195. David Hornbrook DDS, FAACD, FACE - Cosmetic Dentistry Secrets
Oct 15, 2023
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Dr. David Hornbrook, a renowned expert in aesthetic dentistry, shares his insights in this podcast. Topics include addressing red flags in dental patients, the significance of airway in dentistry, deprogramming techniques for bite determination, and the use of appliances like leaf gauges and NTI devices.
Understanding both function and aesthetics is crucial in dentistry to ensure long-term stability of restorations.
Recognizing red flags such as anterior wear without significant posterior wear and obstructive sleep apnea helps establish functional foundations for successful aesthetic restorations.
Deep dives
Importance of Function in Aesthetic Dentistry
Dr. David Hornbrook emphasizes the significance of understanding both function and aesthetics in dentistry. He highlights the failures he witnessed in cases that focused solely on aesthetics without considering the bite and functional occlusion. By integrating the assessment of occlusion, anterior wear, and posterior wear, he develops a comprehensive approach termed "functional aesthetics." This approach ensures that restorations not only result in beautiful smiles but also provide long-term stability and functionality.
Red Flags in Aesthetic Dentistry
Dr. Hornbrook identifies several red flags that practitioners should be aware of in aesthetic dentistry. The first red flag is observing anterior wear without significant posterior wear, indicating possible issues with the bite and occlusion. Additionally, the presence of obstructive sleep apnea (OSA) and airway problems can compromise treatment outcomes. Patients presenting with non-functioning posterior teeth, such as flat restorations or worn crowns, may experience difficulties in achieving ideal anterior aesthetics. Recognizing these red flags is crucial in establishing the functional foundations required for successful aesthetic restorations.
Muscle-Centric Bite and Vertical Dimension
Dr. Hornbrook highlights the importance of understanding and adjusting the vertical dimension to achieve optimal functional aesthetics. He refers to this bite concept as "muscle centric" rather than centric relation (CR). By stabilizing the condyles in a position guided by the patient's musculature, restorations can be designed to enhance both aesthetics and function. Dr. Hornbrook explains how anterior wear combined with no or minimal posterior wear necessitates restoring the bite in the muscle-centric position. This involves deprogramming the patient, determining the appropriate vertical dimension, and considering the presence of posterior interferences or intercuspal contacts.
The Role of Appliances in Bite Management
To aid in bite management, Dr. Hornbrook utilizes appliances such as the NTI (nociceptive trigeminal inhibition) and the freedom appliance. These appliances act as anterior midpoint stop devices, separating the influence of the posterior teeth on the condyle's positioning. The NTI, specifically developed for clenching, helps alleviate symptoms such as migraines and tension headaches by minimizing temporalis muscle activity. The freedom appliance, similar to an Essex retainer, allows the mandible to be guided by the patient's musculature. By employing these appliances, Dr. Hornbrook achieves stability, balance, and muscle comfort during bite adjustments and restorative treatments.
Dr. David Hornbrook is a gifted clinician and product researcher turned mentor. Through education, Dr. Hornbrook guides participants of his instructive events to the realization that they, too, possess the ability to practice aesthetic dentistry at the very highest level.
He is one of dentistry’s most famous faces and one of the pioneers of live-patient, hands-on clinical education, as the founder and past director of Pac-live and the Hornbrook Group. He has been a guest faculty member of the post-graduate programs in Cosmetic Dentistry at Baylor, Tufts, SUNY at Buffalo, UMKC, and the UCLA Center of Cosmetic Dentistry.
Dr. Hornbrook lectures internationally on all facets of aesthetic and restorative dentistry and has published articles in all of the leading dental journals. A prolific researcher and materials enthusiast, he consults with numerous manufacturers on product development and refinement. Dr. Hornbrook’s warm and engaging style earns him the highest possible marks from participants and meeting sponsors.
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