INTRODUCTIONToday’s parents are concerned about aesthet-ics for their children. Aesthetic dentistry canprovide the beautiful smile that both par-ents and children desire. Self-image is veryimportant for our youngpatients so they canlook and feel good about themselves. Wehave all experienced the wonderful smile apatient gives to us when we have turned the“ugly duckling into a beautiful swan.” Weare so fortunate to have the dental materialsand devices that allow us the opportunity toprovide the very best in aesthetic dentistry.

Some of the techniques and materials wehave available for our teenage patients’ smilecreations include: porcelain veneers, directcomposite veneers, microabrasion, bleaching,orthodontics, including clearbraces andalign-ers, direct and indirect composite restorations,implants, and porcelain crowns. The purposeof this article is to provide a brief synopsis andto illustrate various aesthetic restorative op-tions that can be used for our child and ado-lescent patients. Also, some of the latest inno-vations in dental restorative techniques willbe briefly described and illustrated. Theauthor’s intent is to broaden the scope of aes-thetic dentistry for children and teens.

Primary Anterior and Posterior TeethAnterior primary teeth can be restored withvarious tooth-colored restorations. Unfor-tunately, we have many children who sufferfrom early childhood caries. Fortunately, wedo have aesthetic alternatives. With thedevelopment of aesthetic restorations, thereis no reason for a child to go to school withthe silver stainless steel crowns on his/heranterior teeth. We have wonderful aestheticcrowns as alternatives including: celluloidstrip crowns, open face stainless steelcrowns; stainless steel crowns with whitefacings; and acrylic or polycarbonate crowns.A child who has one or more missing anteri-or primary teeth can have an aesthetic main-tainer replacingmissing teeth fabricated.

Permanent Anterior TeethThere are several alternatives for aesthetical-

ly restoring permanent teeth in children andteenagers. Let’s take a look at several com-mon aesthetic problems that we find inyoung patients and the aesthetic alterna-tives that are available today. Enamel hypo-

calcification and hypoplasia are a commonaesthetic concern. When these conditionsoccur on the facial surfaces of anterior teeth,direct composite veneers are an option to

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DENTISTRYTODAY.COM • APRIL 2010

Figure 1a. Enamel hypocalcification. Figure 1b. Opaquer placed over discolorations due tohypocalcification (Creative Color [Cosmedent]).

Fred S.Margolis, DDS

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a b

Figures 2a and 2B: Enamel hypocalcification before and after microabrasion Opalustre [Ultradent Products] andPrema [Premier Dental]).

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Figure 3a and 3b. Correction of anterior diastema with direct-bonded composite veneers.

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Figure 1c. Completed composite resin restoration(Vitalescence [Ultradent]).

Figure 1d. Resin Coating placed over composite veneer(G-Coat Plus [GC America]).

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ReadRead WatchWatch

andandYou can see Dr. Margolisand an excerpt of hisprogram atdentistrytoday.com.

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improve the aesthetics of the smile.Figures 1a to 1d illustrate the use ofdirect-bonded composite resin tomask the enamel hypocalcifi-cation/enamel hypoplasia on the fa-cial surface of a permanent central inci-sor. Microabrasion can also be utilizedin some situations to reduce the whiteand/or brown hypocalcified areas inthe enamel (Figures 2a and 2b) (Opa-lustre [Ultradent] and Prema [PremierDental]). In the case of anterior teeththat are imperfect in shape and/or size,composite or porcelain veneers canalso be utilized (Figures 3a to 4b). ClassIII carious lesions can also be restoredaesthetically (Figures 5a and 5b).

Primary Posterior TeethFortunately, there are many choicesavailable in the cosmetic restoration ofprimary posterior teeth. Figures 6a and6b illustrate the aesthetic techniquethat may be used for restoring cariousprimarymolars.

Permanent Posterior TeethClass I, II, and V caries can also berestored as aesthetic restorations. In

Figures7ato7d,2ClassIIrestorationsareshown.

Fractured Anterior TeethFractures of primary and permanentanterior teeth can be restored withcomposite materials (Figures 8a to8d). Porcelain veneers may also beused for permanent anterior teeth.

NEW INNOVATIONSThere have been several innovationsthat have made the preparation andrestoration of primary and permanentteeth more efficient and practical forthe dentist, and more comfortable forthe patient. Among the most signifi-cant innovations is in the area of adhe-sive dentistry. The dentalmanufactur-ers have continually improved thematerials for self-etching prior to theplacement of the restorative materialof choice. There are now primerswhich are antibacterial and bondingagents that contain fluoride. Theseadditions will help us eliminate theneed for cavity cleansing and allow forstronger, longer lasting, and virtuallyavoiding postoperative sensitivity. Inaddition the fluoride release allows forthe prevention of secondary caries.(Figure 7a)

Other innovations include: Simp-ler and easy to use composite polish-ing kits, such as the SS White JazzSupreme Kit; Erbium; Chromi-um:YSGG Laser for hard tissue cavitypreparation (Waterlase MD [Biolase])(Figure 9); alginate substitutes; seg-mentalmatrices (Figure 7b to 7c); non-stick matrices; mouthprop for isola-tion that incorporates both an intrao-ral light and saliva evacuation (Figure10); disposable bleaching trays; digitaloperating microscopes (Figure 11);and plastic burs for the safe removal ofcaries (SS White Smart Prep). (Note:The products mentioned above can beviewed in the Read and Watch video byDr. Margolis that accompanies this articlelocated on dentistrytoday.com.)

CONCLUSIONDentists who care for children andadolescents have the wonderful taskand ability to create beautiful restora-tions for these young patients. Withthe advent of many wonderful tech-

niques, devices, and materials, we canhave “fun” while achieving profes-sional satisfaction from creatingbeautiful restorations which helpchildren and adolescents improvetheir self-image. I hope that each ofyou accept children into your practiceso that you too can have the wonder-ful experiences that those of us whotreat children on a daily basis enjoy.�

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Figures 4a and 4b. Correction of abnormal tooth size (teeth Nos. 7 and 10) with prepless porce-lain veneers (Lumineers [DenMat]).

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Figures 5a and 5b. Class III caries in permanent maxillary incisors; preparations were done withthe Erbium laser (Waterlase MD [Biolase]); final restorations (Venus Diamond Composite [HeraeusKulzer]).

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Figures 6a and 6b. Primary tooth with Class II caries and restoration with a flowable compositelayer followed by regular bodied composite (Venus Diamond Composite [Heraeus Kulzer]).

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Figures 8a and 8b. Fractured primary centralincisor and composite restoration (TPH3[Dentsply CAULK]).

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Figure 9. Using the Erbium; Chromium:YSGGlaser (Waterlase MD [Biolase]).

Figure 10. Mouthprop with light and evacua-tion (Isolite [Isolite Systems]).

Figure 11. Digital operating microscope(CamSight [CamSight]).

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c

d

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Figures 7a to 7d. Permanent tooth with Class IIcaries. Two-step primer and bonding agent (ClearfilSE Protect [Kuraray]); flowable composite and com-posite restoration. (Majesty [Kuraray]). Note use ofsegmental matrices (Garrison Dental Solutions).

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Suggested ReadingsDaou MH, Tavernier B, Meyer JM. Clinical evaluationof four different dental restorative materials: one-year results. Schweiz Monatsschr Zahnmed.2008;118:290-295.

Drummond JL. Degradation, fatigue, and failure ofresin dental composite materials. J Dent Res.2008;87:710-719.

Krämer N, Reinelt C, Richter G, et al. Nanohybrid vs.fine hybrid composite in Class II cavities: clinicalresults and margin analysis after four years.Dent Mater. 2009;25:750-759.

Krämer N, García-Godoy F, Frankenberger R.Evaluation of resin composite materials. Part II:in vivo investigations.Am J Dent. 2005;18:75-81.

Magne P. Composite resins and bonded porcelain:the postamalgam era? J Calif Dent Assoc.2006;34:135-147.

Ritter R. Using a nanohybrid composite with ceram-ic-like properties. Dent Today. 2009;28:74.

Olivi G, Margolis F, Genevese MD. Pediatric LaserDentistry: A User’s Guide and Atlas. Chicago, Ill:Quintessence Publishing; 2010.

Owens BM, Johnson WW. Effect of new generationsurface sealants on the marginal permeability ofClass V resin composite restorations.Oper Dent.2006;31:481-488.

Dr. Margolis received his BS and DDS fromThe Ohio State University and his certificate inpediatric dentistry from the University of IllinoisCollege of Dentistry. He is a clinical instructorat Loyola University’s Oral Health Center andan adjunct clinical assistant professor at theUniversity of Illinois College of Dentistry. Hehas lectured internationally and has receivedMastership from the Academy of Laser Den-tistry. Dr. Margolis has contributed articles toboth lay and professional journals. He is theauthor the book Beautiful Smiles for SpecialPeople, which is a course manual for dentalpersonnel treating the disabled patient. He isco-author of a book Pediatric Laser Dentistryand Atlas, to be published by Quintessence in2010.Dr.Margolis is in full-time private practiceof pediatric dentistry in Buffalo Grove, Ill. Hecan be reached at kidzdr@comcast.net.

Disclosure: Dr. Margolis receives an honorar-ium and product from Biolase Technology,Inc. and receives product from other manu-facturers whose products may be used forillustration purposes.

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