No-prep dentistry using the Simple Orthodontic Extrusion (SOE) technique to create occlusal space. Illustration in tooth wear and resin-bonded bridges

In restorative dentistry, the lack of occlusal space may lead to the mutilation of healthy tissue in order to provide sufficient space for the restorative material. Noprep dentistry can be achieved by placing high-bite restorations, followed by Simple Orthodontic Extrusion (SOE) of other teeth to close the created open bite. This rapid, partial orthodontic treatment is well accepted by patients as it can be easily performed using simple buttons, and it takes only a few weeks to reestablish occlusal contacts. The SOE technique is a further development of the Dahl concept. It has the advantages without the disadvantages. Two applications of this technique are presented in this article: the treatment of the severe wear of anterior teeth with no-prep palatal veneers made of Polymer-infiltrated Ceramic Network (PICN, 'hybrid ceramic') material and the realization of no-prep zirconia resin-bonded bridges (RBBs) to replace missing lateral incisors. An original 3D-printed resin guide for correctly positioning RBBs and facilitating the removal of excess composite cement is also presented. This work highlights the considerable advantages of multidisciplinary collaboration in the field of minimally invasive dentistry.

Color alteration of CAD/CAM 3D-printed, milled resin-ceramic hybrid material compared to enamel.

To assess color and translucency change (∆E00 and ∆TP) of 3D-printed (Varseosmile crown plus, VS) and milled resin-ceramic hybrid material (Cerasmart, CS) compared to enamel (E) when immersed in distilled water (DW) and coffee (C). Sixty VS, CS, and E specimens were immersed in DW and C for 30 days. Statistics analysis using t-test and one-way ANOVA at p≤0.05. ∆E00 of VS, CS, and E significantly increased when immersed in coffee (p<0.001, p<0.001 and p=0.01, respectively). E has more ∆E00 than VS and CS (p<0.001). The translucency of VS and CS was reduced after water and coffee immersion. The translucency of E was increased after immersion in water and coffee. ∆TP of VS, CS, and E were not different between immersion in water and coffee at p=0.08, p=0.43 and p=0.72, respectively. Therefore, DW and C have distinct effects on the ∆E00 and ∆TP among VS, CS and E.

Gingival fibroblast response to (hybrid) ceramic implant reconstruction surfaces is modulated by biomaterial type and surface treatment.

OBJECTIVES: Surface characteristics of implant reconstructions determine the gingival fibroblast (GF) response and thus soft tissue integration (STI). However, for monolithic implant reconstructions it is unknown whether the (hybrid) ceramic biomaterial type and its surface treatment affect GF response. Therefore, this investigation examined the influence of the implant reconstruction biomaterials hybrid ceramic (HC), lithium disilicate ceramic (LS), 4 and 5 mol% yttria partially stabilized zirconiumdioxide ceramics (4/5Y-PSZ) and their surface treatment - machining, polishing or glazing - on surface characteristics and GF response. METHODS: After characterization of surface topography and wettability by scanning electron microscopy, interferometry and contact angle measurement, the adhesion, morphology, metabolic activity and proliferation of GFs from six donors was investigated by fluorescent staining and a resazurin-based assay at days 1, 3 and 7. Titanium (Ti) served as control. RESULTS: Biomaterial type and surface treatment affected the GF response in a topography-dependent manner. Smooth polished and glazed surfaces demonstrated enhanced GF adhesion and earlier proliferation onset compared to rough machined surfaces. Due to minor differences in surface topography of polished and glazed surfaces, however, the GF response was similar for polished and glazed HC, LS, 4- and 5Y-PSZ as well as Ti. SIGNIFICANCE: Within the limits of the present investigation, polishing and glazing of machined HC, LS and 4/5Y-PSZ can be recommended to support STI-relevant cell functions in GF. Since the GF response on polished and glazed HC, LS, 4- and 5Y-PSZ surfaces and the Ti control was comparable, this investigation proofed equal cytocompatibility of these surfaces in vitro.

Zirconia-Reinforced Lithium Silicate Ceramic in Digital Dentistry: A Comprehensive Literature Review of Our Current Understanding.

Zirconia-reinforced lithium silicate (ZLS) ceramic is a new innovative dental material with unique a chemical composition that is designed to combine harmoniously with the appropriate optical properties of lithium disilicate and the enhanced mechanical strength of zirconia. A thorough understanding of ZLS materials is essential for both clinicians and dental technicians. At present, the mechanical behavior and optical properties of the ZLS ceramic system have not been extensively researched, and there is still a lack of consensus regarding the fabrication process and clinical behavior of ZLS all-ceramic restorations. The aim of the present study was to present a selection of comprehensive information concerning zirconia-reinforced lithium silicate ceramics and their optical and mechanical properties, as well as to assess data regarding cementation procedures and clinical outcomes for ZLS all-ceramic restorations. Three electronic databases (PubMed, Web of Science, and the Cochrane Library) were used for the research by two independent reviewers. The search was limited to articles published in the English language, as well as clinical and in vitro studies of color and studies on mechanical behavior and the cementation procedures of ZLS restorations. The exclusion criteria comprised abstracts, questionnaire-based studies, case reports, literature reviews, and studies that were not available in English. Zirconia-reinforced lithium-silicate-based ceramic presents a unique and complex microstructure that increases mechanical resistance but decreases aesthetic appearance, especially its translucency, due to tetragonal zirconia content. A material's thickness, the color of the underlying tooth structure, and the resin cement shade are important factors that influence the final shade and aesthetic appearance of ZLS restorations. Mechanical properties, which are defined by the fracture toughness, flexural strength, elastic modulus, and hardness of ZLS ceramic are higher compared to feldspathic, lithium disilicate, and hybrid ceramics, as well as resin nanoceramics; however, they are lower than translucent or high-translucency zirconia. Acid etching, sandblasting, and laser etching represent the most used methods to prepare the ZLS restoration surfaces for proper bonding procedures.

Three-dimensional evaluation of the machinability of monolithic CAD/CAM-generated posterior crowns by nano-hybrid ceramic / 대한치과재료학회지

The purpose of this study comparatively analyzed the machinability of various dental hybrid blocks manufactured by using the CAD/CAM system. Three hybrid composite blocks (Vita enamic, Lava Ultimate, GC Cerasmart) were used for experimental groups and one conventional ceramic block (Vita Mark II) was used for control. The digital impression of the master model and abutment was taken by using a scanner, and then the CAD software program was used to design restorations. The four-axis milling machine (inLab MCXL; Sirona Dental Systems GmbH, Bensheim, Germany) was used four materials. The digitized data was superimposed with 3D inspection software to quantitatively obtain the machinability of a ceramic crown, and visual differences were confirmed with a color map. The root mean square (RMS) values of ceramic crown group were statistically analyzed with one-way ANOVA (α=0.05). While there was a significant difference in the machinability of the internal surface, among four groups, there was statistically significant difference between conventional (VM group) and hybrid ceramic (VE, LU, GC groups) (p<0.05). Consequently, the machinability of VM is lower than that of other hybrid ceramics, and the machinability of VE is better than that of LU and GC. For ceramics as final restorations, manufacturing of dental restorations using hybrid composite ceramic is recommended.

Clinical effect of resin hybrid ceramic onlay in repairing posterior tooth defects / 口腔疾病防治

Objective@#To investigate the clinical effect of restoration of posterior teeth with machinable CAD/CAM resin hybrid ceramic (VITA Enamic) onlays after root canal treatment. @* Methods @#136 posterior teeth restored after root canal treatment in our hospital were selected as the research subjects. The posterior teeth were restored chairside with CAD / CAM ceramic onlays to recover occlusion relation and protect residual dental tissues. With 68 teeth in each group, one group was restored with a machinable CAD / CAM resin hybrid ceramic (VITA Enamic) while the control group received zirconia-reinforced lithium silicate ceramic (VITA Suprinity). Before bonding, all the onlays were examined for good adjacency, fitness and occlusion, and then the adhesive surface was etched with hydrofluoric acids. After isolating the rubber dams in the mouths, the onlays were bonded with dual-cure resin cements. The patients were followed up for 24 months to compare the degree of prosthesis integrity, marginal fitness, gingival health, dental integrity, color matching and secondary caries. @* Results @#After restoration, all the onlays were in harmony with the surrounding teeth with good aesthetic effect and suitable marginal fit. Two years later, there were no significant differences in the marginal fitness, gingival health, dental integrity or secondary cavities between the two groups (P > 0.05). In terms of restoration integrity, the VITA Enamic onlays (100%) were intact and displayed good retention. The group that received VITA Suprinity had 6 onlay (9.23%) fractures and a success rate of 90.77%; however, the residual dental tissues did not break. The difference of prosthesis integrity between the two groups was statistically significant (χ2= 4.45, P < 0.05). @*Conclusion@#Chairside CAD/CAM resin hybrid ceramic (VITA Enamic) onlays can quickly restore posterior teeth after root canal therapy and better protect the residual dental tissue.

The effect of light sources and CAD/CAM monolithic blocks on degree of conversion of cement

PURPOSE: To assess the degree of conversion (DC) and light irradiance delivered to light-cured and dual-cured cements by application of different light sources through various types of monolithic computer-aided design and computer-aided manufacturing (CAD/CAM) materials. MATERIALS AND METHODS: RelyX Ultimate Clicker light-cured and dual-cured resin cement specimens with 1.5-mm thicknesses (n=300, 10/group), were placed under four types of crystalline core structure (Vita Enamic, Vita Suprinity, GC Ceresmart, Degudent Prettau Anterior). The specimens were irradiated for 40 seconds with an LED Soft-Start or pulse-delay unit or 20 seconds with a QTH unit. DC ratios were determined by using Fourier transform infrared spectroscopy (FTIR) after curing the specimen at 1 day and 1 month. The data were analyzed using the Mann-Whitney U test (for paired comparison) and the Kruskal-Wallis H test (for multiple comparison), with a significance level of P < .05. RESULTS: DC values were the highest for RelyX Ultimate Clicker light-cure specimens polymerized with the LED Soft-Start unit. The combination of the Vita Suprinity disc and RelyX Ultimate Clicker dual-cure resin cement yielded significantly higher values at both timepoints with all light units (all, P < .05). CONCLUSION: Within the limitations of this study, we conclude that the DC of RelyX Ultimate Clicker dual-cure resin cement was improved significantly by the use of Vita Suprinity and the LED Soft-Start light unit. We strongly recommend the combined use of an LED light unit and dual-cure luting cement for monolithic ceramic restorations.

Utilização de cerâmica híbrida CAD/CAM em restaurações posteriores com limitação de espaço interoclusal / Use of CAD/CAM hybrid ceramic in posterior restorations with interocclusal space limitation ­ case report

O objetivo deste relato de caso foi descrever o tratamento restaurador de elementos posteriores com limitação de espaço interoclusal, através de uma cerâmica híbrida CAD/CAM. Paciente do sexo masculino, com 54 anos de idade, foi reabilitado com restaurações monolíticas posteriores no hemiarco superior e inferior direito através de duas inlays, uma onlay, uma overlay, uma coroa total e uma coroa endodôntica adesiva, utilizando-se bloco de estrutura híbrida. Após diagnóstico, planejamento, procedimentos operatórios especiais, preparos dentários e afastamento gengival, a aquisição de imagens, o processamento de modelos e o desenho de restaurações foram executados em um sistema CAD/CAM chairside. As restaurações foram fabricadas em uma fresadora de quatro eixos, sendo submetidas a procedimentos de acabamento, polimento e cimentação adesiva. A cerâmica híbrida para CAD/CAM constituiu-se em um material adequado para a fabricação de restaurações posteriores, com ou sem limitação de espaço interoclusal. Durante o período de acompanhamento de 36 meses, não foram observadas patologias pulpares ou perirradiculares, além de função, ajuste marginal, forma anatômica e ausência de descolorações ou pigmentações nas restaurações. Confi rmados sucesso e estabilidade do procedimento restaurador, são necessários acompanhamentos clínicos de longa duração para corroboração de resultados, assim como investigação dos efeitos sobre a dentição antagônica.

The objective of this case report was to describe the restorative treatment of posterior elements with interocclusal space limitation through a CAD/CAM hybrid ceramic. A 54-year-old male patient was rehabilitated with posterior monolithic restorations in the upper and lower right arch through two inlays, one onlay, one overlay, one total crown and one adhesive endodontic crown using a hybrid framework block. After diagnosis, planning, adhesive procedures, dental preparations and gingival displacement, the image acquisition, model processing and restorations' design were performed in a "chairside" CAD/CAM system. The restorations were fabricated in a four-axis milling machine, finished, polished and adhesively cemented. Hybrid CAD/CAM ceramics was a suitable material for the manufacturing of posterior restorations with or without interocclusal space limitation. During the 36-month followup examination, no pulp or periradicular pathologies were observed, besides function, marginal adjustment, anatomical shape and absence of discoloration or pigmentation in restorations. Confirmed the success and restorative procedure stability, longterm clinical follow-ups are necessary to corroborate the results, as well as to investigate the effects on the opposite dentition.

Effects of staining liquids and finishing methods on translucency of a hybrid ceramic material having two different translucency levels

PURPOSE: Beverages may affect the translucency of esthetic dental restorative materials. The aim of the present study was to investigate the effects of coffee and red wine on the translucency of a PICN material with two translucency levels, and finished with different methods. MATERIALS AND METHODS: 2M2 high translucent and translucent VITA Enamic hybrid ceramic blocks were investigated. Rectangular specimens with the dimensions of 12 mm × 14 mm × 2 mm were prepared. The specimens were finished and polished with different methods as suggested by the manufacturer. The translucency parameters of the specimens were evaluated before and after 24 hours, 7 days, and 28 days immersion in distilled water, coffee and red wine. Translucency parameters were measured using a portable spectrophotometer. RESULTS: At the end of 28 days, there was no statistically significant difference between the groups of specimens kept in coffee (P>.05). In the red wine groups, there was a statistically significant difference between the control group and all other groups (P<.05) at the end of 28 days. CONCLUSION: The translucency of hybrid ceramic for a restoration may not be important regarding the effects of coffee on translucency change because the specimens with different translucencies and finishing methods that were immersed to coffee had similar translucency parameters at the end of 28 days. The translucency of hybrid ceramic may be important in the case of red wine, however, since the results showed that highly translucent specimens exposed to red wine demonstrated better translucency parameters than specimens made from translucent blocks at the end of 28 days.

Restorative management using hybrid ceramic of a patient with severe tooth erosion from swimming: a clinical report

This clinical report presents the clinical appearance and treatment approach in a case of excessive anterior teeth erosion resulted from swimming in a poorly-chlorinated swimming pool. Clinical findings revealed tooth sensitivity, severe enamel erosion resembling veneer preparations, and the presence of anterior open bite. A novel hybrid ceramic (Vita Enamic) was chosen for fabricating full-coverage crowns for this patient. After 6-months follow-up, the tooth sensitivity disappeared and the patient was satisfied with esthetic outcome. The hybrid ceramic restorations can be recommended with no complications.