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With the life expectancy increasing, there is a growing need for prosthetic dental treatments to restore the oral health, function, and quality of life of edentulous patients. Presently, only a few articles are available describing the oral rehabilitation of patients with severely resorbed ridges with milled complete dentures. This clinical case report provides a straightforward protocol consisting of a combination of analog and digital techniques for the rehabilitation of edentulous patients with severely resorbed ridges with milled fixed and removable complete dentures. This technique permits the minimization of the number of appointments, improves patient comfort, allows for the digital archiving of important clinical data, and permits the manufacture of prostheses with improved mechanical properties. These favorable outcomes were achieved by using the patient's existing PMMA complete denture as a custom tray for a final impression with light-bodied Polyvinylsiloxane. Subsequently, the resulting models were digitized, and a digital complete denture was designed and manufactured in an expedited manner using CAD-CAM techniques. Therefore, this case report highlights the potential of CAD/CAM technology to predictably restabilize oral functions and improve patients' quality of life.
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Boca Edéntula , Calidad de Vida , Humanos , Dentadura Completa , Boca Edéntula/rehabilitación , Diseño Asistido por ComputadoraRESUMEN
Background and Objective: This study aimed to compare the surface finish of milled leucite-reinforced ceramics polished with ceramic and composite polishing systems based on the manufacturers' recommendations. Materials and Methods: Sixty subtractive computer-aided manufactured (s-CAM) leucite-reinforced glass-ceramic specimens (IPS-Empress-CAD) were assigned into six groups: no polishing, a ceramic polishing kit, and four composite kit groups. The roughness average (Ra) was evaluated in microns using a profilometer, and scanning electron micrographs were obtained for qualitative analysis. A Tukey HSD posthoc test (α = 0.05) was used to determine significant intergroup differences. Results: After surface evaluation of the ceramics, the Ra values of the polishing systems ranked OptraFine (0.41 ± 0.26) < Enhance (1.60 ± 0.54) < Shofu (2.14 ± 0.44) < Astropol (4.05 ± 0.72) < DiaComp (5.66 ± 0.62) < No Polishing (5.66 ± 0.74). Discussion: Composite polishing systems did not provide as smooth surfaces as the ceramic polishing kit for CAD-CAM leucite-reinforced ceramics. Thus, using ceramic polishing systems, polishing leucite ceramics is recommended, whereas composite polishing systems should not be considered as an alternative for use in minimally invasive dentistry.
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Cerámica , Resinas Compuestas , Humanos , Ensayo de Materiales , Propiedades de SuperficieRESUMEN
Background: Comparative studies of interim veneer restorations crafted using subtractive computer-aided manufacturing (s-CAM) milling technology and traditional direct hand-made approaches are needed. Purpose: This comparative in vitro study evaluated the fracture resistance of two types of provisional veneer restorations for maxillary central incisors: milled (s-CAM) and traditional direct hand-made bis-acryl veneers. Materials and methods: Fifty maxillary right central incisor veneers (25 specimens per group) were fabricated and divided according to the fabrication method: (1) s-CAM milled (Structure CAD, VOCO Dental); and (2) hand-made (Protemp Plus, 3M). The restorations were cemented onto 3D-printed resin dies using temporary cement and subjected to 1000 cycles of thermal cycling between 5° and 55 °C. These restorations subsequently were subjected to compressive loading until fracture occurred. Images of the fractured samples were captured using a scanning electron microscope (SEM). Statistical analysis was performed using the one-way ANOVA test and the Mann-Whitney U test. Results: Significant differences (p < 0.001) in the fracture resistance were observed between the two groups. s-CAM milled interim veneers displayed higher fracture resistance values (439.60 ± 26 N) compared to the traditional method (149.15 ± 10 N). Conclusion: The manufacturing method significantly influences the fracture resistance of interim veneer restorations. s-CAM interim laminate veneer restorations for maxillary central incisors exhibit a fracture resistance superior to that of the traditional method using bis-acryl.Clinical relevanceClinicians should consider CAD/CAM milled veneers for scenarios demanding long-term interim restoration and the withstanding of high occlusal forces.
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To assess the fracture resistance of computer-aided design and computer-aided manufacturing (CAD/CAM) ultratranslucent multilayered zirconia (5Y-YZP) veneers with varying facial thickness. Sixty translucent zirconia veneers were designed and milled using a chairside CAD/CAM system for maxillary central incisors. The butt joint incisal veneer tooth preparations consisted of 1.00 mm incisal reduction, 0.40 mm chamfer margin, and three different facial reductions; 0.50, 0.75, and 1 mm, respectively. The ceramic veneers were cemented to printed resin dies and subjected to thermal cycling. Subsequently, the restorations were loaded with compressive loading force, and fracture occurrences were recorded. Scanning electron microscope (SEM) images of the fractured specimens were captured. The fracture resistance varied among the veneers with different facial thicknesses. Ultratranslucent zirconia veneers with a facial thickness of 1.00 mm exhibited the highest fracture resistance values (742.15 N), followed by those with 0.75 mm facial thickness (673 N). Minimally invasive veneers with 0.50 mm thickness displayed similar fracture resistance as thicker veneers with 0.75 mm. However, veneers with 1.00 mm thickness displayed the highest values. SEM fracture patterns for 0.50 and 0.75 mm display similar and fewer crack lines than 1.00 mm veneers. RESEARCH HIGHLIGHTS: Minimally invasive zirconia veneers exhibit similar fracture resistance to thicker veneers.
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This report describes multidisciplinary care combining orthodontics and restorative dentistry for a patient with Class II occlusion and stained mandibular and maxillary resin composite veneers. The orthodontic treatment improved severe overjet and malocclusion prior to restorative care. Occlusal assessment was provided with a novel digital device (PlaneSystem, Zirkonzahn) that is integrated with digital workflows for the evaluation of the occlusal plane and condylar path inclination. Diagnostic digital impressions and digital wax-up for intraoral mock-ups led to the patient's treatment acceptance. Minimally invasive tooth preparation, final digital impressions, and bonding under dental dam isolation fulfilled the patient's esthetic and functional demands with all-ceramic restorations.
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BACKGROUND: We compared the repeatability of the shade determination of resin composite restorations and acrylic teeth in light and darker shades at baseline and after an aging process through two digital tooth color-matching methods: using a Trios 3Shape intraoral scanner and using a Vita Easyshade Compact spectrophotometer. MATERIAL AND METHODS: Forty upper central incisor acrylic teeth in the shade A1 (n = 10) and A3 (n = 10) were randomly assigned to be restored with Filtek Bulk Fill in the shade A1 (n = 10) or A3 (n = 10). Subsequently, 20 Class V cavities were prepared in a standardized manner (mesio-distal = 3.0 mm, cervical-occlusal = 2.0 mm, depth = 1.5 mm). Cavities were restored using an universal adhesive system and resin composite in two increments and were light-cured. The shade difference between the resin composite Class V restorations in acrylic teeth of the A1 and A3 shades was evaluated at baseline and after aging. Aging was simulated using ultraviolet light for 120 h. An Easyshade device and an intraoral scanner were used under D65 illumination. Measurements were taken five times, on top of the restoration and on the acrylic teeth, in a randomized manner. RESULTS: Data analysis was on the calculation of the arithmetic mean for the percentage of repeatability conducted by the Trios scanner and the Easyshade device. There was no statistically significant comparison between the shade measurement devices (p > 0.05). At baseline, the repeatability for both the Trios intraoral scanner and the Vita Easyshade Compact device for artificial teeth in the shades A1 and A3 was 100%. After aging, the trueness recorded by the intraoral scanner and the Easyshade device for artificial teeth in the shade A1 was 80%. For Class V restoration with shade A1, the intraoral scanner recorded 80% trueness and the Easyshade device recorded 60% trueness at baseline. For shade A3, the intraoral scanner recorded 60% trueness and the Easyshade device recorded 60% trueness. CONCLUSIONS: The intraoral scanner and Easyshade device are reliable for baseline shade selection, but their accuracy decreases after aging, particularly for darker shades.
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This report describes the importance of and outlines steps for additive wax-up and diagnostic mockup for anterior teeth as diagnostic and driving tools for non-prep and minimally invasive veneer preparations. A 35-year-old male presented to the clinic with the chief complaint of spaces between his front teeth. Diagnostic additive wax-up provided the possibility of offering minimally invasive preparations, and the use of a diagnostic intraoral mockup fulfilled the patient's esthetic demands for treatment approval. Veneer preparations over the diagnostic mockup were provided as they are minimally invasive. Ceramic veneers were hand-crafted following the previous diagnostic wax-up, and restorations were bonded under rubber dam isolation. Overall, additive wax-up provides information needed to know if minimally invasive veneer preparations are possible, and the diagnostic mockup displays a physical, tentative outcome for the patient's evaluation before irreversible tooth preparations. These simple, but effective, techniques can drive the diagnosis and prognosis of minimally invasive veneer restorations.