International Journal of Esthetic Dentistry (EN), 02/2024

Aim: The present study was a retrospective medium- to long-term follow-up assessment of the clinical outcomes of patients rehabilitated with fixed prostheses according to the biologically oriented preparation technique (BOPT) principles. Materials and methods: Clinical records of patients rehabilitated between January 2007 and December 2014 were retrospectively assessed. Patients whose records met the inclusion criteria were also recalled for a hygiene visit. Data analyzed included the patients’ periodontal condition, the presence of gingival recessions as well as any technical or biologic prosthetic complication. Results: Fifty-eight patients were recalled; of these, 52 patients who had received 220 crowns were available for the evaluation (the dropout being 13.8%). The average follow-up was 9.3 years (range 5 to 13 years): 14 patients (114 prosthetic crowns) had a follow-up between 5 and 8 years, and 36 patients (106 prosthetic crowns) between 9 and 13 years. The prosthetic survival rate was 99.6%. One radicular fracture (0.4%) and four chippings of the veneering porcelain (1.8%) were recorded. Six teeth (2.7% of the examined prosthetic crowns) presented gingival recession of < 1 mm, and 13 teeth (24 sites) had a pocket probing depth of 4 mm (5.9% of the prosthetic crowns/1.8% of the sites). Finally, 20 sites (1.5%) in seven teeth (3.2%) showed bleeding on probing. Conclusions: Tooth preparation according to the BOPT principles (ie, with a vertical finishing line) resulted in medium- to long-term periodontal health and stability of the gingival tissue, and prosthetic success was maintained. Keywords: BOPT, periodontal health, gingival recession, soft tissue stability, retrospective study

Aim: The aim of the present retrospective case series was to longitudinally assess soft tissue volume changes on the vestibular aspect of implants in relation to keratinized mucosa thickness (KMT) and width (KMW) after the application of the microsurgical envelope technique combined with a connective tissue graft (CTG). Materials and methods: A total of 12 healthy patients received 12 dental implants placed either in the posterior maxilla or mandible. The study involved the harvesting of 12 CTGs with a minimally invasive single-incision technique, grafted to the vestibular peri-implant soft tissue utilizing the envelope technique, followed by the insertion of 12 screw-retained IPS e.max crowns. Results: The healing process was uneventful across all areas, and all patients were followed up for a period of 5 years. The evaluation of KMT showed the highest decrease in the first 6 weeks after surgery (5.5 ± 0.79 to 4.59 ± 0.62 mm), then dropped slightly to 4 ± 0.85 mm, after which it maintained at 4 ± 0.36 mm until the 2-year time point. Between the second and third years after surgery, a further decrease of 3.59 ± 0.42 mm was recorded for KMT, which then remained constant until the end of the 5-year research period. The observations regarding KMW were slightly different, with the measurements demonstrating the greatest decrease in first 6 weeks (from 2.5 ± 0.42 to 1.5 ± 0.42 mm), which was maintained until the 1-year time point. Between the first and second years after surgery, the KMW increased to 2 ± 0.60 mm and remained level for the next 3 years, at 2 ± 0.85 mm. Conclusions: The current research demonstrated the advantages of using a combination of a minimally invasively harvested CTG and the microsurgical envelope technique for a duration of 5 years. Keywords: connective tissue graft, envelope technique, implantology, microsurgery, peri-implant soft tissue

The present technical article describes a protocol to digitally reproduce the emergence profile of an interim implant prosthesis (IP) and to transfer its macrogeometry into the definitive restoration. The purpose of this protocol was to minimize alterations in the gingival architecture developed during the interim restorative phase of a single implant that could potentially jeopardize its esthetic outcome. The process included obtaining an intraoral scan with the interim IP in situ, a duplicate of this intraoral scan that was used to capture the exact position of the implant, and an extraoral scan of the prosthesis. These data could then be imported into IOS software to create a model where the patients’ soft tissue was incorporated with precision, allowing for the fabrication of a definitive crown with an optimal soft tissue adaptation. As there are few articles in the scientific literature that have reported a consistent method to replicate the emergence profile of an interim IP, the present technical article aims to highlight the potential of utilizing the emergence profile of an interim IP created by IOS software. Keywords: dental technology, digital mesh, digital workflow, emergence profile, interim prostheses, intraoral scanner, prosthodontics, restorative dentistry

Implant-supported rehabilitation in high-risk patients poses significant challenges for the dental team. The presence of comorbidities and increased infection risk can, for example, lead to a higher risk of implant loss. For the therapy to be completed with as few complications as possible, special anamnesis, detailed diagnostics, and a risk analysis based on those findings are indispensable. The aim of all considerations is to keep the risk of infection for the patient with a disease history to a minimum and to strive for an appropriate functional and esthetic therapeutic success. Particularly in the esthetic zone, in addition to the general health risks of the surgical procedure, esthetic aspects are increasingly taken into account in planning. The present article describes the implant-prosthetic replacement of a single anterior tooth in a dialysis patient. Several aspects (regular dialysis, missing buccal lamella, high smile line, functional risk) increased the risk of complications in this case. Keywords: bone augmentation, emergence profile, esthetics, guided bone regeneration (GBR), high-risk patient, immediate implant placement, immediate provisionalization, implantology, restorative dentistry, single tooth, soft tissue management, xenogeneic cortical bone lamina

Single tooth orange discoloration secondary to root canal calcification occurs as a consequence of dental trauma, orthodontic treatment, or for unknown rea- sons. A correct case history must be compiled and a CBCT study carried out in order to establish the diag- nosis and define the best treatment plan in each case. The aim of the present study was to offer a therapeutic protocol involving a clinical decision-making tree dia- gram based on the presence or absence of apical dis- ease and the degree of canal calcification. Dental bleaching and the use of ceramic veneers allow es- thetic restoration in such cases. Keywords: calcified tooth, orange tooth, pulp canal obliteration, CBCT, bleaching, feldspathic veneers

Objective: A diagnostic mock-up is a key tool that allows a preview of the outcome of an esthetic restoration. With recent developments in CAD/CAM technology, it is important to understand the pros and cons of chairside digital dentistry and the restorative materials used. The aim of the present case report is to describe in detail the use of a 3D-printed mock-up fabricated from a polymer-based material for an esthetic treatment plan within a fully digital workflow. Case report: A 45-year-old female patient presented at the clinic concerned about her esthetic appearance and the color of her anterior incisors. After a conclusive diagnosis, a restoration was planned using ceramic veneers from maxillary premolar to premolar. For a preview visualization of the outcome, an intraoral scanner was used to obtain 3D images and to allow the design of a digital smile. The template STL file was exported to a 3D printer and a 0.6-mm mock-up in A3-shade 3D resin was produced after 25 min. The mock-up was tested through a try-in and approved by the patient. As a result, the printed mock-up was considered predictable and reliable for the final restoration. Conclusions: The ease, speed, and reduced costs derived from the digital workflow, in conjunction with the accuracy of the mock-up, made the procedure highly efficient and recommendable. Keywords: dental technology, prosthodontics, restorative dentistry