Full-mouth rehabilitation with monolithic CAD/CAM-fabricated hybrid and all-ceramic materials: A case report and 3-year follow up.

Esthetic full-mouth rehabilitation represents a great challenge for clinicians and dental technicians. Computer-aided design/ computer-assisted manufacture (CAD/CAM) technology and novel ceramic materials in combination with adhesive cementation provide a reliable, predictable, and economic workflow. Polychromatic feldspathic CAD/CAM ceramics that are specifically designed for anterior indications result in superior esthetics, whereas novel CAD/CAM hybrid ceramics provide sufficient fracture resistance and adsorption of the occlusal load in posterior areas. Screw-retained monolithic CAD/CAM lithium disilicate crowns (ie, hybrid abutment crowns) represent a reliable and time- and cost-efficient prosthetic implant solution. This case report details a CAD/CAM approach to the full-arch rehabilitation of a 65-year-old patient with toothand implant-supported restorations and provides an overview of the applied CAD/CAM materials and the utilized chairside intraoral scanner. The esthetics, functional occlusion, and gingival and peri-implant tissues remained stable over a follow-up period of 3 years. No signs of fractures within the restorations were observed.

Veneered anatomically designed zirconia FDPs resulting from digital intraoral scans: Preliminary results of a prospective clinical study.

OBJECTIVES: The aim of this prospective clinical study was to evaluate the clinical performance of veneered anatomically designed zirconia fixed dental prostheses (FDPs) resulting from intraoral digital impressions. METHODS: 24 patients requiring treatment were provided with all-ceramic FDPs. Intraoral scans (iTero) were performed and veneered anatomically designed CAD/CAM-zirconia FDPs (Zerion/VitaVM9) were fabricated. A feldspar veneering ceramic following a slow cooling firing protocol was applied. A self-curing resin based luting material was used for adhesive cementation. Clinical evaluations were performed at baseline and 6, 12, and 18 months recalls according to the modified USPHS-criteria. Intraoral digital surface scans (iTero) were performed at each recall examination and were digitally superimposed (Geomagic) to evaluate potential veneer cohesive fractures. Kaplan-Meier survival analysis comprised secondary caries, clinically unacceptable fractures, root canal treatment and debonding. Kaplan-Meier success rate included restorations with minimal crevices, tolerable color deviations and clinically acceptable fractures. Data were statistically analyzed. RESULTS: The Kaplan-Meier survival rate and success rate of the FDPs were 100% and 91.7%, respectively. Clinically acceptable veneer cohesive fractures and crevices at the restoration margin were observed in two patients. These shallow veneer fractures were only detected by overlapping baseline and recall scans. Ceramic surface roughness increased significantly over time (p<0.0001). CONCLUSIONS: Veneered zirconia FDPs fabricated from digital intraoral scans showed a favorable clinical performance over an observation period of 18 months. Anatomical zirconia core design and slow cooling firing protocol of the veneering ceramic reduced the incidence of chip fractures to a level that could not be detected clinically. CLINICAL SIGNIFICANCE: The digital workflow on the basis of intraoral digital impressions resulted in clinically satisfying outcomes for veneered zirconia FDPs.

An interdisciplinary noninvasive all-ceramic treatment concept for nonsyndromic oligodontia in adolescence.

Oligodontia has a substantial oral functional and psychosocial impact on the quality of life of children. The treatment of oligodontia in adolescence is an interdisciplinary approach which can include extraction of the primary teeth with orthodontic space closure, or prosthodontic rehabilitation. This case report describes a conservative approach for the rehabilitation of a 12-year-old patient with 19 ageneses (excluding third molars) of permanent teeth, infraocclusion of the persisting primary teeth, deep overbite, and reduced mesiodistal dimension of the maxillary incisors with a central diastema. The treatment plan to restore esthetics and function included an initial noninvasive prosthetic rehabilitation for deep bite correction with additive leucite-reinforced glass-ceramic onlays/veneers until definitive orthodontic and implant therapy are reevaluated and determined in adulthood. Esthetics, functional occlusion, and crown-to-root ratio remained stable over a follow-up period of 3 years. No signs of fractures within the all-ceramic restorations or symptoms of a temporomandibular disorder were evident.

Prospective clinical study of press-ceramic overlap and full veneer restorations: 7-year results.

The aim of this prospective clinical study was to investigate the long-term performance of all-ceramic veneers with overlap (OV) and full veneer (FV) preparation designs. Twenty-five patients were restored using 42 OV restorations (incisal/palatal butt-joint margin) and 24 FV restorations (palatal rounded shoulder margin). All restorations were leucite-reinforced glass-ceramic anterior veneers. The 7-year Kaplan-Meier survival rate was 100% for FV restorations and 97.6% for OV restorations. The all-ceramic veneers revealed significant deterioration over time according to United States Public Health Service criteria, irrespective of the preparation design. Based on the 7-year results of this study, both preparation designs can be considered reliable treatment options for anterior teeth with extended deficits.

Long-term performance of posterior InCeram Alumina crowns cemented with different luting agents: a prospective, randomized clinical split-mouth study over 5 years.

OBJECTIVES: This prospective, randomized clinical split-mouth study investigated the 5-year performance of InCeram Alumina posterior crowns cemented with three different luting cements. 4-META- and MDP-based cements were used for adhesive luting. Glass ionomer cement served as control. MATERIALS AND METHODS: Sixty patients were treated with 149 (n = 62 Panavia F/MDP; n = 59 SuperBond-C&B/4-META; n = 28 Ketac Cem/glass ionomer) InCeram Alumina crowns on vital molars and premolars in a comparable position. Follow-up examinations were performed annually up to 5 years after crown placement using the modified United States Public Health Service (USPHS) criteria. Kaplan-Meier survival analysis comprised secondary caries, clinically unacceptable fractures, root canal treatment and debonding. Kaplan-Meier success rate included restorations with minimal crevices, tolerable color deviations (<1 Vitashade), and clinically acceptable fractures. Logistic regression models with a random intercept were fitted. RESULTS: The 5-year Kaplan-Meier survival probabilities were: SuperBond-C&B 88.7 %, Panavia F 82.8 %, Ketac Cem 80.1 % with no significant difference (p = .813). Endodontical treatment was carried out on 7.4 % of all abutment teeth, and 5.4 % revealed secondary caries. Unacceptable ceramic fractures were observed in 7.4 %. Debonding was a rare complication (1.3 %). The 5 year Kaplan-Meier success rate was 91.6 % for SuperBond-C&B-, 87.4 % for Ketac Cem- and 86.3 % for Panavia F-bonded restorations with no significant difference (p = .624). All cement types showed significant marginal deterioration over time (p < .0001). CONCLUSIONS: Posterior InCeram Alumina crowns showed acceptable long-term survival and success rates independent of luting agent used. Ceramic fractures, endodontical treatments and secondary caries were the most frequent failures. CLINICAL RELEVANCE: Glass-infiltrated Alumina crowns in combination with adhesive as well as conventional cementation can be considered as a reliable treatment option in posterior teeth.

Prospective clinical split-mouth study of pressed and CAD/CAM all-ceramic partial-coverage restorations: 7-year results.

The aim of this prospective clinical split-mouth study was to investigate the longterm performance of pressed and computer-aided design/computer-assisted manufacture (CAD/CAM) all-ceramic partial-coverage restorations (PCRs). Twentyfive patients were restored with 40 lithium disilicate pressed PCRs (IPS e.max-Press, Ivoclar Vivadent) and 40 leucite-reinforced glass-ceramic CAD/CAM PCRs (ProCAD, Ivoclar Vivadent). All restorations were placed in vital first or second molars. The 7-year Kaplan-Meier survival rate was 100% for pressed PCRs and 97% for CAD/ CAM PCRs. Both systems showed significant deterioration over time in all modified United States Public Health Service criteria. Increased surface roughness and impaired color match were significantly more prevalent with pressed PCRs. Based on the 7-year data, both all-ceramic systems can be considered reliable treatment options for posterior PCRs.