Clinical outcomes of minimally invasive ceramic restorations executed by dentists with different levels of experience. Blind and prospective clinical study

Freehand vs. depth-gauge rotary instruments for veneer preparation: A controlled randomized simulator study

PURPOSE

To investigate whether depth-gauge burs in veneer preparations influence preparation depth in a randomized, controlled, single-blinded trial and whether inexperienced operators can perform adequate veneer preparations.

METHODS

Participants were 20 undergraduate dental students with no prior veneer preparation experience. The instruments used were the "Laminate Veneer System" (LVS), "Keramik-Veneers. de" (KVD), and a "Freehand" group (FH) for reference. All participants prepared three educational acrylic resin maxillae and three mandibular central incisors mounted in typodonts in patient simulators. The objectives were to achieve a preparation depth of 0.6 mm (tooth 11) and 0.4 mm (tooth 31). The sequences of the instruments used and prepared teeth were randomized. The measurements were performed using a laser triangulation coordinate-measuring machine. The data were stratified according to tooth location.

RESULTS

The preparation depths of both depth-gauge-instrument-groups LVS and KVD achieved the objectives significantly better than did the instruments from the "Freehand" group (P < 0.001). The differences between the depth gauge groups were insignificant, although the maximum preparation depths were smaller in the KVD group. Regarding the prepared teeth, the preparation depths in the mandibular incisors were lower, and the differences were smaller.

CONCLUSIONS

The use of special depth-gauge burs for initial veneer preparation leads to significantly lower preparation depths than "Freehand" preparations. The tapered instruments resulted in a lower incidence of extreme preparation depths. The inexperienced operators performed veneer preparation remarkably well.

Research Progress and Clinical Application of All-Ceramic Micro-Veneer

Anterior teeth problems affect the patient's daily eating, communication, social activities, self-confidence, and mental health. The trend in dentistry is to address anterior tooth problems with minimally invasive and aesthetic treatments. With the development of adhesive materials and ceramics, micro-veneers have been proposed as an alternative treatment for enhancing the aesthetic appearance and avoiding unnecessary tooth reduction. A micro-veneer is a veneer that can be cemented to the surface without or with minimal tooth preparation. These benefits include no need for anesthesia, postoperative insensitivity, good adhesion to enamel, reversibility of treatment, and higher patient acceptance. However, the micro-veneer repair is suitable only for specific cases and must be strictly controlled regarding indication. Treatment planning is a crucial step to achieving functional and aesthetic rehabilitation, and following the clinical protocol is helpful for the longevity and success of micro-veneer restorations. However, more precise and predictable tooth preparation methods, such as minimally invasive microscopic tooth preparation and digitally guided veneer preparation, are recommended rather than the traditional free-hand method. Therefore, this paper clarifies micro-veneers and compares them with other restorations to gain a deeper and more comprehensive understanding. The authors also review indications, materials, cementation, and effect evaluation of micro-veneers to provide clinicians with valuable information. In conclusion, micro-veneers are minimally invasive treatments that provide good restoration results when used appropriately and are worthy of promotion for the aesthetic restoration of anterior teeth.

Effect of Cement Layer Thickness on the Immediate and Long-Term Bond Strength and Residual Stress between Lithium Disilicate Glass-Ceramic and Human Dentin

This study tested whether three different cement layer thicknesses (60, 120 and 180 μm) would provide the same bonding capacity between adhesively luted lithium disilicate and human dentin. Ceramic blocks were cut to 20 blocks with a low-speed diamond saw under cooling water and were then cemented to human flat dentin with an adhesive protocol. The assembly was sectioned into 1 mm² cross-section beams composed of ceramic/cement/dentin. Cement layer thickness was measured, and three groups were formed. Half of the samples were immediately tested to evaluate the short-term bond strength and the other half were submitted to an aging simulation. The microtensile test was performed in a universal testing machine, and the bond strength (MPa) was calculated. The fractured specimens were examined under stereomicroscopy. Applying the finite element method, the residual stress of polymerization shrinkage according to cement layer thickness was also calculated using first principal stress as analysis criteria. Kruskal–Wallis tests showed that the ‘‘cement layer thickness’’ factor significantly influenced the bond strength results for the aged samples (p = 0.028); however, no statistically significant difference was found between the immediately tested groups (p = 0.569). The higher the cement layer thickness, the higher the residual stress generated at the adhesive interface due to cement polymerization shrinkage. In conclusion, the cement layer thickness does not affect the immediate bond strength in lithium disilicate restorations; however, thinner cement layers are most stable in the short term, showing constant bond strength and lower residual stress.