International Journal of Esthetic Dentistry (EN), 03/2023

An excellent clinical case as a product of masterful teamwork is presented in IJED Espresso. This section focusses especially on young talented professionals giving them the opportunity to share their clinical cases.

Non-preparation (non-prep) ceramic veneers are a convenient and conservative treatment option, but controversy exists about their predictability. Concerns remain about possible overcontouring, poor-quality margins, and early esthetic failure. The present clinical report describes the combination of minimally invasive and non-prep ceramic laminate veneers in the esthetic zone with a 6-year follow-up to replace stained composite resin veneers on both maxillary central incisors. Composite resin veneers on the maxillary central incisors were replaced with ceramic veneers, and a non-prep ceramic veneer was placed on the maxillary right lateral incisor. A diagnostic additive wax-up was done, followed by a mock-up guide to conservatively prepare both maxillary central incisors. The three feldspathic porcelain veneer restorations were cemented under rubber dam isolation. The 6-year follow-up showed that stained composite resin veneers can successfully be replaced with minimally invasive and non-prep ceramic veneers to meet the patient’s esthetic wishes. Overall, well-planned and well-executed restorative procedures combining minimal preparation and non-prep for ceramic laminate veneers can achieve esthetically pleasing outcomes and maximize tooth structure preservation in the maxillary anterior region.

Important changes have occurred over the last decades in the clinical application of the strategies for posterior restorations – from amalgam to composites in direct restorations and from traditional resistance form crowns to adhesive partial restorations such as onlays. Despite much evidence available for these advances, there are still very few established guidelines for common clinical questions: When does an indirect restoration present a clinical advantage over a direct one? When should one perform adhesive cusp coverage such as an onlay? When to implement resistance form designs in adhesive restorations? Which conditions create limitations for adhesion so that a resistance form preparation with a stiffer material such as a traditional crown might be more appropriate? In order to provide clinical guidelines, the present authors consider five parameters to support and clarify decisions – Coverage of cusps, Adhesion advantages and limitations, Resistance forms to be implemented, Esthetic concerns, and Subgingival management – the CARES concept. In Part I of this three-part review article, the focus is on clinical decisions for partial adhesive restorations regarding indications for direct versus indirect materials as well as the need for cusp coverage and/or resistance form preparations based on remaining tooth structure and esthetics.

Much has been published on the socket-shield technique since its introduction to implant dentistry in 2010. The literature reports the technique to be a viable treatment option. Investigations should hence focus on improving the treatment, identifying pitfalls, and better educating clinicians. The technique has been advised as contraindicated at tooth roots with periodontal defects. The present case report aims to illustrate the additional risk and why intrabony periodontal defects may be a contraindication to this already challenging treatment.

Aim: The present case report with medium-term follow-up aims to report on the successful outcomes of ridge preservation using anorganic bovine bone mineral (ABBM) combined with the socket-shield technique (SST) in conjunction with immediate ovate pontic provisionalization of the extraction site, followed by delayed flapless implant placement and immediate implant provisionalization in the rehabilitation of the maxillary anterior esthetic region. Clinical protocol: Three consecutive patients with failing maxillary anterior teeth were treated with this protocol. The alveolar ridge dimension was preserved utilizing ABBM, combined with the retention of a partial tooth root segment in the buccal portion of the extraction socket, to minimize ridge resorption following tooth extraction. An immediate fixed provisional restoration with an ovate base in direct contact with the extraction site was fabricated and delivered immediately to maintain the soft tissue contour. At 4 months postextraction, flapless implant placement was performed via a computer-generated surgical guide, along with immediate implant provisionalization. Definitive restorations were delivered 4 months following implant placement. Results: At the 2-year follow-up after loading, prosthetic and implant success was demonstrated, with a favorable esthetic outcome and a high level of patient satisfaction. Conclusions: The immediate ovate pontic provisionalization in conjunction with ridge preservation combining ABBM and the SST, followed by flapless computer-guided implant placement with an immediate implant provisionalization protocol, as proposed in this article, offers a viable method to minimize alveolar ridge resorption as well as optimize esthetic outcomes.

Aim: The present study aimed to evaluate the retention strength of nonretentive zirconia occlusal veneers bonded to different bonding surfaces (enamel, enamel and dentin, and enamel with composite filling) using two adhesive resin cement systems that use either organophosphate carboxylic acid or organophosphate monomers as a ceramic primer. Materials and methods: Sixty extracted mandibular molars were prepared to receive occlusal veneers as follows (n = 20): 1-mm reduction within enamel; 2-mm reduction within enamel and dentin; 1-mm reduction within enamel with composite filling. Each occlusal veneer was designed with an occlusal bar to aid in the retention test, then milled from a zirconia block, and sintered. Within each group, the zirconia occlusal veneers were bonded using either Duo-Link Universal or Panavia V5 (10 specimens each). All specimens were thermocycled for 5000 cycles. After the pull-off test, the retention strength was calculated for each specimen. Each specimen was examined under magnification to determine its mode of failure. Representative specimens were examined using a scanning electron microscope. Data were analyzed using the two-way analysis of variance (ANOVA) and Tukey HSD tests (P = 0.05). Results: Both bonding substrate and cement type had a significant influence on retention strength values (P 0.05). The two-way ANOVA showed a significant interaction between bonding substrate and cement type (P = 0.003). There were significant differences in the retention strength between the cements in both the enamel and enamel and dentin substrates (P 0.05), but no significant difference between the cements in the enamel with composite filling substrate (P > 0.05). The predominant mode of failure was cement remaining principally in the restoration surface (adhesive failure), followed by cement adhesion to both the tooth and the restoration surface (mixed failure). Conclusions: Among the studied substrates, enamel was the optimal dental bonding surface. However, bonding to dentin was not a limiting factor for the retention of zirconia occlusal veneers. The resin cement using an organophosphate (Panavia V5) provided superior retention strength compared with the cement using organophosphate carboxylic acid monomer (Duo-Link Universal).

The goal of this section ist o bring our readers eye-catching and high quality images related to novel techniques, clinical challenges and emerging trends relevant to esthetic dentistry. The section portrays the clinical image, the photographer, the camera and a short caption of the story behind the photograph.

The goal of this section ist o bring our readers eye-catching and high quality images related to novel techniques, clinical challenges and emerging trends relevant to esthetic dentistry. The section portrays the clinical image, the photographer, the camera and a short caption of the story behind the photograph.

In this section world-renowned dentists share a personal secret with us: Even the best sometimes make mistakes, and what makes them true experts is the capability to manage errors and complications. On The Last Page they present cases that normally no one would share.