Dr. Brian Vence’s Publications

The fabrication and delivery of functional, biocompatible restorations with a natural appearance have become the definitive goals of restorative dentistry. Although contemporary ceramic materials allow light to be manipulated in restorations to replicate the natural dentition, this objective can be difficult to achieve when tooth preparation is not performed properly. This article presents a sequential approach that can be used to render the proper shape and margin design critical to the fabrication of full-coverage crown restorations that are indistinguishable from the adjacent natural teeth.

The goal of this clinical report is to describe and illustrate the principles for achieving a predictable esthetic result for patients with worn incisal edges by creating a harmonious angle of disclusion. Patients can create an esthetic problem from altered tooth form and tooth migration,caused by worn incisal edges resulting from parafunctional activity. This presents substantial challenges to the restorative dentist, paramount among them, achieving longevity of porcelain or composite bonded restorations used in an esthetic reconstruction. Although a number of therapies are available to provide esthetic improvement, the predictability in the continuing presence of the parafunction that caused the esthetic problem is in doubt. Altering the incisal edge position for esthetics and achieving a harmonious angle of disclusion, though, is a clinical approach that may substantially reduce this risk.

Even when dentists execute proven principles and use contemporary techniques optimally, the oral environment, cyclic loading, and thermal cycling cause materials or structures to fail. Implant dentistry enables dentists to limit the extent of their restorations and plan for one-tooth or fixed partial dentures of just three or four units, limiting the extent of replacing failures in contingency plans. To illustrate this, the following article presents a case involving the failure of a single central tooth in a patient with a high smile line; moderate gingival display; and a thin, high scalloped biotype. The case also demonstrates that pink esthetics are just as important as white, and that gingival health and architecture are critical to making restorations “transparent.”While grooming soft tissue is not essential to achieving gingival esthetics, the technique simplifies fabricating the definitive restoration for the technician by eliminating the question of gingival architecture. The purpose of this case study is to demonstrate a technique to groom the soft tissue around an implant by developing the gingival architecture with the emergence profile of a screw-retained provisional as previously described in the literature.

This 60-year-old Caucasian male had been under the care of his longstanding general dentist with regular dental visits annually. Tooth #20 had recently been extracted after fracturing while eating a burger. He had previously lost tooth # 18. He reported a problem with a post and crown that didn’t feel right, explaining that his previous dentist said the tooth was crumbling because it was brittle and decayed. He was previously informed that he grinds his teeth and was wearing a splint. The patient reported a history of muscle pain and cramping. Six months prior to the initial consultation he had been diagnosed by his medical doctor with sleep apnea and was using a CPAP machine, which he believed had alleviated his muscle pain. The patient was also aware that he may clench during the day. He was referred by his family dentist to the periodontist for implant placement in site #’s 18 & 20. The patient asked the periodontist for a referral for a second opinion.

Pretreatment knowledge of crestal and radicular dentoalveolar zones and their associated thicknesses can improve risk assessment to meet esthetic and functional goals, particularly when discrepancies in anterior maxillary and mandibular arches exist and when an anterior protected articulation is to be achieved. This paper discusses a new classification of dentoalveolar bone phenotypes that differentiates the alveolar crestal zone from that of the radicular zone and classifies the thickness of facial bone at each compartment to aid in interdisciplinary dentofacial therapy risk assessment. The zone of crestal bone is defined as the region of the tooth alveolus measured from the cementoenamel junction (CEJ) to a point 4 mm apical. The dentoalveolar radicular zone is dependent upon the individual root length. It begins at a point 4 mm apical to the CEJ (base of the crestal zone) and extends the length of the tooth root. Dentoalveolar bone phenotype at both zones (crestal and remaining radicular alveolar aspect) can be categorized as either thick or thin.

Comorbidities that negatively impact orthodontic (malocclusion), periodontal (periodontitis, deficient dentoalveolar bone volume, mucogingival), and prosthetic (structural integrity compromise from caries, attrition, and erosion) conditions can affect the general health of the patient. In addition, emerging data highlights the importance of undiagnosed airway volume deficiencies and sleep-disordered breathing conditions in the adult and pediatric population. Deficiencies in dentoalveolar bone and discrepancies in skeletal relationships can impact the volume of hard- and soft-tissue structures of the periodontium and decrease oral cavity volume. Contemporary interdisciplinary dentofacial therapy (IDT) is a key process for addressing the comprehensive problems of patients based on etiology, homeostasis, and sustainability of physiologically sound outcomes.