistry is a major spe- cialty in practical clinical dentistry. In order to treat dental caries, we need to excavate the pathology and restore the cavity with a proper dental filling material. One of the options is the use of light polymerized direct-tooth- colored restorative materials. Resin-based composite restorative material is one of the light polymerized restorative materials, an ac- cepted dental filling, and more clinically accepted from 1970s [8] [9]. Since then, evolution has made it one of the most commonly used types of filling; the light cured composite resin [2] [3] [9]. With its success rate is in an increasing scale [6] [9], composite restoration is being more and more used in restorative dentistry field. Many countries have recognized the importance of technology assessment in dental care. Dental technology review is needed because of the rapid increase of published research and rising dental-care expenditures due to new dental treatment options. The pace of change with which dentists must cope daily in their practices has also accelerated. Evaluating, adopting, implementing new technologies, has taken an important role in a dental prac- tice. Some of the areas which have emerged recently are Dental Composites, Aesthetic Posts, Ceramics, Veneers, Computer-aided design/Computer aided manufacturing (CAD/CAM). This paper looks at the advantages and disadvantages of each of these materials (Table 1 ). Table 1.  Advantages and disadvantages of the aesthetic materials. ADVANTAGES DISADVANTAGES Dental Composites Strong and durable Tooth sensitivity Tooth colored Technique sensitive Single visit for fillings Costs more than dental amalgam Resists breaking Shrinkage Maximum amount of tooth preserved Leakage over time Does not corrode Frequency of repair or replacement is low Aesthetic Posts Good retention without extensive tooth preparation Restorative material’s strength not increased Less time consuming Induces stress Less expensive Increased chances root canal perforation Ceramic Crowns Esthetics Expensive Low thermal conductivity Technique sensitive  No galvanic reactions Post-operative pain from cementation Biocompatible Excessive wear of opposing tooth CAD/CAM for Ceramic Restoration Independence Cost Reduced potential inaccuracies Requirement of training Single appointment Increased productivity Ceramic Veneers Esthetics Brittle Stain resistant Irreversible application process Durable Cost Smooth, translucent surface provides a natural appearance Tooth sensitivity  Y. A. AlJehani et al  . 1943 2. Dental Composites (Figure 1) “Composite” refers to a mixture of different materials. Dental composites are tooth-colored filling materials composed of synthetic polymers, particulate ceramic reinforcing fillers, molecules which promote or modify the  polymerization reaction that produces the cross-linked polymer matrix from the dimethacrylate resin monomers, and silane coupling agents which bond the reinforcing fillers to the polymer matrix [10]. Every component of the composite has a different function and contributes towards the success of the final dental restoration. How- ever, the most significant developments in the evolution of commercial composites to date have been direct re- sults of modifications to the filler component. Fillers are used in dental composites to provide strengthening [11],  increased stiffness [12], reduced dimensional change when heated and cooled  [13], reduced setting contraction [14], enhanced esthetics, and improved handling. Ferracane [10] classified dental conposites based on the filler size as: 1) Microfills: Amorphous silica filler particles (0.04 µm), pre-polymerized resin fillers (5 - 50 µm), inorganic filler volume 25% - 50%; 2) Minifills: Barium, strontium or zirconia silicate fillers (0.6 - 1.0 µm), amorphous silica (0.04 µm), typical inorganic filler volume 50% - 70%; 3) Midfills: Barium, strontium or zirconia silicate fillers (1 - 1.5 µm), amorphous silica (0.04 µm), typical in-organic filler volume 55% - 70% and also contains quartz fillers. 2.1. Advantages Dental composites are esthetic and relatively less expensive. The restoration can be completed in one day and it has also the property of “self-sealing”. Another advantage is that these restorations can be easily repaired though the frequency of repair is relatively low. 2.2. Disadvantages Sometimes after the placement of dental composites, the patient may complain of moderate tooth sensitivity. Another disadvantage is that the method of application is technique sensitive. It also costs more than dental amalgam. Dental composites tend to shrink when hardened and also may wear faster than dental enamel. 3. Aesthetic Posts The introduction of aesthetic posts has made a great impact on the restoration of endodontically treated teeth. Since their introduction [15] [16], technology had modified and further improved post shape and materials; in Dental Amalgam Dental Composites Figure 1.  Dental composites. Courtesy: Durham dental fillings, Dr. Christo- pher Bouldin.    Y. A. AlJehani et al  . 1944 addition, the use of innovative adhesive systems and cementation techniques has offered the possibility to achieve high level of adhesion within the root canal [17]-[19], producing new posts which ensure dental tissue conservation [19]. The restoration of endodontically treated teeth is a critical step in the success of root canal treatment [20]. Factors such as trauma and caries can lead to the creation of a large flared root canal. Traumatic impact on the anterior teeth in young patients often interrupts apical closure and full root development, leading to the formation of an enlarged root canal that remains flared. Flared canals are more susceptible to fracture be- cause the remaining walls are thin, and the restoration of these teeth requires techniques that will not compro- mise the integrity of the remaining radicular tooth structure [21] [22]. Until 15 years ago, the restoration of these teeth involved a combination of prefabricated or custom made metallic posts and cores [22]. However, the in- troduction of materials that can bond to dentine has created an alternative option for the reconstruction and re- habilitation of root canals that have been severely damaged by caries, trauma, congenital disorders, or internal resorption [23]. Polyethylene fibers are used to improve the impact strength of composite materials, and they are nearly invisible in resinous matrices. For these reasons, polyethylene fibres seem to be the most appropriate and aesthetic strengtheners of composite materials [24] [25].  3.1. Advantages The advantages of aesthetic posts are: It offers retention without the need for extensive preparation of tooth structure, it may increase resistance form of the tooth preparation to some extent, and it is less time consuming and less expensive than cast restorations which require multiple appointments [24].  3.2. Disadvantages It does not increase the strength of the overlying restorative material. It induces stresses in dentin in the form of cracks or craze lines, which may increase the potential for the fracture of tooth and micro leakage. It could in- crease the chances of perforation into root canal or on the external tooth surface. The long term results are also not available [23].  4. Ceramic Crowns (Figure 2) Ceramics are replacing metals as materials of choice in dental crowns [26], as well as in other biomechanical  prostheses. Although alumina-based crowns continue to replace metal-based crowns, failure rates remain an is- sue [27]. Clinically, bulk fractures are the reported cause of all ceramic crown failure whether the crown is a monolith or a layered structure [28]. Failure generally does not result from damage at the occlusal surface, but rather from subsurface radial cracks at the cementation interface. The radial cracks are initially contained within the inner core layer, but subsequently propagate to the core boundaries, ultimately causing irretrievable failure. 4.1. Advantages The major advantage of ceramic crowns is the esthetic result. The thermal conductivity is low for ceramics and Before Ceramic Crowns After Ceramic Crowns Figure 2. Ceramic crowns. Courtesy: Smile by design dental group, Dr. Choi.
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