Burke Et Al-2009-Journal of Esthetic and Restorative Dentistry
Burke Et Al-2009-Journal of Esthetic and Restorative Dentistry
Burke Et Al-2009-Journal of Esthetic and Restorative Dentistry
146
well, offer a high degree of patient approach to sound tooth tissue aforementioned publication. The
satisfaction and require only an demonstrated in publications in the wrong treatment carried out
acceptable level of maintenance. United States and increasingly in beautifully is still, sadly, the wrong
Patient accommodation to the the UK. By the rules of chance, it treatment. The structural damage
technique was good. No detrimen- would seem highly unlikely to us performed to these teeth and the
tal effect on TMJ, periodontal or for the patient to require the associated biologic costs for a
pulpal health was noted in any preparation of all of his or her questionable esthetic gain is very
patient. Bulk fracture and failure teeth, unless they represent rank worrying. We are health-care
were uncommon.” Other research and extraordinary bad luck. Surely, professionals concerned with long-
has indicated similar results.7–9 if patients are presented with term health gain and are not short-
relevant information on the very term opportunistic and temporary
The fallback position is something real potential for pulp death fol- beauticians who prey on the vani-
that always should be considered, lowing crown preparation, which ties and insecurities of vulnerable
given that no restoration lasts must be a consideration with even patients. We would doubt that
forever. Common sense and moderate, let alone more destruc- many patients are given an
experience prove that this fallback tive preparations,11,12 it would be objective, clear picture of the
position is much better with astonishing if any sane patient destruction of their teeth involved
restorations that do not involve decided to proceed with such in these traditional but
cutting away of residual sound aggressive treatment for that level outmoded procedures.
tooth substance, especially when of problem. The biologic cost of
this is already reduced because aggressive treatment, in terms of The dental profession needs a
of wear. both hard- and soft-tissue destruc- wake-up call and needs to be
tion, should always be and has to focused on the real and present
We have noted another case in be an emphasized part of the dangers of these destructive
which a 57-year-old male requested informed consent process. It is very approaches to teeth. Dr.
“longer teeth and a better-looking sad and professionally a long-term Friedman’s excellent and balanced
smile.”10 He received full-mouth concern that the concept of mini- article forms part of that much-
crown preparations and, ultimately, mally invasive dentistry for mild needed correction in the profes-
a “beautiful result” using state-of- cases, which initially was devel- sion’s thinking. Richard Simonsen,
the art materials in order to oped in the UK and AustralAsia one of those who introduced the
lengthen his upper front teeth by a and which has become well estab- porcelain veneer technique to the
couple of millimeters. We question lished in the UK and Europe, does profession, recently stated, “Where
whether the preparation of all of not appear to have reached the is the professional and public
the teeth (in one course of treat- west coast of the United States. outrage at the troubling trends in
ment) in the maxillary arch could This is especially so if the cases the marketing and selling of ‘cos-
ever have been really necessary, that we have read are metic’ dentistry that besiege our
and we are extremely concerned typical examples. profession today?13 The code of
that the mandibular arch was primum non nocere (firstly, do no
treated in similar fashion. We have We would not question the harm) seems to have been cast
seen and have been concerned undoubted technical and labora- aside in the headlong pursuit of
about this outmoded and cavalier tory skills demonstrated in the outrageous overtreatment for
financial gain by some.” The to know and to understand the 2. Anderson DJ. Tooth movement in experi-
mental malocclusion. Arch Oral Biol
members of the American Academy patients (Why do they want the 1962;7:7–15.
of Esthetic Dentistry have also treatment and why do they want it
3. Dahl BL, Krogstad O, Karlsen K. An
responded in a questionnaire,14 as now?), to understand their prob- alternative treatment in cases with
follows, demonstrating that it is lems, and to have a full under- advanced localised attrition. J Oral
Rehab 1975;2:209–14.
becoming aware of the problems of standing of the range of techniques
excessive preparation and poor that might be employed predict- 4. Poyser NJ, Briggs PFA, Chana HS, et al.
The evaluation of direct composite resto-
treatment. Among the results were ably, including an objective rations for the worn mandibular anterior
the following: approach to the benefits and risks dentition—clinical performance and
patient satisfaction. J Oral Rehabil
of each. 2007;34:361–76.
1. The biggest threat to the dental
5. Chen Y-W, Raigrodski AJ. A conservative
profession today is botched den- It may be timely now to introduce approach for treating young adult
tistry (24% of respondents). patients with porcelain laminate veneers.
an unscientific but potentially very
J Esthet Restor Dent 2008;20:223–
2. The biggest threat to relevant test, which might be of 36.
esthetic dentistry today is help in elective esthetic treatment
6. Dumfahrt H, Schaffer H. Porcelain lami-
overtreatment (33%). planning, especially if this planning nate veneers. A retrospective evaluation
after 1 to 10 years of service. Part II:
involves the elective loss of tooth clinical results. Int J Prosthodont
In this respect, there are well- tissue. This is the “Daughter Test.” 2000;13:9–18.
known risk factors for veneers and This asks the question “Knowing 7. Hemmings KW, Darbar UR, Vaughan S.
esthetic treatments: what I know about what is Tooth wear treated with direct composite
restorations at an increased vertical
involved with this proposed den- dimension: results at 30 months.
1. These are complex treatments tistry, would I carry out this treat- J Prosthet Dent 2000;83:669–76.
that carry increased risk. ment on my own daughter’s 8. Redman CDJ, Hemming KW, Good JA.
2. Veneers are placed in patients teeth?” Variations on this test The survival and clinical performance of
resin-based composite restorations used
who can afford them (and include “Would I have this treat- to treat localised anterior tooth wear.
know how to spell lawyer!). ment carried out on my own teeth, Br Dent J 2003;194:566–72.
3. The patient could be my children’s teeth, or my part- 9. Gow AM, Hemmings KW. The treatment
suffering from a body ner’s teeth?” A negative response of localised anterior tooth wear with
indirect Artglass restorations at increased
dysmorphic disorder. should prompt a radical rethink occlusal vertical dimension. Results after
and probably initiate a change of 2 years. Eur J Prosthodont Rest Dent
2002;10:101–5.
Our long-term concern for the plan involving a more sensible and
patients’ well-being and for the less destructive approach with 10. Nam J, Raigrodski AJ, Heindl H. Utiliza-
tion of multiple materials in full mouth
profession at large is borne out by which the operator and his/her rehabilitation: a clinical report. J Esthet
a large increase in settlements for patient and family are more com- Restor Dent 2008;20:251–63.
cases involving esthetic treatment fortable because it addresses the 11. Felton D, Madison S, Kanoy E, et al.
when this has not led to patient health of the teeth and the patient Long-term effects of crown preparations
on pulp vitality. J Dent Res
satisfaction (Kevin Lewis, Dental in the much longer term. 1989;68:1009, Abs.1139.
Director, Dental Protection Ltd.,
12. Saunders WP, Saunders EM. Prevalence
London, personal communication, REFERENCES of periradicular periodontitis associated
1. Friedman M. A 15-year review of porce- with crowned teeth in an adult Scottish
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13. Simonsen RJ. Commerce vs care: Martin G.D. Kelleher, BDS, MSc, Reprint requests: Frederick James Trevor
troubling trends in the ethics of esthetic Burke, Birmingham School of Dentistry, St.
dentistry. Dent Clin North Am FDSRCPS, FDSRCS Chad’s Queensway, Birmingham, UK B4
2007;51:281–7. 6NN; email: [email protected]
14. Goldstein RE. Attitudes and problems The opinions expressed in this feature are
faced by both patients and dentists in those of the authors and do not necessarily
Frederick James Trevor Burke is a Professor represent those of Wiley-Blackwell.
esthetic dentistry today: an AAED mem- of Primary Dental Care, University of Bir-
bership survey. J Esthet Restor Dent mingham (UK) School of Dentistry,
2007;19:164–70. Birmingham, UK; email: f.j.t.burke@bham.
ac.uk
Frederick James Trevor Burke, DDS, Martin G. D. Kelleher is a Consultant
BDS, MDS, MSc, FDSRCS (Edin.) in Restorative Dentistry, Kings College
Dental Institute, London, UK; email: martin.
FADM [email protected]