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.

[Teeth wedge-shaped defects in adults of different age groups: remark to prevention and treatment]. / Klinovidnye defekty zubov u vzroslykh liudei raznykh vozrastnykh grupp: remarki k profilaktike i lecheniiu.

The aim of the study was to assess the treatment of teeth wedge defects in different age groups. Records of 383 patients (125 males and 258 females aged 22-85 years) treated in outpatient dental facilities with different ownership forms. It is shown that the medical care of patients with wedge-shaped teeth defects routinely consists of remineralization therapy and restoration of anatomical teeth shape regardless of the form of ownership. The extensiveness of dental rehabilitation as well as the use of more modern technologies are typical for private clinics and 96-100% of patients finished their treatment there. In the state and departmental institutions complete rehabilitation of wedge-shaped defects was provided in 45.5-58.0% and 54.3-83.9, respectively. The paper also highlights the drawbacks of primary medical documentation identified in medical institutions of all forms of ownership.

Vertical dimension augmentation with a full digital approach: a multiple chairside sessions case report.

The last few decades have seen an upward trend of the pathologies of abrasion, erosion, and abfraction. These pathologies, especially in combination, can provoke a significant loss of tooth substance. Nowadays, modern digital chairside technologies and new restorative materials allow clinicians to restore the lost tooth structure with a minimally invasive and fully digital approach. This article describes a step-by-step procedure of a full-mouth rehabilitation performed with a total digital chairside approach in several appointments.

Gastro-oesophageal reflux disease and dental erosions in adults: influence of acidified food intake and impact on quality of life.

BACKGROUND AND AIM: Gastro-oesophageal reflux disease (GORD) and dental erosions (DE) have an established association. We assessed whether GORD is associated with DE controlling for acidified food intake and their relationships with quality of life (QOL). METHODS: In this cross-sectional study, 419 adult patients who sought dentistry consultation were considered eligible. Patients responded to questionnaires for GORD symptoms, acidified food ingestion and World Health Organization quality of life (WHOQOL Bref), followed by an oral examination, in which DE were characterized according to the Smith & Knight criteria. RESULTS: A total of 417 patients were included (43.8±13.7 years; 68.8% women). There were 143 patients with GORD (34.3%) and 274 controls without GORD. The prevalence of DE was higher in GORD patients compared with the controls (25.9 vs. 17.2%; P=0.041). GORD was associated with DE after adjusting for acidified food intake (P=0.035), with a prevalence ratio of 1.52 (0.95 confidence interval 1.03-2.22). The WHOQOL Bref score was significantly lower in the presence of GORD [median 17.2 (GORD-DE-) vs. 15.4 (GORD+DE+); P<0.01], irrespective of DE. CONCLUSION: In adults examined in a referential dentistry centre in South America, DE were prevalent and significantly associated with GORD. This association was independent of the intake of acidified food in our study. Impairment in QOL was observed in GORD patients irrespective of the presence of DE.

Esthetic rehabilitation of a worn dentition with a minimally invasive prosthetic procedure (MIPP).

A minimally invasive prosthetic procedure (MIPP) for the esthetic rehabilitation of the complete arch advocates the preservation of enamel to optimize the adhesive bond of the luting agent to both the tooth surface and the etchable ceramic restoration. When esthetic rehabilitation of a worn dentition is required, a MIPP can be selected to reduce the biological cost of removing additional enamel tooth structure. The fundamental steps to achieve this goal are to: (1) increase the vertical dimension of occlusion (VDO); (2) reduce the thickness of the monolithic ceramic material; (3) preserve the enamel during tooth preparation; and (4) adhesively bond the etchable ceramic restorations. This article presents a comprehensive, minimally invasive prosthetic treatment approach for the esthetic rehabilitation of a severely worn dentition using a lithium disilicate all-ceramic material with partial and complete coverage restorations.

CAD/CAM monolithic restorations and full-mouth adhesive rehabilitation to restore a patient with a past history of bulimia: the modified three-step technique.

Due to an increasing awareness about dental erosion, many clinicians would like to propose treatments even at the initial stages of the disease. However, when the loss of tooth structure is visible only to the professional eye, and it has not affected the esthetics of the smile, affected patients do not usually accept a full-mouth rehabilitation. Reducing the cost of the therapy, simplifying the clinical steps, and proposing noninvasive adhesive techniques may promote patient acceptance. In this article, the treatment of an ex-bulimic patient is illustrated. A modified approach of the three-step technique was followed. The patient completed the therapy in five short visits, including the initial one. No tooth preparation was required, no anesthesia was delivered, and the overall (clinical and laboratory) costs were kept low. At the end of the treatment, the patient was very satisfied from a biologic and functional point of view.

The challenge of erosion and minimally invasive rehabilitation of dentitions with BEWE grade 4.

OBJECTIVE: Dental erosion is a challenging problem. In addition to dental erosion's dental effects, general health also has to be taken into account. In particular, consumption of newly marketed beverages as well as psychosomatic and gastroesophageal disorders contribute to decayed dentitions. Without a comprehensive method for implementing preventive concepts in daily practice, many young adults will require large-scale, long-term treatment in the near future. Thus, dentists should be aware of preventative methods, prerequisites for rehabilitation, and treatment concepts available for such cases. Clinical Considerations: Patients with severe dental erosions are often young adults who suffer from hypersensitivity and loss of vertical dimension and occlusal structure. Modern ceramics enable a minimally invasive, esthetic, and rugged approach for achieving a complete rehabilitation. In particular, monolithic restorations using lithium disilicate or zirconia-reinforced lithium silicate seem to be promising treatment strategies. In addition to the dentist, the dental technician needs to be educated and experienced with complex occlusal and functional rehabilitation. Currently, clinical longterm experiences have only been reported for adhesively bonded silicate and lithium disilicate restorations. CONCLUSION: Heat-pressed and adhesively bonded monolithic lithium disilicate restoration fulfills all needs of complex treatment and long-term rehabilitation in young adults with dental erosion. Even if minimal tooth preparation is needed, in healthy teeth, adhesively bonded restorations require minimal thickness of the ceramic layer to obtain function, durability, and esthetics for this type of patient.

Prosthetic Rehabilitation of a Patient With Gastroesophageal Reflux Disease: Five-Year Follow-up.

Tooth wear is a multifactorial process that is a growing concern in dentistry. This phenomenon can be caused by mechanical (attrition, abrasion, or abfraction) or chemical (erosion) processes. Etiologic factors in dental erosion can be due to changes in behavior, an unbalanced diet, or gastrointestinal disorders such as acid regurgitation, which may influence the salivary flow rate and buffering capacity of saliva. This case report describes an esthetic rehabilitation of a patient with gastroesophageal reflux and dental erosion, with a treatment rationale that includes the use of a diagnostic template and five-year follow-up. This technique, presented here in a clinical case with moderate enamel loss, integrates an additive wax-up and a direct intraoral bis-acryl resin mock-up. Lithium disilicate glass-ceramic (IPS e.max Press, Ivoclar Vivadent) laminate veneers were fabricated with the heatpress technique. They were veneered with a layering ceramic (IPS e.max Ceram, Ivoclar Vivadent) to improve the appearance of the incisal edge. The case demonstrated the success of veneers as an effective, conservative, and esthetic treatment for patients with this pathology.

Non- and minimally invasive full-mouth rehabilitation of patients with loss of vertical dimension of occlusion using CAD/CAM: an innovative concept demonstrated with a case report.

Abrasion and erosion are two increasingly common indications for dental treatment. Thanks to modern digital technologies and new restorative materials, there are novel therapeutic approaches to restoring such losses of tooth structure in a virtually non-invasive manner. The case study in this article demonstrates one such innovative approach. The patient's severely abraded natural dentition was restored in a defect-driven, minimally invasive manner using high-performance composite materials in the posterior region, and the "sandwich technique" in the anterior region. The restorations were milled on an optimized milling machine with milling cycles adapted for the fabrication of precision-fit restorations with thin edges.

Systematic Treatment Using a Direct Deprogrammer to Resolve Long-Standing Problems in a Phobic Patient.

In this case, a patient who had been responsible and regularly sought good care was disappointed with previous dental work and felt let down and angry in the face of worsening oral health. She presented in the author's office with trepidation and distrust in the profession. Through the use of a Kois deprogrammer, which was immediately fabricated chairside, the patient experienced rapid relief from long-standing discomfort, then proceeded to accept a comprehensive solution to her dental problems. In addition to discussing the case, this article details instructions for the fabrication of this immediate appliance.

Oral rehabilitation and psychosocial evaluation of a patient with bulimia nervosa following Teeth in a Day® immediate loading protocol.

PURPOSE: The purpose of this patient report is to accurately portray the clinical experience of treating an active bulimic patient by employing an immediately loaded dental implant protocol to provide the patient with an expedited esthetic and functional result. Implementation of a psychometric component statistically quantifies the psychological effects of the oral rehabilitation. MATERIALS AND METHODS: A 34-year-old woman presented with severe dental perimolysis (erosion) resulting from a 28-year history of bulimic behaviors. Clinical and radiographic evaluation of the existing dentition indicated advanced dental erosion and previous restoration attempts in a state of failure. The patient's existing teeth were extracted and treated with full maxillary and mandibular implant-supported prostheses, following the Teeth in a Day® (TIAD) immediate functional loading protocol. Psychometric assessment was conducted through administration of a 20-item questionnaire, as seen in previous literature. RESULTS: Radiographic and clinical analysis suggested all implant fixtures to be viable and accompanied by normal levels of alveolar bone 7 months into treatment. Questionnaire results at the new-patient presentation (T1) resulted in a composite score of 4.0 (SD = 2.9; P = 0.004), indicating severe body-image dysphoria. At 3 months postoperative (T2), the questionnaire score was 0.4 (SD = -1.7; P = 0.09). The final psychometric questionnaire at 7 months (T3) resulted in a score of 0.5 (SD = -1.5; P = 0.12). The patient was followed for a total of 7 years following implant placement. CONCLUSION: In this patient report, oral rehabilitation using the TIAD protocol provided an expedited and predictable alternative method for restoring functional abilities, esthetics, and self-esteem to a severely depressed bulimic patient. Psychometrically, at the postoperative (T2) and final testing period (T3), the patient's body image profile was no longer considered to be significantly different from established normative values.

Rehabilitation of molar-incisor hypomineralization (MIH) complicated with localized tooth surface loss: a case report.

Molar-incisor hypomineralization (MIH) is a developmental enamel hypomineralized condition characteristically involving the first permanent molars and sometimes also the incisors. The affected teeth are predisposed to tooth surface loss (TSL) which may not only compromise the esthetics and function but also endanger the pulp and longevity of the teeth. This report describes the management of a patient with MIH complicated with localized TSL and lack of occlusal clearance due to dentoalveolar compensation. The atypical TSL pattern involved all anterior teeth and required the placement of Dahl appliances on both arches.

A multidisciplinary approach for the rehabilitation of a patient with an excessively worn dentition: a clinical report.

This clinical report describes a multidisciplinary approach to the diagnosis and treatment of a patient with a severely worn dentition. The treatment included osteotomy and immediate implant placement and loading in the mandible. The definitive restorations were implant- and tooth-supported metal ceramic restorations. These restorations were fabricated with metal occlusal surfaces at an increased occlusal vertical dimension, which provided acceptable esthetics and function.

Full-mouth rehabilitation of severely worn dentition due to soda swishing: a clinical report.

Diagnosis and treatment planning of severely worn dentition are complex and complicated. Erosion is one of the common causes of lost tooth surface. Defining the etiology of the erosion is essential before proceeding with treatment to be able to provide the most predictable treatment outcome. Multiple specialists including psychologists, family medicine practioners, and social workers should be involved in the diagnosis and the prevention of a continuing erosion process. The treatment plan should be based on the severity of the tooth surface lost. It can range from simple direct restorations to a full-mouth rehabilitation. This clinical report is a detailed description of a complex prosthodontic diagnostic index class IV patient based on current evidence-based dentistry.

Rehabilitation of a patient with an elusive medical history and loss of occlusal vertical dimension.

In this clinical report, we describe the medical history, diagnosis and prosthodontic treatment of a 61-year-old man with a previous history of oral cancer. Loss of a full upper denture and severe erosion of his teeth prompted the patient to seek treatment at the dental clinic at the British Columbia Cancer Agency. Although he stated that he was being treated for a sleeping disorder, hospital records revealed multiple recent admissions for alcoholism and depression. The patient's limited finances prevented complex restoration of worn lower dentition; thus, definitive treatment consisted of extraction of teeth with a poor prognosis, removal of a glandular odontogenic cyst and fabrication of a full maxillary prosthesis and a removable mandibular cast-metal overlay.

A systematic approach to recreate a patient's former smile.

In this case involving a 29-year-old woman with a history of stomach-acid-related reflux and extensive loss of tooth structure, the patient desired to regain the smile she "used to have." The treatment goals throughout the process were to manage risk, use minimally invasive procedures, and improve the prognosis in each of the four dental categories-periodontal, biomechanical, functional, and dentofacial. The treatment plan utilized a systematic approach to sequentially restore and protect the young woman's dentition. It included esthetic crown lengthening, establishing the ideal esthetic position of maxillary anterior and posterior teeth, addressing the mandibular plane of occlusion, and achieving optimal function.

CAD/CAM-generated high-density polymer restorations for the pretreatment of complex cases: a case report.

Complex rehabilitations represent a particular challenge for the restorative team, especially if the vertical dimension of occlusion (VDO) needs to be reconstructed or redefined. The use of provisional acrylic or composite materials allows clinicians to evaluate the treatment objective over a certain period of time and therefore generates a high predictability of the definitive rehabilitation in terms of esthetics and function. CAD/CAM technology enables the use of prefabricated polymer materials, which are fabricated under industrial conditions to form a highly homogeneous structure compared with those of direct fabrication. This increases long-term stability, biocompatibility, and resistance to wear. Furthermore, they offer more suitable CAD/CAM processing characteristics and can be used in thinner thicknesses than ceramic restorative materials. Also, based on the improved long-term stability, the transfer into the definitive restoration can be divided into multiple treatment steps. This article presents different clinical cases with minimally invasive indications for CAD/CAM-fabricated temporary restorations for the pretreatment of complex cases.