Clinical guidance and an evidence-based approach for restoration of worn dentition by direct composite resin

Evaluation of direct restorations for pit-and-fissure caries using stamp combined with single-shade composite resin technique: A 12-month follow-up in vivo study

OBJECTIVES

To evaluate the clinical performance of direct restorations for pit-and-fissure caries in molars using stamp combined with single-shade composite resin (S/SCR) technique, and assess the effect of the number of stamp pressing on the trueness of S/SCR technique.

METHODS

Twenty molars of fifteen patients with pit-and-fissure caries but with an intact or micro-cavitated occlusal morphology were restored using S/SCR technique and were randomly divided into single pressing group (n = 10) and double pressing group (n = 10). Intraoral scans were obtained before treatment (scan 1), after filling (scan 2) and after polishing (scan 3). Deviation distribution maps of pairwise fitting were created including comparison 1 (scan1/scan 2), comparison 2 (scan1/scan 3), and comparison 3 (scan2/scan 3) using Geomagic Control X software. Root mean square (RMS) values were calculated to evaluate the trueness of restorations. Clinical performances including esthetic, functional, and biological properties of all restorations were evaluated according to FDI criteria after a 12-month follow-up. Analysis of variance, independent-samples T test and Wilcoxon rank-sum test were used for statistical analysis (α=0.05).

RESULTS

RMS values for comparison 1, comparison 2, and comparison 3 were 0.1243 ± 0.0151, 0.0966 ± 0.0136, and 0.0605 ± 0.0137 mm in single pressing group, while 0.0831 ± 0.0140, 0.0741 ± 0.0107, and 0.0475 ± 0.0099 mm in double pressing group, respectively. RMS value of single pressing group was higher than that of double pressing group in the same comparison (p ≤ 0.001). No statistically significant differences were observed between the two groups regarding esthetic, functional and biological properties (p > 0.05). For all properties, all restorations scored within 3, with over 80% scoring 1.

CONCLUSION

S/SCR technique presents satisfying clinical performances for pit-and-fissure caries in molars after a 12-month follow-up. Besides, double pressing can improve the trueness of restorations compared to single pressing.

CLINICAL SIGNIFICANCE

S/SCR technique is efficient in direct composite resin restoration for pit-and-fissure caries, with satisfying esthetic, functional and biological properties after a 12-month follow-up. Significantly, double pressing improves the trueness of S/SCR technique, reducing the need for occlusion adjustment.

The Putty Index Technique for Anterior Tooth Fracture Restoration: A Case Report

Traumatic injuries of anterior teeth can seriously affect a person's smile, which contributes significantly to an individual's overall personality and sense of self. Hence, various efforts have been made over the years to develop techniques that enable clinicians to replicate the natural tooth anatomy while being practical enough to allow its use in clinical practice. The putty index technique helps to make significant progress in achieving such goals by forming a template against which composite material can be placed for restoration of various modalities - in this case, Ellis class I and II. The prepared index replicates the palatal anatomy of the wax build-up done on the patient's cast. This reduces the chair time while improving the predictability of the final restoration.

Time-and cost-effective 3-dimensional-printing workflow to rehabilitate worn dentitions: A clinical report

Current restorative methods of restoring worn or eroded dentition present drawbacks that may deter dentists or patients from pursuing complete mouth rehabilitation. A novel additive manufacturing approach using 3D printed definitive composite resin restorations is described as a less technique-sensitive and more cost-effective alternative. These restorations are straightforward to repair, modify, or replace.

Case Report: Case report: Rapidly progressing tooth wear dominated by intrinsic and extrinsic erosion

Tooth wear is multi-factorial presenting as a combination of abrasion, attrition, and erosion. This case report represents a case of combined tooth wear in a 46-year-old Indo-Trinidadian male, with a predominant erosive component with both the clinical signs and features of intrinsic and extrinsic erosion. This patient case is unique since the wear predominated by dental erosion has occurred rapidly evidenced by the physical clinical appearance of a lack of compensation and the upper left premolars and molars relatively unaffected by the overall effects of tooth wear. This lack of compensation, where opposing teeth have not supra-erupted to maintain inter-arch stability, and the maintenance of occlusal vertical dimension on the left due to the non-worn posterior maxillary teeth, provides the benefit of simplifying subsequent restorative management. The medical and diet history corroborates the diagnoses of intrinsic and extrinsic erosion respectively. Complications noted with rapid tooth wear, such as dentine sensitivity and pulpal necrosis are known sequelae of tooth wear however the patient presented in this case report shows a concomitant high caries experience and poor oral hygiene. Cases such as the one presented here require not only comprehensive dental management, utilizing a restorative approach but also medical referral for confirmation of a diagnosis and management of gastroesophageal reflux disease. Inherent to the management of this patient should be a multidisciplinary medical and dental approach, with confirmation and management of the cause of the intrinsic erosion as well as restorative dental management, together with dietary counseling to mitigate the effect of intrinsic and extrinsic sources of acid on dental hard tissue. A key lesson learned from this case is the importance of history and targeted questioning when trying to determine the cause of tooth wear dominated by intrinsic and extrinsic erosion.

Longevity of Anterior Composite Restorations for Localized Tooth Wear: A Scoping Review

(1) Objective: This scoping review evaluates composite restorations as a treatment modality for anterior tooth surface loss and investigates the longevity of the direct and indirect composites used herein. (2) Method: The search encompassed Medline, Embase, Web of Science, the Cochrane Library, and hand search utilizing the PICO framework. (3) Results: Eight studies were included in this review, comprising one randomized controlled trial, one retrospective, and six prospective studies. Some studies reported favorable outcomes for composite restorations in anterior teeth. Although not statistically significant, evidence supported the anterior composite as a viable short- to medium-term solution for managing tooth wear. Direct resin composites were deemed clinically and cost-effective when managing localized anterior tooth wear. However, limitations and inconsistencies in this scoping review limited definitive clinical recommendations. (4) Conclusions: Further research, including well-managed randomized controlled trials using standardized protocols and longer follow-up periods, is essential to reconfirm the long-term efficacies of anterior composite restorations when managing tooth wear. A robust research design and exacting protocols could facilitate more meaningful clinical conclusions.

Effect of Curing Modes on the Mechanical Properties of Commercial Dental Resin-Based Composites: Comparison between Different LEDs and Microwave Units

Resin-based composites (RBCs) have transformed restorative dentistry and its procedures. However, the characteristics of RBCs have been modified over the years to enhance the physical and chemical properties of the materials. This context raises the need for studies that evaluate whether the properties of the RBCs that are commercially available are clinically adequate with different curing modes. This study aimed to evaluate the mechanical behavior of commercial RBCs after undergoing different curing modes. Twenty-three RBCs of different classes were evaluated. For curing the specimens, a microwave (BMS45, Brastemp) (for 3 min at 450 W) and three LED units were used: an Emitter A Fit (Schuster (second generation)) (light-curing for 15 s with an irradiance of 1250 mW/cm2), VALO (Ultradent (third generation)) (light-curing for 15 s with an irradiance of 1100 mW/cm2), and Emitter Now Duo (Schuster (second generation)) (light-curing for 15 s with an irradiance of 1100 mW/cm2). A total of 670 RBC specimens of 8 mm in diameter and 1 mm in depth were obtained. Afterward, a biaxial flexure strength test was performed until the failure of the specimens, using a universal testing machine set at a speed of 0.5 mm/min. The same specimens were subjected to infrared spectroscopy for evaluating the degree of conversion. Tukey’s test was used for multiple comparisons at a significance level of 5%. The light-curing mode did not affect the flexure strength of the RBCs (p > 0.05), but the type and shade of RBCs did so (p < 0.05). In conclusion, the type of RBC directly interferes with the mechanical behavior of the material. However, the curing modes within the same RBC did not change the mechanical properties.

The dental demolition derby: bruxism and its impact - part 3: repair and reconstruction

Bruxism is a term that encompasses a range of presentations of rhythmic and repetitive muscular activity. For many, this is not a significant problem but for some, this behaviour leads to substantial impact and tissue damage that can be significant, compromising function and quality of life. This paper will review management methods for reconstructing the damaged dentition.

Reconstruction is complex. Interventions should be pragmatic and guidance is provided in a themed approach.

Interventions may be conformative or reconstructive. The grinding style should be identified to allow reconstruction to work with activity, not in conflict.

Preservation of tooth tissue is essential and direct placed bonded composite materials are biologically friendly, easily repaired, cheap and act as stress breakers.

Complex fixed restorative reconstruction and implant supported bridges are likely to have high failure rates and must be protected with occlusal splints. Reconstructions should be planned with maximum retrievability and removable options figure significantly in effective treatment plans.

Crown Reconstruction of Erosive Wear Using High-viscosity Glass Ionomer Cement: A Case Report

The aim of this clinical report is to present a possible alternative treatment, with 24-month follow-up, for restoring tooth loss due to extensive erosive tooth wear. A 21-year-old male patient, complaining of intense sensitivity in the maxillary posterior teeth, and presenting severe wear on maxillary premolar and molar teeth due to gastroesophageal reflux, sought care in the university clinics. The planned treatment was to refer for medical treatment and perform restorations with the high-viscosity glass ionomer cement Equia Forte (GC Corporation, Tokyo, Japan), aiming to restore the dental anatomy and to consequently decrease the pain symptomatology. A silicone guide, obtained from a diagnostic waxing, was used during the restorative approach considering the patient's occlusion. After all the clinical steps of the restorative technique, an occlusal adjustment of restorations was performed. During monthly recalls up to 24 months, the treatment was stable and in service. In addition, the patient reported no pain and improved chewing, leading to a better quality of life.

Minimally Invasive Rehabilitation of Posterior Erosive Tooth Wear: Two Case Reports of the One-Stage Dahl Approach

Rehabilitation of posterior erosive tooth wear can be especially challenging in the presence of substantial tooth structure loss and limited inter-occlusal space. This article describes two case reports illustrating a conservative approach using the one-step Dahl approach in the management of localized posterior erosive tooth wear. The occlusal surfaces of worn teeth in both cases were successfully restored using direct composite resin and gold onlay, respectively. The material was placed in supra-occlusion during the initial stage. This technique enables intrusion of affected worn teeth and the opposing counterpart. Eruption of the remaining dentition will occur after two to three months to re-establish a complete occlusal relationship. With proper treatment planning, the one-step Dahl approach offers a simpler and predictable positive outcome in restoring structurally compromised posterior worn teeth.

[Morphology accuracy evaluation of direct composite occlusal veneer using two types of modified stamp-technique]

OBJECTIVE

To evaluate the morphology accuracy of direct occlusal veneer using two types of modified stamp-technique, comparing the Results of two types of stamp and different composite resin.

METHODS

Model scanner was used to get the original data from the standard resin teeth in plastic model. Two types of stamps were made: solid silicon stamp and transparent silicon stamp. In the study, 54 resin tooth were randomly divided into 9 groups: Groups 1-8 were restored by direct composite resin, using general and bulk-filled composite resin in occlusal veneer (1 mm or 2 mm) with two types of stamp-technique (the solid silicon, and the transparent silicon), and the control group was restored by indirect way using CAD/CAM composite resin restoration by biocopy technique to mimic the original shape of the teeth. After the resin teeth were prepared for occlusal veneer, the direct and indirect composite resins were restored. After the restoration was finished, the data were obtained again by the same model scanner in the plastic model. 3D comparisons were made using the original and restoration data, the average difference and the root mean square of difference (RMS) were recoded from the software. The RMS of all the groups were analyzed using one way ANOVA (α=0.05).

RESULTS

The RMS of occlusal surface in solid silicon stamp group was (0.136±0.031) mm, in transparent silicon group was (0.130±0.024) mm, and in control group was (0.130±0.009) mm. There were no significant difference. While the RMS of buccal/lingual surface in solid silicon stamp group was the smallest [(0.135±0.020) mm, P < 0.05], and in transparent silicon group it was (0.147±0.021) mm, and control group (0.153±0.014) mm. The general composite resin using the two types of stamp had the largest occlusal RMS in 2 mm occlusal veneer, which were significantly larger than control group (P < 0.05).

CONCLUSION

The direct occlusal veneer using two types of modified "stamp-technique" had relatively good morphology accuracy. Direct occlusal veneer using bulk-filled composite resin made with two types of stamp technique had even more accurate morphology than using general composite resin. The solid silicon stamp had a better morphology accuracy in buccal/lingual surface than the transparent silicon stamp.

The Restoration of Severe Generalized Dental Erosive Wear using Direct Composite: A Case Report

Introduction:

This case report describes a conservative restorative approach in the management of severe generalized tooth wear.

Case report:

The male, aged 57 years, was mainly concerned with the poor appearance of his teeth with short and discolored upper incisors. History revealed that he suffered from gastric reflux for 25 years, for which he was prescribed Ranitidine and was advised to self-medicate with cider vinegar. Furthermore, he divulged that he ground his teeth at night and during the day and had a high intake of carbonated cola drinks. On examination, dentine was exposed in several areas, and to a significant extent, on the incisal aspects of the lower incisors, the palatal surfaces of the upper incisors, and the occlusal surfaces of the molars. Mandibular tori were present.

The primary diagnosis was erosive tooth wear with elements of attrition and abrasion. The intervention included dietary advice and restoration with direct composite resin at an increased occlusal vertical dimension of 1.5mm on the retruded axis. The patient reported no functional problems and was pleased with the aesthetic result.

Conclusion:

Vinegar is promoted to have health benefits, especially with respect to glucose response, but the dental implications are overlooked. This paper reviews the literature on vinegar as a medicament and considers its role as a co-factor for erosion in this case. The clinical steps used to restore the eroded dentition by direct composite are described. The use of this approach is a safe, conservative and successful treatment option without recourse to complex and biologically costly conventional alternatives. The application of direct composite in tooth wear cases meets the European consensus requirements.

Treatment of Tooth Wear Associated with Reduced Occlusal Vertical Dimension Using Direct Composite Restorations and a Removable Prosthesis

Tooth wear is increasing in prevalence within the United Kingdom. Treatment of tooth surface loss can be daunting for both the clinician and patient. However, use of additive resin composite restorations is a minimally invasive treatment modality. This case illustrates the treatment of tooth surface loss in both the maxillary and mandibular arches with direct composites restorations using putty indices generated from a diagnostic wax-up recorded in centric relation. The tooth surface loss had resulted in reduced restorative space on the right hand side. The restorative treatment involved increasing the anterior vertical dimension, enabling the provision of a cobalt-chrome partial denture. This case shows the restoration of form, function and aesthetics using a reorganised occlusal approach.

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.

Conservative Management of Dental Erosion in Adolescents with Medical Conditions

The prevalence of dental erosion among children and adolescents is trending higher in recent decades and is becoming a major concern. Dental erosion can be caused by either extrinsic or intrinsic acids or both. One of the established aetiological factors for dental erosion by intrinsic acid is the gastrooesophageal reflux disease. The degree of dental erosions may be influenced by any medical conditions that cause a reduction in salivary flow such as the salivary gland excision, autoimmune disease, radiation to the head and neck regions, and medications. If left untreated, the dental erosion can cause dentine hypersensitivity, loss of occlusal vertical height, and aesthetic problems. For effective management of dental erosion, the aetiology of each case must be determined, and its detection at an early stage is of prime importance. This case report illustrates the conservative management of dental erosion in two adolescent patients presented with their medical conditions and behaviour issues. The aim of the treatments was to preserve the vitality of the affected teeth. The treatments were successfully completed using a conservative approach, with the patients' medical conditions taken into consideration.

Four-Year Follow-up of Increased Vertical Dimension of Occlusion using Resin Composites

The objectives of this case report were to treat a severe loss of the vertical dimension of occlusion with indirect composite and to evaluate the durability of the restorations. A 55-year-old male complains from severe wear of teeth, leading to a change in normal occlusal plane. Two major treatment modalities were proposed to this patient; a conventional invasive crown placement with root canal treatments or a minimally invasive approach relying on adhesion. The latter was adopted and used to treat this patient. This paper describes a step-by-step approach of the different treatment phases starting with teeth preparation, then provisional prostheses, and ending with the placement of indirect anterior veneers and posterior onlays, all made with laboratory resin composite. Satisfactory clinical results were observed over the 4-year follow-up, with minimum failures limited to one partial fracture of inlay treated with direct adhesive repair.