A patient-calibrated individual wax-up as an essential tool for planning and creating a patient-oriented treatment concept for pathological tooth wear.

Tooth wear is generally a physiological process; however, it can also be a pathological condition associated with attrition, abrasion, and erosion processes in which the quantity of tooth loss is atypical for the patient's age. Tooth substance loss often causes functional problems, symptoms of discomfort/pain, and esthetic impairments. Patients presenting this condition frequently need restorative treatment, combined with an increase in the vertical dimension of occlusion (VDO). A diagnostic wax-up (DWU) provides assistance in determining a new occlusal plane and VDO, and is a fundamental tool considering the backward planning involved in the execution of a complex rehabilitation. In cases of severe tooth wear, preventive measures must be taken. Yet, when a restorative intervention is needed, the use of a DWU, in conjunction with a mock-up, helps to achieve a predictable and satisfactory outcome. This article presents a case report of a young female patient with pathological tooth wear, related symptomatology, and esthetic complaints. Initially, a DWU and a diagnostic mock-up were created. After esthetic and functional corrections, a second DWU was generated and transferred to the patient's mouth by means of a therapeutic mock-up. This mock-up was used as a trial restoration for the pretreatment phase, to evaluate the new VDO/esthetics/function and to guide tooth preparation. Lithium disilicate (LS2) occlusal onlays were used to stabilize the VDO, and anterior LS2 and feldspathic veneers, combined with direct composite restorations, were executed to reach the planned minimally invasive result.

Anterior restorations: The performance of ceramic veneers.

Adhesive bonding techniques in combination with tooth-colored restorative materials are one of the greatest achievements of restorative dentistry. Adhesively bonded veneers made from various silicate ceramic materials have contributed significantly to this. Ceramic veneers had long been considered to be only esthetic implements. However, their range of indications has been steadily increasing, making ceramic veneers a highly viable alternative to classic, far more invasive forms of restorative treatment. Today these veneers are used to restore the biomechanics of the dentition, to establish adequate function, to mask highly discolored endodontically treated teeth, and for many other purposes. The present article explains the principles of modern veneer technology based on clinical examples, with special emphasis on collaboration with the dental laboratory and communication within the dental team. This includes analyzing the case, defining the treatment goal, determining the right shade, selecting the most suitable ceramic material, finding the best preparation design, and choosing the most appropriate adhesive concept. The article will also explore the long-term prognosis of ceramic veneers as reported by a number of scientific studies.

Multidisciplinary full-mouth rehabilitation with soft tissue regeneration in the esthetic zone.

OBJECTIVE: Oral rehabilitation often requires a multidisciplinary approach including restorative dentistry, prosthodontics, and periodontology to fulfill high esthetic and functional demands, frequently combined with changes in the vertical dimension. The presence of gingival recessions can be associated with numerous factors, such as brushing or preparation trauma and persistent inflammation of the gingiva due to inadequate marginal fit of restorations. Because gingival recessions can cause major esthetic and functional problems, obtaining stability of the gingival tissue around prosthetic restorations is of essential concern. Modifications of the occlusal vertical dimension require sufficient experience of the whole dental team. Especially in patients with functional problems and craniomandibular dysfunction, a newly defined occlusal position should be adequately tested and possibly adjusted. CLINICAL CONSIDERATIONS: This case report presents a complete prosthetic rehabilitation combined with a periodontal surgical approach for a patient with gingival recessions and functional/esthetic related problems. The vertical dimension was carefully defined through long-term polymethyl methacrylate provisionals as a communication tool between all parts involved. All-ceramic crowns were inserted after periodontal healing as definitive rehabilitation. CONCLUSIONS: Complex rehabilitation in patients with high esthetic demands including soft tissue corrections requires a multidisciplinary team approach that consists of periodontal surgeon, dentist and dental technician.

Minimally Invasive Treatment of an Ankylosed, Severely Discolored, and Intruded Central Incisor with a Masking Ceramic Veneer: A Clinical Report.

Dental therapy of traumatically ankylosed maxillary anterior teeth with an additional slight root resorption represents a great challenge for the restorative team and requires intensive planning and communication between patient, dentist, orthodontist, periodontist, and dental technician. The inhibition of vertical growth often makes dental intervention indispensable. Porcelain laminate veneers have been successfully used for more than two decades, mainly on anterior teeth, and was the minimally invasive treatment option for the present case report. Preprosthetic planning with a digital approach of the width-length ratio and the red-white esthetics were important prerequisites for a satisfactory treatment result. The treatment goal was clarified using a wax-up and a corresponding template for intraoral verification with a mock-up. The template also served as a preparation guide. Despite all risk factors, including the endodontic treatment, the 3-mm intruded position, and the slight root resorption, the patient and the restorative team decided to restore the situation with two feldspathic-ceramic veneers to provide an esthetic, time-saving, nonsurgical process for the patient.

Combining Esthetic Layering and Lithium Disilicate Sintering Technique on Zirconia Frameworks: A Veneering Option to Prevent Ceramic Chipping.

Major and minor chipping of veneering porcelain are two of the most frequent complications in all-ceramic restorations with zirconia frameworks. In cases of major chipping, replacement of the affected restoration may be necessary. High-strength lithium disilicate ceramic offers new options to serve as veneering material in a sintering technique or as repair material for chipping in combination with the adhesive technique. The purpose of three case presentations here was to describe the use of lithium disilicate ceramic on zirconia frameworks for reliable and esthetic veneering in the posterior region and to repair extended chipping in conventional veneering materials.

Innovative Single-Tooth Replacement with an Individual Root-Analog Hybrid Implant in the Esthetic Zone: Case Report.

The goal of this study was to explore an innovative approach to single-tooth replacement using an individually custom-fabricated, root-analog, hybrid dental implant, in the esthetic zone, to avoid the microgap and micromovements between the implant and abutment. Moreover, the use of burs to prepare the implant recipient site is not necessary in this technique, reducing the bone removal, heating, and trauma. The process requires capturing accurate root geometry through combined computer-aided design/computer-assisted manufacturing (CAD/CAM) and a three-dimensional (3D) visualization (digital volume tomography [DVT]) of the tooth in situ, which might result in reduced remodeling after insertion. A good esthetic and functional outcome was obtained. The use of a root-shaped tooth analog implant might be in selected cases a viable alternative to current threaded cylindrical and cone-shaped implants. The new concept avoids the microgap between the implant and the abutment and reduces the trauma to the tissue and bone.

Clinical Benefits of the Immediate Implant Socket Shield Technique.

OBJECTIVE: Extraction-socket resorption is considered a major problem that can limit implantological rehabilitation options and compromise the esthetic outcome. Surgical techniques to reduce remodeling are of restricted predictability and commonly require several surgical interventions and grafting. This increases the treatment cost and places a physical and psychological strain on the patient. This clinical case report presents a replacement of an upper canine using the socket-shield technique (SST) with a CAD/CAM surgical guide, resulting in a predictable, high esthetic, and functional result. CLINICAL CONSIDERATIONS: The SST is an alternative approach to curbing remodeling and resorption by retaining the facial part of the root during tooth extraction. An immediately placed implant supports the facial root fragment, preventing the collapse of the buccal wall. The SST with digital precision planning in combination with a CAD/CAM surgical guide benefits patients by preserving their tissue architecture and causing only insignificant trauma. Furthermore, the SST reduces the number of surgical and prosthetic interventions required to one each for pre-operative planning, surgical procedures, and prosthetic rehabilitation. CONCLUSIONS: The socket shield technique is a minimally invasive implantological approach offers patients and clinicians multiple benefits. CLINICAL SIGNIFICANCE: The socket-shield technique (SST) represents an alternative approach to intervene remodeling and resorption processes by the maintenance of the facial part of the root during tooth extraction. The immediate placement of an implant supports the facial root fragment and thereby prevents a collapse of the buccal wall. The SST associated with a CAD/CAM fabricated surgical guide, can reduce the amount of appointments, due to the immediate fabrication of the definitive restoration with the existing model. Therefore, no further necessary appointments are required apart from first pre-operative planning, second for surgical treatment, and third for prosthetic rehabilitation. (J Esthet Restor Dent 29:93-101, 2017).

Oral features and computerized rehabilitation of a young patient with CHARGE syndrome using minimally invasive long-term interim CAD-CAM restorations.

Patients with CHARGE syndrome (where CHARGE stands for coloboma of the iris or retina, heart defects or cardiac malformations, atresia/stenosis of the choanae, retardation of growth and development, genital anomalies, and ear abnormalities) present several orofacial anomalies. Their treatment depends on the specific type of manifestation. To perform the complex oral rehabilitation and achieve a conservative, esthetic, and functional exploration of the definitive treatment goal, computer-aided design and computer-aided manufacturing (CAD-CAM) polymers can be used as long-term interim restorations. This article reports the treatment of a young patient with CHARGE syndrome combined with oral alterations. CAD-CAM polymers offer an intermediate treatment with satisfying esthetics and function at low biological cost until bone growth is completed. This period facilitates additional planning for the definitive restoration.

Rehabilitation of a patient with amelogenesis imperfecta using porcelain veneers and CAD/CAM polymer restorations: A clinical report.

The complete dental rehabilitation of patients with a vertical dimension loss (VDL) caused by structural enamel deficits associated with amelogenesis imperfecta (AI) represents a difficult challenge for restorative teams. Accurate analysis and treatment planning that includes esthetic and functional evaluations and adequate material selection are important prerequisites for successful results. Long-term provisional restorations play an important role in exploring and elucidating the patients' esthetic demands and functional needs. Restorative treatment options can vary from requiring only oral hygiene instructions to extensive dental restorations that include composite fillings, ceramic veneers, metal-ceramic, or all-ceramic crowns. This case report describes a full-mouth rehabilitation of a patient with amelogenesis imperfecta including the case planning, bite replacement, preparation, and restoration setting steps with an experimental CAD/CAM polymer and porcelain veneers.