1、ESTHETICSINDENTISTRYSECOND EDITIONV O L U M E1PRINCIPLES COMMUNICATIONS TREATMENT METHODSV O L U M E2INDIVIDUAL TEETH MISSING TEETH MALOCCLUSION FACIAL APPEARANCEV O L U M E3SUPPORTING STRUCTURES EMERGENCIES TREATMENT FAILURES SPECIAL POPULATIONS TECHNICAL PROBLEMSESTHETICSINDENTISTRYSECOND EDITIONV

2、 O L U M E1 PRINCIPLES COMMUNICATIONSTREATMENT METHODSRonald E. Goldstein, D.D.S.Clinical Professor of Oral Rehabilitation Medical College of Georgia School of Dentistry Augusta, GeorgiaAdjunct Clinical Professor of ProsthodonticsBoston University Henry M. Goldman School of Dental MedicineAdjunct Pr

3、ofessor of Restorative DentistryThe University of Texas Health Science Center at San AntonioVisiting Professor of Oral and Maxillofacial Imaging and Continuing EducationUniversity of Southern California School of Dentistry, Los Angeles, California1998B.C. Decker Inc.Hamilton LondonB.C. Decker Inc.4

4、Hughson Street SouthP.O. Box 620, L.C.D. 1 Hamilton, Ontario L8N 3K7 Tel: 905-522-7017Fax: 905-522-7839e-mail: website: 1998 Ronald E. GoldsteinAll rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in

5、 any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.98 99 00 01 / BP / 9 8 7 6 5 4 3 2 1 ISBN 1-55009-047-XPrinted in CanadaSALES AND DISTRIBUTIONUnited StatesU.K., Europe, Scandinavia, Middle EastB.C. Decker I

6、nc.Harcourt-Brace & Company Ltd.P.O. Box 7852428 OvalRoadLewiston, NY 14092-0785London, NW17DX United Kingdom Tel: 71-267-4466Fax: 71-482-2291CanadaKoreaB.C. Decker Inc.Jee Sung Publishing Company4 Hughson Street South236-15, Neung-DongP.O. Box 620, L.C.D. 1Seung Dong-Ku, SeoulHamilton, Ontario L8N

7、3K7KoreaTel: 905-522-7017Tel: 02 424-5463Fax: 905-522-7839Fax: 02 456-5058JapanIndiaIshiyaku Publishers Inc.Jaypee Brothers Medical Publishers Ltd.710, Honkomagome 1-ChomeB-3, EMCA House,Bunkyo-ku, Tokyo 11323/23B Ansari Road, Daryaganj,JapanP.B. 7193, New Delhi-110002, IndiaTel: 03 5395-7604Tel: 11

8、 3272143Fax: 03 5395-7606Fax: 11 3276490Notice: The authors and publisher have made every effort to ensure that the patient care recommended herein, including choice of drugs and drug dosages, is in accord with the accepted standard and practice at the time of publication. However, since research an

9、d regulation constantly change clinical standards, the reader is urged to check the product information sheet included in the package of each drug, which includes recommended doses, warnings, and contraindications. This is particularly important with new or infrequently used drugs.ContributorsJack D

10、. Preston, DDSDon and Sybil Harrington Foundation Professor of Esthetic DentistryChairman, Department of Oral and Maxillofacial ImagingUniversity of Southern California CaliforniaRobert M. Ricketts, DDS, MSProfessor of Orthodontics University of California Los Angeles, California Professor of Orthod

11、ontics University of Illinois IllinoisSidney I. Silverman, BA, DDSProfessor Emeritus and Clinical Professor of ProsthodonticsNew York University College of Dentistry Clinical Professor of NeurologyNew York University School of MedicineRobert C. Sproull, DDS Cofounder and Past President American Coll

12、ege of Prosthodontics Past PresidentAmerican Academy of History of Dentistry American Academy of Esthetic DentistryEdwin J. Zinman, DDS, JDLaw Practice, specializing in dental jurisprudence and personal injurySan Francisco, California ConsultantAmerican Academy of PeriodontologyContributors At Large

13、Pinhas Adar, MDT, CDTOral Design Center, Inc. Atlanta, GeorgiaDavid A. Garber, DMDClinical Professor, Department of Periodontics Clinical Professor, Department of Oral Rehabilitation School of DentistryMedical College of Georgia Augusta, GeorgiaCary E. Goldstein, DMDClinical InstructorDepartment of

14、Oral Rehabilitation School of DentistryMedical College of Georgia Augusta, GeorgiaCathy Goldstein Schwartz, DDSPrivate Practice Atlanta, GeorgiaVan B. Haywood, DMDProfessorDepartment of Oral Rehabilitation School of DentistryMedical College of Georgia Augusta, GeorgiaAngela Gribble Hedlund, DMDPriva

15、te Practice Atlanta, GeorgiaMaurice A. Salama, DMD Clinical Assistant Professor Department of Periodontics School of DentistryMedical College of Georgia Augusta, GeorgiaContentsPrefaceixAcknowledgmentsxPART 1 Principles of Esthetics1. Concepts of Dental Esthetics32. Esthetic Treatment Planning173. M

16、arketing514. Legal Considerations655. Photography836. Biology of Esthetics1017. Pincus Principles1238. Creating Esthetic Restorations through Special Effects1339. Divine Proportion18710. Understanding Color207PART 2 Esthetic Treatments11. Cosmetic Contouring22312. Bleaching Discolored Teeth24513. Co

17、mposite Resin Bonding27714. Etched Porcelain Restorations: Veneers and Inlays/Onlays33915. Crown Restoration395Appendix A453Appendix B457Appendix C: Manufacturer Index461Appendix D: Product Index463Index464PrefaceI was first drawn to the study of esthetics a number of years before my 1969 article “T

18、he study of the need for esthetic dentistry” was published in the Journal of Prosthetic Dentistry. That article identified den- tistrys general lack of understanding of and appreciation for the natural link between a patients appear- ance and his or her self-perception.During the first half of the 1

19、970s, I avidly pursued my study of esthetics, investigating every known aspect of dentofacial appearance. I became convinced of the huge untapped potential the field offered for improving patient outcomes and enhancing dental practice. Eventually, I was inspired to dedicate my professional career to

20、 promoting a comprehensive interdisciplinary approach to dentistry that united function and esthetics in the service of total dentofacial harmony.When the first edition of this text was published in 1976, the United States was in the midst of a cel- ebration marking the 200th anniversary of our birt

21、h as a nation. It was an unprecedented national obser- vance of the highly successful American Revolution. At the time, I considered the two eventsboth of considerable importance to medistinct from one another. Since that time, however, I have come to rec- ognize that, although the publishing of any

22、 textbook could never be considered in the same breath with the emergence of a nation, both events were indeed revolutionary.Two decades ago or longer, esthetics was considered, at best, a fortuitous byproduct of a dental proce- dure a bridesmaid, but certainly not a bride. In the years that have en

23、sued, esthetics has taken its right- ful place, along with functionality, as a bona fide objective of dental treatment. The revolution that has transpired has been not only in our knowledge of the field but also in methodology and technology. Todays patients are highly informed about the possibiliti

24、es of esthetic dental restorations and fully expect that expert esthetics will be considered, from the inception of treatment to the final result.Consumers know that dental esthetics play a key role in their sense of well-being, their acceptance by others, their success at work and in relationships,

25、 and their emotional stability. Informed by books and ongoing media coverage, bolstered by increased means, and driven by the desire to live better lives, patients seek out dentists who can deliver superior esthetic services.The ongoing effort to meet these demands with state-of-the-science treatmen

26、t represents the contin- uation of that revolution. Little did I know, at the time this book first appeared, that esthetics would eventually hold a preeminent position in our profession. That it is recognized today as a basic principle of virtually all dental treatment is a gratifying and exciting s

27、tate of affairs.As with the original text, the three volumes of this edition have been organized into two basic cate- gories: patient problems and technical problems. This first volume deals specifically with problems of communication, esthetic principles, and the basic esthetic treatments such as c

28、osmetic contouring, bleaching, bonding, porcelain laminates, and the full crown restoration.Joining me to help complete volumes two and three will be a respected colleague and highly knowl- edgeable academician Van Haywood. Volume Two will feature problems of individual teeth, missing teeth, maloccl

29、usion, and facial appearance. Volume Three will feature problems of the supporting structures, emer- gencies, esthetic failure, and issues associated with the elderly and the youth. Finally, technical problems such as chairside procedures, and specific problems dealing with various restorative mater

30、ials will be covered.It is my hope that, in some small way, this updated volume will serve to advance all aspects of the esthetic dental revolution and, in so doing, help patients and practitioners achieve ever greater, more sat- isfying esthetic outcomes.Ronald E. Goldstein May 1998AcknowledgmentsS

31、o many people have worked on various aspects of this book that it would take far too much space to mention all of them. However, there were those who gave significant time to the project, and it is those people who I will attempt to thank at this time.To begin with, I must acknowledge the excellent

32、chapter contributions of the contributors, Dr. EdwinJ. Zinman, Dr. Sidney I. Silverman, Dr. Robert M. Ricketts, Dr. Robert C. Sproull, and Dr. Jack D. Preston. They were patient in enduring a number of delays, including the time I needed to find a publisher who would invest the appropriate time, tal

33、ent, and money to produce the quality I wanted in this second edition.B.C. Decker made that commitment and followed through with excellent color separations, improved illustrations, and many other quality-enhancing areas to significantly improve on the first edition. I would like to thank the produc

34、tion staff at Decker Inc., and Andy Rideout who created the high-quali- ty illustrations for all the dedication and hard work they put into the making of this book. A special thanks to Lewis Hinely, who also created several of the illustrations.Most helpful in every way was the extraordinary effort

35、of my personal executive assistant, Susan Hodgson. Susans attention to detail and meticulous follow-through helped me to complete this first volume. Others who assisted me on various aspects of the book were Cindy Sullivan, Kelly Sadowski, Mary Jane King, and Sylvia Wrobel.My clinical office staff h

36、as always been generous with their help over the years. Those assistants who have been most helpful with this volume were Regina Baird, Charlene Bennett, Pat Jones, Silvia Rodriguez, and Carlyn Kalmar.It also takes a talented group of professionals for the day-to-day support necessary to sustain a l

37、engthy project such as this text. My most sustaining support is derived from my long-time partner, David Garber. No one could ask for a more understanding and gifted friend than David. Maurice and Henry Salama have always been ready to lend a hand or help solve a dilemma as only they can. Angie Grib

38、ble Hedlund was particularly helpful during the final edits and contributing material, especially in Chapter 15. Thanks also to Pinhas Adar, who has always been willing and available to help with technical or illustrative assistance.We have been blessed with competent and especially remarkable admin

39、istrative assistants over the years: Cynthia Clement, Candace Paetzhold, Elaine Swyers, and for many years Margie Smith. They are always willing to help me despite their workload. Final peer reviews of certain chapters were efficiently and expertly done by Van Haywood, Howard Strassler, and Bill Gla

40、ssgold.Last but not least, I must thank my busy but devoted family: first and foremost my wife, Judy, who has continued to support and advise me throughout my career; our eldest son, Cary, a prosthodontist, who was with our group before opening his own practice, his wife Jody, and son Maxwell; our d

41、aughter, Cathy, a general dentist, her husband Steve, daughters Katie and Jennie, and son Brett; our son Rick, a physician, and his wife Amy; and our son Ken, an endodontist. They are all a source of great pride and joy for me.PART1PRINCIPLES OF ESTHETICSCHAPTER 1CONCEPTS OF DENTAL ESTHETICSBeauty i

42、s in the eye of the beholder.Margaret HungerfordWHAT IS ESTHETICS?Websters Third New International Dictionary defines “esthetic” as “appreciative of, responsive to, or zealous about the beautiful; having a sense of beauty or fine culture.” Each of us has a general sense of beauty. However, our own i

43、ndividual expression, interpretation, and experience make it unique, however much it is influenced by culture and self-image.What one culture perceives as disfigured may be beautiful to another. Chinese women once bound their feet, and Ubangis distend their lips. Individ- uals sense of what is beaut

44、iful influences how they present themselves to others. Esthetics is not absolute, but extremely subjective.HISTORICAL PERSPECTIVE OF DENTAL ESTHETICSRecognizably cosmetic dental treatment dates back more than four millenia. Throughout histo- ry, civilizations recognized that their accomplish- ments

45、in the field of restorative and cosmetic den- tistry were a measure of their level of competence in science, art, commerce, and trade. There are repeated references in history to the value of replacing missing teeth. In the El Gigel cemetery located in the vicinity of the great Egyptian pyra- mids,

46、two molars encircled with gold wire were found. This was apparently a prosthetic device.4 In the Talmudic Law of the Hebrews, tooth replacement is permitted for women. The Etr- uscans were well-versed in the use of human teeth or teeth carved from animals teeth to restore missing dentition.11Other h

47、istorical evidence that ancient cultures were concerned with cosmetic alteration of the teeth include reference to the Japanese custom of decorative tooth-staining called “ohaguro” in 4000- year-old documents. Described as a purely cosmetic treatment, the procedure had its own set of imple- ments, k

48、ept as a cosmetic kit. The chief result of the process was a dark brown or black stain on the teeth. Studies suggest that it might also have had a caries-preventive effect.2Smiles are evidenced as early as 3000 BPE.1 A smile on the face of a statue of an early king of Abab is noted in the art of Sum

49、er. Aboucaya noted in his thesis that the smile was absent or not very marked in early works of art and, when present, was almost always labial. The dentolabial smile, where the teeth are seen behind the lips, starts to emerge in the first decades of the 20th century. This is attributed to an increa

50、sed emphasis of awareness of the body and art of cosmetics due to the evolution of social life and the change in habitsFigure 11: This 2000-year-old Mayan skull provides some of the best evidence that jadeite inlays were used for cosmetic, rather than functional, purposes.4Esthetics in DentistryFigu

51、re 12A: Discolored teeth and leaking and discolored fillings marred the smile of this 24-year-old internationally known ice skating performer. (Note also the slight crowding of the front teeth, with the right lateral incisor overlapping the cuspid.)Figure 12B: A new sense of self-confidence and a mu

52、ch more appealing smile was the result of six full porcelain crowns. The teeth appear much straighter and the lighter color brightens the smile and enhances the beauty of her face and lips.and manners. Teeth began to play an increasingly important role as more attention was paid to the face, which e

53、xhibited more open and unrestricted expressions. The resulting emphasis on dental treatment and care also created an interest in the improvement of the esthetics of the smile.At the height of the Mayan civilization, a system of dental decoration evolved in which some teeth were filed into complicate

54、d shapes (see Figure 11), and others were decorated with jadeite inlays. These dental procedures were purely cosmetic and not restorative. That ancient Japanese proudly dis- played black teeth and the Mayans flashed a jadeite-studded smile testify to an apparently deep- seated urge to decorate the b

55、ody.Although the intent of these ancient attempts at cosmetic dentistry was strictly ornamental, there were sometimes beneficial side effects, such as the possible caries-preventive consequence of ohaguro. More often, however, the side effects were harmful. Some Mayans, seeking to brighten their smi

56、les with jadeite, developed periapical abscesses because of careless or overenergetic “filers of the teeth,” as their dentists were called.Today, dental esthetics is founded on a more ethically sound basis: the general improvement of dental health. But the same desires of those ancient men and women

57、 to submit to dental decoration as an outward portrayal of the inner self, motivate todays adults to seek esthetic treatment. Althoughesthetic dentistry can help achieve self-assurance, it must always be predicated on sound dental practice and keyed to total dental health. The limitations of estheti

58、c treatment must be communicated to the patient by dentists who are fully conversant with the procedures, methods, and materials available.THE SOCIAL CONTEXT OF DENTAL ESTHETICSA desire to look attractive is no longer taken as a sign of vanity. In an economically, socially, and sexually competitive w