L'influence des composites renforcés avec fibres de verre sur l'intégrité marginale, la résistance à la fracture et les modes d'échec des dents dévitalisées et restaurées avec une Endocrown en résine CAD/CAM

Objectif: Evaluer l'adaptation marginale, la résistance à la fracture et le mode d'échec des des Endocrowns CAD/CAM renforcées avec des composites fibrés. Matériel et méthodes: 4 différents groupes ont été formés: 1(contrôle)-composite microhybride; 2–composite micro-hybride recouvert par trois couches de ʺE-Glass fibersʺ; 3–composite fibré; 4–composite fibré recouvert par trois couches de ʺE-glass fibersʺ. L'analyse marginale des Endocrown en résine a été effectuée avant et après le vieillissement thermomécanique. Les dents ont été forcées à la fracture et analysées, et la statistique a été accomplie. Résultats: L'adaptation marginale n'a pas été différente parmi les différents groupes (p>0.05). Les charges moyennes statiques ont été: 1-2817(873); 2-2128(952); 3-2429(1091); 2577 (833). Aucune différence statistiquement significative n'a été trouvée. Dans les groupes avec les couches des fibres, les propagations des fractures ont été quelquefois partialement déviées. Conclusions : Le renforcement des fibres n'a eu aucune influence sur l'adaptation marginale des restaurations, ni sur leur résistance à la charge. L'analyse au SEM montre une tendance des couches de fibres à dévier la fracture, mais leur effet n'a pas été suffisant dans cette configuration pour permettre des fractures plus favorables

Interceptive treatment of tooth wear: a revised protocol for the full molding technique

A modern approach to treating tooth wear aims to stop its progression at an early stage and, ideally, to install effective preventive measures or, in cases when it is already late, to intervene using an interceptive treatment approach. It is important to avoid the need for a full prosthetic treatment that implies additional tooth substance removal, with potential biologic complications. As signs of tooth wear often appear in young individuals, an interceptive treatment has the great potential of stabilizing tooth wear progression early using a no-prep approach and composite resins. The additional benefit of this treatment approach is its affordability and maintainability in the light of tooth wear being, usually, a lifelong pathology. Among the various options for restoring tooth wear lesions with composite resins, interest has lately been increasing for molding techniques (single or full) due to their efficiency and simplicity. This article describes modifications of the basic full molding technique to alleviate most of the known shortcomings of this method; namely, the index deformation, the time-consuming removal of excesses in the proximal and contact areas, and the possible insufficient precision in the molding of the occlusal anatomy. The 1- and 3-year follow-ups of both cases presented here confirmed the functional and esthetic quality of the results obtained with this technique. A kinesiographic and 3D superimposition of the posttreatment and 1-year results of one case provided additional perspectives on this treatment method

Multiple diastema closure in periodontally compromised teeth: How to achieve an enamel-like emergence profile

This article describes a direct composite resin technique for the closure of multiple diastemas. The described procedure allows an anatomic and esthetic emergence profile of the apical third of the tooth to be obtained in periodontally compromised teeth without the use of interproximal wedges

CAD/CAM-based chairside restorative technique with composite resin for full-mouth adhesive rehabilitation of excessively worn dentition

Since the first introduction of the Cerec system (Sirona) in the early 1980s, the use of computer-aided design/computer-aided manufacture (CAD/CAM) technology has spread widely in modern adhesive dentistry. Thanks to this innovative technology, it has been possible to carry out chairside restorations fully managed by the clinician, with the advantages of lower costs for the patient, more rapid execution of the restorations, and the exclusion of the provisional phase. With further improvements in chairside technologies and materials, specifically in the field of composite resin blocks, it is now possible to fabricate multiple ultrathin, minimally invasive or even noninvasive restorations in one single appointment. The clinical case presented here was solved using an innovative approach: It was entirely studied and realized chairside by a dentist on a computer, without any plaster cast or classic articulator. Vertical dimension of occlusion (VDO) augmentation was projected with the 'Incisal Tip' tool on the virtual articulator of the Cerec system. Eight composite resin overlays were designed on the non-prepared posterior teeth of a patient suffering from generalized tooth loss principally caused by a history of bulimia nervosa. The maxillary anterior teeth were restored with six palatal veneers modified with direct composites from the vestibular side, in order to improve the esthetic integration of the restorations. The mandibular posterior teeth were built up with direct composites

Il trattamento conservativo nel paziente fortemente usurato: approccio diagnostico multidisciplinare che ci permetta di prevenire e mantenere la maggior quantità di tessuto sano dentale possibile ripristinando una nuova stabilità occlusale

L’incidenza delle lesioni non cariose (NCL) è in costante aumento nelle comunità occidentali e spesso queste possono indurre gravi condizioni di usura dentale nei pazienti. In passato, una sostanziale perdita di tessuto dentale implicava un approccio terapeutico invasivo con ricoprimento integrale dell’elemento mediante corona e ulteriore sacrificio di tessuto sano. Tuttavia, lo sviluppo e il miglioramento dell’odontoiatria adesiva hanno segnato un cambio di paradigma che ha reso possibile approcciare questi casi con tecniche minimamente invasive e/o additive. Nell’ultimo decennio sono stati proposti diversi protocolli operativi con lo scopo di rendere queste riabilitazioni più predicibili. L’avvento delle tecniche digitali ha poi allargato ulteriormente il campo di azione, potendo integrare nelle fasi di progettazione del caso avanzati software di pianificazione funzionali ed estetici. Lo scopo di questo Modulo è di illustrare il problema dell’usura dentale con l’obiettivo di saper identificare e intercettare preventivamente condizioni potenzialmente patologiche. Inoltre, verranno illustrati principi terapeutici e protocolli di trattamento additivi e minimamente invasivi per riabilitazioni complete della bocca utilizzando tecniche e approcci analogici e digitali nell’intento di esporre i vantaggi terapeutici apportati da entrambe le tecniche

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 appointment

The potential of three-dimensional printing technologies to unlock the development of new 'bio-inspired' dental materials: an overview and research roadmap

Bio-inspiration is an approach in engineering aimed at optimizing artificial systems by borrowing biological concepts from nature. This review sets out to summarize the fundamental aspects employed by nature to avoid premature dental failures. On the basis of these findings, it then defines and evaluates rules for 'post-modern' manufacturing processes to imitate or regenerate complex biological systems

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 stepby- 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