Clinical Success Evaluation of Ultrathin Ceramic Veneers Bonded to Nonprepared Teeth: An Observational Prospective Cohort Study.

BACKGROUND: Patients' increasing interest in achieving optimal cosmetic outcomes and the widespread use of ultrathin ceramic veneers offer advantages such as high esthetic results and long-term durability. Several issues related to tooth preparation have been raised, including dental sensitivity, periodontal diseases, and increased treatment phases, in addition to complications associated with previous procedures, the treatment of which remains controversial to date. With the advancement of dental ceramic and its manufacturing techniques, it was widely used to manufacture ultrathin ceramic veneers with minimal preparation. Issues such as fracture and abfraction are the most common in ceramic veneers made of feldspathic ceramic due to their weak mechanical properties against various forces, which led to the emergence of lithium disilicate glass-ceramic manufactured using the heat-press technique. This has resulted in ultrathin ceramic veneers with a thickness of up to 0.1-0.2 mm easily bonded and finished as they have high mechanical properties and esthetic qualities that mimic natural tooth color and shape. The current cohort study aimed to evaluate the success rates of this kind of treatment for patients treated at our department. MATERIALS AND METHODS: This observational cohort study's sample comprised 60 ultrathin ceramic veneers manufactured from lithium disilicate glass-ceramic bonded to nonprepared upper teeth. The clinical performance of the studied sample was evaluated and monitored at monthly intervals (one month, three months, six months, and one year) using the clinical success evaluation based on Walton's principles adopted for evaluating the success and failure of fixed restorations. RESULTS: Ultrathin ceramic veneers made from lithium disilicate glass-ceramic, bonded to nonprepared teeth, proved to be a successful clinical and esthetic treatment option, with a clinical success rate of 100% during the entire follow-up period. CONCLUSIONS: This study's findings indicate that ultrathin ceramic veneers made from lithium disilicate glass-ceramic, bonded to nonprepared teeth, are a successful clinical and esthetic treatment option, with a clinical success rate of 100% during the entire follow-up period.

Three Dimensional-Printed Gingivectomy and Tooth Reduction Guides Prior Ceramic Restorations: A Case Report.

Computer-aided design and computer-aided manufacturing (CAD/CAM) dentistry have significantly changed workflows in recent years. Restorations and devices can now be digitally designed and 3D-printed for dental care purposes. This clinical case report provides straightforward protocols for the digital design and 3D manufacture of gingivectomy and tooth preparation guides. These types of guides improved the gingival architecture of the anterior teeth and provided controllable tooth preparations prior to labial ceramic veneers. Thoughtful clinical evaluation started with listening to the patient's chief complaint and extra- and intra-oral evaluations. Then a digital wax-up was performed, followed by an intra-oral mock-up, to evaluate the shape of the proposed restorations. After patient acceptance, the clinical procedure started with the gingivectomy and tooth preparation. Hand-crafted porcelain veneers were bonded under rubber dam isolation to avoid any contamination and maximize the bonding protocol. The esthetic and functional demands were fully satisfied. Predictable outcomes can be obtained whenever a meticulous evaluation and execution of all the steps are performed. Three dimensional printing technology allows the fabrication of devices such as gingivectomy and tooth reduction guides that help accomplish the desired results.

Minimally invasive prosthodontics using the concept of prosthetically guided orthodontics.

OBJECTIVE: This case report aims to present how digital technology can be employed to plan the orthodontic movement of teeth into their final positions for prosthodontic rehabilitation. An interdisciplinary approach to treatment planning and the result of prosthodontic treatment involves the cooperation of an orthodontist and a prosthodontist. When planned to achieve optimal results for a minimally invasive and functional prosthodontic treatment, orthodontic pretreatment provides superior esthetic results and favorable long-term success. CLINICAL CONSIDERATIONS: The orthodontic movements of the teeth were planned so that the prosthodontist could reconstruct an optimally functional and esthetic occlusion while preserving the hard dental tissues. The orthodontic pretreatment minimized the need to prepare the teeth, avoiding any mucogingival surgery to improve the gingival architecture. CONCLUSIONS: In complex clinical cases, it is essential to evaluate the advantages of an orthodontic pretreatment before starting a prosthodontic treatment. This pretreatment can help preserve dental tissues, reduce or eliminate the need for surgical intervention, and achieve long-term stability and esthetic results. CLINICAL SIGNIFICANCE: This case clearly shows the benefits of orthodontic pretreatment for prosthodontic outcomes. With modern digital tools, such an orthodontic pretreatment should become standard clinical practice when planning a complex clinical case.

Evaluation of marginal and internal adaptation of veneers generated by the guided prosthetic tooth preparation system.

OBJECTIVE: This in vitro study aimed to assess and contrast the marginal and internal adaptation of all-ceramic prefabricated veneers manufactured via the FirstFit guided tooth preparation system against all-ceramic veneers produced using the chairside Computer-Aided Design/Computer Aided Manufacture (CAD/CAM) system following identical guided preparation protocols. MATERIALS AND METHODS: Two main groups were included, with 16 lithium disilicate veneers per group. Four typodonts were used for the test (FirstFit) and control CAD/CAM groups. Intraoral scans created master casts and preparation guides. Guides performed preparations on typodont teeth (two central incisors and two lateral incisors). Prepared teeth were scanned (CEREC Omnicam) to design and mill CAD/CAM veneers. Marginal gap thickness and cement space thickness were measured using light microscopy at four locations: marginal, cervical internal, middle internal, and incisal internal. RESULTS: No significant difference existed between groups for marginal adaptation (p = 0.058) or incisal internal adaptation (p = 0.076). The control group had significantly lower values for middle internal adaptation (p = 0.023) and cervical internal adaptation (p = 0.019). CONCLUSIONS: Guided preparation evaluation showed no significant differences in marginal or incisal internal adaptation. The CAD/CAM group had significantly lower middle and cervical internal adaptation values.

Freehand vs. depth-gauge rotary instruments for veneer preparation: A controlled randomized simulator study.

PURPOSE: To investigate whether depth-gauge burs in veneer preparations influence preparation depth in a randomized, controlled, single-blinded trial and whether inexperienced operators can perform adequate veneer preparations. METHODS: Participants were 20 undergraduate dental students with no prior veneer preparation experience. The instruments used were the "Laminate Veneer System" (LVS), "Keramik-Veneers. de" (KVD), and a "Freehand" group (FH) for reference. All participants prepared three educational acrylic resin maxillae and three mandibular central incisors mounted in typodonts in patient simulators. The objectives were to achieve a preparation depth of 0.6 mm (tooth 11) and 0.4 mm (tooth 31). The sequences of the instruments used and prepared teeth were randomized. The measurements were performed using a laser triangulation coordinate-measuring machine. The data were stratified according to tooth location. RESULTS: The preparation depths of both depth-gauge-instrument-groups LVS and KVD achieved the objectives significantly better than did the instruments from the "Freehand" group (P < 0.001). The differences between the depth gauge groups were insignificant, although the maximum preparation depths were smaller in the KVD group. Regarding the prepared teeth, the preparation depths in the mandibular incisors were lower, and the differences were smaller. CONCLUSIONS: The use of special depth-gauge burs for initial veneer preparation leads to significantly lower preparation depths than "Freehand" preparations. The tapered instruments resulted in a lower incidence of extreme preparation depths. The inexperienced operators performed veneer preparation remarkably well.

Total Rehabilitation Using Adhesive Dental Restorations in Patients with Severe Tooth Wear: A 5-Year Retrospective Case Series Study.

INTRODUCTION: Currently, there is little clinical evidence to support the medium- and long-term survival and clinical performance of ultraconservative approaches using adhesive restorations in full-mouth restorations. The aim of this case series study was to evaluate the medium-term clinical performance of anterior and posterior adhesive restorations applied with direct and indirect techniques using resin composites and glass-ceramic-based materials. MATERIALS AND METHODS: The inclusion criteria were an esthetic problem as the main reason for consultation and severe generalized wear of grade 2 to 4 according to the Tooth Wear Evaluation System (TWES 2.0). In addition, at each follow-up appointment, patients were required to submit a clinical-parameter-monitoring record according to the modified United States Public Health Service (USPHS) criteria. RESULTS: Eight patients with severe tooth wear were treated through full rehabilitation in a private dental clinic in Spain by a single operator (AFC). A total of 212 restorations were performed, which were distributed as follows: 66 occlusal veneers, 26 palatal veneers and 120 vestibular veneers. No signs of marginal microleakage or postoperative sensitivity were observed in any occlusal, vestibular and/or palatal restoration after the follow-up period. The estimated survival rate of the 212 restorations was 90.1% over 60 months of observation, with a survival time of 57.6 months. Only 21 restorations had complications, which were mostly resolved with a direct composite resin. The dichotomous variables of the restoration type (posterior veneer, anterior veneer) and the type of restored tooth (anterior, posterior) were the risk predictors with statistically significant influences (p < 0.005) on the survival of the restorations. CONCLUSION: According to the results of this study, there is a significantly higher risk of restorative complications in posterior teeth compared to anterior teeth. Also, it can be concluded that the indication of adhesive anterior and posterior restorations is justified in the total oral rehabilitation of patients with severe multifactorial tooth wear, as they are associated with a low risk of failure.

The Influence of a Novel, Crenelated Design of CAD-CAM Ceramic Veneers on the Debonding Strength.

(1) Background: Aesthetic dentistry has become one of the most dynamic fields in modern dental medicine. Ceramic veneers represent the most appropriate prosthetic restorations for smile enhancement, due to their minimal invasiveness and highly natural appearance. For long-term clinical success, accurate design of both tooth preparation and ceramic veneers is of paramount importance. The aims of this in vitro study were to assess the stress in anterior teeth restored with Computer-Aided Design (CAD) and Computer-Aided Manufacturing (CAM) ceramic veneers and compare the resistance to detachment and the fracture of ceramic veneers prepared using two different designs. (2) Methods: Sixteen lithium disilicate ceramic veneers were designed and milled using the CAD-CAM technology and divided into two groups according to the preparations (n = 8): Group 1, conventional (CO), with linear marginal contour and Group 2, crenelated (CR), the latter with our novel (patented) sinusoidal marginal design. All samples were bonded to anterior natural teeth. The mechanical resistance to detachment and fracture was investigated by applying bending forces on the incisal margin of the veneers in order to determine which type of preparation leads to better adhesion. An analytic method was employed, as well, and the results of the two approaches were compared. (3) Results: The mean values of the maximum force recorded at the veneer detachment were 78.82 ± 16.55 N for the CO group and 90.20 ± 29.81 N for the CR group. The relative increase, equal to 14.43%, demonstrated that the novel CR tooth preparation provided higher adhesive joints. In order to determine the stress distribution within the adhesive layer, a finite element analysis (FEA) was performed. The statistical t-test showed that the mean value of the maximum normal stresses is higher for the CR-type preparations. (4) Conclusions: The patented CR veneers represent a practical solution to augment the adhesion and mechanical properties of ceramic veneers. The obtained results demonstrated that CR adhesive joints triggered higher mechanical and adhesive forces, which subsequently led to a higher resistance to detachment and fracture.

An in vitro comparison of incisal preparation design on load-to-failure of ceramic veneers.

Introduction: This in vitro study aimed to compare the load-to-failure values of two different ceramic veneers (IPS e.max Press [Ivoclar Vivadent] and Vintage lithium disilicate [LD] press [Shofu]) with incisal preparation designs under standardized conditions. Materials and Methods: Twenty-two intact extracted maxillary incisors were selected and divided randomly into two groups (n = 11). The veneer tooth preparation was standardized in both groups where a butt joint incisal preparation was done along with chamfer margin. Group 1 included veneers made from IPS e.max Press (Ivoclar Vivadent) and Group 2 included veneers fabricated from Vintage LD Press (Shofu). Veneers were luted to their respective abutment teeth using standardized bonding protocols and resin cement for both groups. Later, every specimen was loaded to failure utilizing a universal testing machine, and the outcomes were noted in Newtons (N). Results: The mean load-to-failure value obtained for Group 1 (IPS e.max Press) was 1386.46 N while that obtained for Group 2 was 1777.07 N. Statistically significant difference was found in this intergroup comparison (P = 0.006). Conclusion: The load-to-failure value of Vintage LD Press veneers (Shofu) was greater than that of IPS e.max Press veneers (Ivoclar Vivadent).

Effect of ultrasound on preheated resin composites used as ceramic luting agents.

This study investigated the effect of ultrasound application when luting ceramic using two preheated composites that show distinct responses to preheating at 69°C: Filtek Z100 and Z350XT. RelyX Veneer was the control. Feldspar disks were luted using the resin-based luting agents (RBLAs), and ultrasound was tested. Biaxial flexure strength (σbf) was calculated at z-axial positions of the luted disks (z=0; z=-t2). Microtensile bond strength (µTBS) to ceramic was tested (n=30). Data were analyzed at α=0.05. At z=0, the σbf was higher for Z350 when ultrasound was not used. When ultrasound was applied, the σbf was similar between Z350 and Z100. At z=-t2, differences across the RBLAs were observed: Z350 was superior than Z100 and control without ultrasound. Ultrasound increased σbf for Z100 at both axial positions. The preheated composites yielded higher µTBS than the control. Ultrasonication increased the mechanical performance of ceramic luted with Z100 without influencing the film thickness.

Substantial in-vitro and emerging clinical evidence supporting immediate dentin sealing.

The application of resin adhesive to freshly cut dentin after teeth preparation, the so-called immediate dentin sealing (IDS) has been suggested as an alternative to the delayed dentin sealing (DDS), a technique in which resin adhesive is applied just before final bonding of indirect restorations. The aim of this review is to demonstrate the evidence of the claimed advantages made by the proponents of IDS technique. The results of this review revealed substantial in-vitro evidence supporting the IDS benefits including improved bond strength, reduced dentin permeability, improved restorations' adaptation, and increased fracture strength of the restorations. Clinical studies have shown that IDS improves survival of ceramic laminate veneers bonded to prepared teeth with increased exposure of dentin. Moreover, it has been shown that IDS reduces post-cementation hypersensitivity in full coverage restorations, which is characterized by exposure of a large number of dentinal tubules. The selection of filled resin adhesive that is capable of producing thick adhesive layer appears to contribute to the success of the technique. Furthermore, careful management of the oxygen inhibition layer before conventional impression making and proper cleaning of the residual temporary cement used with provisional restorations appears to affect the outcome of the restorations.

Multidisciplinary clinical approach of an orthodontic treatment and complete digital rehabilitation of laminate veneers for esthetically compromised worn teeth.

AIM: The present clinical case reports on the workflow of a multidisciplinary treatment including both orthodontic and esthetic procedures for the rehabilitation of a young patient with severe wear in the anterior area of both the maxillary and mandibular arches due to malocclusion. The described workflow comprises a digital step-by-step process that involves 3D printing, intraoral scanners, and CAD/CAM milling systems. RESULTS: Accurate diagnostic and treatment planning were paramount when different specialties needed to combine and work together. For that purpose, different digital procedures helped to improve the predictability and the dynamic of the orthodontic and restorative treatments. CONCLUSION: The present multidisciplinary clinical case was executed with a digital approach that assisted to speed things up and achieve a predictable treatment option.

Rubber Dam Isolation for Bonding Ceramic Veneers: A Five-Year Post-Insertion Clinical Report.

It has been well-documented that uncontaminated ground enamel provides the most predictable substrate for the bonding of ceramic veneers, and thus conservative tooth preparation with complete isolation using a rubber dam is key to the long-term success of the restorations presented with five years of follow-up. Rubber dam isolation provides several advantages to the clinician, such as preventing contamination of the working field by saliva, blood, and sulcular fluids, and improving direct visibility. However, it may be a challenge to the younger clinician to properly isolate teeth prior to bonding ceramic veneer. The present case report demonstrated the sequence and some clinical tips for a case in which the rubber dam is placed from a second premolar to the opposite second premolar and held with clamps, the rubber dam is gently invaginated into the sulcus, and clamps are selected and placed on each tooth to create an ideal situation for the adhesion of the ceramic veneer. This step-by-step sequence may help the younger clinician in understanding how to gently manage soft tissue in order to properly provide complete isolation with rubber dam for future bonding of ceramic veneers. Following these methods, the clinician can achieve complete isolation, invaginate the rubber dam in the sulcus without causing tissues to bleed, and reduce the time needed for bonding procedures.

Essay III: Adhesive restorative options for restorative space management in the anterior zone with or without orthodontic pretreatment: some clinical considerations and case presentations.

An unfavorable relationship between the form and dimension of the dental arch and the number, dimension, and shape of the existing teeth can pose several esthetic, biologic, and functional problems. In this article, the various restorative options are discussed based on clinical and scientific evidence: Gap closure and substitution of missing teeth: restorative transformation of substituted teeth into homologous teeth with odontoplasty, direct composite, etched pieces or porcelain veneers. Gap opening and tooth replacement with all-ceramic adhesive bridges, including pontic site development. Gap distribution and restorative compensation with direct composite restorations, etched pieces or porcelain veneers. Gap shifting and restorative compensation with all-ceramic adhesive bridges, composite, etched pieces or veneers. Gap compensation by reconstructive compensation without orthodontics. The reconstructive tools including composite restorations, ceramic veneers, and adhesive bridges are discussed, and numerous cases are presented to illustrate the concepts.

Ceramic laminate veneers: effect of preparation design and ceramic thickness on fracture resistance and marginal quality in vitro.

OBJECTIVES: The aim of the present study was to investigate the influence of five different preparation designs and two different ceramic thicknesses on margin quality and fracture resistance of ceramic laminate veneers after thermomechanical loading in vitro. MATERIALS AND METHODS: Eighty human central incisors were randomly assigned to 10 groups (n = 8) with five different preparation designs: non-prep (NP), minimally invasive (MI) = exclusively enamel-bonded, semi-invasive (SI) = 50% bonded in dentin, invasive (I) = 100% in dentin, and semi-invasive with two additional class III composite resin restorations (SI-C). IPS InLine veneers were fabricated in two thicknesses (L1 = 0.2-0.5 mm; L2 = 0.5-1.2 mm). After adhesive luting (OptiBond FL, Variolink Veneer) with light curing and polishing, specimens were stored in distilled water at 37 °C for 21 days, then thermocycled (2000 cycles between + 5 and + 55 °C), and finally mechanically loaded at the incisal edge at an angle of 45° for 2,000,000 cycles at 50 N und further 1,000,000 cycles at 100 N. Impressions were taken initially, after thermocycling, and after every 250,000 mechanical cycles in order to evaluate cracks and margin quality under a SEM. The veneers were evaluated in a light microscope (× 20) for cracks, chippings, partial, and catastrophic fractures. RESULTS: Margin quality after three million cycles revealed medians for continuous margin of 82-95% without significant differences among groups, neither at the ceramic/composite (p = 0.943) nor at the tooth/composite interface (p = 0.571). Visual inspection of veneers exhibited 22 cracks, 11 chippings, 4 partial and 4 catastrophic fractures in 38 of 80 veneers. The statistical ranking regarding fracture risk (p ≤ 0.05) was: IL1 = SIL1 = MIL1 = IL2 = CL1 = CL2, MIL2 = NPL1 = NPL2 = SIL2, IL2 = CL1 = CL2 = MIL2 = NPL1 = NPL2 = SIL2. CONCLUSIONS: Even after three million cycles with up to 100 N, all groups showed high survival rates. However, the fracture risk increases with thin veneers and preparations with medium to high dentin portions when compared to thicker veneers with preparations in enamel or partially in dentin (p ≤ 0.05). Preexisting resin composite restorations did not show any significant influence on margin quality and facture risk (p > 0.05). CLINICAL RELEVANCE: Ceramic laminate veneers are extremely durable with thin veneers and substantial enamel loss being main risk factors for fracture.

Color stability of ceramic veneers luted with resin cements and pre-heated composites: 12 months follow-up

Abstract The objective was to evaluate the color stability of ceramic veneers luted with resin cements and pre-heated composite resins (60oC) for 12 months, and determine the degree of conversion (DC) of the luting agents. Two resin cements (AllCem Veneer, light-cured (LRC) and AllCem, dual-cured (DRC)] and three composite resins [Z100 (MNCR-minifilled), Herculite Classic (MHCR-micro-hybrid) and Durafill (MCCR-microfilled)] were used for cementing 0.8-mm-thick lithium-silicate glass-ceramic laminates (Suprinity, shade B2-HT, Vita) on bovine enamel (n=10). The specimens were stored at 37oC in distilled water. CIELab parameters were determined at 24h after luting (baseline), 7, 30, 90, 180 days and 12 months. Three specimens were prepared for DC evaluation, performed by micro-Raman spectroscopy. Data were analyzed by ANOVA and Tukey's test (a=5%). For ΔEab and ΔE00, there were significant differences for luting material (p<0.001), time (p<0.001), and double interaction (p<0.001). The groups cemented with MHCR (1 year), MCCR (90 days and 1 year) and MCCR-PH (1 year) were the ones with ΔE values greater than the acceptability threshold. All other groups maintained their ΔE lower than the acceptability threshold after 1 year in distilled water. Regarding DC, there were no significant differences (p=0.127) among the materials. Non-significant negative correlations were observed between the mean ΔEab and DC (R=-0.65) and ΔE00 and DC (R=-0.64). A significant positive correlation was observed mean ΔEab and ΔE00 (R=0.99). It was concluded that the different luting agents influenced the final color of the restorations. The heating of the composite resins did not affect their DC.

Resumo O objetivo foi avaliar a estabilidade de cor de laminados cerâmicos de fina espessura, após a cimentação com cimentos resinosos e resinas compostas em temperatura ambiente e aquecida (60oC), durante 12 meses; bem como determinar o grau de conversão dos diferentes materiais para cimentação. Foram utilizados dois cimentos resinosos [AllCem Veneer, cimento resinoso fotoativado (LRC) e AllCem, cimento resinoso dual (DRC)] e três resinas compostas [Z100 (MNCR - resina composta de partículas finas), Herculite Classic (MHCR - resina composta micro-híbrida) e Durafill (MCCR - resina composta microparticulada)] para cimentação de laminados cerâmicos a base de silicato de lítio (Suprinity, cor B2-HT, Vita Zahnfabrik) com 0,8 mm de espessura, sobre esmalte bovino. Oitenta espécimes foram distribuídos aleatoriamente em 8 grupos de acordo com o material para cimentante (n=10). Os espécimes foram armazenados a 37oC em água destilada. Os parâmetros do CIELab foram determinados 24h após a cimentação (baseline), 7, 30, 90, 180 dias e 12 meses. Outros três espécimes foram preparados para avaliação de grau de conversão, realizada por espectroscopia micro-Raman. Os dados foram analisados por ANOVA e teste de Tukey (a=5%). Para ΔEab e ΔE00, houve diferenças estatisticamente significantes para o material de cimentação (p<0,001), tempo (p<0,001) e interação dupla (p<0,001). Os grupos cimentados com o MHCR (1 ano), MCCR (90 dias e 1 ano) e MCCR-PH (1 ano) foram os únicos com valores de ΔE maiores que o limite de aceitabilidade. Todos os demais grupos mantiveram seu ΔE menor que o limite de aceitabilidade ao final de 1 ano de armazenamento em água destilada. Em relação ao grau de conversão, não foram observadas diferenças estatisticamente significantes entre os materiais para cimentação avaliados (p=0,127). O grau de conversão variou entre 64,0% (MNCR-PH) e 85,1% (DRC). Correlações negativas moderadas a fortes não significativas foram observadas entre a média ΔEab e grau de conversão (R=-0,65) e ΔE00 e grau de conversão (R=-0,64). Observou-se uma correlação positiva forte significativa nos valores médios de ΔEab e ΔE00 (R=0,99). Pode-se concluir que os diferentes agentes cimentantes utilizados na cimentação de laminados cerâmicos de espessura fina influenciaram na cor final das restaurações. O aquecimento das resinas compostas não implicou em alteração do grau de conversão.

Multidisciplinary approach for anatomical correction and diastema closure with laminates veneers: a clinical report / Abordagem multidisciplinar para correção anatômica e fechamento de diastemas com facetas laminadas: relato de caso clínico

Objective: multidisciplinary treatment has become increasingly common in dental offices and this treatment strategy is based on the achievement of a healthy, harmonious, and pleasant smile. In addition, the development of new ceramic systems and the possibility of making indirect restorations with a low thickness, such as laminates veneers, allowed combining highly satisfactory aesthetic properties, preserving the dental structure through minimally Invasive technique. Case report: this paper describes a multidisciplinary approach involving periodontics and restorative dentistry for the successful, functional, and aesthetic treatment in an adult patient. The digital smile design was performed as a guide to plan the clinical case considering factors such as tooth inclination and position, golden proportion, tooth size and shape. Discussion: based on these concepts, the present work reports, through a clinical case, the restoration of aesthetics and function with ceramic laminates veneers in lithium disilicate, in the case of anatomical correction and diastema closure. Conclusion: overall, the multidisciplinary treatment plan demonstrated to have greater advantages both for the aesthetics and function of the patient, as well as for the work team. During the 24-month follow-up, this case presented great functional and aesthetics results. (AU)

Introdução: o tratamento multidisciplinar tornou-se cada vez mais comum nos consultórios odontológicos, sendo uma estratégia baseada no tratamento da obtenção de um sorriso saudável, harmonioso e agradável. Além disso, o desenvolvimento de novos sistemas cerâmicos e a possibilidade de fazer restaurações indiretas com baixa espessura, como facetas laminadas, permitiram combinar propriedades estéticas altamente satisfatórias, preservando a estrutura dentária com o mínimo desgaste. Caso clínico: este artigo descreve uma abordagem multidisciplinar envolvendo Periodontia e Odontologia restauradora para um tratamento funcional e estético em um paciente adulto. O desenho digital do sorriso foi realizado como um guia para planejar o caso clínico, considerando fatores como inclinação e posição do dente, proporção áurea, tamanho e formato do dente. Discussão: com base nesses conceitos, o presente trabalho relata, através de um caso clínico, a restauração estética e funcional com laminados cerâmicos em dissilicato de lítio para correção anatômica e fechamento de diastemas. Conclusão: em geral, o plano de tratamento multidisciplinar demonstrou ter maiores vantagens tanto para a estética e função do paciente, quanto para a equipe de trabalho. Durante os 24 meses de acompanhamento, esse caso apresentou ótimos resultados funcionais e estéticos. (AU)

Interventions in management of dental fluorosis, an endemic disease: A systematic review.

OBJECTIVE: Mottling and pitting of enamel due to excess fluoride consumption may affect one's self-esteem due to unaesthetic appearance and also in turn can affect the quality of life. This present study was conducted to assess various treatment approaches available for patients with dental fluorosis. MATERIALS AND METHODS: Literatures were searched from August 1998 to August 2019 for articles in the management of dental fluorosis. The databases used were National Center for Biotechnology Information (NCBI) and Google Scholar. In NCBI, the filters were modified to randomized controlled trial, clinical trial, human trial, and free full-text articles. The following queries were used in order to search for the article: treatment for dental fluorosis, intervention of dental fluorosis, and management of dental fluorosis. RESULTS: All the five studies selected after screening were randomized controlled trials. Total number of patients included in this study were 304 with the mean age of 17.7 years old. They were treated with microabrasion, bleaching, resin infiltration or combination of microabrasion with bleaching, and resin infiltration with bleaching. Microabrasion resulted in less esthetic improvement compared with bleaching. Meanwhile, resin infiltration showed a greater improvement in esthetics in comparison to bleaching. Resin infiltration with additional infiltration time and combination of resin infiltration with bleaching are the best treatment options. CONCLUSION: Based on this systematic review, resin infiltration with increased infiltration time is the best treatment approach in treating dental fluorosis.

Response of composite resins to preheating and the resulting strengthening of luted feldspar ceramic.

OBJECTIVE: This study evaluated the influence of preheating different composite resins on their viscosity and strengthening yielded to ceramic. METHODS: Modulus of elasticity, Poisson's ratio, and degree of CC conversion were measured for three restorative composite resins (Z100-microhybrid; Empress Direct-nanohybrid; Estelite Omega-supranano) and one photoactivated resin cement (RelyX Veneer). Viscosity was measured during a heating-cooling curve (25°C-69°C-25°C) and also using isothermal analyses at 25°C and 69°C. Feldspar ceramic disks simulating veneers were bonded with the luting materials. Biaxial flexural strength, characteristic strength, and Weibull modulus were calculated at axial positions (z=0 and z=-t2) of the bilayers. Film thickness was measured and morphology at the bonded interfaces was observed. Data were statistically analyzed (α=0.05). RESULTS: A gradual decrease in viscosity was noticed as the rheometer temperature gradually increased. Viscosity differences between the composite resins were large at the beginning of the analysis, but minor at 69°C. At 25°C, the composites were up to 38 times more viscous than the resin cement; at 69°C the difference was 5-fold. CC conversion was similar between all resin-based agents. The resin cement yielded lower film thickness than the composites. All resin-based agents were able to infiltrate the ceramic porosities at the interface and strengthen the ceramic. However, the magnitude of the strengthening effect was higher for the preheated composite resins, particularly at z=-t2. SIGNIFICANCE: Selection of composite resin impacts its response to preheating and the resulting viscosity, film thickness, and magnitude of ceramic strengthening.

Influence of light-cured luting agents and associated factors on the color of ceramic laminate veneers: A systematic review of in vitro studies.

OBJECTIVE: The luting agent plays a significant role in the appearance of ceramic laminate veneers (CLV), allowing improved/stable shade matching with adjacent teeth. A systematic review was conducted to investigate the influence of light-cured luting agents and color-associated factors aiming to draw guidelines for stable shade matching of CLV. The paper has also given an overview of the compositional characteristics of all luting agents and ceramic systems whose performance was presented herein. METHODS: A search of in vitro studies that quantitatively investigated the influence of light-cured luting agents on the color of CLV was conducted. PubMed/MedLine, Cochrane Library, SciVerse Scopus and Web of Science databases were explored until December 2017 with no year limit. Data regarding the effect of light-cured luting agent, ceramic systems, effect of background, accelerated aging and surface treatments on color change were collected. A meta-analysis was not possible due to heterogeneity of data. RESULTS: After duplicates' removal, 3630 studies were identified, 48 were selected for full-text analysis, and 21 remaining papers met the inclusion criteria and were included in this systematic review. SIGNIFICANCE: Considering the shade aspects of luting agents, translucency and value showed the greatest visible color differences for CLVs. The effect of luting agent shade on the color of veneers is greatly affected by ceramic thickness and opacity.

Esthetic rehabilitation with ultra-thin ceramic veneers and direct mock-up in the treatment of dental erosion ­ case report

Dental erosion is a high prevalence condition characterized by the loss of dental substance due to chemical agents. it can also be associated with physical wear, affecting function and aesthetics. ceramic veneers can provide effective solutions to patients affected by erosive disorders, by means of an indirect approach and minimal intervention. recent advances in cementation techniques and ceramic materials have allowed their use in reduced thicknesses, known as "dental contact lenses" or "ultra-thin veneers". they contribute significantly to the preservation of the dental structures, having excellent mechanical properties and providing satisfactory aesthetic solutions. their manufacture requires rigorous planning and the use of three-dimensional models or mock ups in order to preview the final outcome. case: the aim of this report is to communicate the use of this technique for the treatment and successful 12-months follow-up of a patient affected by dental erosion of the maxillary central incisors. special interest was placed on direct mock-up, which is a simple technique not requiring laboratory steps. luting of the lithium disilicate veneers was carried out with a light-curing resin cement and try-in pastes, yielding a very satisfactory result. conclusion: diagnosis and early treatment of this disorder allows the application of conservative techniques, such as ultra-thin veneers, which are seen as a promising alternative treatment to full coverage restorations and traditional ceramic veneers.