Minimally invasive veneers: current state of the art.

Ceramic veneers are considered a conservative solution for patients requiring improvement of the shape, color, or position of their anterior teeth. Ceramic veneers have been extensively and successfully used to mask intrinsic staining, to give the appearance of straightening, and to correct minor malformations of anterior teeth without the removal of substantial amounts of sound tooth substance. The current literature was reviewed to search for the most important parameters determining the long-term success and correct application of ceramic veneers.

Clinical and radiographic evaluation of early loaded maxillary anterior single-tooth bone-level implants.

PURPOSE: The aim of this study was to evaluate the clinical and radiographic outcomes of early loaded platform-switched implants in the anterior maxilla. MATERIALS AND METHODS: In this study, patients were treated with implants that supported all-ceramic single-tooth crowns and were followed for 2 to 4 years. Implants were evaluated on the basis of clinical and radiographic parameters, including Plaque Index, Sulcus Bleeding Index, peri-implant probing depths (PDs), Papilla Index, soft tissue recession, and marginal bone levels. Statistical analyses were performed. RESULTS: Fifty-five implants were placed in 47 patients. At the recall examinations, all implants had successfully integrated, demonstrating healthy peri-implant soft tissues as documented by standard clinical parameters. At the time of recall, 7 implants had been followed for 4 years, 30 implants for 3 years, and 18 implants for 2 years. Plaque accumulation scores of 2 and 3 were not noted at any point during the study. At baseline, the mean PD was 2.1 ± 0.6 mm, at 2 years it was 2.2 ± 0.6 mm, at 3 years it was 2.2 ± 0.6 mm, and at 4 years (7 implants), the mean PD was 1.9 ± 0.4 mm. There were no statistically significant differences between time intervals. Complete papilla fill was seen for 49 implants. All implants showed less than 0.5 mm of marginal bone loss; mean bone loss at the time of final recall was 0.12 ± 0.22 mm. Seven implants showed an increase in the level of bone contact. There were no statistically significant differences over time. CONCLUSION: Bone-level implants with a platform-switched design are a successful treatment modality for anterior single-tooth implants.

Esthetic outcome evaluation of maxillary anterior single-tooth bone-level implants with metal or ceramic abutments and ceramic crowns.

PURPOSE: The aim of this study was to evaluate the treatment outcome of implants placed in the maxillary anterior segment. MATERIALS AND METHODS: Patients were treated with bone-level implants (Straumann Bone Level Implant, Institut Straumann) that supported all-ceramic single crowns and were followed for 2 to 4 years. Titanium or ceramic abutments were used according to the quality of the soft tissue at each site. Esthetic parameters were recorded to assess treatment outcomes. Pink esthetic scores (PES) and white esthetic scores (WES) were used to evaluate the esthetic outcome of anterior single-tooth implant-supported crowns. Patient satisfaction was also evaluated by means of a questionnaire. RESULTS: Fifty-five implants were placed in 47 patients. At the recall examinations, all implants were confirmed to have successfully integrated and demonstrated healthy peri-implant soft tissues, as documented by generally accepted clinical parameters. Overall, the esthetic results were considered favorable, and there were no significant differences between restorations with ceramic or titanium abutments. WES values were slightly superior to PES values. None of the implants had mucosal recession. CONCLUSION: Objective and subjective evaluation of maxillary bone-level implants in the esthetic zone yielded satisfactory results. Pleasing esthetic outcomes and stable facial soft tissues were achieved.

Fracture resistance of manually and CAD/CAM manufactured ceramic onlays.

PURPOSE: This in vitro study aimed to evaluate fracture resistance in lithium disilicate onlays fabricated with IPS e.max Press and IPS e.max CAD systems and luted with different adhesive cements. MATERIAL AND METHODS: Fifty maxillary first molars were prepared using a mesio-occluso-disto-lingual onlay cavity model. Ten onlays from each group were cemented using etch-and-rinse adhesives and high-viscosity composite resin cement, and 10 were cemented with self-adhesive, dual-curing universal resin cement. Fracture resistance was measured. RESULTS: Significant differences were observed between resin cements (p < 0.05) and between materials (p < 0.05), but the interaction of these variables did not produce a significant difference. The fracture resistance of pressable ceramics was significantly higher than that of CAD/CAM onlays (p < 0.05), and Syntac Variolink was significantly higher than that of Multilink Sprint (p < 0.05). CONCLUSION: All groups showed clinically acceptable fracture strength results. According to the study, both the onlay fabrication system and adhesive cements can be a viable treatment option.

Marginal-internal adaptation and fracture resistance of CAD/CAM crown restorations.

This study evaluated the marginal adaptation and fracture resistance of CAD/CAM-fabricated zirconia crowns luted using different luting agents. Twenty crown restorations were produced using IPS ZirCAD zirconium oxide blocks (IZC), and another 20 using Lava zirconium oxide blocks (L). Ten teeth were used as control. Luting agents used were an etch-and-rinse adhesive (Variolink II) and a self-etch adhesive (Multilink Automix). Internal and marginal adaptation was evaluated using silicone replica technique. Fracture resistance was evaluated using a compression test. Marginal discrepancy was 89.26 µm for L crowns and 88.84 µm for IZC crowns, and difference was statistically insignificant. However, L crowns showed significantly larger axial and occlusal gaps than IZC crowns (p<0.05). Fracture resistance of IZC-Multilink was higher than the other groups, although the difference was not significant. Results showed that CAD/CAM-fabricated crowns showed acceptable in vitro marginal discrepancies and fracture strengths.

Experimental custom-made zirconia abutments for narrow implants in esthetically demanding regions: a 5-year follow-up.

PURPOSE: This prospective clinical study evaluated an experimental custom-made zirconia abutment with respect to peri-implant hard and soft tissue reaction in narrow implants. MATERIALS AND METHODS: Patients were treated with prefabricated titanium implants and custom-made zirconia abutments. All-ceramic crowns were fabricated and cemented with resin cement. Clinical parameters such as Plaque Index, Sulcus Bleeding Index, peri-implant probing depth, and radiographic marginal bone loss levels were recorded, along with any biologic and mechanical complications, at baseline and up to 5 years. RESULTS: Twelve patients with missing maxillary lateral incisors treated with a total of 23 implants were evaluated. Thirteen Straumann Narrow Neck Solid Screw implants with a diameter of 3.3 mm and 10 Astra MicroThread implants with a diameter of 3.5 mm were used. Six patients with 11 implants were treated with custom-made zirconia abutments and prefabricated metal abutments were used in the control group. Implant and abutment success at 5 years was 100%. No abutment fractures occurred. Abutment screw loosening was reported for one restoration at the 1-year recall. Mean marginal bone loss measured 0.21 mm after 5 years of functional loading. CONCLUSION: Custom-made zirconia abutments offered sufficient stability to support all-ceramic restorations over narrow implants in anterior regions over a 5-year period. The soft and hard tissue reactions to zirconia were favorable.

Internal and marginal adaptation of pressable and computer-aided design/computer-assisted manufacture onlay restorations.

The aim of this research was to evaluate internal and marginal adaptation of lithium disilicate partial crowns fabricated using IPS e.max Press and IPS e.max CAD systems. Forty maxillary first molars were divided into two groups. The margins were located above the cementoenamel junction mesially and below it distally. The adaptation of the restoration was evaluated by means of the silicone replica technique. The lowest marginal discrepancy was measured between the preparation margin on the enamel and the IPS e.max Press specimens; the highest discrepancy was observed on the occlusal surface of the IPS e.max CAD specimens. Both systems tested demonstrated acceptable marginal discrepancies in vitro.