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Dr. Ken Malament's outstanding lecture on Implant Prosthetics kicked off our 2009 Implant Study Club

Sunday October 26, 2008

Dr. Kenneth Malament lectured on Fri, Oct. 17, 2008 at the Centurion Conference & Event Center. His lecture was entitled 
 

"INTEGRATION OF ESTHETIC DENTISTRY AND PROSTHODONTICS "
 

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At the end of the lecture, participants :

• Understood what factors and concerns a prosthodontist would have treating patients that require “esthetic procedures”.
• Understood the controversies that exists with modern dental materials.
• Understood what clinical factors impact on long term survival of dental ceramic materials.
• Understood the restoration of dental implants in complex conditions.

Dr. Malament received his D.D.S. from N.Y.U. College of Dentistry and a specialty certificate and Master’s degree from Boston University School of Graduate Dentistry. He has a full time practice limited to prosthodontics in Boston that includes a dental laboratory with Master Dental Technologists. Dr. Malament is a Clinical Professor at Tufts University and a Course Director in postgraduate department of Prosthodontics. He is the Vice President, Examining Director and Diplomate of the American Board of Prosthodontics. Dr. Malament is a Fellow of the American College of Prosthodontists, Academy of Prosthodontics, Greater New York Academy of Prosthodontics, and Northeastern Gnathological Society. He is an active member of many dental organizations including the International College of Prosthodontists, American Academy of Fixed Prosthodontics, American Academy of Esthetic Dentistry, Academy of Osseointegration, Northeastern Prosthodontic Society and American
Equilibration Society. A Past President of the Greater New York Academy of Prosthodontics, Northeastern Gnathological Society and the Northeastern Prosthodontic Society, he has served as the Secretary and Director of the American College of Prosthodontists and Secretary-Treasurer of the International College of Prosthodontists. Dr. Malament was on the research and development teams for two different well-known ceramic products and developed instrumentation used in clinical practice. He is a consultant to three journals and has published significantly in the dental literature. Dr. Malament has been afforded the honor to speak often about prosthodontic issues concerning ceramics, implants and periodontics.

INTEGRATION OF ESTHETIC DENTISTRY AND PROSTHODONTICS
Dentistry that is esthetic to the patient is an important clinical objective. The knowledge within dental technology, dental science and dental practice has dramatically expanded leading to better quality; artistry and more standards based clinical applications. Ceramics are the most consistently predictable esthetic dental material. Today dentists can offer more treatment options for patient’s complex problems. Metal-ceramics continue to be the “state of the art” and profoundly affect prosthodontic care and the future.
Understanding methods to manage simple and complex restorative issues are critical to improving patient acceptance and even long term ceramic success. Methods to integrate the efforts of laboratory technologists and managing occlusion and patient’s desires can have a profound impact in the practice of dentistry.
All-ceramic materials were developed to improve ceramic color and marginal fit. Until recently few research reports attempted to study their long term use or factors that relate to their performance without modeling the data. All-ceramic crowns on molars have yet to reach their full potential. Despite substantial improvements in material strength and toughness, they still fail at relatively high rates. Ultimately crown performance is a complex set of interactions between crown material and geometry, the characteristics of the support structure of the cement and crown, and the clinical loading history. This presentation will provide a comprehensive look at failure modes and effects in bilayer all-ceramic crown-cement-tooth systems, tying together the influences on resistance to fracture initiation and propagation of ceramic material properties and thickness; crown/tooth geometry; cement modulus and layer thickness; damage induced by shaping, fabrication, clinical adjustments, and sandblasting; and fatigue in the wet intraoral environment. Some counter-intuitive findings will be addressed including changes in fracture behavior with different geometry and the influence of the compliant cement layer beneath stiff cores. Original research will be presented that studied the clinical behavior of over three thousand all-ceramic restorations. Life history and fracture rates were studied over twenty years in relationship to factors that might affect success. Factors such as tooth position, preparation, luting procedures and gender are significant to long-term ceramic success.
Dental implants have become an integral part of dental practice today. Maintaining predictability and high success rates impose great challenges to the dental team. Edentulous ridge defects constitute a major problem. In the past long teeth have been placed into defects to take up vertical space. Gingival and tooth symmetry and the esthetic results were often compromised. Today these conditions as well as the lack of bone can be augmented surgically with soft and hard tissue grafting. This may not always produce a long-term predictable result. Prosthetic techniques will be discussed utilizing newly developed ceramic gingival material and design for fixed prosthodontics.