An esthetic minimally invasive rehabilitation performed with a fully digital workflow and hybrid restorative approach

AIM

The aim of the present study was to demonstrate that fully digital workflows can provide predictable esthetic and functional outcomes.

MATERIALS AND METHODS

The present clinical case report provides a step-by-step documentation of a full-mouth rehabilitation planned and performed with a fully digital approach utilizing an adhesive and no-prep method. After assessing the patient's needs, a treatment plan was established that considered the patient's functional and esthetic requests. The overlap of 2D images and 3D models and facial scans of the patient allowed the digital previsualization of the esthetic result by implementing the "copy-paste" approach to restore the maxillary anterior sextant.

CONCLUSION

The final outcome was satisfactory in terms of esthetics, function, and soft tissue health.

A novel approach to full-mouth rehabilitation of dentinogenesis imperfecta type II: Case series with review of literature

RATIONALE

Dentinogenesis imperfecta (DI) is an autosomal-dominant disorder. The most common clinical manifestations, including obliterated tooth tissues and severe tooth wear, usually lead to tooth extractions. It remains a great challenge for dentists to preserve the residual tooth tissue and establish the esthetics and occlusion of dentitions.

PATIENTS CONCERNS

25-year-old twin sisters, who had suffered from dentinogenesis imperfecta type II for more than 10 years, presented with continuous tooth wear and discomfort from wearing a removable partial denture for more than 3 years.

DIAGNOSIS

Intraoral examination showed extensive tooth wear with enamel exfoliation and typical amber-brown color with an opalescent discoloration. Their panoramic radiographs revealed completely obliterated tooth tissues and severe tooth wear.

INTERVENTIONS AND OUTCOMES

The dentitions were restored with post-and-core crowns and pin lays after preparing root post paths and pin holes guided by computer-aided design/computer-aided manufacturing (CAD/CAM) procedures, resulting in a successful repair.

LESSONS

Severe tooth wear and tooth tissue obliteration are typical clinical manifestations in DI-affected dentitions, increasing the complexity and difficulty in dental restorations. Early diagnosis and appropriate treatments are essential to achieve a favorable prognosis. CAD/CAM procedures, permitting accurate and effective treatment, possess promising potential in the treatment of DI-affected dentitions.

Evaluation of Risk Factors associated with Caries Development after Full-mouth Rehabilitation for Early Childhood Caries Under General Anesthesia

AIM

To evaluate the risk factors associated with caries development after full-mouth rehabilitation for early childhood caries (ECC) under general anesthesia.

MATERIALS AND METHODS

A total of 100 children diagnosed with ECC requiring full-mouth rehabilitation under general anesthesia were recruited for the study. At baseline, caries status, plaque index, Streptococcus mutans count, and Lactobacillus count were evaluated. The risk assessment for caries was evaluated using a cariogram. Children were recalled after 12 months for evaluation. All children returned for the recall and data was recorded at the recall visit. Children were grouped into caries-free or caries recurrent based on the absence or presence of caries. Chi-square tests and student's t-test were used for statistical analysis using the statistical package for the social sciences (SPSS), version 23.

RESULTS

All 100 children returned for follow-up. 76% of the children developed new carious lesions in a period of 1 year. A statistically significant association between caries recurrence and S. mutans count and caries risk assessment (CRA) score was found (p < 0.001). No significant associations were seen between parental education levels and the oral health practices of the child.

CONCLUSION

Children treated under full-mouth rehabilitation for ECC under general anesthesia are at risk for developing new carious lesions after treatment. New carious lesions are strongly correlated with the presence of S. mutans, and high cariographic risk scores serve as an indication of future caries. Early childhood caries may be avoided if children are more diligent in practicing good dental hygiene.

CLINICAL SIGNIFICANCE

Relapse of caries after full-mouth rehabilitation under general anesthesia can affect the quality of life of children. Preventive measures should be initiated and reinforced to prevent the occurrence of new carious lesions after full-mouth rehabilitation. How to cite this article: Mathew MG, Jeevanandan G, Maganur PC, et al. Evaluation of Risk Factors associated with Caries Development after Full-mouth Rehabilitation for Early Childhood Caries Under General Anesthesia. J Contemp Dent Pract 2024;25(1):85-91.

CAD/CAM full-mouth rehabilitation of an elderly patient: One-piece digital complete denture meets multilayered zirconia with gradient technology

OBJECTIVE

This article highlights a CAD/CAM complete-mouth rehabilitation in an 82-year-old patient by means of a complete maxillary prosthesis and mandibular implant- and tooth-supported fixed restorations made from multilayered zirconia.

CLINICAL CONSIDERATIONS

Comprehensive complete-mouth rehabilitations in elderly patients with adaptation of the occlusal vertical dimension (OVD) often present particular challenges. This applies especially when exacting functional and esthetic requirements are to be met and the treatment should not cause the patient too much effort, still ensuring the highest level of quality and efficiency and a low intervention rate.

CONCLUSION

The digital approach used for the present patient allowed for an efficient treatment procedure, facilitated virtual evaluations using a face-scan, and enhanced the predictability of the prosthodontic outcome. The approach enabled some steps required in the conventional protocol to be omitted, resulting in a straightforward clinical treatment with minimal strain on the patient.

CLINICAL SIGNIFICANCE

Because of the comprehensive recording of extraoral and intraoral data, for example with a facial scanner, it was possible to transfer a digital replica of the patient to the dental laboratory technician. With this protocol, many steps can be performed in the absence of the real patient.

Full-mouth rehabilitation in a completely digital workflow using partially adhesive monolithic zirconia restorations

OBJECTIVE

This clinical case describes a completely digital workflow using current digital technologies for a full-mouth adhesive rehabilitation with ultra-translucent multilayer zirconia restorations.

CLINICAL CONSIDERATIONS

A healthy 60-year-old man with abfractions on all upper and lower molars and severe tooth wear underwent a full-mouth rehabilitation with laminate veneers and partial adhesive restorations. A proper zirconia bonding protocol was realized to provide a durable bond between the ultra-translucent zirconia and the resin cement. Furthermore, the implementation of a digital workflow enables the clinician to have an effective communication during treatment planning and simplify the clinical and laboratory procedures, providing the patient with long-term esthetic treatment and functional results.

CONCLUSION

The implementation of a completely digital workflow and the use of ultra-translucent multilayer zirconia for indirect adhesive restorations can be an alternative with simplified and predictable procedures for patients with dental wear and teeth discolorations.

CLINICAL SIGNIFICANCE

The digital workflow described is intended to facilitate the planning and execution of a full-mouth adhesive rehabilitation and demonstrates to clinicians a reliable zirconia bonding concept for minimally invasive anterior and posterior restorations.

Full-Mouth Rehabilitation of a Patient with Gummy Smile-Multidisciplinary Approach: Case Report

The impairment of aesthetic function leads to a decreased quality of life. An unaesthetic smile due to excessive gingival exposure demands, most of the time, a complex treatment in which the objective is the vertical reduction of the amount of exposed fixed gingiva by obtaining a complete exposure of the anatomical crown of the teeth and restoring the ideal dimensions of the biological width. This paper presents a case of a 48-year-old female patient who was unsatisfied with her aesthetics and had disturbed masticatory function due to the absence of some posterior teeth. The cone beam computed tomography was performed to evaluate the facial and dental morphology. The treatment plan included diode laser and piezo-surgery utilization for the frontal area of the upper arch and implants to restore the distal area of the lower and upper arch. Zirconia ceramic was used for the final restorations. This complex and multidisciplinary full-mouth rehabilitation lasted for two years, and the patient was pleased with the result. This case showed that a well-established treatment plan is necessary to obtain long-lasting results. The use of adequate procedures and equipment ensures a predictable result.

Impact of complete mouth rehabilitation following Pankey Mann Schuyler versus HOBO Philosophy on Oral Health-Related Quality of Life using Oral Health Impact Profile-14: A randomized clinical trial

Aim

Aim of this in vivo study was to assess the impact of two rehabilitation philosophies namely; Pankey Mann Schuyler (PMS) & Hobo Twin Stage (HOBO) on Oral Health-related Quality of life (OHRQoL) using Oral Health Impact Profile (OHIP 14).

Settings and Design

This was a randomized clinical trial.

Material and Methods

This study was designed based on the PICOT model. 40 patients were selected who need to undergo complete mouth rehabilitation. The intervention performed was complete mouth rehabilitation therapy and the results were compared with that of no intervention. The outcome was assessed in terms of improvement in mastication, phonetics, esthetics and overall OHRQoL (OHIP-14) over a period of 01 year at intervals of 48 hrs, 01 mon, 6 mon and 12 months. Patients were unaware of the treatment philosophy being used and were given a questionnaire (OHIP-14); at baseline (pre-treatment) and 48 hrs, 1, 6 and 12 months after completion of treatment (post-treatment) to evaluate OHRQoL. The data was collected by independent reviewers blinded to the regimen followed making the participants and the outcome assessors blinded to the procedure.

Statistical Analysis

Independent Student's t-test and Chi-Square test were used for analysis.

Result

Analysis illustrated significant differences in scores obtained pre-treatment and post-treatment in both groups at 12 months (P < 0.05). At 12 months, OHIP-14 scores showed a mean percentage change of 51% in Group A (PMS); (P = 0.001) and a mean percentage change of 49% in group B (Hobo).

Conclusion

Complete mouth rehabilitation therapy for management of generalized attrition or mutilated dentition is a viable and effective treatment option and brings about definitive improvement in Oral Health Related Quality of Life (OHRQoL) and overall health status of an individual.

Full-Mouth Rehabilitation Using a Tissue-Level Angled-Head Dental Implant System: A Retrospective Analysis with Long-Term Follow-Up

PURPOSE

A new tissue-level implant design with angulations of 17, 30, and 45 degrees has been introduced to allow the use of the existing bone while maintaining the restorative platform at an angle to ensure an optimal functional and esthetic result for treatment of edentulous patients. The aim of this study was to measure implant survival, bone loss, and peri-implant health of the novel tissue-level angled-head dental implant system.

MATERIALS AND METHODS

A retrospective analysis of cases from three private offices that were using the new implant system was performed. Data regarding patients' demographics, number and location of implants, restoration type, bone loss, implant failure, bleeding, and pocket depths were collected and analyzed. The data collected were analyzed using mainly descriptive statistics.

RESULTS

A total of 29 participants were selected, and 185 dental implants were placed. The average patient age was 61 ± 7 years, and 52% were female. Some of the patients were medically compromised; 7% were diabetic, 20% were smokers, and 7% had osteoporosis. The average time from dental implant placement to the placement of the screw-retained crowns was 6 ± 5 months. Four implants failed with an average time to failure of 18 ± 8 months. Implant survival rate was 97.8%. The average bone loss was 0.014 ± 0.082 mm at 1 year, 0.133 ± 0.306 mm at 5 years, and 0.426 ± 0.903 mm at 10 years. Overall, 18.9% of implants were associated with bleeding, and only one implant had a pocket depth greater than or equal to 5 mm.

CONCLUSION

The new tissue-level implant design with angulations of 17, 30, and 45 degrees has demonstrated predictable survival and success rates with minimal bone loss. The long-term follow-up seems highly promising; however, further studies are warranted to validate the results.

A Systematic Approach to Full-Mouth Rehabilitation of a Complex Case Using a Digital Workflow, Proper Isolation

To achieve excellence in dentistry, a multitude of steps needs to be completed. From performing a thorough history, to diagnosis and treatment planning, all the way to accurate insertion of the restorations, every aspect of the restorative process requires careful thought and precision, especially in a complex case. This article describes a stepwise approach to completing a full-mouth rehabilitation using an entirely digital approach. Additionally, it discusses ideal measures of isolation and bonding as pertaining to all-ceramic restorations. Through utilizing a systematic strategy, the clinician can establish a predictable path to ensure a successful result.

Treatment planning for a patient with generalized advanced periodontitis: a case report

Severe damage to the periodontium requires stabilization and restoration of masticatory function. This case report examines the therapeutic planning process for a patient with generalized periodontitis (stage IV, grade C). The main dilemma in this case was whether periodontally compromised natural teeth should be retained during the full-mouth rehabilitation or extracted. Retention of natural teeth usually is associated with better oral health-related quality of life. This article presents challenging treatment considerations and describes why extraction of periodontally compromised natural teeth is sometimes a viable treatment option.

Digitally Fabricated Dentures for Full Mouth Rehabilitation with Zirconia, Polyetheretherketone and Selective Laser Melted Ti-6Al-4V Material

CAD/CAM technologies have been embedded into the fabrication of removable partial denture (RPD). Various materials such as zirconia and polyetheretherketone (PEEK) are developed for subtractive manufacturing. As for additive manufacturing, dental professionals have begun to use selective laser melting (SLM) techniques for fabricating metallic RPD frameworks. This report demonstrates a case rehabilitated with a maxillary telescopic crown-retained combining PEEK and zirconia material denture and a mandibular Kennedy Class I RPD fabricated with SLM techniques. First, a conventional impression was performed and the master cast was mounted with a centric relation record. Digital models were obtained using tabletop scanners and then the telescopic primary zirconia crowns were designed and milled. After transferring the intraoral distribution of primary crowns using pick-up impression, secondary PEEK crowns and framework were designed, milled, and veneered with composite resin. Mandibular framework was designed and constructed using SLM technique with Ti-6Al-4V. Definitive prostheses for both jaws were finished and delivered. Delivered prostheses functioned well for a one-year period. The was patient satisfied with the improvements in chewing function and esthetics. Both substrative and additive manufacturing techniques are suitable for framework fabrication. Further investigation is needed for improving the mechanical performance and long-term prognosis of digitally made prostheses.

Developing a Classification System for Prioritizing Pediatric Dental Patients Needing Treatment under General Anesthesia

PURPOSE

The aim of this study was to explore a classification system for children requiring full-mouth dental rehabilitation (FMDR) in the operating room (OR) and its association with adverse events.

METHODS

Patients treated at a pediatric dental residency clinic and determined to need FMDR in the OR were classified on initial examination, based on the extent of caries, pain and the presence of a dental abscess. On the treatment date, parents were given a questionnaire concerning adverse events that occurred while waiting for treatment. Χ2 tests of independence were used to determine associations between classification (OR code) and the occurrence of adverse events. The Pearson's r test was used to determine relations among adverse events and wait time.

RESULTS

The study included 82 patients (age range 2-10 years, mean 4.73 years, median 4 years). The average wait time was 55.6 days. The most common OR classification was caries in the outer third of dentin without pain or abscess, and the most common adverse event was difficulty eating or drinking. The OR code category most closely associated with negative outcomes was the presence of a dental abscess, followed by caries depth, then pain. Wait time was not associated with the occurrence of adverse events.

CONCLUSIONS

These data provide evidence to support the need for a classification system for children requiring FMDR in the OR. Dental abscess, caries depth and pain were associated with adverse events.

Minimally Invasive Prosthetic Procedure (MIPP): Up to 12-Year Survival of Full-Mouth Rehabilitations in Patients with Severely Worn Dentition (Managed with Lithium Disilicate Ceramic Restorations)

Minimally invasive prosthetic procedures (MIPPs) have been suggested and utilized for the esthetic rehabilitation of severely worn dentition. Minimizing the reduction of tooth structure and the use of additional adhesive techniques are key elements to ensure long-term results. This article presents the long-term result of this restorative technique. A total of 1,040 lithium disilicate restorations were adhesively luted, and 45 patients and 87 arches were treated. The cumulative survival rate recorded was 99.15%, with a 10-year survival probability of 96.5%. These remarkable results strongly support the use of MIPP as a restorative option for severely worn dentition.

Clinical performance of direct composite resin restorations in a full mouth rehabilitation for patients with severe tooth wear: 5.5-year results

OBJECTIVES

To evaluate the 5.5-year performance of direct resin composite restorations, prescribed for patients with severe tooth wear, requiring full-mouth rehabilitation.

METHODS

A convenience sample of 34 patients were recruited to a prospective trial between December 2010 and June 2013. The participants were provided 1269 full-mouth direct resin composite restorations (Clearfil AP-X) by 5 experienced operators, using the DSO-technique. Treatment resulted in an increase in the vertical dimension of occlusion (VDO). Failure was assessed at three levels. Frequencies of failure were analysed using Kaplan Meier survival curves and the effects of the relevant variables calculated with a multifactorial Cox regression (p < 0.05).

RESULTS

Annual failure rates (for all levels of failure, 'Level 3- ') of ≤ 2.2% and ≤ 2.9% were respectively reported for the anterior and posterior restorations with a mean observation time of 62.4 months. The completion of an anterior restoration with the need for further appointments resulted in significantly more Level 2- & 3- failures. An evaluation of the performance of the premolar and posterior maxillary restorations showed significantly lowered risks of certain types of failures, compared to the molar and posterior mandibular restorations.

CONCLUSIONS

At 5.5 years, 2.3% of the overall restorations displayed catastrophic, (Level 1) failures. Molar restorations, posterior mandibular restorations and the anterior restorations requiring two further sessions for completion, were associated with significantly higher risks for failure.

CLINICAL SIGNIFICANCE

Direct resin composite can offer an acceptable medium-term option for the treatment of severe, generalized tooth wear; molar restorations may require higher maintenance.

Biological outcomes and patient-reported outcome measures (PROMs) of minimally invasive full-mouth rehabilitations of patients with erosions and/or abrasions by means of the "3-step technique": part 2 of the 6-year outcomes of a retrospective clinical study

PURPOSE

To evaluate biologic and esthetic outcomes, as well as the patient-reported outcome measures (PROMs), of full-mouth rehabilitations in patients suffering from generalized erosive and/or abrasive tooth wear following the 3-step technique.

MATERIALS AND METHODS

Patients who received a minimally invasive full-mouth rehabilitation according to the 3-step technique and who were treated at the University of Geneva and/or in a private practice were considered for inclusion. The minimum service time of the restorations was 12 months. The biologic outcomes were analyzed by assessing pocket probing depth (PPD), Plaque Index (PI), and bleeding on probing (BOP). Furthermore, secondary caries, tooth vitality, and sensitivity to temperature were evaluated using the modified United States Public Health Service (USPHS) criteria. The esthetic outcomes were rated with the White Esthetic Score (WES). Finally, PROMs were evaluated using visual analog scales (VAS).

RESULTS

A total of 19 patients with 406 restorations (149 direct composite resins, 110 indirect composite resin/ceramic onlays, and 147 composite resin/ceramic veneers) were examined after a mean follow-up of 71.8 ± 28.6 months. Periodontal parameters were good (mPPD = 2.9 ± 0.4; mPI = 0.1 ± 0.2; and mBOP = 0.05 ± 0.1). No secondary caries were found, and no abutment tooth had lost vitality. A total of 36 abutment teeth had moderate sensitivity, but none presented pronounced sensitivity. The rehabilitations exhibited good esthetic outcomes (mWES = 8.4 ± 1.9). Patients reported satisfying esthetic results of their rehabilitations (mean VAS = 9.2 ± 1.6) and considered their treatment as comfortable (mean VAS = 8.2 ± 2.1), while the least favorably rated parameter was the cost of treatment (mean VAS = 4.1 ± 3.2).

CONCLUSION

Minimally invasive full-mouth rehabilitations of patients with generalized tooth wear by means of the 3-step technique exhibit very good clinical medium-term results with respect to biologic and objective/subjective esthetic outcomes. The patient satisfaction with this treatment was high.

Part 1: 6-year survival rates and technical outcomes of the restorations

PURPOSE

To evaluate the survival rates and technical outcomes of minimally invasive full-mouth rehabilitations in patients affected by dental erosion and attrition.

MATERIALS AND METHODS

For this retrospective study, 28 subjects (8 women, 20 men; mean age: 45.6 years) who suffered from generalized erosions and attrition and who were treated according to the 3-step technique were invited to participate. The patient records were reviewed, and the restorations were clinically and radiographically examined. This part of the study (part 1) evaluated restoration survival and technical outcomes using the modified United States Public Health Service criteria (mUSPHS). Survival analysis was performed using Kaplan-Meier survival statistics, and comparison between subgroups was made using log-rank test. For all other comparisons, cross-tabulations of occurrence were performed, and significance was tested using Pearson chi-square test. The level of statistical significance was set at P < .05.

RESULTS

A total of 19 patients (3 women, 16 men; mean age: 45.6 years) agreed to participate. In these patients, 406 restorations (149 direct composites, 110 onlays, 147 veneers) supported by 365 teeth were examined. The mean time in service was 71.8 ± 28.6 months. Six failed restorations were identified; all were direct composites. The 6-year survival rates were 97.3% for direct composites, 98.2% for onlays, and 100% for veneers (P > .05). No differences were found among materials and locations of the restorations. Nineteen technical complications included 14 partial fractures, 3 fissures, 1 wear, and 1 decementation. The mUSPHS evaluation showed good technical outcomes. Presence or absence of a nightguard influenced restoration survival (P = .003).

CONCLUSION

Minimally invasive rehabilitations of patients with erosions/attrition with the 3-step technique are a reliable treatment option in the medium term. Protective nightguards are recommended.

Facts and Fallacies About Occlusal Philosophies for Full Mouth Rehabilitation

This article reviews various full mouth rehabilitation occlusal concepts along with their main beliefs and controversies. Many of those occlusal teachings were well-meant at the time they were introduced. However, closer examination reveals that many of them involved serious destruction of sound tooth tissue - without delivering many of their purported benefits.The biologic and structural disadvantages of 'subtractive' dental procedures, which were, and still are, undertaken to provide traditional full mouth rehabilitation are discussed. Those approaches are contrasted with the proven advantages of minimally destructive additive techniques, which can solve frequently encountered clinical problems previously deemed to require traditional 'full mouth rehabilitations'. Pragmatic clinical cases are used to illustrate how to solve common clinical problems by using minimally destructive means, without causing structural damage to residual sound tooth tissue.

Changes in Occlusal Philosophies for Full Mouth Rehabilitation

This article reviews some of the main tenets of different occlusal philosophies involved in 'full mouth rehabilitation' and evolved since the late 19^th century. This review is not intended as a comprehensive historical review of all the people who wrote, researched, or taught on the topic, and it is certainly not intended to disparage their well-meaning contributions. It is intended to highlight some of the changes that occurred in relation to full mouth rehabilitation occlusal concepts along with the dates when they were articulated.

Comparison of Stress Distribution and Deformation of Four Prosthetic Materials in Full-mouth Rehabilitation with Implants: A Three-dimensional Finite Element Study

AIM

This study aimed to compare the von Mises stress distribution and deformation on the implant, abutment, and abutment screw using metal-ceramic, zirconia, polyether ether ketone (PEEK), and Trinia as prosthetic materials for full-mouth cement-retained implant prosthesis using finite element analysis.

MATERIALS AND METHODS

Four, 3-dimensional mandibular models were designed using Solidworks software. Six conical implants of 4.5 × 11.5 mm, with an internal hexagonal abutment, were fabricated and placed. The physical properties of the implant components, bone, and crowns were simulated to mesh the three-dimensional finite element models. The bite was recorded, and various contact points were marked, on which 50 N loads were applied. The von Mises stress distribution and resultant deformation were analyzed using the finite element method.

RESULTS

Higher stress distribution was recorded on the implants, abutments, and abutment screws when zirconia and PEEK prosthesis were used in comparison to metal-ceramic and Trinia. In consideration of deformation, zirconia and Trinia resulted in higher deformation of the implant assembly, abutment, and abutment screw when compared to metal-ceramic and PEEK prosthesis. Anterior implants showed a higher deformation and stress distribution when compared to posterior implants for all four prosthetic materials.

CONCLUSION

Within the limitations of the study, metal-ceramic and Trinia showed less stress distribution, while metal-ceramic and PEEK exhibited less deformation on implant and its components. Hence in future, Trinia and PEEK along with metal-ceramic can be promising prosthetic materials of choice in full-mouth rehabilitation with implants.

CLINICAL SIGNIFICANCE

Considering the deformation and stress distribution on the implant and its components, the selection of prosthetic material in full-mouth rehabilitation has always been a challenge. Findings of the abovementioned cross-sectional observational study could give an overall insight into materials such as metal-ceramic and Trinia as materials of choice, which can provide a basis for future clinical trials.

Effect of Full-Mouth Rehabilitation on Streptococcus mutans and Streptococcus sobrinus Levels in Children with Severe Early Childhood Caries

Purpose: To investigate the effect of full-mouth rehabilitation on the levels of Streptococcus mutans and Streptococcus sobrinus in plaque samples of children suffering from severe early childhood caries using the quantitative reverse transcription polymerase chain reaction method.<br/> Methods: A dental examination was performed to determine the decayed, missing, and filled primary teeth and surfaces (dmft and dmfs, respectively) in three- to five-year-old children using the World Health Organization's caries diagnostic criteria. Supragingival plaque samples were collected from all tooth surfaces with a sterile universal scaler at baseline and six months after full-mouth rehabilitation. The Wilcoxon signed-rank test was used to compare the mean values of dmft and dmfs scores and the mean values of S. mutans and S. sobrinus levels between the pre- and post-treatment period.<br/> Results: At six months, the mean relative quantification values of S. mutans and S. sobrinus showed significant reductions (P > 0.05) in the post-treatment samples but the mean dmft scores remained the same.<br/> Conclusion: Full-mouth rehabilitation is effective in reducing levels of S. mutans and S. sobrinus, thus diminishing the cariogenic challenge in the oral cavity.

Full-mouth rehabilitation of a severe tooth wear case: a digital, esthetic and functional approach

The proliferation of digital technology is progressively changing dentistry. Thanks to continual improvements in CAD/CAM devices and dental materials, it is possible nowadays to carry out a treatment plan for oral rehabilitations with fully digital approaches and noninvasive concepts. The availability of digital resources allows clinicians to increase the predictability of enhanced esthetics and good functional results. There is an increasing number of patients today who are affected by excessive tooth wear and may benefit from these kinds of treatments. This article provides a step-by-step documentation of a full-mouth rehabilitation performed with a digital approach and additive CAD/CAM composite resin restorations. An innovative functional evaluation is also documented and discussed. The initial situation was assessed and compared with the rehabilitation project through a snap-on device. After the intraoral adjustment and validation, the final rehabilitation was performed according to the information obtained in the provisional phase and digitally transmitted to the laboratory.

The one-step no-prep approach for full-mouth rehabilitation of worn dentition using PICN CAD-CAM restorations: 2-yr results of a prospective clinical study

OBJECTIVES

To prospectively evaluate the One-step No-prep treatment of full mouth-worn dentition, a minimally invasive and multidisciplinary approach using PICN CAD-CAM composite restorations without provisional phase.

METHODS

Seven patients (n = 192 restorations) with severe tooth wear were included. Patient data were recorded, and an occlusal analysis and a tissue-guided wax-up were realized. After replacement of old fillings, no-prep Vita Enamic restorations (posterior restorations and palatal veneers) were bonded within 24 h. Direct composites were performed to mask the buccal joint on anterior teeth. Maxillo-facial physiotherapy was performed. Restorations were evaluated following World Dental Federation criteria. Treatment influence on Oral-Health-Impact-Profile-49 (OHIP-49) score was assessed.

RESULTS

Tooth wear etiology was related to soft drink consumption and bruxism. Mean VDO increase was 5.09 ± 0.85 mm on the incisal pin. The mean restoration thickness on molars was 0.55 ± 0.21 mm, and the lowest was 0.11 mm. 2-year survival rate of restorations was 100 % and success rate was 93.5 %, with 11 minor chippings and one debonding. A significant improvement of the global OHIP-49 score was observed.

CONCLUSIONS

In this clinical study on high risk patients, PICN restorations, applied in a minimally invasive way, showed high survival and success rates after two years, while minor chipping of very thin occlusal borders constituted the most frequent complication. Moreover, the patient acceptance was good according to OHIP-49 in this multidisciplinary approach.

CLINICAL SIGNIFICANCE

The use of PICNs allows the development of no prep and simple treatment protocols of worn dentition. The absence of provisionals did not engender any problem, on the basis of the realization of an occlusal analysis, the support of a maxillo-facial physiotherapist, and the use of an easy-to-adjust restorative material.

An Argument Against Extraction as a Treatment Alternative for Restorable Teeth

Extraction is commonly presented as a treatment alternative for restorable teeth, and patients are biased to choose it for a variety of reasons. However, without subsequent rehabilitation, patients' health, function, and esthetics could be compromised. This article explores problematic outcomes where extraction was offered as a treatment option when teeth were restorable; a case report example demonstrates this issue. The case involved a patient who was diagnosed with moderate to severe periodontitis and had severe attrition and lingual erosion on his maxillary teeth. Despite being given the option of full-mouth rehabilitation, ie, periodontal and restorative treatment, due to financial reasons the patient chose to have all maxillary teeth extracted and receive a maxillary denture. Respecting the patient's autonomy, the dental team performed surgical extraction of the maxillary teeth and an alveoloplasty and delivered an interim denture. The patient did not adapt well to the denture, and several postoperative issues transpired, which required unanticipated surgical procedures. Dissatisfied with the treatment, the patient continued to need dental appointments more than a year after the extractions, and his oral health, function, and esthetics have still not been restored. The dental community must educate patients regarding extraction being an irreversible, last-resource procedure, and mainly indicated only when teeth restoration is not possible. Presenting extraction together with more conservative options for restorable teeth may contribute to patients' misconceptions that it is a treatment alternative as good as any other.

Full-mouth Rehabilitation of Hypocalcified-type Amelogenesis Imperfecta With Chairside Computer-aided Design and Computer-aided Manufacturing: A Case Report

BACKGROUND

This case report describes the complete full-mouth treatment of hypocalcified amelogenesis imperfecta (AI) by chairside computer-aided design and computer-aided manufacturing (CAD/CAM).

CASE SUMMARY

After several years of interrupted dental care, a 17-year-old female patient presented with pain and also esthetic and functional discomfort. With loss of enamel and dyschromia affecting all teeth, the diagnosis was hypocalcified AI. Affected tissues were eliminated, gingivectomy with laser was performed, an indented jig was used to record the centric relationship during optical impressions, and 28 full ceramic crowns were created by chairside CAD/CAM in four sessions. The patient reported rapid pain relief and an overall improvement of well-being.

CONCLUSION

AI sequelae can be treated promptly and conservatively with chairside CAD/CAM, obtaining esthetic and functional results.

Management of Amelogenesis Imperfecta: A 15-Year Case History of Two Siblings

OBJECTIVE

Amelogenesis imperfecta (AI) is a heterogenous genetic disorder that interferes with normal enamel formation in the absence of systemic disorders. The patients' main concerns are caries susceptibility, poor esthetics, and generalized sensitivity. There is a broad clinical spectrum, from discolorations to consequent enamel alterations. This case report describes the 15-year case study and the full-mouth rehabilitation of two siblings affected by a hypocalcified AI. Clinical Considerations: In these two patients, conservative care with stainless steel crowns and direct composite restorations was undertaken to restore function and esthetics and to reduce sensitivities in primary and mixed dentitions. The difficulties in monitoring resulted in severe infectious complications (dental abscess with cutaneous fistula), important dental defects, and loss of spaces with subsequent malocclusion. In the young adult dentition, they were treated by extractions, root canal therapies, and new restorations: stainless steel crowns for permanent molars, direct composite restorations (with strip crowns) for incisors and maxillary canines (to improve the crown morphology as well as to mask the discolorations and the malpositions), and adjusted composite crown molds using a thermoforming procedure for premolars and the mandibular canines. The main difficulties were rapid tooth surface loss, bonding to atypical enamel, developing dentition, long-term follow-up.

CONCLUSION

Restoring function and esthetics in AI-affected patients is a challenge from primary to adult dentition. Early corrections are essential to avoid dental damage and for psychological benefits. This clinical report highlights the adhesive rehabilitation for anterior and premolar areas and the difficulty of patient follow-up.

Full Mouth Implant-supported Rehabilitation of a Patient with Ectodermal Dysplasia: Clinical Report and Literature Review

OBJECTIVE

The purpose of this case report is to present the clinical course of full mouth rehabilitation in an 1 8-year-old female patient with ectodermal dysplasia who was treated with implant-supported fixed partial dentures for the mandible and the maxilla.

CASE REPORT

Fourteen dental implants (8 in the maxilla and 6 in the mandible) were placed simultaneously after full mouth extraction and alveoloplasty surgery. After 6 months of healing, prosthetic rehabilitation was started for screw-retained fixed partial dentures. The patient was followed for one year and a peri-implant maintenance regime established for six-month recalls. The patient was satisfied with the prosthesis both esthetically and functionally. Furthermore, the patient reported significant improvements in oral function and psychosocial activities.

CONCLUSION

The use of dental implants to support full mouth prosthetic rehabilitation for adolescents with ectodermal dysplasia may provide a considerable improvement in function and esthetic compared to conventional removable prosthetic options. This has the potential to enhance the quality of life for these patients.

Implantologie in der Mund-Kiefer-Gesichtschirurgie

Since the last 30 years endosseous implants are a well established treatment technique in maxillofacial surgery. Implants are used in the rehabilitation of patients having lost parts of maxilla or mandible due to tumor surgery, or which due to radiotherapy have problems tolerating mucosa-borne dentures. The implant borne prosthesis will aid to regain live quality to those patients. Improvement of live quality is also the result when epithetic reconstructions of soft tissue defects in the face are stabilized by extraoral implants. Aim of the paper is to give an overview on important implant related pathophysiological osseous healing patterns, discuss methods to influence these processes, to show correction possibilities for the bony bed and highlight their indications as well as to inform about clinical experiences with endosseous implants.

Full-Mouth Rehabilitation Following Treatment of Temporomandibular Disorders and Teeth-Related Signs and Symptoms

The literature is replete with theories regarding temporomandibular disorders (TMD). However, there is a paucity of information concerning perceived malocclusion and other teeth-related signs and symptoms after full-mouth rehabilitation. This clinical study was designed to evaluate the perception of TMD patients concerning perceived malocclusion and other teeth-related signs and symptoms after full-mouth rehabilitation guided by the Mental Analog Scale (MAS). Among 38 patients referred for full-mouth rehabilitation, 20 were diagnosed as having TMD after reviewing a questionnaire, recording the major complaints and symptoms, in addition to performing comprehensive clinical examination. Nonsurgical therapy was performed, including fabricating an anterior programming device, a centric relation occlusal device and finally full-mouth rehabilitation by means of placing crowns on all upper and/or lower teeth. All full-mouth rehabilitation procedures were performed using a fully adjustable articulator and mandibular movements were recorded following pantographic tracings. After full-mouth rehabilitation, the patients were followed up at 1, 2, 4, 6, 9, and 12-month intervals, and the major signs and symptoms were recorded along with adjunctive teeth-related signs and symptoms. Fisher exact probability tests were applied to analyze the results (P<.05). Statistical comparisons of the MAS responses before and after treatment (at 1-month recall) showed significant improvement (P<.05) for all teeth-related signs and symptoms except for bruxism (P=.0699). Further improvement was noted at the 4-month recall period. However, these improvements were not statistically significant for all teeth-related signs and symptoms. No further change was noted after the 4-month recall period. There was a marked reduction in perceived malocclusion and adjunctive teeth-related signs and symptoms during function, only after performing occlusal equilibration of the final restorations.

Full-mouth esthetic rehabilitation with acellular dermal matrix

Treatment of multiple recession defects with the adjunct use of a connective tissue graft (CTG) represents a challenge when diagnosed in several teeth of the mouth. The amount of CTG harvested from the palate may not be adequate to address this condition. In such scenarios, alternative sources such as acellular dermal matrix (ADM) are preferred due to the unlimited availability. A case report is presented, dealing with the treatment of multiple gingival recessions affecting the majority of dentition using ADM, with a 6-month follow-up.

Treatment planning and dental rehabilitation of periodontally compromised partially edentulous patient: a case report - part II

When planning a prosthetic rehabilitation of a periodontally compromised case, the clinician is often confronted with difficulties and dilemmas related to selecting the appropriate treatment that would provide long-term successful outcomes in function and esthetics. In such cases, a correct diagnosis and prognosis of the intraoral situation supported by evidence-based dentistry is the basis for the establishment of a proper treatment strategy. In this second part of a two-part treatment planning series, a systematic approach of patient examination and prognosis of each tooth is presented. Furthermore, different removable and fixed treatment possibilities are described and the rationale governing the decision-making process is revealed. The execution of the final treatment plan as specified by the concept of comprehensive dental care is outlined, and the final outcome is discussed according to the literature.

Occlusion and weight change in a patient after esophagectomy: success derived from restoration of occlusal support

Occlusal support may be an important factor affecting nutritional support after major surgery. This report presents a patient who gained body weight after receiving a new prosthesis. The patient was an 82-year-old man with thoracic esophageal carcinoma. He did not have occlusal support because of multiple caries lesions. His body weight slowly increased after surgery, but almost stopped in the period of 54 to 68 days after surgery. After treatment with dentures (day 72 postsurgery), body weight gain was observed again, although his medical treatment had not changed. An appropriate prosthesis could contribute to perioperative nutrition support and may lead to earlier recovery after surgery.

[Implant-retained restoration in esthetically important zone]

The article analyzes the features and clinical aspects of implant-retained restorations in the anterior maxilla important for achieving optimal functional and esthetic results.

[Estimation of impression quality in fixed prosthesis oral rehabilitation]

In spite of the constant improvement of impression materials impression taking is still rather challenging procedure. Impression quality considerably defines the effectiveness of prosthodontics oral rehabilitation. The method for impression quality assessment was elaborated in the study and used to estimate the quality of impressions taken for fixed prosthesis (teeth preparation quality was not assessed). More than 50% of impressions had improper quality.

Dental Discomfort Questionnaire for young children following full mouth rehabilitation under general anaesthesia: a Follow-up report

AIM

The aim of the present study was firstly to assess the persistence of pain related behaviours of the Dental Discomfort Questionnaire (DDQ) and secondly to complete a follow-up study to assess the effect of dental treatment on pain related behaviours in preschool children.

METHODS

The 9-question DDQ instrument was used to assess dental pain related behaviours in a group of preverbal children. The test-retest analysis questionnaire was filled out twice by 44 parents on behalf of their referred child. For the follow-up study the questionnaire was filled out by 71 parents before and after all dental disease was completed.

RESULTS

A strong correlation for the test-retest was found over a 2 month period before treatment. When the behaviour items were compared independently before and after treatment it appeared that after treatment all but one behaviour (i.e. bite with molar instead of teeth) was displayed less often. Overall, after treatment all children had a lower mean DDQ score.

CONCLUSIONS

Dental treatment of children leads to reduced toothache related behaviours and subsequently to a better quality of life. The DDQ is a sensitive instrument to measure dental discomfort before and after restorative treatment if and when the follow-up period is short. The DDQ can possibly support healthcare providers, teachers and parents in their assessment of toothache in young children.

Levels of oral disease in a sample of children with disability; a study carried out immediately before comprehensive dental treatment under general anaesthesia

AIM

To audit the levels of oral disease in those children whose disability required general anaesthesia for comprehensive dental treatment.

METHODS

An audit was conducted of oral disease levels in a sample of 51 children attending for treatment.

RESULTS

The proportion of untreated decayed teeth was 72%, previously extracted 25% and restored 3%. Very high levels of debris and gingival bleeding indices were found. There were very low proportions of previous restorations and past treatment had comprised mainly extractions.

CONCLUSIONS

There was a low restorative care index in both the primary and permanent dentitions indicating that high needs continue to exist in terms of comprehensive dental care for these Irish children.

Cosmetic concerns provide opportunity for comprehensive dentistry

This case involved a woman with occlusal dysfunction who was dissatisfied with her smile because of the unsightly display of gold crowns in her posterior and unattractive mottling on her anterior teeth. Factors such as a significant history of clenching and grinding, the management of active disease and infection, and the patient's desire for an ideal or "media-generated" smile increased the difficulty of the case. As part of a comprehensive restorative plan that included disease control treatment, root canal therapy, and orthodontics to idealize tooth positioning, a Kois deprogrammer was used to evaluate the patient's increasingly symptomatic, unacceptable function. In addition to reducing functional and biomechanical risks, the case resulted in improved esthetics with which the patient was highly pleased.

Multidisciplinary treatment plans in the adult patient - step by step and rationale

Interdisciplinary, multidisciplinary and comprehensive treatment plans are now part of everyday practice. The interaction between different specialists can provide patients with better, more conservative and more pleasing results. This case report shows the step by step of a multidisciplinary treatment plan and the rationale for each part of a process where conservative dentistry, periodontics, orthodontics, implant dentistry and prosthetics are involved.

Full-mouth rehabilitation using dental implants in a patient with scleroderma

Scleroderma is an autoimmune multisystem rheumatic condition that affects connective tissues. Oral manifestations of the disease are directly relevant to the dental and periodontal diagnosis, treatment plan, and management of patients diagnosed with scleroderma. In the presented case, progressive limitation of mouth opening together with severe caries and periodontal disease warranted a fixed implant-supported rehabilitation using dental implants. Three-year follow-up revealed good oral hygiene and clinical appearance with no radiologic evidence of bone loss around the implants. Implant-supported rehabilitation might be a viable treatment option in patients with scleroderma under chronic use of systemic steroids. Further studies with long-term follow-up are warranted.