Conservative and Restorative Dentistry Posts

12/09/17
ADDITIVE dentistry and MODIFIED 3 STEP technique to treat a case of Initial Dental Erosion Using Pressed Lithium Disilicate Ceramic Restorations: A 6 year follow-up case Report
Francesca Vailati August Bruguera Urs Christoph Belser

11/10/16
Compound preparation design on 3.3: Vestibular 100° shoulder; Lingual conservative micro-chamfer
Loris Prosper

20/07/16
The Classic 3-STEP Technique, a simplified protocol for ADDITIVE adhesive rehabilitations
Francesca Vailati Urs Christoph Belser

16/02/15
The Conservative Restoration In Critical Areas
Antonio Cerutti

04/04/12
Direct and indirect adhesive composite restorations of posterior regions: reconstructive and periodontal approach
Marco Veneziani

12/07/09
Composites in dentistry
Davide Apicella


ADDITIVE dentistry and MODIFIED 3 STEP technique to treat a case of Initial Dental Erosion Using Pressed Lithium Disilicate Ceramic Restorations: A 6 year follow-up case Report

ADDITIVE dentistry and MODIFIED 3 STEP technique to treat a case of Initial Dental Erosion Using Pressed Lithium Disilicate Ceramic Restorations: A 6 year follow-up case Report

Dental erosion is spreading rapidly among younger generations of patients. Clinicians often underestimate the extent of this disease and postpone its treatment due to a lack of awareness and/or to uncertainty regarding the proper course of action.

The discussion of when and how to treat young individuals affected by dental erosion has split the dental community into two groups: clinicians who treat eroded teeth excessively and clinicians who do not treat eroded teeth at all.

In this case report, a young adult patient affected by generalized dental erosion was treated even though his tooth degradation was only at an initial stage. The rationale behind this early intervention was that no or minimal tooth preparation would have been required for treatment. In fact, only ADDITIVE adhesive procedures were implemented to replace the missing tooth structure and protect the remaining dentition from further damage.

Compound preparation design on 3.3: Vestibular 100° shoulder; Lingual conservative micro-chamfer

Compound preparation design on 3.3: Vestibular 100° shoulder; Lingual conservative micro-chamfer

Dear friends,

I’m doctor Loris Prosper a dentist and a dental technician. I love our beautiful work since I started doing it, more than 45 years ago. My area of expertise is fixed prosthodontic in aesthetic area that, in my opinion, should respect biology, preserve teeth and soft tissue health and respond to minimal invasive criteria since we make irreversible procedure when we prepare the abutment. It is only a short while I’ve published the book :”Bioestetics  in the Oral Reabilitation “ Quintessence Publishing , that collects my expertise and my researches. Since the beginning of my practice my mission was to teach all the technical expertise and the tricks I’ve been acquiring through experience and mistakes.

Much contemporary literature mainly focuses on abstractions not linked to daily practice of either general either specialist dental practitioner.

The Classic 3-STEP Technique, a simplified protocol for ADDITIVE adhesive rehabilitations

The Classic 3-STEP Technique, a simplified protocol for ADDITIVE adhesive rehabilitations

Introduction

Patients affected by dental wear often are treated only when their dentation becomes extremely compromised.

However, when pathologies such as dental erosion, and/or parafunctional habits are not intercepted at an early stage, full mouth rehabilitations, mostly implementing crowns, are often considered. Thanks to improved adhesive techniques, the indications for crowns have decreased and a more conservative approach can be nowadays proposed to protect the remaining tooth structure.

The Conservative Restoration In Critical Areas

The Conservative Restoration In Critical Areas

 

A young patient presented to the Author with a traumatic coronal fracture of tooth 21, localized at cervical level at about 1 mm from the cementum-enamel junction.

A standardized periapical radiograph was taken and a careful treatment plan was designed. A multidisciplinary approach was chosen, based on endodontic treatment, temporary conservative restoration, orthodontic treatment and prosthetic rehabilitation of the tooth.

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Direct and indirect adhesive composite restorations of posterior regions: reconstructive and periodontal approach

Direct and indirect adhesive composite restorations of posterior regions: reconstructive and periodontal approach

The present case report describes the multidisciplinary treatment of a 25-year old male patient. A complex conservative rehabilitation of all the posterior regions was performed by means of adhesive composite restorations. All teeth were treated with direct restorations with the exception of one tooth that required the fabrication of an indirect restoration cemented with an adhesive luting agent.
It is worth pointing out that specific stratification techniques (horizontal, 4-increment, oblique) were employed according to the different cavity configurations (little, medium, wide, complex). Sometimes those techniques were combined with periodontal surgery in a one-step approach, using an original surgical technique proposed by the author (EJED 2010).
Moreover, the presented case report allows to discuss clinical procedures described in the literature, just like the preservation of cervical enamel not sufficiently supported and the coronal placement of restorative margins without enamel.

INTRODUCTION

In the last 15 years, the evolution of adhesive aesthetic materials dramatically modified the restorative approach in the posterior regions, leading to a more and more limited use of the traditional metal restorative materials. Nowadays, if correctly used, the available composite materials and enamel-dentin adhesive systems allow to guarantee very good long-term aesthetic and functional results, making aesthetic restorations almost invisible in both anterior and posterior regions.
The best advantages offered by resin based materials in comparison to traditional metal alloys regard the aesthetic appearance, the preservation of sound tooth structures and the possibility of reinforcing residual tooth structures. Nonetheless, problems regarding polymerization shrinkage and dentinal adhesion are still controversial.
Nowadays, the increased reliability of adhesive restorations in the posterior regions is mainly due to hybrid resin composites with mini-particles as well as to the last generation adhesive systems. Such materials are characterized by excellent physical-mechanical properties: in fact, they are densely filled, resistant and radiopaque, their elastic modulus is very similar to that of dentin, they are provided with very good surface characteristics and a wear resistance comparable to those of sound enamel and silver amalgam (10-15 micron/year). Consequently, these materials are indicated for all kinds of restorative cavities.
When a proper quantity of sound enamel is present on all cavity margins, direct adhesive restorations represent the first choice therapy in little and medium I and II class cavities. Different clinical procedures were proposed to compensate for shrinkage stress; the most reliable technique is the segmental stratification using pluri-stratified approaches. The incremental techniques vary according to the cavity type; the most validated are the horizontal, the oblique and the 4-increment technique. Conversely, the traditional three-sites procedure described by Lutz (1986) using transparent matrixes and reflective wedges is no longer used.
In the last decade, several studies showed very satisfactory results using direct adhesive techniques in wide cavities requiring cusp coverage as well.
Nonetheless, in the presence of wide and different cavities without two or more walls, with multiple cusp coverage and with absent or reduced cervical enamel, indirect adhesive restorations (inlays, onlays, overlays) cemented with luting agents should be considered as a viable treatment. Such restorations are stratified on a master model and complete polymerization is achieved in the dental laboratory before intraoral cementation. Consequently, indirect restorations allow to better control polymerization shrinkage, bypass the objective procedural difficulties aimed at restoring a correct morphology of the restoration due to the different steps of direct techniques and are provided with better physical-mechanical properties (better dimensional stability, increased toughness and wear resistance) thanks to post-polymerization procedures.

CASE REPORT

A 27-year old male patient with moderate caries propensity was treated. The patient presented with multiple primary and secondary decays on previous incongruous restorations; such decays were evident at both the clinical and radiographic examination by means of bite-wings.
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Some of these decays involved the subgingival part of the teeth.
The treatment plan aimed at establishing proper oral hygiene and periodontal conditions by means of scaling, root planing, polishing and hygienic motivation. Then, a complete aesthetic rehabilitation of all intraoral sites was planned using conservative direct and indirect adhesive restorations. Furthermore, a simultaneous periodontal surgical approach was planned to lengthen the clinical crowns of the teeth interested by subgingival lesions. The maxillary third molars were extracted due to their incongruous position, leading to a difficult achievement of a correct home hygienic maintenance; the extraction of such molars did not impair oral functions. Finally, the impacted right mandibular molar was extracted as well.
The orthodontic examination also evidenced a malocclusion but the patient did not accept to treat it.

Composites in dentistry

Composites in dentistry

 

Composite materials used in dentistry are made up of a fluid resin and a solid filler. The resin is made up of monomers (monomers are molecules). The solid filler is made up of glass, quartz and silicon particles. Taken alone the filler is like a fine-grained powder (silicon, quartz, glass particles powder) to the touch. Defining a composite material as macro-, micro- or nano- filled refers to the particle dimension (granulometry).

How much powder is mixed with how much resin?

The amount of filler in respect to the amount of resin is defined filler percentage. The “amount” referred to is the volume of filler and of resin. A filler percentage of 80% means that the amount of filler mixed with resin accounts for the 80% of the volume of resin alone.

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