Veneer Preparation Design he nee aration design can be influenced by tooth size, location and crientation in the arch, dental anatomy, occlusal function, mechanical forces, quantity and quality of remaining tooth structure, the parameters for extension of the preparation to the aesthetic zone, and the final ated restorative dimension! #8 Using these clinical considerations, modifications in the 1 design could be requited to include the following designs: interproximal wraparound, al overlap, and inftaenamel or window preparation: The primary consideration factors prior to veneer preparation of any tooth include: anatomic variatt in enamel thickness according to tooth and location on the tooth and the final restor ative dimension. Removing predetermined foath dimensions [i.e., depth reduction guides) without nsideration of these two factors ean result in improper and extensive removal of tooth structure and p sensivily. A conservative intraenamel preparation should preserve as much the natural enamel as possible. The facial reduction should be at two different angles so as to enve perative oe region and the gingival margin should be prepared to & minimal (0.3 mm} chamfer and should be placed at or slightly above the level of the gingival crest unless caries, defects, or discoloration the double convergence of the labial buccal surface. Axial reduction begins at the cervical sqire 9 subgingival position. A conservative facial reduction should be 0.9-0.5 mm whereas sub ations may require increased reductions af 0.5 mm to 0.9 mm. All angles and Jd have smooth, rounded line angles, to improve resin adaptation” prevent stress niations in ceramic material and facilitate laboratory fabrication. Furthermore, healthy tooth structure should be removed only when the outline requires extension to a point beyond or within i « eviously indicated functional stops +plied fo the to the proximal surf the maxillary lateral with un-waxed medium. (9) The first layer body, an opacious d hybrid composite resin (Aelite LS* ntoured with a rial is sally with a #2 sable brush. The edge incisal embrasures. (10a - 10d) A ed interproximal instrument, The nitalateral tooth and sd fo form id increment of hybrid composite can n (Aelite [S™, Bisco) was placed with an interproximal iment fo complete the internal n from the incisal 12.(11) A diluted whit le brush ipate the final enamel dime: ntin core into the enamel zo lied with a ighlight the lobes cific regions was used to dilute the yel >incisally (13 - 14)The matrix is repositioned onto the anterior teeth and a lingual composite scaffold is de veloped onto the maxillary lef central and light cured for 40 seconds. (9) The preselected ‘ronslucent and opacious nanopanicle hybrid composites are placed onto the scaffold and adapted with a long bladed interproximal instrument and smocthed using a #000 sable brush. Notice the incisal halo that is created and the nuances in the incisal onehird that can be developed by altering the opacious cand translucent shades and their thickness. It is important to monitor the facial contour from the incisal so as to allow adequate space for the artificial enamel layer. (10a - 10¢) The completed composite veneer on the maxillary left central illustrates a noninvasive adhesive procedure that can provide an optimal fune tional and aesthetic result. (11) A translucent shaded incisal hybrid composite (Premise™, Kerr/Sybron) is placed over the facial surface to encapsulate the dentin core. (12a -12b) Dentistry and photography courtesy of Tetsuji Aoshima, D.D.S. m- haped bunser ntaminal soft state. (12) The anneale support for the the foll to a de foil matrix all Jatinur fol is f sculpting, and firing of the & carefully burni substruct proximal core let up the frac natesshrinka. perature is alt of the ic required. (15 - 16) while llusion is applied fo enhc (21-22) Utlizing the some more powder [ proximal the ma contrast. (23) Afi minimizing Jentin was built fo final shape and c rn entite facil back to provide space for the incis. svered with a combination of translucer (18) The enamel incis 5 designed to simulate and distal to develop (19) A segmental buildu powders (.2., 50/5 region. Alt4 | cezawc MarteaisDouble Cord Gingival Displacement Technique Ultrapak, Ult ®) ond ti a cord packing inst jhe gingival su red aluminum caked in a plain in the bottom of the Jthadent Product Inc prepare 1s around the pp free gingival margin (3) The apical migration of the her's Utrapak #170, f sed. (4) the initial finish line mCONTEMPORARY ADHESIVE CEMENTS Contributing Authors Blt Fh.Historical Progression of Luting Cements During the PreAdhesive era, cementation of restorations was dependent upon the restorative principles of resistance and retention form achieved from the preparation geometry and the fitting surface of the casting, Introduced to the profession in 18799 zine phosphate cement has been the most widely used luting cement in the 20th century and has been accepted a the “gold standard" for cast restorations. However, a few of the challenges of these waterbased cements included increased clinical solubily,° sensitivity from initial low pH and lack of anticariogenic effect’ to prevent caries af the restorationtocth interface: The late sixties sparked the evolution of the Adhesive Era, with a major breakthrough in the development of polycarboxylate cements. These cements were developed fo improve the original challenge of pulpal biocompatibility from the low pH of zinc phosphate cement! ! In addition, these materials demonstrated chemical adhesion to tooth structure between their negatively charged carboxylic groups and calcium phosphate cations, while providing lower compressive strengths (55 to 85 MPa} and higher tensile strengths (8 to 12 MPa]. The seventies brought significant improvement to the challenges of the traditional cements with the introduction of the glassionomer cements. These bioactive materials provided improved physico-chemical adhesion fo tooth structure and fo non-precious metal alloys,’ higher com pressive strengths than polycarboxylate and zinc phosphate cements, fluoride ion release with potential for remineralization, a low coefficient of thermal expansion, and improved fesistance to dissolution. The popularity in aesthetic indirect restorations of the mideighties launched the increased use of composite resin cements. These luting agents offered the clinician better options for shade matching, higher compressive and tensile strengths, while enhancing the fracture re sistance of ceramic malerials that can be elched ond silanated® '? However, these cements sill exhibit the potential for secondary caries and have been associated wilh a higher level of postoperative sensitivity. Furthermore, some of the adhesive cements requite clinical pra cedures that are more complicated Resin-ionomer cements debuted in the early nineties with advanced physical and mechani cal properties. These cements provided solutions to the challenges of all their predecessors by providing fluoride release'® and cariostatic potential and resistance to marginal micro leakage.” They were also characterized by an improved adhesion to enamel and dentin enhanced fracture resistance and wear characteristics. In addition, these materials exhibited more resistance to moisture and were less soluble than conventional glass-ionomer cements? improved setting characteristics, lower resistance to permanent deformation, a command of working time (photo-curing), lower film thickness,” improved aesthetics, and ease of manipulation. However, these cements were contraindicated for cementing allceramic res toratfions and posts due to thelr volumetric expansion that leads to dimensional change and postcementation expansion of the restoration or root fracture>Laboratory Fabrication of a Composite Resin Bridge mstorations rationMechanssus oF AniesoN m Total-Etch Technique Rebonding the Fractured Porcelain Veneer aluminum o: was etched for 2 Produ Inc.). (3) Application Porcelai ond Primer actu ‘eramic surface of the intact venee fered hydrofluoric acid gel [P lain Etch, Ultradent Product? Ine. th preparation was etched for 15 seconds with a 37.5% phosphoric ac10 | Fvsine & Poustine 2 Finishing and Polishing Anterior Ceramic Restorations: Gingival Regions After bonding the porcelain veneers, any excess polymerized resin cement can be removed from the interface using a scalpel blade (#12 BD Bard-Parke™, BD Medical}. (1) Any modi- fications or adjustments to the gingival surface of the porcelain can be made using a 15 ym short, tapered, diamond (DET3, Brasseler USA®) by retracting the gingiva with an 8A instrument (TINPFIAG, Hufriedy?), while closely observing tooth structure and the gingival margin area, and finishing margins with gentle sweeps. (2) The gingival region of the porcelain veneer can be smoothed and polished with prepolish and high shine silicone abrasive hollow cups (DCAM, DC2, Brasseler USA®| and silicone abrasive points. (3a- 3b) A properly polished cotamic veneer allows an optimal bicintogration of ceramic material with sof tissue. (4) mReferences and Suggested Readings 1. Towot 8. Bonded cores rsraion:.achoing pdt abit: Proc Penadont Seah Det 1995 714)99-97 2. stewart GP, Bachman TA, Halon F Tempera vi fue to fmching of direct restorative mates. Am | Dent. 1991 a) 23-28 3. Cooley RL. Baslmeler WW, White JH. Heat generation ‘dang polshing oF restoratone, Gurtexcence In Dent Dig. 19789(12)77-80 A. Baten CM, Lambrecht: PQurynan M Compation of taloce raghnes of rel hard matric fo thshold fare toughness ar taal plague rsianan a review of he Mare fore Dent Mater 1997 18 258- 5. Kaplon BA, Goistn GR, Viayoraghaven TV, Neon Ik fect hres pollu sycems onthe surface roughness cf far hybrid competes a poflomenc and coving electon tmeroscopy sy | Proshet Dat, 1996, 761) 34-36 6. Serosegu E Conalda C, Brow Miquel © Surface roughness of finshed compost rain | Froshes Dent 1992.0815) 742-749 7. Golda RE Finch of compostes and laminates Dent Cin Non Am. 1989 9512}05-018 8. Yap AU ing HO, Chong KC enc fring te on rmorgrlsalng ably fnew generation composts boning Syms | Ort Behe 1998 2511] 871-876. 9. Jetfenes SF. The ort and science of abranee fishing Gnd poichinginrstortve demir, Dane Cin Non Sm 1998 4214) 618-0 10. summi}B, Robbins MY, Hon), Schworts RS. Fina end palshng, In Fundamenlo: of oparaive deny. com temporary oppreach Carel Seam, Quescence Publdang 1996 201-205 T ute Sees, Phils RW. New fishing iment for composi ears im Der Asoc. 1985, 107{s 575-560 12. Yoo AU Sav CW lye KW Eft of nshng poling time on surface stractrsneeoftostheolsred etoanies Cro Rehab. 1998 2516) 456-401 13. Van Noott R Conteversial aspects cf camposie resin reserve matnal. Br Deat). 1985, 155)11) 380 14. Chung KH Effects ot friching and polishing proce ures onthe sfaces sure otrsn companies Dent Mater 1994 1015'325-380 15. jung 9% Fioching and polishing of @ hybad com posta and a hearpratced glass ceramic. Oper Dart 2002,27(21175-168 16. Stace: HE tights and innovahons | Ehst Dent 199217178) V7. tenella Frade IR, Dovalos WH lonogens tooth brcoon compansans omeng compet matenas ond inching technquse J Poshet Derr 200288)31320-828 18. Chondler HH, Bowen RL Patfenbarger GC. Method for Findhng composts reseratve matenat | An Dew 1971892}244-248, 19. on 44, Chan CA The pobhablty poser comper ves | Pouhet Dent 1989, 611} 196-146 20. Baghosan AA, Randalph RG, Jthok: Vf Relay instar inet fing of merchled and snaparcla bd compose trems | an Bent soe, 1987 118121209301 D1. Rew AF Grane, LovadnaJ® Ambrosano GM, Ets ‘tvatou fishing tsa on th suface oughness and stan ing euscephbilly cf packabla componte asin Dan Moker 2003,191) 12-18 Schmidseder Calor lla af derial medicine aesthetic sry Shitgat DE Theme, 2000) 23. DistchiD, Compania G, Hal: Mayer. Compszon Sfthe color sey of en neeganeraton companies on So andy Dent Mater 1994 10861 953-302, 24. Chatencen BF, Chstansan G]. Companson of near Tank ond conmetciol pases ued fr ichng and pol Compote cin” Gan Dect 1981,29()) 40-43. 25. Duke 5 Fecha and polthra techniques foecomposte reas Compend Conin Educ Dent 2001 2215) 392-896 26. Honan C8, Paves HM Palle GB, Rudolph An volun ton o commercial pats for fing conpeata eum sufaces J Prous Dent 1977.76) 674-579 D7. Toledans M, De La Tene f], OzoH0 F Evaluation of two pelthng methods for resin composies Am J Dent 19947928330 28. Froven DH Johoson GH An evaluation ofnshing inane Inert for on anterior and a postr composts J Peake Dert oes o0(z) 154-158 29. WisonF Heoh J, Wert: DC Fnshng composts raitor ‘ve mater. J Oral Rehabil. 190,711) 70-87 30. Chen BCS, Chon DC, Chan KC. A quanttative sy of Frhng and pelhng technique: fr a compose. | Poshet Derk 1988 $912) 292-297 31. Yona: ght ond colorinonenor composts resonant Pract Penodore Aechet Dent 1996;87| 678-082 32. Judd DB, Homson WN, Sao Bl, Hickson EF at ol Ophea specicahon of kghtscatanng mater] Res Nor Br Stand. 199719 267-317 33. once SB Srégone GL Auher AIM Rogues Yt Thee “mensional opncal protlomety analy of stare states btaned aferfinshng esquances fer hres compost reine OperDert 20002514 511-815 3A, Welundie AC, Muay FD. Companzon of methods sed in finishing composite resin.) Frosthat Dent W97AUaH 168-171 35. Heath, Witon Hy Surace roughness of reorations Br Daw) 197514044) 31-197 36. Wawel RV MeCabelF Wall AW Wacechororannes Inatwobody weortast Dent Water 1994 10|s} 209-7 37, Wikon GS, Doses EH. von Fraunhola JA. Micierhond eis choracanates of amor ectortve mata. Br Det | 1980 148/2137403B. Gray HS, Gav JB. The surface ere of ried coor poste ngs A acanang elation mctoscopy sly NZDerd 39, Hitonan},Rananen AV Evcucion of fart compote fring meshode Pree FmDant Soe. 1976,720011-18 AO. valcke CF Some srace choclate: cf compaste rin ‘leg otal J Dent Assoc S A 1976,3540) 21-27 41. Demion|8, Crag RO. Pysea propre ond fihed duke ote scmpatie rare sme] Das se 1972. 101-108 2. Hamch CM, Sith GA The sala ch cfcomposia tectcrcve moat. Br Den] 197313511) 485-458 43. de Gee A), Ten Hartel HC. Abrasion of compos motets by toothbrushing labstioct 61) J Dent Res 1982.54) 571 4A. Gry J Fring posaiorcompostes An SEM sey ca ronge cticrumen ond ther sfet on a compost and fname! Retort Dent 19856 48-58 45. Tery DA. Notral Ethetc wih compost eons lat ad Mahwah, Nj Montage Medio Corp, 2004, AG, Cust, ert DL The allt of pohing procenes on ightced eonpone stations Conpend ortn Fa Det Toes le) 3789 AT. brie Kod Pili! since of daniel maak. 10th 4 Phlodlpha, PA. WWE Gonder, 1996 AB. Magne F Oh WS, Pintado ME. Delong R. Waar of tramel ond vanseong carnice ae labortory ond chars fining proceduas | Moshe! Dent. 1999,82(6) 569-879 49, uk WO, Fach 9 Suface fang of deni pace lin) Poahet Dee TB a6 217-221 50. Money GE, Taylor OF Saas on he waer cf pores, name, and gold | Preset Dest. 1971,25(9) 290908, 51. Wiley MG. Etec: cf porsain on occladngsutaces of tetera tosh J Preahet Dent 1969,61/2) 133-197 52. Jelena: SR Baskmsier WW. Ginna A) Thee con patie nihing sylame a missin vito valuation | E Bent 1992di6) 181-185 53. CloytonJa, Green Roughness of pont mets ond denial plaque | Poshet Dent 1970,23}4) 407~a1 54, Swartz ML. Philpe RW. Comparison of bacterial acc tmdation on ough and smoath enamel sufaces | Panodontl 1987, 2048) 304-207 55. iclaan WW Science ond ot of dental ceramics Vol 1 The nei f daniel carers and hircincal ca. Tt ed Guinesence, 1979 56. Bessing C, Wiltonson A Companion of two dit {arent mathods of polhing potcslom ‘Scond | Dant Ras 1983 916) dB2-a67 ‘57, Campbell SD. Evaluation of autoce roughness ‘hg techniques or new ceramic mates | P 1989,6119 562-568, cond pak het Dent 5B. Haywood VB, Heymann HO, Ky RP Whiley J, etl Peking porslanvenear An SEM and speeder rlleconce noha Dew Mtr 1985 40) 116-121 59. Haywood VB, Hayman HO Seu MS Hct of wo, {peed ond expeomerealitumertaton on bchng and oleh ing porclan moray Der Mater 1989.53] 185-188 60. Ward MT, Tote WH, Powers JM Surface rough rate of opalescent porcelains afr polehing. Oper Dent 1995,20)3} 106-110, 61. Tery DA Feihing and pelsbing adhesive reorons pal Prot Proced Aeshe! Dew 20051777) 47 7-47511 | bea rest Clinical Photographic Techniques Clinical photography is an essential component in aesthetic and restorative dentistry. It has become paramount fo our security and indispensable in communication 2® * Inroral photographs allow the pre-existing condition to be evaluated, diagnosed, documented, and described to the patient. The aesthetic examination is not complete without photographs In fact, the diagnosis is often discovered as the photographic series is taken and reviewed. Restorative treatment should nat be initiated prior to completion of a preoperative series of photographic images since they are not only & diagnostic to0! but provide legal suppor for ‘any treatment provided. In addition, by reviewing postoperative photographs the restorative team (i.e., technician, clinician} can evaluate the outcomes and learn from positive as well as negative results, There is @ myriad of photographic tips and tricks that can improve the image capture. For example, one suggestion is fo hold one's breath as soon as an image is clear in the view finder just prior to releasing the shutter. To stabilize the camera the photographer can stand slightly astride with one foot forward and lean against the dental chair. The weight of the camera seems manageable by supporting the weight with the palm undemeath the camera: body while bracing the elbow against the body. Another method of stabilizing the camera is to extend a finger to use as a brace against the patient's face or tooth. Taking the portrait at the end of the series helps the patient to be at ease and comfortable for the most natural and relaxed smiles. The authors’ 1éimage photographic serfes will describe the magnification ratfo, patient ot entation, photographic composition, position of camera angle, and flash position for each of these intra-oral and extra-oral views.Maxillary or Mandibular Anterior Incisors Retracted Frontal View (Intra-Oral View) Magnification Ratio - Equiva is. agli display « horiz maxillary wandibula th ond gingiva. Thi h 4 Patient Orientation ~ The pat cated in an up h ted 4 e fi porallel fo the floc : 6 | " the floot. The pati be post the oppo: . The h 4 a frm as nol to disp a the c Position of Camera Angle meta chould be positioned to create o h ye and the le yerpandicular to the patient's face. The phar should position in fr 2 patent. The J be parallel to the horizon Flash Position - 1b, h ned atPERIODONTAL PLASTIC SURGERY Contributing Authers: douglas, Tery, D.D.S., Erm ce, DMD, Dr, Cin, Dent, David A. Garber, DM mCrown Lengthening Procedures Crown lengthening procedures have become an integral component of the aesthetic armameniarium and are utilized wih increasing frequency to enhance the appearance of restorations placed within the aesthetic zone. Whether performed for he purposes of exposing sound tooth structure, or to enhance the appearance of the defintive restorations, these procedures must be planned following sound biologic principles, in order lo avoid deleterious effects, The implementation of evidence-based diagnostic criteria, along with contemporary surgical and restorative protocols, may result in increased predictabiliy and optimum results when treating the aesthetic zone. STRIPE TRee ar ott Crown lengthening procedures have been traditionally performed to provide access for treatment of subgingival caries, fractures, or defective restorations. It is also recommend ed when there is inadequate tooth structure for crown retention as a result of excessive occlusal wear, abrasion, altered passive eruption, hyperplastic tissue, and asymmetrical ginginval margins.” Is surgical objectives include the exposure of an area of sound tooth situcture suitable for placement of a restorative margin, while providing adequate biologic width space.” 182° Crown lengthening procedures may also be required for the trealment of chronic gingivitis caused by the placement of an cthenwise satisfactory restoration exhibiting margins that impinge upon the biologic width 2" Additionally, crown lengthening procedures may be performed fo enhance the appear ance of restorations placed within the aesthatic zone. Regardless of the clinical indications however, similar biological parameters must be taken into consideration and it is therefore essential to possess a basic knowledge of the anatomic slructures invalved?' Independently of whether the rationale for crown lengthening surgery Is guided ky functional or aesthetic requirements, the biologic principles involved remain the same. The periodontium is the basic functional unit supporting the teeth. lis components include the alveolar bone, pericdontal ligamen!, cementum, junctional epithelium, and gingiva These tissues are interdependent and exist in a state of physiologic hemastasis, where normal cellu lar activity allows the maintenance of health and a defensive response to environmental insults. The gingiva is comprised primarily by connective tissue, which is covered by an epithelial layer that provides o protective barrier against bacterial, mechanical, and immunologica insults. Collagen fibers within the gingival connective tissue insert into the periosteum of the alveolar process and into the root cementum.13 | banc Anterior Ridge Augmentation Anterior ridge deficiency or defects can result from the loss of teeth from disease, trauma, surg cal injury, or developmental origin.!$*° The ideal form for fixed prosthesis pontics is described as having the occlusal height at the lingual half, an adequate zone of gingiva with a smooth regular surface which is free from aberrant muscle attachments, and an accommodating contour mesio-distally and faciolingually. The aesthetics and function can be compromised in the maxik lary anterior regicn when pontics or implants are adapted to deficient alveolar ridges!" 42 Reconstructive periodontal plastic surgery procedures, originally referred to as mucogingival surgery “ allow the restoration of the hard and soft tissue profiles ofthe alveolar ridge to proper dimensions for the optimal functional and aesthetic result. There are various types of techniques to reconstruct deficient or defective alveolar ridges. The soft tissue mucogingival augmentation procedures available for these defects include the connective tissue pedicle grafts—the "Roll technique," 45 pouch graft!?°4#1” interpostional wedge and inlay] graft!2° #445 7and the onlay graft'2° "44!" The amount of soft fe, supporting alveolar bone, and available blood supply are factors that contribute to the stability and success of the reconstruction procedure!%° The selection of the proper teotment plan requires an understanding of the type of defect present the extent of the defect, and the quantity of tissue or graft material18 A sol tissue diagnostic waxup is prepared to indicate the additional buccolingual dimen: sion that is required for optimal biologic and aesthetic results. (10) The connective tissue graft was harvested from the palate using sharp dissection. The volume of connective tissue required was predetermined from the buccolingual wax-up dimension. A subepithelial/sub- connective tissue graft procedure [pouch graft Jwas used to restore the buceolingual ridge defect (Class I'4® or Class 8“ defect). This procedure uses a wedge of connective tissue that is placed in a surgically created pouch that maintains a supraperiosteal blood supply to surround the graft. A matrix of the diagnostic waxup is used to confirm the predetermined dimension. (11 - 14) A postsurgical review demensttates an improved gingival architectural contour with an enhanced buccofingual alveolar ridge dimension. (15)3 ° The socket is gently debrided using 0 suigical cucete, (9) A surgical guide [Alanis Allantis Cor ponents Inc.) was fabricated during the pretreatment phase to a predetermined orientation ar depth and the custom abutment was fabricated, prior to the surgical procedure. A 2mm dispe guide. (10) A 3 mmm tapered dl is measured and placed Imm beyond the actual length (13 mm] ofthe fxtu apex. (11 - 12] The implant is transfered under sterle conditions and delivered to the pre able twist dill is precisely placed, Notice the precise alignment with surg pared surgical site. Implant selection was based upon preoperative considerations (i.e radiographic evaluation and diagnostic waxup) and confirmed by the root mea: after extraction and post surgical assessment of the anatomical parameters. (13 - 14) Th remer implant is placed 3 mm below the cementcenamel function of the adjacent teeth usin 30 N-cm torque. Notice the ideal position of the implant in relation to the adjacent teet confirms the preplanned position. (15 - 16)BIOMODIFICATION OF TOOTH DISCOLORATION Contributing Authors: douglas A. Trt, D.0.5., Cynthia P. Tojtenberg, D.D.S., M.S Theodore P, Crll, D.O.S. Alterations in tooth color can be due to a variety of causes. Some of these occur during tooth formation and others afterwards.! There are three well defined groups. These include alterations due to external agents and thase generated by intrinsic etiology. The third group includes heterogeneous alterations of color [i.e., enamel wear from aging darkens tooth color). Itis important to identify the correct etiology for effective treatment? Extrinsic Origin Extrinsic stains are superficial discolorations of the tooth surface or restorative material re- sulting from an accumulation and adherence of foreign particles of various origins [i.e., tobacco, coffee, tea, medications such as iron supplements, chlorhexidine, chromogenic type bacterium, tannin in dietary supplements, efc.). Extrinsic stains can consist of multiple colors: brown, black, green, orange, grey metallic.® Brown stains are thin, pigmented pellicles usually located on the buccal surfaces of maxillary molars, the lingual aspact of mandibular incisors and less frequently on maxillary incisors. The specific origin of the brown staining has not been determined but tannin depositions from tea and coffee are suspected? Dark brown fo black stains are the result of tobacco usually located on the gingival third of teeth and on enamel defects +Green stains are found as wide bands on the facial aspect of moxillary incisors becouse the bacteria originating the stain develop in the presence of light. These stains are commor- ly found in children and more commonly affect females. This type of stain is originated by fluorescent bacteria or fungi such as the penicillum or asper gillus. Orange stains which ate not very common are due to chromogenic bacterium.? Chlothexidine discolorations are typically brown and can stain teeth and composite restoralions after prolonged uses a Reported tom Theodor F Crol, DDS *h permission Intrinsic Origin Intrinsic stains are caused by trauma toa developing permanent tooth. The trauma causes damage to the blood supply which results in degeneration of pulpal tissues and subsequently to 88 of vitality. The blood pigments left behind infiltrate the dentinal tubules leading to significant tooth discolor ation.* Other forms of intrinsic staining include tetracycline and fuoresis. Tetracycline staining occurs as a result of the tetra cycline molecule becoming incorporated into the develocing dentin causing a change in color of the dentin to a yellow, blue-grey or brown discoloration. The results depend upon the concentration administered to the patient and exposure ofthe tooth structures fo ullravie let light following eruption.” Fluotesis presents as brown and white speckled mottling of the tooth and is due to the intake of excessive concentrations of fluoride during formation of the coronal aspect of the tooth * Repinted fom Theodore P. Crol, 0.0.5 wih par Other intrinsic staining is created by local, systemic, or genetic factors that result in hypopla sia or opacities or hypocalcification of the enamel. In the case of amelagenesis imperfecta the enamel presents itself as hypoplastic, hypocaleified, or hypomaturated.° The staining ranges from opacious white to yellow.