Mounting digital casts on a virtual articulator by using two-dimensional facial photographs with a facebow: A technique.

This technique uses 3 or 4 two-dimensional (2D) photographs, including a frontal headshot with a facebow and lip retractors, a profile headshot with a facebow and lip retractors on the right or left side, and a frontal headshot with a facebow during maximum smile without retractors. These 2D photographs are used to digitally mount casts on a virtual articulator.

Clinical guidelines for posterior restorations based on Coverage, Adhesion, Resistance, Esthetics, and Subgingival management. The CARES concept: Part III ­ subgingival margins, "ferrule" design, and posts in severely compromised teeth

Despite the clear advances regarding the restoration of posterior teeth, especially with the minimally invasive approach, there are still several topics where the available scientific evidence does not provide clear answers in terms of clinical decisions. The indications, differences, and clinical protocols for partial adhesive restorations (onlays, overlays, and endocrowns) and resistance form restorations (full-contour resistive crowns) were presented in Parts I and II of the present article series based on Coverage of susceptible cusps, Adhesion advantages and limitations, Resistance forms to be implemented, Esthetic concerns, and Subgingival management - the CARES concept. Now, in Part III, the focus is on different approaches of managing subgingival areas, gaining "ferrule" design, and the role of posts on the restorability strategies of severely compromised teeth.

Clinical guidelines for posterior restorations based on Coverage, Adhesion, Resistance, Esthetics, and Subgingival management. The CARES concept: Part II - full-contour resistive crowns with vertical preparation.

Restoration of posterior teeth with different extents of tissue loss has been a matter of debate in the literature. There are several recommendations and guidelines on when, how, and why to perform adhesive restorations (onlays, overlays, and endocrowns) or resistance form restorations (full-contour resistive crowns). In Part I of this three-part article series, the authors focused on adhesive partial restorations. In that article, the evidence was extensively described, and a clinically reasonable thought process was suggested for these decisions based on Coverage of susceptible cusps, Adhesion advantages and limitations, Resistance forms to be implemented, Esthetic concerns, and Subgingival management - the CARES concept. Now, in Part II, the focus is on clinical decisions for full-contour resistive crowns regarding their indications based on remaining tooth structure, materials, and different preparation designs as well as the particularities of vertical marginal preparations, perio-restorative considerations, and esthetic challenges.

Clinical guidelines for posterior restorations based on Coverage, Adhesion, Resistance, Esthetics, and Subgingival management. The CARES concept: Part I ­ partial adhesive restorations

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.

Conservative restoration of the worn dentition - the anatomically driven direct approach (ADA).

The treatment or management of tooth wear with composite resins can be challenging because significant alterations in the patient's occlusion are usually required. Comprehensive approaches include the use of facebows, articulator-mounted casts, laboratory-made wax-ups, and silicone indexes to deliver the restorations. Even though this sequence of steps is recommended, in many cases it is not applied. The reason for this is related to the complexity and time required for these steps, which are normally applied in indirect restorations like ceramics but not properly used in direct composite resin rehabilitations. Moreover, a large portion of these patients, clinicians, and technicians in many countries may not have the resources and/or tools to undertake a full comprehensive approach. In order to aid clinicians to use an exclusively direct method to manage these patients for whatever reasons, the authors propose in this article a thought process applied to diagnosis and treatment planning that allows the restoration of extensively worn dentitions in a logical clinical sequence. The first goal is to provide a clear and organized vision of the functional, biologic, and esthetic principles of treatment planning based on the most current, evidence-based notions and clarified insights from experts. These are principles that should be applied universally in any comprehensive treatment plan. The second goal is to propose the application of these principles to direct restorations even when no individualized articulator mounting or appropriate laboratory wax-ups are available - the anatomically driven direct approach (ADA).

Soluções estéticas não invasivas com resinas compostas: caso clínico / Non invasive esthetic solutions using resin composites: a case report

As abordagens não invasivas apresentam a imensa vantagem de preservação estrutural, que é fundamental para a sobrevivência a longo prazo da peça dentária. No âmbito desses tratamentos, este artigo descreve um caso clínico em que as resinas compostas foram utilizadas para otimização estética não invasiva do sorriso. Neste caso, tal como diversos autores têm demonstrado, as resinas compostas permitiram obter resultado estético satisfatório para a paciente. Além da habilidade clínica, é necessário que a equipe possa fazer diagnóstico, simulações, bem como comunicar ao paciente as possibilidades e vantagens dessas estratégias de tratamento. O facto de abordagens não invasivas serem reversíveis com relativa facilidade permite que não se excluam outras abordagens futuras, o que representa coerência interessante do ponto de vista biológico e estético.

Non-invasive dental treatments allow tissue preservation, which is important for long-term survival of teeth. The authors describe a clinical case where resin composites were used for a non-invasive esthetic optimization of a patient’s smile. In this case, similar to several authors have described, a good esthetic result was achieved. In addition to the clinical skills, it is important for the team to be able to diagnose, make simulations of the result and communicate the patients all the possibilities and advantages of these treatment possibilities. Since these non invasive approaches are easily reversible, it is possible to make other treatment options in the future, making these treatments very feasible from a biologic and esthetic point of view.

Clinical decisions for anterior restorations: the concept of restorative volume.

UNLABELLED: The choice of the most appropriate restoration for anterior teeth is often a difficult decision. Numerous clinical and technical factors play an important role in selecting the treatment option that best suits the patient and the restorative team. Experienced clinicians have developed decision processes that are often more complex than may seem. Less experienced professionals may find difficulties making treatment decisions because of the widely varied restorative materials available and often numerous similar products offered by different manufacturers. The authors reviewed available evidence and integrated their clinical experience to select relevant factors that could provide a logical and practical guideline for restorative decisions in anterior teeth. The presented concept of restorative volume is based on structural, optical, and periodontal factors. Each of these factors will influence the short- and long-term behavior of restorations in terms of esthetics, biology, and function. Despite the marked evolution of esthetic restorative techniques and materials, significant limitations still exist, which should be addressed by researchers. The presented guidelines must be regarded as a mere orientation for risk analysis. A comprehensive individual approach should always be the core of restorative esthetic treatments. CLINICAL SIGNIFICANCE: The complex decision process for anterior esthetic restorations can be clarified by a systematized examination of structural, optical, and periodontal factors. The basis for the proposed thought process is the concept of restorative volume that is a contemporary interpretation of restoration categories and their application.

Co-existence of crowns and veneers in the anterior dentition: case report.

Crowns and veneers provide distinct treatment strategies with different outcomes in terms of tissue conservation, periodontal distress and esthetic result. It is not always clear where a crown or veneer is indicated, but in the last two decades, adhesive technology, conservative approaches and esthetic demands have increased clinical indications for porcelain veneers in restorative dentistry. A combination of veneers and crowns may be required, especially in the anterior region. It may be desirable to reinforce some teeth and preserve tissue on others. Problems can arise with the esthetic integration of both types of restoration, owing to their inherent mechanical and optical properties. Several clinical and laboratory techniques can be applied for a successful combination. In this article the authors describe the procedures and difficulties in treating a case with such needs.

CAD-CAM all-ceramic fully sintered zirconia crowns for the oral rehabilitation of an amelogenesis imperfecta case / Coroas CAD-CAM de zircônia totalmente sinterizada para reabilitação oral de um caso de amelogenesis imperfecta

Purpose: To present a case report of a patient with amelogenesis imperfecta rehabilitated with 26 CAD-CAM all-ceramic fully sintered zirconia crowns.Case description: A male subject, 28 year-old, sought dental treatment presenting a clinical condition compatible with amelogenesis imperfecta. All teeth had yellow, brown, and white areas of weak enamel. Composite restorations were present on teeth 14, 16, 24, 25, 26, 27, and 46; dental caries were shown on teeth 36, 37, and 47. Hipersensitivity was reported. The treatment included fully sintered zirconia crowns for all teeth, using a CAD-CAM system. No problems of marginal adaptation of the crowns were detected, and the final results were satisfactory for both the patient and the clinician. Conclusion: The clinical rehabilitation of an amelogenesis imperfecta case is a challenge, and a multidisciplinary approach is required. Zirconia all-ceramics crowns are an excellent option to restore dental aesthetics as the opaque zirconia coping can mask dischromic abutments, and the crowns have biocompatibility and improved physical properties.

Objetivo: Apresentar o caso clínico de um paciente com amelogenesis imperfecta, que foi reabilitado com 26 coroas CAD-CAM de zircônia totalmente sinterizada. Descrição do caso: Um sujeito do sexo masculino, 28 anos, procurou tratamento odontológico apresentando uma condição clínica compatível com amelogenesis imperfecta. Todos os dentes tinham áreas amarelas, marrons e brancas de esmalte enfraquecido. Havia restaurações de resina composta nos dentes 14, 16, 24, 25, 26, 27 e 46; cárie dentária estava presente nos dentes 36, 37 e 47. Relatou-se hipersensibilidade dentária. O tratamento incluiu coroas de zircônia totalmente sinterizada para todos os dentes, usando um sistema CAD-CAM. Nenhum problema de adaptação marginal das coroas foi detectado e os resultados finais foram satisfatórios para ambos o paciente e o clínico. Conclusão: A reabilitação clínica de amelogenesis imperfecta é um desafio e a abordagem multidisciplinar deve ser mandatória. As coroas de zircônia são uma excelente opção para a reabilitação de pacientes com esta anomalia, pois o opaco dos copings de zircônia pode mascarar as diferentes cores dos pilares e o resultado final é esteticamente aceitável, com biocompatibilidade e propriedades físicas superiores.

CAD-CAM: a informática a serviço da prótese fixa / CAD-CAM: informatics applied to fixed prosthodontics

O desenho de uma estrutura protética num computador seguido da sua confecçãopor uma máquina de fresagem é designado comumente por CAD-CAM. Essa tecnologia temtrazido uma evolução muito grande na Odontologia nos últimos 20 anos com o objetivo principalde otimizar a produção de estruturas protéticas. A evolução dos sistemas CAD-CAM tem sidoacompanhada também pela evolução dos materiais, sobretudo da zircônia, a cerâmica maisresistente disponível nessa área. Entre os sistemas CAD-CAM para a Odontologia, este trabalhorealça o Cerec®, o Procera®, o Lava® e especialmente o Everest®, sistema da Kavo® existente naFaculdade de Medicina Dentária da Universidade do Porto, Portugal.

The virtual design of a structure, followed by its machining in a milling unit isnormally called as CAD-CAM. This technology has evolved greatly in Dentistry in the last 20years, with the main purpose of optimizing the production of prosthetic structures. Together withthe evolution of this systems we can observe the changes in dental materials, specially zirconia,the most resistant ceramic available in Dentistry. Within this CAD-CAM systems this manuscriptwill focus the Cerec®, the Procera®, the Lava®, and specially the Everest®, from Kavo® corporation,which exists in the Dental Faculty of Porto University, Portugal.