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OBJECTIVE: Optimal tooth reduction is a key requirement for aesthetics, function, and the longevity of fixed restorations. Research has demonstrated that controlled and conservative tooth preparation is crucial for the long-term success of adhesive restorations. Different techniques of fabricating reduction guides have been previously reported in literature. The present technical note describes the fabrication technique and clinical application of a customized metal preparation reduction guide. MATERIAL AND METHOD: Patient presented with tilted maxillary left central incisor. The flared-out part of the tooth was modified prior to veneer restoration preparation. Resin pattern reduction guide was fabricated on the diagnostic cast with a window on the tilted mesial portion of the tooth. After intraoral evaluation, resin pattern guide was casted. Metal reduction guide was place intraorally and reduction was provided on the exposed surface of the tooth. After the removal of the tilted portion, a harmonious arch form allowed the clinician to provide adequate evaluation and preparation for veneer restorations. RESULTS: The device demonstrated good practical value, allowing for selective and controlled reduction of tooth structure, and definitive protection of adjacent tooth surfaces from iatrogenic damage. The clinical outcome successfully addressed the patient's restorative and aesthetic needs, and the veneer was stable 2 years postoperatively. CONCLUSION: Use of a metal guide assists clinicians to provide a more predictable reduction of a desired tooth surface, while decreasing the risk of compromising the other/adjacent tooth surfaces.
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Clinical decision-making regarding retention and treatment vs extraction and replacement of teeth can be a significant challenge. This systematic review and meta-analysis aimed to assess decision-making in clinical practice related to the retention and endodontic treatment of natural dentition vs extraction and replacement with implant-assisted restorations. The PubMed/MEDLINE, Scopus, Web of Science, and Education Resources Information Center (ERIC) databases were comprehensively searched for studies published through May 31, 2019. All randomized controlled trials and cohort studies that assessed the effect of endodontic treatment/retreatment and implant treatment were included. Primary outcomes included success, survival, and failure rates. Meta-analysis software was used for data analysis. Of 1550 identified articles, 5 were eligible for qualitative and quantitative analyses. All 5 of the included studies reported that both therapies are viable and predictable treatment options. The meta-analysis showed no significant difference between therapies when survival rates were considered to be successes, while a significant difference was found in favor of endodontic therapy when survival rates were considered to be failures. The available evidence suggests that both therapies have approximately similar outcomes, but endodontic therapy provides moderately better outcomes. Endodontic therapy should be considered the first option when possible.
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Toma de Decisiones Clínicas , Humanos , RetratamientoRESUMEN
OBJECTIVE: The combination of partial edentulism and a worn anterior tooth in the esthetic zone can be a challenge for the dentist. This clinical situation requires extensive knowledge of soft and hard tissue management, surgical planning and execution for implant therapy, and conservative tooth preparation with ideal bonding protocols for the tooth-supported prosthesis. Moreover, an optimal selection of the final restorative materials is imperative to manage occlusal forces and fulfill the patient's esthetic demands. MATERIALS AND METHODS: The patient presented with partial edentulism on site 11, a worn incisal edge, and facial defects on tooth 21. Minimally invasive implant therapy for site 11 was performed with a papilla-sparing flap design that only included the edentulous site, and the soft tissue contouring was started for an immediate provisional restoration. A suturing technique was executed that aimed at maintaining an interproximal papilla. Conservative veneer preparation was performed on tooth 21 in order to bond the restoration to the enamel structure. Final restorations included a custom abutment with a lithium disilicate fused to zirconia crown for the implant on site 11 and a lithium disilicate veneer on tooth 21. CONCLUSIONS: A well-planned single implant and a ceramic veneer restoration was able to fulfill the patient's esthetic expectations. The selection of materials for the final restoration was crucial to manage the occlusal forces and to mimic the shade and shape of the adjacent teeth.