Introduction

Esthetics: A Fundamental Component of Prosthodontics

Krikor Derbabian, DDS

Contributing Editor

Krikor Derbabian, DDS, maintains a practice limited to prosthodontics. He is the principal of the Center for Prosthetic Dentistry, a prosthodontic group practice with locations in Burbank and Pasadena, Calif.

Copyright 2003 Journal of the California Dental Association.

Dentistry has undergone major changes in the past 25 years. Most of these changes have originated from advances in materials and technology and the widespread acceptance of dental implants. In the field of prosthetic dentistry, where the emphasis used to be primarily on restoring function and comfort, the present-day provider of care must also pay close attention to a third component: esthetics. Today’s patients have high expectations regarding esthetics and providing functional and comfortable restorations alone may not be sufficient to satisfy many of them. Choice of restoration type and adjunctive procedures can affect the esthetic outcome of prosthetic dental care.

With heightened esthetic expectations, it becomes imperative that the restorative dentist understands the patient’s desires and expectations prior to initiating irreversible therapy. More emphasis should be placed on diagnosis and treatment planning because in most situations, the proper diagnosis will dictate the appropriate treatment plan. Since esthetics is a subjective criterion, good communication is critical to understanding the patient’s esthetic goals. Education of the patient with respect to anatomic and technical limitations is required as part of every patient’s initial examination. In addition, proper interspecialist communication is of the utmost importance. Most treatments are multidisciplinary in their approach, so each member of the treatment team must understand the treatment goals.

In addition to the above discussion, patients should also be informed about the longevity of restorations, especially when otherwise healthy teeth are to be restored for elective procedures. Devan stated this best, “Our objective should not be the meticulous restoration of what is missing but the perpetual preservation of what remains” He admonished all clinicians that prosthetic treatment should not hasten the loss of the remaining dentition.

When providing elective procedures to healthy dentitions, Devan’s admonition carries even more weight. Other authors have also noticed the commonplace sacrifice of tooth structure in the name of “cosmetic” or “esthetic enhancements.” When this is contemplated, patients must be informed of the disadvantages of preparing tooth structure.

In summary, while more emphasis is placed on esthetics, we should not forget that our goal is to preserve what remains. When treatment is necessary, all principles of esthetic dentistry should be applied. This can be achieved with all types of dental prostheses. Each restoration type has its indication depending upon patient presentation and preference. The articles in this issue have been assembled to address esthetics as a fundamental component of prosthodontics.

* In the first article, Winston W.L. Chee, DDS, and I describe several relatively straightforward techniques that can assist in the communication between the treating dentist, the patient, and the other members of the team, including the laboratory technician and other allied specialists.

* Sajid A. Jivraj, DDS, MSEd, and Winston W.L. Chee, DDS, illustrate how esthetics can be enhanced with traditional fixed prosthodontics. Several cases are presented.

* Terry E. Donovan, DDS, and George C. Cho, DDS, show how esthetics can be achieved in removable prosthodontics with proper treatment planning.

* In his article, Winston W.L. Chee, DDS, brings his expertise in discussing restoratively driven treatment planning and soft-tissue management for optimal implant esthetics.

* Lastly, Terry E. Donovan, DDS, and George C. Cho, DDS, discuss the role of all-ceramic crowns in contemporary restorative dentistry. While this class of restorations has improved esthetic properties and mimic natural teeth very well, they do have some limitations, which are discussed.

Although this issue may be different from many related to cosmetic dentistry, it is my hope that it reminds us that esthetics is only one component of prosthodontics; and, as part of the health care profession, each clinician must weigh the benefits, costs, and risks prior to initiating irreversible treatment that may reduce the life of the dentition.