Accuracy of partially and fully guided surgical techniques for immediate implant placement: An in vitro assessment.

STATEMENT OF PROBLEM: Optimal implant positioning is essential to achieving predictable results. Computer-guided surgery has been reported to be an accurate technique for implant placement in healed sites, but the accuracy of guided techniques for immediate implant placement into fresh sockets is still unclear. PURPOSE: The purpose of this experimental randomized split-mouth study in pig jaws was to determine the accuracy of partially and fully guided surgical techniques for immediate implant placement into fresh sockets and to compare 2 different methods of implant position deviations analysis. MATERIAL AND METHODS: Twenty implants were installed in 10 pig jaws using 2 different techniques: partially guided (n=10) and fully guided (n=10). Cone beam computed tomography and digital scanning were performed before and after the surgical procedure to plan the virtual implant position and fabricate the surgical guide, as well as to determine implant position deviations. Two methods were used to evaluate implant deviations: tomographic and digital scanning. The Shapiro-Wilk test of normality was used. Deviation comparisons were carried out by using paired t tests (α=.05), and intraclass correlation coefficient (ICC) was computed to assess the agreement between the 2 methods of implant deviation analysis. RESULTS: In the tomographic analysis, the partially guided technique resulted in significantly higher global apical and lateral coronal deviations (2.25 ±0.59 mm; 0.96 ±0.55 mm) than fully guided (1.52 ±0.89 mm; 0.75 ±0.52 mm) (P<.01 and P<.05, respectively). The analysis performed using digital scanning showed significantly higher angular, global apical, and lateral apical deviations in the partially guided (6 ±3.28 degrees; 2.49 ±1.03 mm; 2.16 ±1.07 mm) technique than in the fully guided (3.32 ±1.84 degrees; 1.5 ±0.58 mm; 0.98 ±0.67 mm) (P<.05). An ICC of 0.522 between the 2 methods of implant deviation analysis was obtained. CONCLUSIONS: The partially guided technique was less accurate than the fully guided technique for immediate implant placement into fresh sockets. A moderate concordance was observed between cone beam computed tomography and digital scanning analyses, suggesting that more studies are required to validate and to define the most reliable method of measuring implant deviation.

Socket regeneration after immediate loading implants with tissue and bone graft: 1-year clinical follow-up

Evaluation of ridge alteration after 1 year follow up after immediate loading implant placement. Methods: Ten patients were included in the study, in whom the ridge volume, height, and thickness were evaluated from region of interest (ROI) of tomographic images of the operated areas (test group) and compared to the opposite tooth (control group). Results: After one year, there was no implant loss and all patients were satisfied with the treatment. In the test group there was a statistically significant increase in ridge height (2.89±1.05 mm) when compared to the control group. No significant difference in relation to ridge volume and thickness was observed. In the intragroup evaluation, a significant gain in ridge height (2.65±3.08 mm) was observed when compared to baseline. Conclusion: The placement of an immediate implant, temporary crown, and tissue regeneration in sockets with buccal defects promotes the regeneration of the buccal wall while preventing the reduction of bone volume and thickness

Effect of osseodensification on the increase in ridge thickness and the prevention of buccal peri-implant defects: an in vitro randomized split mouth pilot study.

BACKGROUND: Implant installation with conventional drilling can create buccal bone defects in areas of limited ridge thickness. Implant installation with osseodensification may aid in preventing buccal bone defects in these situations. This in vitro pilot study evaluated the impact of osseodensification on the increase in alveolar ridge thickness and the prevention of buccal peri-implant defects. METHODS: Ten fresh pig mandibles with limited bone thickness were selected for use in an experimental randomized split mouth pilot study. Two site-preparation protocols were used: conventional drilling with cutting burs (CTL, n = 10) and osseodensification with Densah® burs (OD, n = 10). After implant bed preparation, 20 implants (4.5 × 10 mm) were placed in the prepared sites and the insertion torque was recorded. Clinical and photographic analysis evaluated ridge thickness and the extent (height, width, and area) of bone defects in the buccal and lingual bone walls following implant placement. Three-dimensional measurements were performed using STL files to analyze the increase in buccal ridge thickness following site preparation and implant placement. The height of the buccal bone defect was considered as the primary outcome of this study. Defect width, area, implant insertion torque, and linear buccal ridge increase after implant site preparation and installation were also assessed. Non-parametric evaluations were carried out with the Mann-Whitney test to verify intergroup differences. RESULTS: There was no statistically significant difference between groups in the baseline ridge thickness. OD presented a significantly higher insertion torque, associated with reduced buccal and lingual bone defect width, in comparison to CTL. CONCLUSIONS: The increase in buccal ridge thickness after site preparation and implant placement was significantly higher in OD compared to CTL. Osseodensification increased the ridge thickness through expansion and reduced buccal bone defects after implant installation.

Improving the bonding stability between resin cements and zirconia-based ceramic using different surface treatments.

PURPOSE: To evaluate the effects of airborne-particle abrasion with alumina particles or silicamodified alumina particles on the bond strength between zirconia and conventional MDP-based (Ph; Panavia F 2.0, Kuraray) or self-adhesive (SA; RelyX U200, 3M ESPE) resin cements. MATERIALS AND METHODS: Five surface treatments were evaluated: C = no surface treatment; AB = airborne-particle abrasion with alumina particles (BIO-ART Dental Supplies and Equipment); ABP = AB combined with MDP-based primer (Alloy Primer, Kuraray); SS = airborne-particle abrasion with silica-modified alumina particles (CoJet, 3M ESPE) combined with silane (RelyX Ceramic Primer, 3M ESPE); and SSP = SS combined with MDP-based primer. The surface roughness (Ra) of the airborne particle-abraded samples (n = 5) was measured by a contact profilometer (Mitutoyo Surftest SJ-401, Mitutoyo). Cylinders of the resin cements tested were bonded to the surface-treated zirconia. The microshear test was performed by the application of a load with a wire loop parallel to the adhesive interface until debonding of the resin cement cylinders. The microshear bond strength (µSBS) of the samples was measured before and after being subjected to thermocycling (TC; 5°C to 55°C, 60 seconds dwell time for 3,000 cycles; MSCT, Marcelo Nucci). One-way (Ra) and two-way (µSBS) analysis of variance followed by Tukey post hoc test (α = .05) were used. RESULTS: The SS (Ph: 12.6 MPa; Ph-TC: 6.37 MPa; SA: 11.8 MPa; SA-TC: 9.37) and SSP (Ph: 10.4 MPa; Ph-TC: 5.82 MPa; SA: 10.4 MPa; SA-TC: 10.0) surface treatments produced the highest surface roughness values (P < .001). The SS samples achieved the highest immediate bond strength for both resin cements. However, after TC, SA resin cement associated with any surface treatment produced the highest bond strength values. CONCLUSION: The self-adhesive resin cement promoted higher and more stable bond strength values when associated with a surface roughening method.

Flapless Guided Implant Surgeries Compared with Conventional Surgeries Performed by Nonexperienced Individuals: Randomized and Controlled Split-Mouth Clinical Trial.

PURPOSE: The study aimed to evaluate the outcomes of flapless guided surgery related to surgery, patient, operator, assistant, and advisor, comparing it with conventional surgery performed by undergraduate students who had never placed implants in patients. MATERIALS AND METHODS: A randomized controlled split-mouth clinical trial was carried out. Ten patients with bilateral mandibular posterior tooth loss received an implant on each side with conventional flap surgery or flapless guided surgery that was performed by undergraduate students. Surgery time, pain, patient satisfaction, quantity of consumed medications, time of procedure, ease of procedure, anxiety, and stress were assessed. RESULTS: Conventional surgery showed statistically significantly inferior results compared with flapless guided surgery in terms of procedure time (56 minutes, 36 seconds ± 8 minutes, 38 seconds vs 30 minutes, 1 second ± 6 minutes, 2 seconds), consumption of analgesic medications (49 tablets vs 15 tablets), intraoperative (1.75 ± 1.56 vs 0.65 ± 0.64) and postoperative pain (4.62 ± 2.17 vs 1.17 ± 0.72), and operator anxiety (4.76 ± 1.66 vs 3.47 ± 1.50), respectively. CONCLUSION: Flapless guided implant surgeries performed by individuals with no previous clinical experience showed reduced surgery time and delivered better patient-reported outcomes both in the intraoperative and postoperative periods; reduced medication consumption; and showed better results in the operator and assistant perspectives.

Emergency 3-Dimensional-Printed Devices for Splitting Ventilators in Lungs With Different Compliances: An In Vitro Study.

Ventilator shortages occurred due to the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). This in vitro study evaluated the effectiveness of 3-dimensional (3D)-printed splitters and 3D-printed air flow limiters (AFL) in delivering appropriate tidal volumes (TV) to lungs with different compliances. Groups were divided according to the size of the AFL: AFL-4 was a 4-mm device, AFL-5 a 5-mm device, AFL-6 a 6-mm device, and no limiter (control). A ventilator was split to supply TV to 2 artificial lungs with different compliances. The AFL improved TV distribution.

Impact of fully or partially guided surgery on the position of single implants immediately placed in maxillary incisor sockets: A randomized controlled clinical trial.

PURPOSE: The aim of this study was to compare the deviation of the implant position after placement in single maxillary incisor post-extraction sockets between fully and partially guided surgery. MATERIALS AND METHODS: Twenty-four patients with a failing maxillary incisor were randomly allocated into two groups: the partially guided surgery (PGS, n = 12) group or fully guided surgery (FGS, n = 12) group. Clinical analyses, intra-oral scans, and computed tomography scans (CT) were initially performed to define the virtual positioning of the implants and fabrication of the 3D printed surgical guides. A narrow, 3.5 × 16 mm implant was placed in each socket. In this moment, the insertion torque (IT) was assessed and resonance frequency analysis (RFA) was performed. All patients received an immediate provisional without occlusal contacts. Another CT scan was performed after the procedures to compare the implant position with the virtually planned position. RESULTS: Significant deviations occurred at the implant apex, according to the global and facial-palatal analyses, in comparison to its cervical position. The PGS group also presented a larger deviation in the MD position. No statistical differences between the groups were detected, however, there was a tendency of lower angular deviation in the PGS group. CONCLUSIONS: While there was a slight deviation from the virtually planned position of the implant to the actual position and a tendency of lower angular deviation in the PGS group, there was no difference among groups regarding its position and primary stability. (UNT: 1111-1214-2812 - http://www.ensaiosclinicos.gov.br/rg/RBR-4tmcrk/).

Treatment of peri-implant soft tissue defects: a narrative review.

Soft tissue defects around dental implants, such as papilla or volume loss, peri-implant recession and alterations of the ridge color and/or texture, lead to esthetic and functional complaints. Treatments of these defects in implants are more demanding than in teeth because peri-implant tissue exhibits different anatomical and histological characteristics. This narrative review discusses the proposed treatments for soft tissue defects around implants in the current literature. Several clinical and pre-clinical studies addressed methods to augment the quantity of the peri-implant keratinized mucosa. Autogenous grafts performed better than soft tissue substitutes in the treatment of soft tissue defects, but there is no clinical consensus on the more appropriate donor area for connective tissue grafts. Treatment for facial volume loss, alterations on the mucosa color or texture and shallow peri-implant recessions are more predictable than deep recessions and sites that present loss of papilla. Correction of peri-implant soft tissue defects may be challenging, especially in areas that exhibit larger defects and interproximal loss. Therefore, the regeneration of soft and hard tissues during implant treatment is important to prevent the occurrence of these alterations.

Impact of Soft Tissue Grafts to Reduce Peri-implant Alterations After Immediate Implant Placement and Provisionalization in Compromised Sockets.

This study evaluated the impact of soft tissue grafts to reduce marginal peri-implant recession (MPR) after 1 year of follow-up. A total of 24 patients with one single failing maxillary incisor presenting facial bone dehiscence and receiving an immediate implant, bone graft, and provisional were randomly divided into three groups (n = 8 in each group): control (CTL), collagen matrix (CM), and connective tissue graft (CTG). Clinical, photographic, and tomographic analyses were performed to evaluate tissue alterations. The use of a CTG avoided MPR (P < .05) and provided better contour of the alveolar ridge (P < .01) and greater thickness (P < .05) of the soft tissue at the implant facial aspect.

Evaluation of bone turnover after bisphosphonate withdrawal and its influence on implant osseointegration: an in vivo study in rats.

OBJECTIVES: The aim of this study was to investigate bone turnover alterations after alendronate (ALD) withdrawal and its influence on dental implants osseointegration. MATERIALS AND METHODS: Seventy female Wistar rats were randomly divided in 2 groups that received on day 0 either placebo (control group-CTL; n = 10) or 1 mg/kg sodium alendronate (ALD; n = 60) once a week for 4 months. At day 120, ALD treatment was suspended for 50 animals. Then, a titanium implant was placed in the left tibia of each rat that were randomly allocated in five subgroups of ten animals each, according to the period of evaluation: day 0 (INT-0), day 7 (INT-7), day 14 (INT-14), day 28 (INT-28), and day 45 (INT-45) after ALD withdrawal. CTL group and a group that received ALD until the end of the experimental period (non-interrupted group-non-INT; n = 10) underwent implant placement on day 120. Animals were euthanized 28 days after implant surgery. Bone mineral density (BMD) of femur and lumbar vertebrae were evaluated by DXA, biochemical markers of bone turnover were analyzed by ELISA, and bone histomorphometry was performed to measure bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO). RESULTS: All groups receiving ALD showed higher BMD values when compared to CTL group, which were maintained after its withdrawal. Decreased concentrations in all bone turnover markers were observed in the non-INT group, and in the groups in which ALD was discontinued compared to the CTL group. The non-INT group showed lower %BIC and notably changes in bone quality, which was persistent after drug withdrawal. CONCLUSION: Collectively, the findings of this study demonstrated that ALD therapy decreased bone turnover and impaired bone quality and quantity around dental implants, and that its discontinuation did not reverse these findings. CLINICAL RELEVANCE: The severe suppression of bone turnover caused by the prolonged use of ALD may alter the capacity of bone tissue to integrate with the implant threads impairing the osseointegration process.

Treatment of peri-implant soft tissue defects: a narrative review

Abstract Soft tissue defects around dental implants, such as papilla or volume loss, peri-implant recession and alterations of the ridge color and/or texture, lead to esthetic and functional complaints. Treatments of these defects in implants are more demanding than in teeth because peri-implant tissue exhibits different anatomical and histological characteristics. This narrative review discusses the proposed treatments for soft tissue defects around implants in the current literature. Several clinical and pre-clinical studies addressed methods to augment the quantity of the peri-implant keratinized mucosa. Autogenous grafts performed better than soft tissue substitutes in the treatment of soft tissue defects, but there is no clinical consensus on the more appropriate donor area for connective tissue grafts. Treatment for facial volume loss, alterations on the mucosa color or texture and shallow peri-implant recessions are more predictable than deep recessions and sites that present loss of papilla. Correction of peri-implant soft tissue defects may be challenging, especially in areas that exhibit larger defects and interproximal loss. Therefore, the regeneration of soft and hard tissues during implant treatment is important to prevent the occurrence of these alterations.

Periodontics, Implantology, and Prosthodontics Integrated: The Zenith-Driven Rehabilitation.

A customized treatment plan is important to reach results that will satisfy the patient providing esthetics, function, and long-term stability. This type of oral rehabilitation requires professionals from different dental specialties where communication is a major key point. Digital Smile Design allows the practitioners to plan and discuss the patient's condition to establish the proper treatment plan, which must be driven by the desired zenith position. The ideal gingival position will guide the professionals and determine the need to perform surgical procedures or orthodontic movement before placing the final restorations. In this article, the zenith-driven concept is discussed and a challenging case is presented with 4-year follow-up where tooth extraction, immediate implant placement, bone regeneration, and a connective tissue graft were performed.

Diabetes and increased lipid peroxidation are associated with systemic inflammation even in well-controlled patients.

BACKGROUND: The effect of the interaction between type 2 diabetes and dyslipidemia on inflammation and lipid peroxidation (LPO) has not been assessed. AIM: To investigate whether diabetes coupled with dyslipidemia alters oxidative metabolism leading to increased LPO products and inflammatory status. METHODS: 100 patients were divided into four groups based upon diabetic and dyslipidemic status: poorly controlled diabetes with dyslipidemia (DM-PC/D), well-controlled diabetes with dyslipidemia (DM-WC/D), normoglycemic individuals with dyslipidemia (NG/D), and normoglycemic individuals without dyslipidemia (NG/ND). Plasma was evaluated for an LPO product (MDA), antioxidant levels and inflammatory cytokines. RESULTS: Diabetics presented significantly higher levels of LPO (p<0.05) and the DM-PC/D had higher levels of proinflammatory cytokines and MDA in the plasma in comparison with normoglycemics (p<0.05). Interestingly IL1-ß, IL-6, and TNF-α in DM-WC/D were not statistically different from those in DM-PC/D. Normoglycemic individuals with dyslipidemia presented significantly increased levels of IL-6 and TNF-α when compared to normoglycemic without dyslipidemia (p<0.05). MDA levels were also positively correlated with the presence of DM complications (r=0.42, p<0.01). CONCLUSIONS: These findings show that dyslipidemia is associated with an increased inflammatory status, even in well-controlled diabetics and in normoglycemics. Our results suggest that lipid metabolism and peroxidation are important for the development of inflammation, which is elevated in several complications associated with diabetes.

Etiologia e tratamento cirúrgico das recessões gengivais / Etiology and surgical treatment of gingival recessions

A migração apical da margem gengival com exposição da superfície radicular é denominada recessão gengival, possui alta prevalência na população e aumenta em quantidade e severidade com o passar dos anos. O tratamento desta alteração pode ser necessário, já que o paciente pode apresentar lesões cervicais cariosas ou não cariosas, hipersensibilidade dentinária cervical, controle inadequado de biofilme, perda de inserção periodontal progressiva e queixas estéticas. Existem diversas possibilidades de técnicas cirúrgicas para o tratamento da recessão gengival, e a combinação que mostra resultados mais favoráveis é a realização de um retalho posicionado coronalmente e um enxerto de tecido conjuntivo subepitelial. O objetivo deste artigo foi realizar uma revisão da literatura e apresentar um caso clínico acerca da etiologia, prognóstico e tratamento cirúrgico da recessão gengival.

Gingival recession is defi ned by the apical migration of the gingival margin exposing the root surface. This alteration presents a high prevalence in the population and increases in number and severity along the years. The treatment of this condition may be necessary since the patient may present carious or non-carious cervical lesions, cervical dentinal hypersensitivity, inadequate plaque control, progressive periodontal attachment loss and aesthetic complaints. There are several surgical techniques to treat gingival recessions and the procedure that shows more favorable results is the combination of a coronally positioned flap and a subepithelial connective tissue graft. The aim of this article is to review the literature and present a clinical case about the etiology, prognosis, and surgical treatment of gingival recession.

Semidirect Restorations in Multidisciplinary Treatment: Viable Option for Children and Teenagers.

Due to the esthetic necessity required nowadays, the multidisciplinary treatment became a fundamental step in the restoration success. When the patient exhibits dental agenesis of one or more elements, he can show difficulty in social interactions. The age of the patient is a limiting factor to esthetic procedures, however, it should be evaluated as a real indicative with each case. The utilization of semi-direct restorations is a viable option due the cost, esthetic and improvement of physical and mechanical properties. The purpose of this paper is to present a case detailing the confection and cementation of anterior semi-direct restorations aimed at an anatomic reestablishment associated with integrated treatment with periodontics and orthodontics.

Effects of the long-term administration of alendronate on the mechanical properties of the basal bone and on osseointegration.

OBJECTIVE: To evaluate the effect of the long-term administration of alendronate on the mechanical properties of the basal bone and on osseointegration. MATERIAL AND METHODS: One hundred and sixty female rats were randomly allocated into two equally sized groups: the control (CTL) group, which received the subcutaneous administration of saline solution, and the alendronate (ALD) group, which received the subcutaneous administration of alendronate (1 mg/kg/week). After 120 days of these therapies, one implant was placed in each rat tibia. Ten animals in each group were euthanized at 5, 10, 15, 20, 25, 30, 45, or 60 days after surgery. The tibias with implants evaluated regarding the removal torque, bone-implant contact (BIC), the bone area fraction occupancy (BAFO), and Ca/P ratio. The femurs were evaluated regarding bone mineral density (BMD) and using mechanical tests to evaluate the maximal force of fracture, stiffness, and tenacity. RESULTS: The ALD group presented statistically significant higher BMD (all periods except 15 days), maximal force of fracture (at 20, 30, and 45 days), tenacity (at 10, 20, 30, and 45 days), stiffness (45 days), removal torque (at 20, 25 and 30 days), BIC (at 20 and 60 days), and BAFO (at 20, 30, and 45 days) than the CTL group. No differences were found between the groups regarding the Ca/P ratio. CONCLUSION: Previous long-term therapy with alendronate caused an increase in the BMD, maximal force of fracture of the bone without changing the inorganic composition and elastic deformability of this tissue. Furthermore, the ALD therapy enhanced osseointegration.

Conservative treatment of intraosseous hemangiomas in the mandible: case report with a 17-year follow-up period.

Intraosseous hemangiomas in the jaws are rare lesions and may lead to several complications. The authors present a case of a 12-year-old girl with a radiolucent periapical lesion between tooth 35 and 36 where nocturnal exsanguinating bleeding started to occur from periodontal sulcus during orthodontic treatment. Diagnosis of an intraosseous hemangioma in the mandible was based on positive needle aspiration for blood, computed tomography and arteriography. At first the family chose to only follow-up the lesion but episodes of nocturnal hemorrhage were becoming more frequent and a treatment was requested. Embolization and dental extraction were performed in order to treat the lesion. After a follow-up period of 17 years no more cases of hemorrhage occurred and lesion regressed.

Tratamento do sorriso gengival: como estabelecer proporção e harmonia / Treatment of gingival smile: how to establish proportion and harmony

A etiologia do sorriso gengival é multifatorial, e o correto diagnóstico determinará o plano de tratamento adequado. A erupção passiva alterada ocorre quando, durante a fase final de erupção dentária, não existe a migração apical dos tecidos periodontais estabelecendo uma distância maior que 2 mm entre a crista óssea alveolar e a junção cemento-esmalte. Essa alteração leva ao encurtamento da coroa clínica, podendo levar à exposição gengival excessiva. Para seu tratamento existe a necessidade da remoção combinada tanto de tecido gengival como ósseo. Este artigo discorre sobre a literatura acerca do assunto e relata um caso clínico em que foi necessária a realização de cirurgia plástica periodontal para correção do sorriso gengival...

The etiology of the gingival smile is multifactorial and the correct diagnosis will determine a successful treatment planning. Altered passive eruption occurs during the final stages of tooth eruption, when apical migration of the periodontal tissues does not occur, resulting in a distance > 2 mm between the alveolar crest and the cement-enamel junction. This change leads to the shortening of the clinical crown and even further may lead to excessive gingival exposure. For treatment, there is a necessity for the combined removal of gingiva and bone tissue. This article discusses the literature on the issue and reports a case where periodontal plastic surgery was performed for the correction of a gingival smile...

Predictable interproximal tissue removal with a surgical stent.

The correction of diastemas in the anterior region with composite resin is considered to be practical and conservative. Harmony between the restorative material and the periodontium is necessary to achieve satisfactory functional and esthetic results. Whenever excessive gingiva occurs in the interproximal region, removal is necessary to avoid excessively contoured restorations. A predictable technique is described to conservatively remove interproximal tissue in situations in which crown lengthening is required to treat bilateral diastemas. A surgical template based on the diagnostically waxed cast was produced to serve as a reference during periodontal surgery.

Interação entre odontologia restauradora e periodontia. Parte 2: reanatomização dentária / Periodontics and restorative dentistry integrated. Part 2: dental reanatomization

O avanço no desenvolvimento de novos materiais odontológicos ampliou as modalidades terapêuticas, garantindo excelência nos tratamentos restauradores estéticos. Sendo assim, os procedimentos restauradores diretos têm sido utilizados em casos de reanatomização dentária, possibilitando tratamento eficaz, de baixo custo, além de preservar estrutura dentária sadia. No entanto, domínio clínico do material e das técnicas a ser realizadas é necessário pra garantir longevidade e sucesso no procedimento restaurador direto. O objetivo do artigo é descrever, após a finalização dos procedimentos cirúrgicos periodontais, a etapa restauradora direta realizada para reanatomização dentária e fechamento das diastemas presentes. A integração entre a Odontologia Restauradora e a Periodontia possibilitou o restabelecimento da harmonia do sorriso de forma conservadora, garantindo estética e satisfação da paciente

The development of new dental materials has expanded dental therapeutic modalities ensuring excellence in aesthetic restorative treatments. Thus, the direct restorative procedures have been used in cases of dental reconstruction allowing an effective treatment with a low cost, while preserving healthy tooth structure. However, the clinician must be used to the techniques and the material in order to ensure longevity and success in the direct restorative procedure. The aim of this paper is to describe, after completion of periodontal surgical procedures, the direct restorative step performed for dental reconstruction and diastema closure. The integration between Restorative Dentistry and Periodontics enabled the restoration of a harmonious smile in a conservative manner, ensuring aesthetics and patient satisfaction