International Journal of Esthetic Dentistry (EN), 01/2024

Despite the clear advances regarding the restoration of posterior teeth, especially with the minimally invasive approach, there are still several topics where the available scientific evidence does not provide clear answers in terms of clinical decisions. The indications, differences, and clinical protocols for partial adhesive restorations (onlays, overlays, and endocrowns) and resistance form restorations (full-contour resistive crowns) were presented in Parts I and II of the present article series based on Coverage of susceptible cusps, Adhesion advantages and limitations, Resistance forms to be implemented, Esthetic concerns, and Subgingival management – the CARES concept. Now, in Part III, the focus is on different approaches of managing subgingival areas, gaining “ferrule” design, and the role of posts on the restorability strategies of severely compromised teeth. Keywords: adhesive dentistry, dental technology, periodontology, prosthodontics, restorative dentistry

Objectives: The present case report describes the atraumatic extraction of a primary maxillary right canine followed by immediate implant placement with a customized zirconia abutment and monolithic ultra-translucent zirconia (5Y-PSZ) crown. Clinical considerations: A 31-year-old patient presented to the clinic with the primary concern of mobility and gingival inflammation around the maxillary right canine. After clinical evaluation, the tooth was found to be a primary retained tooth that presented grade 3 mobility and gingival inflammation. Atraumatic tooth extraction was performed, followed by immediate implant placement of a screw-retained provisional restoration with the use of a surgical guide. The soft tissue was contoured until ideal architecture was obtained. The final restoration included a customized zirconia and titanium abutment and a characterized implant-supported monolithic 5Y-PSZ crown. Conclusions: Well-planned surgical and restorative procedures including atraumatic extraction, 3D implant planning for surgical guide fabrication, implant placement, and a customized zirconia abutment with a monolithic 5Y-PSZ crown can achieve high esthetic results in replacing a primary tooth in the esthetic zone. Keywords: primary tooth, tooth extraction, immediate implant placement, connective tissue graft, zirconia abutment, monolithic crown, highly translucenct zirconia

Aim: The aim of the present retrospective study was to evaluate the long-term results, including technical and biologic outcomes, of maxillary extended porcelain veneers with an incisal edge thickness above 2 mm. Materials and methods: Patients treated with extended porcelain veneers performed by a single clinician at University of Geneva between 1990 and 2003 were identified and invited to an examination. Of the 37 identified patients, 10 patients with 50 veneers agreed to be examined and were included. A clinical examination was performed to assess survival rates as well as technical and biologic outcomes (modified United States Public Health Services criteria). Patient records were also reviewed to retrieve patient and reconstruction data and every complication event. Patient-reported outcome measures (PROMs) were evaluated using a visual analog scale to measure esthetic satisfaction, functional and phonetic comfort, masticatory improvement, tooth sensitivity, and acceptance of restoration replacement in case of failure. Data were descriptively analyzed, and Kaplan-Meier survival estimators were computed for survival rates and complication events. Results: The survival rate of the veneers was 96% after a mean follow-up of 20.7 ± 3.7 years in function. The technical complication rate amounted to 30%, including two failures, nine repairable fractures, three cracks, and one displacement due to trauma. No cavitated caries lesions or endodontic complications were registered. PROMs were very high for esthetic satisfaction and phonetic comfort. Conclusions: Within the limitations of the present retrospective study, extended porcelain veneers appear to be a successful long-term treatment option in terms of clinical outcomes and patient satisfaction. Keywords: adhesive dentistry, esthetics, ceramics, prosthodontics, restorative dentistry, veneers

Achieving optimal implant prosthodontic outcomes in the esthetically demanding anterior region requires sufficient hard and soft tissue volume to provide adequate support and coverage to ensure that the implant restorations are functional and yield predictable, long-lasting treatment results. A comprehensive biologic understanding of the 3D relationships between hard and soft tissue is crucial when treating esthetically demanding areas. Various techniques, notably guided bone regeneration, have been developed and are well documented as being reliable methods for larger 3D bone augmentation procedures. Additionally, dental modification and tooth repositioning in proximity to prospective implant placement sites has been extensively discussed. Recently, orthodontic extrusion with deferred extraction has emerged as a predictable treatment strategy for gaining additional vertical hard and soft tissue. Implementing treatment sequences and the timing of combined treatment methodologies have also been subjects of discussion. Combining orthodontic treatment with staged or delayed tooth extractions has been shown to be beneficial in providing the necessary osseous foundation for implant sites that may not be as amenable to more conventional augmentation techniques. These augmentation techniques and treatment methods require adequately stable and predictable periodontal health since uncontrolled periodontal disease poses a significant challenge and is detrimental to successful outcomes. The purpose of the present clinical report is to demonstrate the staging and sequencing of vertical hard and soft tissue management techniques for a severe anterior periodontal defect to achieve an esthetically functional implant treatment result. Keywords: implantology, nonresorbable titanium honeycomb membrane, partial extraction therapy, periodontology, root submergence

In recent years, tooth wear has been a growing concern in dentistry as it has become increasingly prevalent among the population. At the same time, the development of adhesive techniques has enabled minimally invasive treatment protocols, with the goal of preserving and protecting teeth for as long as possible. This clinical report presents the case of a full-mouth rehabilitation patient with tooth wear who was treated using minimally invasive techniques. Esthetic and functional outcomes were designed and monitored using digital tools such as digital impressions, 3D facial scans, a digital tooth library, transcutaneous electrical nerve stimulation (TENS), MRI, and kinesiographic (KS) analysis throughout the treatment. To increase the vertical dimension of occlusion, instead of using traditional centric relation (CR) methods, a myocentric relation (MCR) technique was employed. This approach allowed the clinician to maintain the occlusal Class I situation, avoiding more invasive orthodontic treatment or maxillofacial surgery and resulting in reduced morbidity, treatment time, and cost for the patient. At the 1-year follow-up, good patient adaptation was shown, suggesting that the MCR concept is a viable alternative to conventional CR methods in appropriate cases. Keywords: adhesive dentistry, restorative dentistry