The cantilever contact-point resin bonded bridge; adhesion 2.0.

AIM: When young patients are congenitally missing anterior teeth, different treatment modalities can be used to complement the dental arch. This article proposes a new treatment modality for the replacement of anterior teeth, the cantilever contact-point resin bonded bridge (CCP-RBB). MATERIALS AND METHODS: In this proof of principle study, CCP-RBB's delivered by one operator were clinically assessed. Patients who were missing maxillary incisors and had suitable intra-oral conditions for a contact-point cantilever RBB were included. Three cases are presented to describe all adhesive steps. This proof of principle clinical study is presented with up to 60 months follow-up of the cantilever contact resin bonded bridges. RESULTS: A total of 19 CCP-RBB's were evaluated after a mean period of 29.8 months. None of the restorations exhibited failure, carious lesions or fractures during the follow-up periods, demonstrating an absence of restoration debonding or the need for repair. CONCLUSION: The new cantilever contact-point resin bonded bridge exhibited an excellent treatment modality without failure or debonding up to 5 years. More and extended duration in vivo studies are needed to evaluate this new treatment modality. CLINICAL SIGNIFICANCE: In this proof of principle the new cantilever contact-point resin bonded bridge obtained excellent results up to 5 years of clinical follow-up.

Deep margin elevation.

Deep subgingival margins are a much-debated topic in adhesive and restorative dentistry. The hydrophobic trait of direct composite resin materials challenges the restorative procedure of cavities with deep subgingival margins since isolation is complicated. A correct indication for a deep margin elevation (DME) treatment is the key to its clinical success, and adequate adaptation of the DME is crucial to its clinical performance. An adequate adaptation of the DME may potentially reduce bacterial accumulation and reduce the incidence of secondary caries as well as maintain periodontal health. The present case report aims to provide a step-by-step overview of the DME technique when applied in combination with a partial indirect glass-ceramic restoration and also provides clinical guidelines to tackle deep subgingival cavities. The indication for a DME and the selection of appropriate materials are explained, supported by the literature.

Partial anterior indirect restorations in cases with dentin exposure.

The partial anterior ceramic restoration is a predictable and durable treatment modality that reestablishes not only esthetics but also strength and function. Bio-emulation, minimally invasive dentistry, and adhesive technology are key to a successful restoration. Partial restorations are only indicated when teeth have enough hard tissue on which to bond veneers. When there is more than 50% of dentin exposure, many clinicians still rely on macromechanical retention by performing a full-crown preparation. However, new research has shown good survival rates for partial restorations with extensive dentin exposure. The present article describes two cases in which a step-by-step protocol was applied to bond a laminate veneer to a tooth with dentin exposure.

Comparison of conventional ceramic laminate veneers, partial laminate veneers and direct composite resin restorations in fracture strength after aging.

OBJECTIVES: The objectives of this study were to test the fracture strength in vitro of laminate veneers, partial laminate veneers and composite restorations after aging and analyze the failure mode. METHODS: Forty extracted, sound human teeth were selected and divided into four groups: 1) Control group (CG); 2) Conventional Laminate Veneer (CLV); 3) Partial Laminate Veneer (PLV); 4) Direct Composite Resin (DCR). Laminate veneer preparations with incisal overlap were made in group CLV whereas only incisal preparations were made with a 1 mm bevel in group PLV and DCR. The indirect restorations were luted with a resin composite and the DCR group was restored with a direct resin composite restoration. The restored teeth were subsequently aged by thermocycling (20.000 cycles, 5-55 degrees C). Subsequently, the fracture strength was tested by a load to failure test at 135° on the incisal edge. A failure analysis was performed using light microscopy. The results were analyzed using Shapiro-Wilk and Kruska-Wallis test. RESULTS: After thermocycling, one sample from group CLV presented a premature adhesive failure and was excluded. Three restorations from groups PLV and DCR presented small cracks but were taken to the fracture test. After aging mean fracture load + SD (N) were: Group DCR (n = 10): 385 ± 225; Group CG (n = 10): 271 ± 100; Group PLV (n = 10): 266 ± 69; Group CLV (n = 9): 264 ± 66. Fracture strength means from groups CLV and PLV did not differ statistically from each other nor from control (p = 0.05). In the group CLV the root fracture was the most occurring fracture. In groups PLV and DCR, material cohesive failures and a mix (adhesive, tooth and material cohesive) failures were most observed. SIGNIFICANCE: This in vitro study showed for the first time that partial laminate veneers can exhibit fracture strength values similar to direct composite restorations or conventional ceramic laminate veneers. All three restorative procedures presented clinically acceptable values of fracture strength. Even though three samples from groups PLV and three from DCR presented small cracks after thermocycling, these cracks do not appear to have a negative effect on the fracture strength.

Performance of ceramic laminate veneers with immediate dentine sealing: An 11 year prospective clinical trial.

OBJECTIVE: In this prospective clinical trial the survival, success rate and patient satisfaction of ceramic laminate veneers with special interest on existing restorations, immediate dentin sealing and endodontically treated teeth was evaluated. METHODS: A total of 104 patients (mean age: 42.1 years old) received 384 feldspathic ceramic laminate veneers on maxillary anterior teeth. Veneer preparations with incisal overlap were performed using a mock up technique. Existing resin composite restorations of acceptable quality were not removed but conditioned using silica coating and silanization. Immediate dentin sealing (IDS) was applied when more than 50% of dentin was exposed during preparation. Endodontically treated teeth were not excluded. After adhesive cementation, restorations were evaluated by calibrated evaluators at baseline and final follow-up using modified USPHS criteria. RESULTS: 225 Laminate veneers were bonded onto teeth without existing restorations, 159 on teeth with pre-existing resin composite restorations, 87 to teeth with more than 50% of exposed dentin surface and 43 to endodontically-treated teeth. In total, 19 failures were observed in form of debonding (n = 3), fracture (n = 15) and extraction due to endodontic complications (n = 1). In teeth with more than 50% of dentin exposure, a significant increase in survival rate was observed when IDS was used (96.4% versus 81.8%). No significant difference was found between teeth with and without pre-existing composite resin restorations (84.6% versus 95.5%) or between vital and non-vital teeth (95.6% versus 88.1%). Laminate veneers luted to endontically-treated teeth had a significant mis-match in color compared to vital teeth. Patients who smoked presented with significantly more marginal discoloration, but no intervention was needed. Patients scored favorably values on the Oral Health Impact Profile questionnaire and were generally satisfied with the treatment. In this clinical trial, the ceramic laminate veneers had a relatively high survival rate. SIGNIFICANCE: Teeth with more than 50% of dentin exposure significantly benefit from IDS. Pre-existing restorations or endodontic treatments do not have an effect on the survival rate of ceramic laminate veneers. However, smoking habits and previous endodontic treatments negatively affect the success rate due to color changes. CLINICAL TRIAL REGISTRATION NUMBER: NCT03645551.