Paul Tipton

Following his look at aesthetic enhancement for bridge restorations, Paul Tipton looks at the use of abutments in bridgework.

Following on from his previous articles on fixed-movable and fixed-fixed bridgework, Paul Tipton now examines aesthetic issues regarding anterior fixed bridge restorations.

Having previously discussed bridge failure and fixed-movable bridgework, Paul Tipton now turns his attentions to fixed-fixed bridgework in the third part of his series.

Dr Paul Tipton continues a new series on dentinaltubules about bridge design. In the second part of his series on bridge design, Paul Tipton looks at fixed-movable bridgework.

Dr Paul Tipton starts a new series on dentinaltubules about bridge design. In the first part of a ten-part series, Paul Tipton looks at the evolution of bridge design and examines the reasons for bridge failure.

Previous articles have dealt with full coverage restorations. I would now like to consider minimal prep restorations.

The aesthetic appearance of the maxillary anterior dentition is determined by the relationship between the shape, contour, colour, position and arrangement of the teeth and the healthy labial gingivae and interdental papillae. On restoring the anterior dentition the objective of a harmonious natural appearance of the teeth surrounded by healthy soft tissue should be achieved through a controlled, predictable treatment protocol.

Long-term success in aesthetic dentistry is dependent on an inter-relationship of several variables often not encountered in other dental disciplines. A patient’s objective interpretation of aesthetics, for example, can prove to be a significant challenge during the delivery of aesthetic treatment. The role of the laboratory technician must also be taken into consideration. Aesthetic failures may occur in the laboratory regardless of the technician’s ceramic skills if his or her contribution is not clearly defined. In addition, patients who require comprehensive therapy represent a particular challenge as they introduce yet another set of variables that may require treatment through a multi-disciplinary team approach, often now including orthodontics. Therefore, the successful integration of aesthetics and functionality does not emerge by chance, but as a result of deliberate discussion and clear anatomical parameters, and the subsequent incorporation of this design in the prosthesis. This article describes the rationale for aesthetic treatment planning based on the pre-operative establishment of definitive restorative objectives, which often require a multi-disciplinary approach including prosthodontist, orthodontist and ceramist to treat the midline diastema

Paul Tipton, BDS, MSc, DGDP UK, presents a new clinical case study . The smile line appears to be one of the most important factors contributing to a beautiful smile. The smile line can be defined as a hypothetical curved line along the edges of the four maxillary anterior teeth that has to coincide or run parallel with the curvature of the inner border of the lower lip. Another principle of aesthetics is to create an overall sense of harmony and horizontal perspective by creating the occlusal anterior plane in the general direction of the inter-pupillary line. This harmony must be further reinforced by the incisal edge occlusal plane following the lower lip line during smiling. Orthodontics is one treatment modality available for occlusal plane correction in this case by extension of the anterior teeth. There is a large group of patients, however, who refuse to undergo orthodontics and instead prefer a quicker restorative solution, especially when some of the teeth involved have had previous restorations. A second option is composite bonding using direct or indirect composite veneers. This article describes the step-by-step approach to ways of re-establishing the correct anterior occlusal plane using tooth preparation techniques, working from initial mounted study casts, diagnostic wax-up and making use of tooth preparation guides. This will be presented in the form of a case study to describe and illustrate the step-by-step restorative approach to anterior occlusal plane correction.

Paul Tipton, BDS, MSc, DGDP UK, presents a new clinical case study highlighting restoration of mandibular incisors. Although mandibular incisors are the smallest teeth in the mouth they are the physiological cornerstone for a good occlusion. It is almost impossible to have long-lasting non-traumatic functional occlusion without adequate crown lengths of these teeth. The central incisors are slightly narrower than the laterals and for maximum aesthetics a young, healthy-looking incisal edge is about 0.5mm in width from labial to lingual. They exhibit a symmetric straight or slightly convex mesial and distal outline. The buccal surface looks flat and dull, which surprisingly creates problems in fabricating a satisfactory restoration. This paper looks at the preparation techniques that lead to the restoration of worn lower incisors with porcelain restorations in a step-by-step manner highlighting the difference in shape and form between the soft rounded appearance of a female and the more angular, straight, aggressive appearance of a male.