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).

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.