Minimally Invasive Multidisciplinary Restorative Approach to the Esthetic Zone Including a Single Discolored Tooth

SUMMARY Objectives: The case report describes a minimally invasive, multidisciplinary approach to a single discolored anterior tooth, with internal bleaching using traditional Japanese paper (Washi), a gingivoplasty with a three-dimensional (3D) printed surgical guide, and ultrathin feldspathic porcelain veneers. Clinical consideration: The patient’s primary concern was improving her smile. After clinical evaluation, internal tooth bleaching for the discolored tooth and gingivoplasty with restoration of the maxillary anterior six teeth and first premolars was recommended. The internal tooth whitening was accomplished with sodium perborate mixed with 30% hydrogen peroxide impregnated in Washi and sealed in the root canal with glass ionomer. Once the tooth bleaching was completed, the 3D printed surgical guide was placed in the patient’s maxillary anterior region and used to guide soft tissue recontouring. After 6 months, ultrathin feldspathic porcelain veneers were placed. Conclusion: Well-planned restorative procedures combining internal tooth bleaching using Washi, gingivoplasty performed with electrosurgery using a 3D printed surgical guide, and ultrathin feldspathic porcelain veneers can achieve the desired results in the esthetic zone and remain successful for 4 years.

Shear Bond Strength of Veneered Zirconia Repaired Using Various Methods and Adhesive Systems: A Comparative Study

The aim of the present study was to investigate the shear bond strength of five different repair methods and adhesive systems for zirconia (Zr) cores layered with feldspathic porcelain. Seventy-five Zr specimens (10 × 10 × 4 mm3) were prepared, sintered, layered with 2 × 10 × 10 mm3 of feldspathic porcelain, and fired. The ceramic was fractured, and the load recorded using a shear-bond test. Specimens were thermocycled and randomly divided into 5 groups (n = 15/group) based on the repair methods. Composite repair blocks with similar dimensions to the layered ceramic (2 × 10 × 10 mm3) were built according to each repair method. Shear bond strength testing of the specimens with composite built up was carried out using a universal testing machine (Instron®5960, Massachusetts, USA). The shear bond strengths of the adhesive interface between repaired composite and the Zr were recorded for all the test groups. The fractured specimens’ surfaces were examined under a scanning electron microscope (Jeol, Musashino, Akishima, Tokyo, Japan) for evaluation of the type of failure and surface characteristics. Shear bond strength of the veneered ceramic bonded to the Zr for all the test groups was non-significant (ANOVA, p = 0.062). Shear bond strength after the repair revealed significant differences (ANOVA, p = 0.002). Group-C (13.79 ± 1.32) and Group-D (9.77 ± 4.77) showed the highest and lowest shear bond strength values, respectively. Paired Sample T-tests showed significantly lower values (p = 0.000) for the repaired (composite) Zr compared to the layered (ceramic) Zr. Multiple comparisons revealed differences (significant) between the shear bond strength of Group-D with Groups A (p = 0.010) and C (p = 0.003, Post Hoc Tukey test). The repair methods tested showed variations in their respective shear bond strengths. Complete ceramic/zirconia repair systems showed better bonding between the repaired composite and Zr core. The mean shear bond strength for the repaired fractured layered Zr showed acceptable outcomes in terms of clinical perspective, but was, however, unpredictable.

Restoring a fractured incisor of a teenager with partial veneer

Since trauma is a common incident that adolescents are faced with, the post-traumatic therapeutic solution presents a challenge for the clinicians .This case report demonstrates how a young patient with minimal extended fracture of incisor was rehabilitated with non-invasive adhesive restoration known as partial veneer or chip with Feld spathic porcelain. Those restorations fit into the anatomy and shape of the teeth perfectly and restore only the fractured part which integrates in tissue economy dynamic. Feldspathic porcelain is the material that best reproduces the characteristics of enamel, in terms of surface properties, modulus of elasticity, resistance to fracture and the reproduction of the optical properties of the dental structure, especially at minimal thickness. In this paper we describe the details of the treatment and the final result which was aesthetic and surpass the patient’s expectation.

Effects of Veneering Ceramic and Methods on Failure Load of Veneered Zirconia

Background: A variety of veneering options to zirconia frameworks are now available. The purpose of this study is to evaluate the effect of veneer materials, veneering methods, cement materials, and aging on the failure load of bilayered veneer zirconia. Material and methods: Zirconia bars (20 × 4 × 1 mm) were veneered to 2 mm total thickness (n = 10/group). Veneering method groups included: 1. Hand-layered feldsparthic porcelain (VM = Vita VM9, Vident) and fluorapatite glass–ceramic (CR = IPS e.max Ceram, IvoclarVivadent); 2. Pressed feldspathic porcelain (PM = Vita PM9, Vident) and fluorapatite glass–ceramic (ZP = IPS e.max ZirPress, IvoclarVivadent); 3. CAD-/CAM-milled feldspathic ceramic (TF = Vitablocs Triluxe Forte, Vident) and lithium-disilicate glass–ceramic (CAD = IPS e.max CAD, IvoclarVivadent). CAD/CAM veneers were either cemented with resin cements (P = Panavia21, KurarayDental), (R = RelyX Ultimate, 3M ESPE), (M = Multilink Automix, Ivoclar Vivadent) or fused with fusion glass–ceramic (C = CrystalConnect, IvoclarVivadent). A three-point bending test (15 mm span, zirconia on tension side) was performed on Instron universal testing machine (ISO 6872) recording load-to-failure (LTF) of first veneer cracks or catastrophic failure. For group VM, PM, TF-M, TF-C, CAD-M, CAD-C, ten more bars were prepared and aged with cyclic loading (100,000 cycles, 50% LTF) and thermocycling (2000 cycles) before testing. Data were analyzed by ANOVA, Tukey HSD post hoc tests, and t-test (α = 0.05). Zirconia veneered with IPS e.max CAD by fusing had significantly higher failure load compared with zirconia veneered with other veneering materials. (p ≤ 0.05). For cemented veneers, the cement type had a significant effect on the failure load of the veneer zirconia specimens. Specimens cemented with Panavia 21 had a lower resistance to loading than other cements. The aging experiment revealed a significant difference in failure load between non-aged and aged bars in groups VM and PM, but not in the groups with CAD-/CAM-milled veneers. In conclusion, veneer materials, veneering methods, and cement materials have a significant effect on the failure load of bilayered veneer zirconia. CAD-/CAM-milled veneer zirconia is not susceptible to aging performed in this study.

Digital smile design as a tool in the planning of porcelain laminate veneers restoration

ABSTRACT Digital smile design is an important tool for esthetic planning in dentistry as it facilitates ease of communication between professionals and patients. This clinical report has the objective of describing a clinical procedure involving digital smile design for the placement of porcelain laminate veneer restorations. The digital smile design included dental and facial analyzes. The smile curve was drawn and a dental ruler was used to delimitate the spaces between each tooth. An approximate simulation of the smile was generated using Adobe Photoshop software. For esthetic and functional evaluation of the digital plan was created a diagnostic waxing and mock-up. The laminate veneers were made with feldspathic porcelain. Digital smile design was essential for successful planning because it enabled better patient contact with the end result. This case demonstrates the importance of this tool in esthetic dentistry.