Retrospective clinical study of minimally invasive full-mouth rehabilitations of patients with erosions and/or abrasions following the "3-step technique". Part 1: 6-year survival rates and technical outcomes of the restorations.

PURPOSE: To evaluate the survival rates and technical outcomes of minimally invasive full-mouth rehabilitations in patients affected by dental erosion and attrition. MATERIALS AND METHODS: For this retrospective study, 28 subjects (8 women, 20 men; mean age: 45.6 years) who suffered from generalized erosions and attrition and who were treated according to the 3-step technique were invited to participate. The patient records were reviewed, and the restorations were clinically and radiographically examined. This part of the study (part 1) evaluated restoration survival and technical outcomes using the modified United States Public Health Service criteria (mUSPHS). Survival analysis was performed using Kaplan-Meier survival statistics, and comparison between subgroups was made using log-rank test. For all other comparisons, cross-tabulations of occurrence were performed, and significance was tested using Pearson chi-square test. The level of statistical significance was set at P < .05. RESULTS: A total of 19 patients (3 women, 16 men; mean age: 45.6 years) agreed to participate. In these patients, 406 restorations (149 direct composites, 110 onlays, 147 veneers) supported by 365 teeth were examined. The mean time in service was 71.8 ± 28.6 months. Six failed restorations were identified; all were direct composites. The 6-year survival rates were 97.3% for direct composites, 98.2% for onlays, and 100% for veneers (P > .05). No differences were found among materials and locations of the restorations. Nineteen technical complications included 14 partial fractures, 3 fissures, 1 wear, and 1 decementation. The mUSPHS evaluation showed good technical outcomes. Presence or absence of a nightguard influenced restoration survival (P = .003). CONCLUSION: Minimally invasive rehabilitations of patients with erosions/attrition with the 3-step technique are a reliable treatment option in the medium term. Protective nightguards are recommended.

Biological outcomes and patient-reported outcome measures (PROMs) of minimally invasive full-mouth rehabilitations of patients with erosions and/or abrasions by means of the "3-step technique": part 2 of the 6-year outcomes of a retrospective clinical study.

PURPOSE: To evaluate biologic and esthetic outcomes, as well as the patient-reported outcome measures (PROMs), of full-mouth rehabilitations in patients suffering from generalized erosive and/or abrasive tooth wear following the 3-step technique. MATERIALS AND METHODS: Patients who received a minimally invasive full-mouth rehabilitation according to the 3-step technique and who were treated at the University of Geneva and/or in a private practice were considered for inclusion. The minimum service time of the restorations was 12 months. The biologic outcomes were analyzed by assessing pocket probing depth (PPD), Plaque Index (PI), and bleeding on probing (BOP). Furthermore, secondary caries, tooth vitality, and sensitivity to temperature were evaluated using the modified United States Public Health Service (USPHS) criteria. The esthetic outcomes were rated with the White Esthetic Score (WES). Finally, PROMs were evaluated using visual analog scales (VAS). RESULTS: A total of 19 patients with 406 restorations (149 direct composite resins, 110 indirect composite resin/ceramic onlays, and 147 composite resin/ceramic veneers) were examined after a mean follow-up of 71.8 ± 28.6 months. Periodontal parameters were good (mPPD = 2.9 ± 0.4; mPI = 0.1 ± 0.2; and mBOP = 0.05 ± 0.1). No secondary caries were found, and no abutment tooth had lost vitality. A total of 36 abutment teeth had moderate sensitivity, but none presented pronounced sensitivity. The rehabilitations exhibited good esthetic outcomes (mWES = 8.4 ± 1.9). Patients reported satisfying esthetic results of their rehabilitations (mean VAS = 9.2 ± 1.6) and considered their treatment as comfortable (mean VAS = 8.2 ± 2.1), while the least favorably rated parameter was the cost of treatment (mean VAS = 4.1 ± 3.2). CONCLUSION: Minimally invasive full-mouth rehabilitations of patients with generalized tooth wear by means of the 3-step technique exhibit very good clinical medium-term results with respect to biologic and objective/subjective esthetic outcomes. The patient satisfaction with this treatment was high.