Midline Archive
January 2022
Synergy Between Minimal Intervention and Digital Workflow for Highly Esthetic Composite Restorations
By Matthew Yeung, DDS, Matthew Blackwell, DMD, Robin Blackman, DMD, Kevin Shepherd, DMD, Courtney S. Babb, DMD, Christian Brenes, DDS, MS, and Mario F. Romero, DDS
Recent improvements in digital scanners and printers, along with better accessibility and affordability, have enabled clinicians to more effectively integrate digital workflows into their practices. Virtual smile design has revolutionized the field of esthetic dentistry, with patients and clinicians able to visualize a proposed smile design superimposed on a photograph of the actual smile to create a digital mock-up. This mock-up can then be exported as a stereolithography file to print three-dimensional models. This clinical report details how minimally invasive dentistry was performed using a combination of virtual smile design and composite resins to treat maxillary central incisal edge discrepancies.
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The Successful Esthetic Rehabilitation Through Simulations
By Dr. Jeff Trembley
The most critical factor to communicate to the laboratory for managing control over an esthetic rehabilitation case is the dentofacial smile design. Imagine the predictable restorative success we all could attain in the esthetic zone if we provided the laboratory with the tooth arrangement and form; the ratio of tooth width to height; and illustrate how these relationships are perceived against the unique facial properties of each patient. If these metrics are truly what determines successful esthetic cases, then the burden to communicate those relationships to the ceramist would lie with the practitioner, without error.
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October 2021
How I Helped a Former Professional Basketball Player Regain Her Confidence
By Dr. Armand Bedrossian
She made history in 1978 as a member of the Milwaukee Does, playing in the first all-female professional basketball game against the Chicago Hustle in a new league called the Women’s Professional Basketball League (WBL). Forty-three years later, Gerry Lynn Booker’s trailblazing and pioneering spirit looks to digital dentistry to restore her smile and regain the confidence she once showed on and off the basketball court. When it came time to consider all the pros and cons of her restorative options, she and her clinician didn’t hesitate to choose a solution that was both definitive and esthetic.
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September 2021
Managing Implant Esthetics
By Dr. Pio Modi
When it comes to managing implant esthetics, there is much to consider. From planning to implant placement to managing tight spaces and more, Pio Modi, DDS, in his new 9-lesson course, "Managing Implant Esthetics" has you covered from start to finish.
You’ll learn: Key difference in implants vs. teeth to help with treatment planning considerations; Socket types and site limitations when placing anterior implant and considerations for immediate implant placement; CT guided stents, gold standard or limitations? And much more.
Learn More and Earn CE
August 2021
Minimally Invasive Full-Mouth Reconstruction with V-Shaped Veneers In the Treatment of Bulimia-Induced Dental Erosion
By Dr. Łukasz Lassmann
The incidence of bulimia appears to be increasing, but diagnosing it can be difficult, especially because many patients are too embarrassed to admit to having it. This disorder should be differentiated from occlusive, nutritional, and gastrointestinal problems, as well as from numerous parafunctions. The correct diagnosis allows the dental clinician to choose a treatment that should solve all of the patient’s esthetic and functional problems with a minimum number of procedures. With a minimally invasive approach in erosive patients, it is necessary to know the decision criteria for increasing the vertical dimension of occlusion and for selecting a preparation technique, type of prosthetic restoration, type of ceramic, and method of cementation.
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July 2021
Digital Photography: An Essential Component of Clinical Success
By Andi Jean Miro, DDS, & Ilon Choai, DDS
There are a variety of cameras on the market today, and new practitioners can be overwhelmed when trying to choose the one that is best suited to their needs. This article describes how to document a case utilizing high-quality dental photographs for optimal treatment planning, documentation, and self-evaluation. It outlines the fundamental principles to understand when using a camera for dental photography and provides information about camera setups and accessory options.
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June 2021
Excessive Gingival Display Managed with Lip Repositioning,
Esthetic Crown Lengthening, and Veneers
By Kenneth Valladares, DDS, CDT, and Paula Vargas, DDS, MBA
Excessive gingival display, also referred to as gummy smile, can be managed by a variety of treatment modalities, depending on the etiology. Mild and moderate gummy smiles can be successfully treated by periodontal plastic surgery. However, for excessive gingival display as in vertical maxillary excess (VME) II or III cases with 5 to 8 mm or more of gingival exposure, this procedure is not enough. Many patients decline the more invasive Le Fort surgery and opt for a less invasive surgical lip-repositioning procedure. Therefore, surgical lip repositioning combined with crown lengthening is suggested as an effective and predictable procedure to reduce gingival display.
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May 2021
Direct Posterior Restorations: Occlusal Anatomy & Stain
By Sandra Hulac, DDS, FAACD
Reproducing occlusal anatomy can be a challenging step in restoring the posterior teeth. Watch as Dr. Sandra Hulac walks you through the use of line guides and when and how to use stain on your posterior restorations. It is always worth asking your patients about adding stain to be sure you are on the same page about the esthetics of the restoration.
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April 2021
Maximizing Esthetics with Minimally Invasive Feldspathic Veneers
By Somkiat Aimplee, DDS, MSc, FACP, AAACD; Pannapa Sinthuprasirt, DDS, MMedSci, PhD; Andres Acevedo, MDC; Alvaro Blasi, DDS, CDT; Aram Torosian, MDC, CDT; Gerard J. Chiche, DDS
The keys to obtaining predictable and consistent results in esthetic treatment are diagnosis, smile design, treatment planning, team communication, and understanding patient expectations. Digital technology can facilitate this important communication with the patient.
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March 2021
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When to Place the Implant
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February 2021
Interdisciplinary Treatment Planning and Digital Workflow:
Integrating Digital Smile Design and Orthodontic Aligners
An interdisciplinary approach in dentistry is important for comprehensive, complete, and effective patient care because patients are becoming more discriminating, increasing demands for more accurate diagnoses and more detailed treatment plans.
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January 2021
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The Lumisynchroma Layering Technique
By Rhodri Thomas, DDS
Natural teeth are complex, polychromatic structures that can be challenging for clinicians to restore while simultaneously reproducing the nuances perceived by the eye. Although custom shade tabs and other techniques have improved the direct composite restoration process, it is still incumbent upon dental artists to design a restoration using tooth-specific composite colors applied in varying thicknesses and locations.
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December 2020
Overcoming and Preventing Surgical Grafting Complications
Surgical grafting complications sometimes occur after socket grafting procedures. How can we overcome these complications, or better yet, prevent them in the future?
November 2020
My Jaw Joint Clicks: Temporomandibular Joint Overview
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October 2020
Management of Cracked Teeth
By Jeffrey Lineberry, DDS, AAACD
The New York Times recently referred to the "epidemic of cracked teeth" resulting from the stress and trauma associated with COVID-19. From poor sleeping habits to lack of ergonomics in work-from-home office set-ups, the author of the article, a dentist in Manhattan, claimed she has seen more tooth fractures in the last six months than she had in the previous six years.
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September 2020
By Camille J. Zelen, DDS
The restoration of a Class IV fracture is a commonly encountered challenge in dentistry. This clinical occurrence, often the result of a traumatic event, can interrupt an already busy schedule. The patient, unsure of the prognosis, may be somewhat fearful or anxious upon presenting for treatment. Having a step-by-step procedure in place for this type of situation enables the treating dentist to deliver a predictable result that is both clinically sound and of optimal esthetics.
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August 2020
July 2020
A Histo-Anatomic Analysis of Color: Dentin Anatomy and the Principle of Scattering
by Javier Tapia Guadix, DDS
In order to create the most natural-looking restorations, a thorough understanding of the histo-anatomic structures and light interaction of the natural dentition is key. While we generally have a great understanding of the external anatomy of teeth, gaining that same level of understanding of the internal anatomy is still not easy for dental practitioners.
There are several techniques that allow us to analyze the relationship between the dentin anatomy and the enamel anatomy. Selective enamel dissolution allows enamel to dissolve in hydrochloric acid, giving us a true vision of the anatomy of the dentin. Becoming familiar with the relationship between convexity and concavity will assist us in creating the most natural-looking restorations.
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June 2020
The Split Centripetal Build-Up Technique for Large Class II Composite Restorations
by Gaetano Paolone, DDS,
Salvatore Scolavino, DDS,
Nitzan Bichacho DMD
There are several layering approaches for Class II restorations. The most commonly used are horizontal layering (HL) and the centripetal build-up technique (CBT). The latter is a proven technique that, in order to simplify restorative and modeling procedures, converts a Class II cavity design to a Class I through the application of a thin composite interproximal wall. The CBT defines the perimeter of the restoration and, once it is completed, the clinician has the advantage of a Class I cavity design.
This short video presents a modified version (split CBT) for medium-to-large Class II cavities in which multiple thicker, separated interproximal increments are used to reduce the number of adhesive surfaces, minimize the shrinkage issues of resin-based restorative materials, and provide proper anatomical information for occlusal modeling.
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May 2020
Anterior Implants:
Key Points for Tooth Position/Free Gingival Margin
Jeffrey Babushkin, DDS, AAACD
Creating esthetic implant restorations that blend seamlessly with the neighboring dentition can be one of our greatest challenges. In 2001, Dr. John Kois identified five pretreatment diagnostic keys to help ensure esthetic results. Watch as AACD Accredited Member, Jeffrey Babushkin, DDS, AAACD, explores the first of these diagnostic keys in the context of two different high-risk cases. See how Dr. Babushkin improves biology to change gingival margins in order to ensure an esthetic result.
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April 2020
The Inverse Injection Layering Technique
Douglas A. Terry, DDS, AAACD
John M. Powers, PhD
Markus B. Blatz, DMD, Dr med dent habil, PhD
The concept of generating a variety of parts for different manufacturing solutions using an injectable molding technique has existed for more than a century. Since its evolution, injection molding has been used by designers and engineers for myriad applications with a host of materials, including glass, metals, confections, elastomers, and thermoplastic and thermosetting polymers to fabricate a variety of complex shapes with high dimensional precision.
The advances in material science and adhesive technology have allowed this concept to be utilized with highly filled next-generation flowable systems. This first part of a planned two-part article provides a simplified, precise, and predictable method for developing natural esthetic composite restorations using this injectable concept with highly filled flowable materials.
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March 2020
Begin With the End in Mind: Preparing Teeth for Predictable Results
By Zachary Sisler, DDS
Preparing anterior teeth for esthetic restorations can be a daunting task for any clinician. In order for the dental laboratory technician to create an ideal restoration, the dentist must be able to prepare and contour a tooth to ensure adequate reduction has been allotted.
The use of preparation guides can increase the efficiency and efficacy of the preparation appointment by ensuring the process is calculated and accurate. It is important to remember that in order to achieve exceptional esthetic results, the dentist must begin with the end in mind. By beginning to visualize the end result during the treatment-planning phase, he or she can establish a diagnostic wax-up to act as a blueprint for the patient’s functional esthetic matrix.
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February 2020
Study & Practice: A Visual Essay on Pink Ceramics
By Jungo Endo, RDT
Creating lifelike restorations and gingiva requires a great deal of knowledge about tooth and gingiva morphology and color. It is necessary to study the different layers and structure of natural teeth and soft tissue and practice replicating them to achieve precise results. Studying the forms and color of natural teeth and soft tissue will help all patients, including the many who have suffered trauma to the teeth and gingiva.
Patients who have suffered from trauma have been dealing with emotional and sometimes physical pain for years, with loss of bone and gingiva. The patient featured in this visual essay was unhappy with her existing restoration. The color of the restored gingiva did not match her natural soft tissue color. By harmonizing the pink and the white with her natural color, natural-looking and beautiful restorations were created. Today's patients have high esthetic demands, which requires us to push the envelope in creating periodontal tissues and teeth.
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January 2020
Master Highly Esthetic Class IV Restorations
By Dr. Brian P. LeSage, DDS, FAACD
SPONSORED BY Tokuyama
Creating a Class IV restoration that blends in naturally with the surrounding tooth structure of the patient is one of the more challenging procedures dentists commonly face. It takes skill, creativity, an impeccable sense of esthetics, and a composite capable of delivering life-like results.
In this video, Dr. Brian LeSage, founder of the Beverly Hills Institute of Dental Esthetics, shares his techniques to achieve exquisite Class IV restorations using Estelite Omega. Estelite Omega is a premium polychromatic composite system developed by Tokuyama Dental in collaboration with the world-renowned cosmetic dentist Dr. Newton Fahl, Jr. With only 11 composite shades, dentists can achieve exquisite results, and re-create tooth anatomy and polychromicity down to the smallest details of tertiary anatomy and maverick coloring.
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December 2019
Noninvasive Trial Restorations: A technique to Improve Diagnostic Mock-up Fabrication and Direct Provisionalization
ByJoão Malta Barbosa, DDS, MSc
Gonçalo Bártolo Caramês, DDS, MSc
Ronaldo Hirata, DDS, MSc, PhD
João Caramês, DDS, PhD
A. Alper Comut, DMD, DMSc
The noninvasive trial restoration (NTR) serves as a diagnostic and communication tool that allows 3D information to be transferred from the diagnostic wax-up to the patient's mouth. If esthetic alterations are required or requested by the patient, the silicone index can be poured and the alterations produced over a new model, saving the original diagnostic wax-up design. Together with clinical photographic documentation, pouring the NTR index improves patient-clinician-laboratory communication, because a 3D record representing the evolution of the esthetic design is saved and can be revisited at any time during the treatment.
The incorporation of noninvasive trial restorations is a desirable step for elective restorative treatments. Achieving a high level of accuracy and precision should be a goal of all the steps, including those involved in fabrication of the NTRs themselves, as they will provide information when decisions are made regarding possible invasive adjunctive treatments.
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November 2019
3 Tips for Finishing and Polishing a Composite Restoration
By James H. Peyton, DDS, FAACD
It's easy to run into trouble due to aggressive and haphazard polishing techniques. With an organized and minimally invasive protocol for finishing and polishing, you can improve—and even save—your anterior composite cases.
Think of the finish, polish, and texture as the tooth’s “fingerprints”. If the adjacent teeth do not display similar characteristics, then—even if the contours are excellent—the case is lost.
These 3 tips can help you define an improved protocol for finishing and polishing your next restoration.
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October 2019
Restoration of Worn Teeth with Composite Resin Additions
By Dr. Tony Rotondo
The patient in this video presented wanting an aesthetic improvement—a “natural look”. She was aware of the localized wear on her maxillary anterior teeth, and the wear—although less so—of her mandibular anterior teeth.
Her treatment plan involved orthodontics to align her moderately crowded anterior dentition, improve the maxillary arch form, align gingival levels, and create space for restorative material to be placed on the maxillary anterior teeth.
The clinician behind this case, Dr. Tony Rotondo, is a featured educator at the AACD Annual Scientific Session in Orlando, Florida, April 22-25, 2020. He will be presenting two courses, including a special invitational presentation open to AACD Accredited members only called Adventures in Composite Resin: Using composite resin in the management of complex cases—techniques, applications, and failures.
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September 2019
Restoring Tetracycline-Stained Teeth with Feldspathic Porcelain Veneers
By David Leo Finkelstein, DDS & John R. Calamia, DMD
Proper treatment planning enables execution of the most appropriate restorative techniques, preservation of healthy tooth structure, and realization of esthetic expectations. A detailed and comprehensive treatment plan is necessary.
Collaboration among the dentist, laboratory, and patient to create an efficient roadmap from case presentation to delivery is a must.
This step-by-step account of how communication, diagnostics, and collaborative techniques combined to successfully restore tetracycline-stained teeth.
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August 2019
The Challenges of Matching a Single Central Incisor
By Dr. Margarita Aleksanyan, DDS, AAACD
Awareness and appearance is of utmost importance to patients today. With composite restorations being used for Class IV fractures, there is a tendency for discoloration and irregular contour and shape.
This Midline shows a successful AACD Accreditation Case, Type II: One or Two Indirect Restorations. If you're pursuing AACD Accreditation, you won't want to miss this.
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July 2019
Transitional Bonding for Severely Eroded Dentition
By Kevin M. Brown, DDS, AACD
This Midline shows a case of major erosion of the teeth. Throughout the case, you will see the transformation of the patient's smile through every step in the process.
June 2019
Breathing Vivid Life into Our Creations
By Yuji Tsuzuki, CDT
By combining artistic sensibility and knowledge of functional essentials, we can maximize the use of various esthetic materials to resolve the challenges we face when creating restorations that mimic multiple facets of natural teeth.
This Midline outlines multiple cases that use a multifaceted approach to create a natural, but restored, smile.
Throughout the various cases, artistic elements are brought forth to make sure the restorations achieve the most natural look possible.
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May 2019
Invisalign® Go Clinical CaseInvisalign Go treatment is a simple, streamlined, fully digital way to give patients the smile they desire. Invisalign Go allows you to treat mild to moderate malocclusion cases with outcomes you can count on through enhanced movement predictability. Offering up to 20 aligners and movement from the second pre-molar to second pre-molar, Invisalign Go gives you the ability to expand arch width and align anterior teeth prior to restorative treatment.
Dr. Justin Leath, Rochester Hills, MI, had a patient present with minor rotating canines and minor crowding in the lower arch – see how he used Invisalign Go to deliver a beautiful smile and better oral health for his patient.
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April 2019
Clinical Efficacy & Sensitivity of In-Office Tooth Whitening With & Without Light Treatment Combined With At-Home Bleaching
By Joe C. Ontiveros, DDS, MS; Magda S. Eldiwany, DDS, MS; Dianna M. Arriaga, DDS, MEd;
Rose-Marie Fay, DDS, MS; Maria D. Gonzalez, DDS, MS; Natalie A. Pereira Sanchez, DDS;
Marilia M. Sly, DDS, MSD; Rade Paravina, DDS, MS, PhD
This study compares clinical in-office bleaching of 6% hydrogen peroxide with and without light, plus three nights of treatment with 16% carbamide peroxide. Visual and instrumental color measurements were performed on 77 subjects immediately, one week, and two weeks after in-office bleaching.
*Find out which method had superior visual results. Plus earn FREE CE, if you are an AACD member.
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March 2019
*Interactive Experience
Maximizing Esthetics and Function of FRC Posts and Full Composite Crowns in Endodontically Treated TeethBy Gerardo Durán, DDS, MSc; Ismael Henríquez, DDS;
José Pablo Tisi, DDS; and Abelardo Báez, DDS, MSc
Ensuring the esthetics and functional longevity of endodontically treated posterior teeth can present dentists with complex challenges that, to date, have been addressed using various therapeutic alternatives.
This Midline details one solution— a conservative, step-by-step technique for rehabilitating an endodontically treated premolar with wide root canals. It illustrates an indirect method for creating an anatomical fiber-reinforced composite post in combination with a full-coverage composite resin crown restoration.
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February 2019
NEW Interactive Experience!
Combined Ceramic Restorations at the Smile ZoneBy Mirela Feraru, DMD; Stefano Inglese, MDT and Nitzan Bichacho, DMD
Many adult patients present with a combination of old crowns at the smile zone that need to be replaced and adjacent teeth that require esthetic treatment. The final esthetic result depends on the treating team’s ability to efficiently communicate during the different steps.
The following clinical case report describes an accurate, controllable, and efficient operative protocol implementing an interdisciplinary approach, together with the step-by-step laboratory workflow.
*For best viewing on a mobile device, turn your phone to landscape orientation.
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January 2019
"Get in Line": Tips to Create Ideal Line Angles
by James H. Peyton, DDS, FAACD & Brian J. Gilbert, DDS, AAACD
Proper placement of line angles is critical to achieving the correct anatomic form and primary anatomy of a restoration. Line angles that are “in line” will lead to a final restoration that is anatomically correct. However, correcting line angles on a composite restoration can be challenging.
These tips suggest ways to “get in line,” achieve ideal line angles, and start creating beautiful composite restorations today!
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