Conservative approach for management of fractured maxillary central incisors in young adults

Soft Tissue Grafting Procedures before Restorations in the Esthetic Zone: A Minimally Invasive Interdisciplinary Case Report

An esthetically pleasing smile is a valuable aspect of physical appearance and plays a significant role in social interaction. Achieving the perfect balance between extraoral and intraoral tissues is essential for a harmonious and attractive smile. However, certain intraoral deficiencies, such as non-carious cervical lesions and gingival recession, can severely compromise the overall aesthetics, particularly in the anterior zone. Addressing such conditions requires careful planning and meticulous execution of both surgical and restorative procedures. This interdisciplinary clinical report presents a complex case of a patient with esthetic complaints related to asymmetric anterior gingival architecture and severely discolored and eroded maxillary anterior teeth. The patient was treated using a combination of minimally invasive ceramic veneers and plastic mucogingival surgery, resulting in a successful outcome. The report emphasizes the potential of this approach in achieving optimal esthetic results in challenging cases, highlighting the importance of an interdisciplinary team approach in achieving a harmonious balance between dental and soft tissue aesthetics.

An Innovative 3D Printed Tooth Reduction Guide for Precise Dental Ceramic Veneers

Tooth reduction guides allow clinicians to obtain the ideal space required for ceramic restorations. This case report describes a novel design (CAD) for an additive computer-aided manufactured (a-CAM) tooth reduction guide with channels that permitted access for the preparation and evaluation of the reduction with the same guide. The guide features innovative vertical and horizontal channels that permit comprehensive access for preparation and evaluation of the reduction with a periodontal probe, ensuring uniform tooth reduction and avoiding overpreparation. This approach was successfully applied to a female patient with non-carious lesions and white spot lesions, resulting in minimally invasive tooth preparations and hand-crafted laminate veneer restorations that met the patient's aesthetic demands while preserving tooth structure. Compared to traditional silicone reduction guides, this novel design offers greater flexibility, enabling clinicians to evaluate tooth reduction in all directions and providing a more comprehensive assessment. Overall, this 3D printed tooth reduction guide represents a significant advancement in dental restoration technology, offering clinicians a useful tool for achieving optimal outcomes with minimal tooth reduction. Future work is warranted to compare tooth reductions and preparation time for this guide to other 3D printed guides.

Minimally Invasive Laminate Veneer Therapy for Maxillary Central Incisors

Minimally invasive dentistry is a considered process that requires the clinician to be prepared with the ideal sequence and the tools needed. This report describes a well-planned ultraconservative approach using only two ceramic laminate veneers for the maxillary central incisors to significantly improve the patient's overall smile. A 30-year-old female presented with the chief complaints of having diastemas between the central and lateral incisors as well as incisal wear. Diagnostic wax-up and mock-up were performed, and the patient approved the minimally invasive treatment with veneers only for central incisors. A reduction guide aided the conservative tooth preparations, and hand-crafted feldspathic veneers were bonded under total isolation with a rubber dam. The two final conservative veneers significantly improved the smile and fulfilled the patient's expectations. Following proper planning and sequencing, predictable outcomes were obtained and fulfilled the patient's esthetic demands. Minimally invasive restorative dentistry with only two single veneers can impact the entire smile frame. Overtreatment in the esthetic zone is unnecessary to meet a patient's esthetic expectations.

Comparison of Fracture Resistance for Chairside CAD/CAM Lithium Disilicate Crowns and Overlays with Different Designs

PURPOSE

To determine the fracture resistance of chairside computer-aided design and computer-assisted manufacturing (CAD/CAM) lithium disilicate full coverage crowns and two different designs of overlay restorations for premolars.

MATERIALS AND METHODS

CAD/CAM lithium disilicate (IPS e.max CAD for CEREC/HT A1 C14, Ivoclar Vivadent) restorations (15 specimens/group) with 1.5 mm occlusal thickness and 1.0 mm chamfer were designed and fabricated with a chairside CAD/CAM system (CEREC, Dentsply Sirona). The restorations were prepared in three different designs: (1) full coverage crowns, (2) overlays with the margin located 2 mm above the gingiva, and (3) overlays with the margin located 4 mm above the gingiva. Restorations were cemented using conventional resin luting cement (Multilink, Ivoclar Vivadent) with primer system (Monobond Plus, Ivoclar Vivadent) to resin printed dies, load cycled (2,000,000 load cycles at 1 Hz with 275 N force), and then finally loaded with a steel indenter until failure. Scanning electron microscopy observations of fractured surfaces were also conducted. Group results were analyzed with one-way analysis of variance, and the medians were evaluated independently with Kruskal-Wallis.

RESULTS

The fracture force of CAD/CAM lithium disilicate restorations was significantly different (p < 0.001) depending on the design of the restoration. Full coverage crowns showed significantly higher force to fracture (1018.8 N) than both types of overlays (p = 0.002 for overlay 2.0 mm and p < 0.001 for overlay 4.0 mm above gingiva). Among the two overlays, the restoration with the margin located 2 mm above the gingiva showed significantly higher fracture force (813.8 N) than the overlay with margin at 4 mm above the gingiva (436.1 N; p < 0.001). The fracture appearance of the crowns was much more complex than that of the overlay restorations.

CONCLUSIONS

Full coverage chairside CAD/CAM lithium disilicate premolar crown showed higher fracture resistance than overlay restorations. Overlays with the margin located 2 mm above the margin demonstrated higher resistance than those with the margin located 4 mm above the gingiva.