Introducing the concept of pragmatic esthetics, with special reference to the treatment of tooth wear

Composite Injection Technique With a Digital Workflow: A Pragmatic Approach for a Protruding Central Incisor Restoration

Esthetic concerns frequently drive individuals to seek dental treatment, leading to a rising demand for minimally invasive and time-efficient procedures. The Minimal Intervention Dentistry (MID) concept, which employs dental adhesive and resin composites, offers an effective approach for enhancing esthetics while preserving natural tooth structure. This case report outlines the esthetic enhancement of a protruding maxillary right central incisor through a direct composite restoration approach, utilizing a composite injection technique with a digital workflow. A 42-year-old male patient presented with a discolored and protruding maxillary right central incisor. After declining orthodontic treatment due to time and cost constraints, the patient opted for an alternative approach. A digital wax-up was 3D printed to create a clear silicone index, enabling precise resin composite injection to achieve the desired esthetic outcome. After internal bleaching and minimal labial surface reduction, a flowable resin composite was applied freehand to the mesial-proximal surface using a curved plastic matrix manufactured universally. The composite injection technique was subsequently employed through the incisal opening of the clear silicone index to shape the labial surface and incisal edge. In order to address insufficient tooth reduction, an additional partial labial resin composite cutback was performed, ensuring minimal reduction while enhancing esthetics. This direct composite veneer restoration, combining conventional proximal surface creation with a composite injection technique utilizing a custom-made clear silicone index prepared via a digital workflow, emerged as a pragmatic solution in a case where orthodontic treatment was not preferred. Moreover, in situations of insufficient dentin preparation, additional cutback preparation and composite placement can enhance color matching with minimal reduction. The direct composite restoration, facilitated by the composite injection technique and digital workflow, effectively rectified the inclination of the protruding maxillary central incisor, highlighting the potential of this approach in addressing esthetic dental concerns. The research and clinical technique presented in this case report hold clinical importance by offering a minimally invasive and practical alternative to orthodontic treatment and conventional restorations for patients with esthetic concerns. The composite injection technique with a digital workflow preserves natural tooth structure, reduces chair time, and enhances esthetic outcomes. This approach is particularly relevant to esthetic dentistry as it addresses anterior dental malalignment and discolored teeth while prioritizing patient satisfaction and individualized care, aligning with the principles of pragmatic esthetics and MID. The potential for long-term durability and patient satisfaction makes it a valuable addition to esthetic dental practice.

Compressive strength evaluation of thin occlusal veneers from different CAD/CAM materials, before and after acidic saliva exposure

In the present study are depicted valuable observations for practitioners, obtained from an in vitro study which aims to evaluate the compressive strength of occlusal veneers fabricated from 3 type of restorative materials, before and after 1 month of acidic artificial saliva exposure (pH = 2.939). In this context, 90 extracted human molars were prepared to receive computer-aided design/computer-aided manufacturing (CAD/CAM) occlusal veneers. The restorative materials considered in this study were: Cerasmart; Straumann Nice and Tetric CAD. The occlusal veneers were designed, milled and cemented with an adhesive dual-cure resin cement. From all the extracted human molars, only sixty specimens were immersed in acidic artificial saliva, for 1 month, at 37 °C ± 1 °C and part of this specimens were also thermo-cycled, between 5 and 55 °C ± 2 °C, before compressive strength test. The results showed a lower compressive strength for both the samples exposed to acidic artificial saliva as well as for the samples exposed to acidic artificial saliva and thermo-cycled. Scanning electron microscopy (SEM) showed that after compressive strength, all the specimens non-exposed to acidic artificial saliva, present extensive cracks formation at the surface of the restorations, and after exposure to acidic artificial saliva for 1 month, the surface damage was characterized by longitudinal and profound fractures of the restoration, as well as the fracture of the tooth structure. Between CAD/CAM materials tested, nanoceramic resin shows more favorable fracture patterns, both before and after acidic artificial saliva exposure.

McNamara's Fallacies in Dentistry. 2: Tooth Surface Loss Fallacies

Given the number of perceived myths and fallacies in relation to tooth substance loss, this article seeks to address these using a wide variety of clinical cases as examples and by way of scientific references.

CPD/Clinical Relevance: The incidence of tooth wear is increasing, so an understanding of the myths and truths surrounding its treatment is valuable.

Information for patients undergoing treatment for toothwear with resin composite restorations placed at an increased occlusal vertical dimension

Toothwear is affecting increasing numbers of the population. In the past, treatment of patients whose teeth were affected by toothwear often involved the reduction of these teeth for crowns; a severe form of toothwear. Contemporary management of such cases is by the bonding of resin composite restorations to the worn and wearing surfaces, with these restorations being placed at an increased occlusal vertical dimension. The advantage of the technique is its minimal- or non-intervention nature and its high reported degree of patient satisfaction. There are, however, short-term disadvantages to the technique, such as the potential for lisping, pain from the teeth which will be subject to axial orthodontic tooth movement, and difficulty in chewing on the posterior teeth if these are discluded. It is therefore important, as with any treatment, that the advantages and disadvantages are fully explained to the patient. This paper therefore describes the clinical technique and presents a Patient Information Leaflet that the author has used for over five years.

CLINICAL RELEVANCE

Patients should be advised regarding the disadvantages and advantages of any technique.

Dental erosion and its growing importance in clinical practice: from past to present

Since the mid-1990s, the focus of studies on tooth wear has steadily shifted from the general condition towards the more specific area of dental erosion; equally, a shift has occurred from studies in adults to those in children and adolescents. During this time, understanding of the condition has increased greatly. This paper attempts to provide a critical overview of the development of this body of knowledge, from earlier perceptions to the present. It is accepted that dental erosion has a multifactorial background, in which individual and lifestyle factors have great significance. Notwithstanding methodological differences across studies, data from many countries confirm that dental erosion is common in children and young people, and that, when present, it progresses rapidly. That the condition, and its ramifications, warrants serious consideration in clinical dentistry, is clear. It is important for the oral healthcare team to be able to recognize its early signs and symptoms and to understand its pathogenesis. Preventive strategies are essential ingredients in the management of patients with dental erosion. When necessary, treatment aimed at correcting or improving its effects might best be of a minimally invasive nature. Still, there remains a need for further research to forge better understanding of the subject.

Tooth surface loss: tools and tips for management

Tooth surface loss is becoming increasingly prevalent. Many cases can be managed with preventive measures, although there remain a number of patients for whom restorative intervention is indicated. Traditional treatment modalities have entailed extensive 'full-mouth' indirect restoration, although this approach has a number of disadvantages. Contemporary restorative techniques allow for a broader range of treatment options: this paper presents an overview of common issues and clinical techniques to overcome these.

CLINICAL RELEVANCE

Treatment options and guidance for managing patients who present with tooth surface loss.