Q U I N T E S S E N C E I N T E R N AT I O N A L
CAD/CAM-generated high-density polymer restorations for the pretreatment of complex cases: A case report Daniel Edelhoff, Prof Dr Med Dent, CDT1'MPSJBO#FVFS 1SJW%P[%S.FE%FOU2/ Josef Schweiger, CDT30MJWFS#SJY $%54/Michael Stimmelmayr, Dr Med Dent2/ Jan-Frederik Güth, Dr Med Dent2
Complex rehabilitations represent a particular challenge for the restorative team, especially if the vertical dimension of occlusion (VDO) needs to be reconstructed or redefined. The use of provisional acrylic or composite materials allows clinicians to evaluate the treatment objective over a certain period of time and therefore generates a high predictability of the definitive rehabilitation in terms of esthetics and function. CAD/CAM technology enables the use of prefabricated polymer materials, which are fabricated under industrial conditions to form a highly homogeneous structure compared with those of direct fabrication. This increases long-term stability, biocompatibility, and resistance to wear. Furthermore, they offer more suitable CAD/CAM processing characteristics and can be used in thinner thicknesses than ceramic restorative materials. Also, based on the improved long-term stability, the transfer into the definitive restoration can be divided into multiple treatment steps. This article presents different clinical cases with minimally invasive indications for CAD/CAM-fabricated temporary restorations for the pretreatment of complex cases. (Quintessence Int 2012;43:457–467)
Key words: CAD/CAM manufacturing, complex rehabilitations, esthetic evaluation, functional evaluation, high-density polymers, provisional restorations, vertical dimension of occlusion
CAD/CAM (computer-aided design/com-
objective. Therefore, it is an important com-
puter-assisted
ponent in a complex treatment strategy.
manufacturer)-fabricated
high-density polymer restorations have the
The use of provisional restorations rep-
potential to offer a noninvasive temporary
resents an essential stage in the course
diagnostic tool to reconstruct an adequate
of indirect restorative and interdisciplinary
vertical dimension of occlusion (VDO) in
treatment strategies. They are normally used
situations of severe tooth wear. An expe-
to protect the prepared tooth structure and
ditious approach offers the possibility to
pulp and stabilize the teeth. In addition, they
restore patients in a relatively short period
play an indispensable role in preserving or
of time with adhesively luted provisional
reestablishing masticatory function, phonet-
restorations, which represent the treatment
ics, and esthetic appearance. According to the fabrication technique, provisional resto-
1
Tenured Associate Professor, Department of Prosthodontics, Dental School of the Ludwig-Maximilians-University Munich,
2
3
Associate Professor, Department of Prosthodontics, Dental
nique), and indirect restorations. The recom-
School of the Ludwig-Maximilians-University Munich, Munich,
mended wear time of individual provisional
Germany.
restorations varies and depends on the dif-
Head of Laboratory, Department of Prosthodontics, Dental
ferences in material properties achieved by
School of the Ludwig-Maximilians-University Munich, Munich,
the various fabrication techniques. Generally,
Germany. 4
rations are divided into direct, indirect-direct (known as the eggshell or veneering tech-
Munich, Germany.
a wear time between 1 and 3 months is
CDT, Innovative Dental-Design, Wiesbaden, Germany.
Correspondence:
Prof
Dr
Med
Dent
Daniel
Edelhoff,
Department of Prosthodontics, Dental School of the LudwigMaximilians-University, Goethestrasse 70, 80336 Munich, Germany. Email:
[email protected]
VOLUME 43 t /6.#&36 t +6/& 2012
recommended for provisional restorations fabricated with the direct technique, up to 6 months for the veneering technique, and up to 2 years for the indirect technique.
457
Q U I N T E S S E N C E I N T E R N AT I O N A L E d e l h o ff e t a l
Table 1
Overview of high-density polymers for CAD/CAM manufacturing
Trade Name
Manufacturer
Indication
Ambarino High-class
Creamed Creative Medizintechnik
Definitive single-tooth restorations and FDPs, telescopic protheses, tertiary structures, fully/partially anatomically milled restorations, milled emergence profiles, implant superstructures and abutments
BSU#MPD5FNQ
Merz Dental
Long-term provisionalization of crowns, partial crowns, and FDPs, immediate implant restorations
Artegral imCrown
Merz Dental
Long-term provisionalization of single crowns in the anterior region
CAD-Temp
Vita Zahnfabrik
Single- and multiunit, fully and partially long-term provisional restorations with up to 2 pontics
cara PMMA prov
Heraeus Kulzer
Tooth-colored PMMA for the CAD/CAM manufacturing of provisional crowns and fixed partial dentures
Cercon base PMMA
Degudent
Provisional crowns and multiunit FDP with up to 16 units (with one pontic between the abutment teeth) for a period of clinical service of up to 6 mo
Everest C-Temp
KaVo
Frameworks for provisional FDPs with veneering and with a span up to 60 mm
/FX0VUMJOF$"5
Anax Dent
Provisional single and FDP frameworks up to 2 pontics, for a period of clinical service of 3 to 12 months, relinable
Organic Composit
3 ,$"%$". Technologie
Approved for definitive restorations of up to 3 units
Paradigm MZ 100 (available only in the USA)
3M ESPE
Final inlays, onlays, veneers, and single crowns
Polycon ae
Straumann CAD/CAM
Long-term provisional restorations, crowns, and FDPs with 1 pontic in the anterior and posterior region
Telio CAD
Ivoclar Vivadent
Long-term provisional restorations, from single-tooth restorations up to 4-unit FDPs including restorations on implants
Zenotec Pro Fix
8JFMBOE%FOUBM
Long-term provisional restorations, fully anatomical crowns and FDPs up to two pontics in the anterior and posterior region
FDP, fixed dental prosthesis; CAD/CAM, computer-aided design/computer-assisted manufacture; bis-GMA, bisphenol glycidyl methacrylate; 1.." QPMZNFUIZMNFUIBDSZMBUF0.1 PSHBOJDNPEJGJFEQPMZNFS*1/ JOUFSQFOFUSBUFEOFUXPSLQPMZNFS.31 NJDSPGJMMFSSFJOGPSDFEQPMZBDSZMJD TEGDMA, triethylene glycol dimethacrylate.
Various polymer systems are suitable
Hence, for a prolonged period of clinical
for the fabrication of direct provisional res-
application, indirect provisional restorations
torations: Powder-liquid systems based on
are usually fabricated in the dental labora-
monomethacrylate (MMA) and polymethyl
tory. In particular, when used as long-term
methacrylate (PMMA), paste-paste systems
fixed dental prostheses (FDPs), they need a
based
metal alloy or glass fiber–reinforced frame-
on
difunctional
or
multifunctional
methacrylate (eg, bis-GMA [bisphenol glycidyl methacrylate], TEGDMA [triethylene gly-
work to increase their load capability. Currently,
many
manufacturers
offer
col dimethacrylate], and UDMA [urethane
high-density polymers based on highly
dimethacrylate]), and preformed light-curing
cross-linked PMMA acrylic resins or com-
composite restorations (eg, Protemp Crown,
posites for CAD/CAM manufacturing meth-
3M ESPE). Due to unfavorable conditions
ods (Table 1). Since they are manufactured
under which they are polymerized and fab-
in an industrial process, provisional res-
ricated, direct provisional restorations are
torations made of high-density polymer
prone to inhomogeneities, pores, and cracks,
exhibit qualities superior to those of direct
which may lead to premature discoloration,
restorations.3–5
bacterial ingress, and a significant decrease
treatment options such as an extended pre-
in long-term stability and biocompatibility.1,2
liminary treatment phase.
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This offers numerous new
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Description
CAD/CAM system
Highly crosslinked polymer blends (bis-GMA, urethane methacrylate, butanediol dimethacrylate, 70.1 wt%, ceramic-type anorganic silicate glass fillers)
Micron 400 (Micron), M7 Dental (Datron), All systems with circular blank automation holder and corresponding templates
Ingot made of highly crosslinked, interpenetrated PMMA (or OMP networks)
Cerec (Sirona)
Semifinished blanks made of unfilled PMMA material with highly crosslinked NBDSPNPMFDVMBSTUSVDUVSF PS*1/T
Cerec (Sirona)
High-molecular, cross-linked acrylic polymer containing 14 wt%, microfillers PS.31
Cerec (Sirona), Everest (KaVo)
PMMA and crosslinked copolymers of the methacrylic acid
cara (Heraeus)
PMMA and crosslinked copolymers of the methacrylic acid
Cercon System (Degudent)
Glass fiber–reinforced high-density polymer as framework material
Everest (KaVo)
PMMA and copolymers of methacrylate, n-alkyl methacrylate, and pigments
0SHBOJDBM 3àCFMJOH,MBS
0QFO;FOP 8JFMBOE
1,4 butanediol dimethacrylate urethane dimethacrylate bis-GMA
0SHBOJDBM 3àCFMJOH,MBS
Polymer consisting of bis-GMA and TEGDMA matrix with 85 wt% zirconium oxide microfillers
Cerec 3 (Sirona), E4D (DVD)
1.."CBTFEBDSZMBUFSFTJOXJUI*1/
Straumann CAD/CAM
99.5% PMMA polymer
1SPDFSB /PCFM#JPDBSF
$FSFD 4JSPOB
Fiber-free, homogenous, methacrylate-based acrylomer
"MM;FOPUFD 8JFMBOE
Using these modifiable provisional res-
smile line. Further on, the provisional resto-
torations over an extended period of time,
ration plays an essential role in the commu-
the patient and restorative team can clini-
nication among the patient, clinician, and
cally evaluate the restorative blueprint with
dental technician during treatment. 6
regard to its esthetics, masticatory function, and phonetics.6 In situations in which a new VDO has to be defined using occlusal splints, it is a challenge to transfer the new VDO into a longterm provisionalization using a minimally
MINIMALLY INVASIVE AND NONINVASIVE OCCLUSAL ONLAYS
invasive or noninvasive method. Moreover, prolonged preliminary treatment phases are indispensable if extensive modifications of
In the future, the number of patients with
shape, shade, and position in the esthetic
severe loss of tooth structure will increase.
anterior region are implemented, because
One reason for this increase is a demo-
essential factors such as lip position and
graphic change, with older people making
dynamics cannot be sufficiently assessed
up an increasing proportion of the popula-
in the dental laboratory to determine the
tion. Due to heightened health awareness
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Fig 1 Case 1. Preoperative view. The esthetic appearance of the maxillary anterior region has been severely compromised by generalized defects caused by abrasive and erosive processes and traumatic injuries.
and improved dental care, people will main-
thin as 0.3 mm, their material properties
tain a healthy natural dentition for longer.7
seem to be favorable for these minimally
This means that natural teeth are exposed
invasive or noninvasive restorations such
to masticatory stresses for longer periods
as provisional veneers and onlays. These
of time, which leads to an increase in the
restorations can be manufactured consider-
functional wear of the natural dentition.8 The
ably thinner than the natural enamel layer,
physiologic wear occurring from frictional
which usually exhibits a thickness of more
contact between opposing teeth is called
than 1 mm. They can be placed using an
attrition. This continuous loss of tooth struc-
adhesive luting technique. Consequently,
ture may be accelerated by extrinsic factors
these measures help to save substantial
such as parafunctional stresses (malocclu-
amounts of tooth structure.
sion or bruxism) and chemical processes (acids).9 Such aggravating processes may prematurely lead to substantial esthetic and
CASE PRESENTATIONS
functional problems. Exogenic factors such as an increased consumption
of
acidic
beverages
and
Case 1
foods and endogenic factors such as buli-
A 29-year-old man requested treatment of
mia and gastroesophageal reflux represent
his extensive tooth defects. He reported
key factors causing erosion-induced loss of
increasing sensitivity to chemical and ther-
tooth structure in young patients. Increasing
mal stimuli and complained about the con-
numbers of young people, including chil-
siderable esthetic impairment created by
dren, are affected by this problem.10 In
the appearance of his teeth (Fig 1). After a
these cases, the attrition proceeds to the
review of the patient’s medical history and an
underlying dentin, and the wear processes
evaluation of the clinical findings, abrasive
might dramatically accelerate, which can
and erosive processes were identified as the
cause a substantial loss of the VDO. In
causative factors for the generalized loss of
the longer term, these changes will have
tooth structure. These processes were asso-
adverse effects on phonetics, masticatory
ciated with the patient’s grinding of teeth
function, esthetic appearance, and the neu-
during extreme sports activities and frequent
romuscular system of the patient.11 After the
consumption of acidic beverages. In addi-
causative factors of the wear have been
tion, sports-related traumatic incidents con-
redressed, restorative treatments should
tributed to the extensive defects. As a result
be initiated as soon as possible. Timely
of dental injuries, the proportions of the teeth
intervention is also advisable to ensure
had been severely affected (Figs 2 and 3).
that appropriate portions of enamel remain
The particular challenges of this com-
available for reliable adhesive cementation.
plex rehabilitation were reconstructing the
The reconstruction of the VDO often creates
VDO,
sufficient space to place thin-walled resto-
and esthetics, and satisfying the patient’s
rations. Since high-density polymer restora-
request for an immediate improvement of
tions can be fabricated in thicknesses as
the clinical situation.
460
establishing
appropriate
function
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Fig 2 Case 1. Preoperative view. The existing defects have also caused functional impairment due to the loss of anterior canine guidance.
Fig 3
Case 1. Initial findings. Severe loss of tooth structure, with functional and esthetic impairments.
Treatment planning. First, the lost tooth
1. Fabrication of an analytic wax-up for
structure should be replaced by high-den-
the reconstruction of a functionally and
sity polymer restorations in an additive
esthetically adequate tooth morphology
approach. The objective of this step was
and predefinition of the reconstructed
to achieve an immediate amelioration of
VDO.
the patient’s situation while sacrificing as
2. Intraoral esthetic evaluation of the wax-
little tooth structure as possible. For further
up with the help of a diagnostic template,
treatment planning, alginate impressions,
which was filled with a bis-GMA–based
a registration in centric relation, and an
direct provisional material and seated
arbitrary facebow registration were con-
on the isolated preexisting tooth struc-
ducted. Additionally, portrait photographs were taken to provide the dental technician information about the initial situation. 8JUI UIF QBUJFOUT JOQVU UIF SFTUPSBUJWF team decided to restore the severely dam-
ture (mock-up/esthetic try-in). 3. 3FQMBDFNFOUPGUIFJOTVGGJDJFOUGJMMJOHTGPMlowed by immediate dentin sealing (IDS) and slight beveling of the enamel areas in the maxillary anterior teeth (Fig 4).
aged dentition with noninvasive provisional
4. Transfer of the defined VDO into an
veneers and onlays made from high-den-
occlusal splint for a 12-week functional
sity PMMA and to bond these restorations
evaluation phase.
adhesively to the damaged tooth structure.
5. Precision impressions of both arches
To establish the reconstructed VDO, the
and bite registration according to the
treatment team decided on the following
successfully clinically proved occlusal
course of eight treatment steps:
splint position. For the transfer of the
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Fig 4 Case 1. Adhesive sealing. Adhesive sealing of the exposed dentin areas in the pulp region of the maxillary anterior region using a multistep adhesive and low- and high-viscosity composite.
Fig 5 Case 1. Transfer of VDO by separated splint. The occlusal splint was separated in half to transfer the reconstructed VDO. A corresponding bite registration was conducted related to each part of the splint, which was joined together again at the end of the session. Fig 6 Case 1. Provisional restorations after the milling process. Unfilled PMMA-based high-density polymer block (Telio CAD) with occlusal onlays immediately after the CAD/CAM milling process in an inLab MC XL milling unit.
reconstructed VDO, the occlusal splint
provisionals were designed identically
was halved, and a corresponding bite
to the shape of the digitized analytic wax-
registration was conducted related to
up. The provisional restorations were
each part of the splint. The splint would
CAD/CAM fabricated from PMMA-based
be joined together at the end of this ses-
high-density polymer blocks (Telio CAD,
sion (Fig 5).
Ivoclar Vivadent) (see Table 1) utilizing a
6. Digitization of the wax-up, design, and CAD/CAM fabrication. The veneer-shaped
462
three-axis milling unit (Cerec inLab MC XL system, Sirona) (Fig 6).
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Fig 7 Case 1. Conditioning of teeth. Conditioning of composite areas on the abutment teeth with an intraoral silicoating device (CoJet, 3M ESPE). A transparent template was placed over the neighboring structures to protect them during air abrasion, while the surfaces in need of conditioning remained uncovered.
Fig 8 Case 1. Maxilla before and after treatment. Pre- and postoperative occlusal view of the maxilla. The provisional high-density polymer restorations were placed with the adhesive technique.
7. Adhesive
placement.
For
the
inser-
nique (Fig 7). Figure 8 displays the intra-
light-curing
oral situation before and after placement.
resin cement (Variolink Veneer, Ivoclar
8. Clinical evaluation of the provisional res-
Vivadent) in the same shade of the try-
torations (at least for 12 months) with the
in paste was used. The inner surfaces
option of modification.
tion
of
the
provisionals,
of the restorations and the composite buildups on the maxillary anterior teeth
#Z HFOFSBUJOH BO FYUFOEFE QSPWJTJPOBM
XFSF TJMJDPBUFE 3PDBUFD 4PGU N
treatment phase with additive restorations, it
3M ESPE) (nozzle-to-surface distance,
was possible to evaluate the reconstruction
10 mm; pressure, 1 bar [14.5 psi]; air
of the VDO for at least 12 months without bio-
abrasion time per unit, 5 seconds), and
logic costs. This offers a high predictability of
a silane agent was applied. The tooth
the outcome of the extensive definitive resto-
structure was conditioned with a multi-
ration. The esthetic and functional require-
step dentin adhesive (Syntac Classic,
ments of the patient could be accomplished
Ivoclar Vivadent) using a total-etch tech-
in a brief treatment period of only 4 months
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Fig 9 Case 1. Placed provisional restorations. Palatal view after adhesive cementation of the provisional occlusal veneers and onlays. By increasing the VDO, the traumatic anterior contacts were eliminated, and the teeth were restored to their correct proportions.
Fig 10 Case 1. Placed provisional restorations. The anterior restorations exhibit a minimum thickness of only 0.3 mm and are not veneered. Nonetheless, they blend in with the surrounding dentition, ensuring a pleasing esthetic appearance.
Fig 11 Case 1. Clinical result. Reconstruction of the VDO by provisional restorations including dynamic occlusion with anterior and canine guidance.
using a virtually noninvasive approach. The
rations can be carried out, also segment by
outcome met with the complete satisfaction
segment. If necessary, the adhesively luted
of the patient (Figs 9 to 11).
temporary material may be used as build-
Further treatment and transfer of the pro-
ups in the subsequent preparation for the
visionals to lithium-disilicate-ceramic resto-
definitive restorations.
464
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Fig 12 Case 2. Initial situation. Missing mandibular first molar. The generalized destruction of the tooth structure has resulted in a loss of vertical dimension and functional impairment.
Fig 13 Case 2. Individual abutment. Situation after implantation and insertion of a CAD/CAM-manufactured zirconium dioxide ceramic abutment with a titanium component.
Case 2 #JPUFDIOPMPHJFT EJBNFUFS NN MFOHUI A 28-year-old man was referred with the
11 mm) was inserted in the region of the
request to have his severe tooth defects
missing mandibular right first molar with the
and edentulous gap in the region of the
help of an implant template created from
mandibular right first molar restored with
the analytic wax-up. After a 3-month heal-
tooth-colored restorations. Initial findings
ing phase, impressions of both arches were
revealed generalized defects caused by
taken using a polyether impression material
abrasive and erosive processes (Fig 12),
(Impregum/Permadyne blue, 3M ESPE).
which necessitated a reconstruction of the
Fabrication and insertion of provisional restorations. The implant was supplied
VDO. Treatment planning. After identification
with a zirconium dioxide ceramic abutment
and elimination of the reason for the erosive
(inCoris ZI meso, Sirona) using the Sirona
destruction and the evaluation of alternative
CAD/CAM system (inLab MC XL) with an
treatment options, the patient and restor-
adhesive titanium base (Camlog) (Fig 13).
ative treatment team agreed on replace-
The provisional implant crown and occlusal
ment of the missing mandibular right first
veneers and onlays were fabricated on
molar with a single-tooth implant and a
the basis of the analytic wax-up and CAD/
CAD/CAM-manufactured zirconium diox-
CAM manufactured (inLab MC XL) (Fig 14)
ide abutment. After the preliminary treat-
from a high-density PMMA material with
ment was complete, initial comprehensive
a low amount of fillers (CAD-Temp, Vita)
rehabilitation using provisional high-density
(see Table 1) in an entirely additive design.
polymer restorations would be carried out.
The single implant-supported crown was
prelimi-
cemented with temporary material (Kerr
analo-
Life, Kerr), whereas partial restorations were
gously to case 1. During this stage, an
permanently seated as described in case 1,
implant (ScrewLine Promote Plus, Camlog
using the adhesive technique (Fig 15).
Preliminary nary
treatment
treatment. was
The
conducted
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Fig 14 Case 2. Restoration after CAD/CAM. Provisional occlusal onlays and one single crown made of low-filler PMMA-based high-density polymer immediately after the CAD/CAM milling process.
Fig 15 Case 2. Provisional restorations after placement. Situation after the provisional insertion of the implant crown and adhesive cementation of the occlusal onlays. A functionally and esthetically pleasing reconstruction of the tooth structure was achieved with minimal biologic costs.
DISCUSSION
standardized conditions used in industrial fabrication processes allow the elimination of these shortcomings by using high-pres-
The specialized literature discusses various
sure polymerization. Over the years, the
strategies for the treatment of generalized
authors have gathered favorable experienc-
tooth defects caused by a combination of
es with CAD/CAM-fabricated, high-density
abrasive and erosive processes. These
PMMA or composite-based polymers for
approaches are based mainly on direct
the above described treatment strategy.13
composite resins, which are fabricated using
In in vitro studies, CAD/CAM-fabricated
a purely additive design and often allow a
ultrathin composite onlays demonstrated an
completely noninvasive treatment method.4
increased survival rate and higher fatigue
Although this conservative approach offers
resistance when compared with those made
some advantages, it involves direct treat-
of ceramic.14,15 Only insufficient clinical data
ment procedures that are time consum-
are available to prove the long-term reli-
ing for the patient and clinician alike. The
ability of this new type of restoration. In a
approach presented promotes an indirect
clinical study with traditionally fabricated
treatment strategy based on a close col-
composite full crowns, the authors saw
laboration with the dental technician. Since
some restrictions for the use as a definitive
essential steps are delegated to the dental
restoration due to a complication rate of
laboratory, the chair time for the patient can
more than 10% and increased plaque accu-
be significantly reduced. In addition, the
mulation.16 After 5 years of clinical service,
use of industrially prefabricated compo-
a probability of 88.5% survival was report-
nents in a CAD/CAM-based indirect manu-
ed. In a clinical trial comparing CAD/CAM-
facturing technique results in restorations
manufactured composite resin crowns with
that exhibit superior material qualities.12 The
CAD/CAM-manufactured
466
ceramic
single
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Q U I N T E S S E N C E I N T E R N AT I O N A L E d e l h o ff e t a l
crowns after 3 years, significantly higher
3. Ireland MF, Dixon DI, Breeding LC, Ramp MH. In
cumulative survival and success rates were
vitro mechanical property comparison of four resins
found for the group of the ceramic restora-
used for fabrication of provisional fixed restorations.
17
tions.
Esthetics and wear resistance of the
composite resin crowns were inferior compared with those manufactured of ceramic. However, in a 3-year clinical trial of CAD/
J Prosthet Dent 1998;80:158–162. 4. Koksal T, Dikbas I, Kazaoglu E. Alternative restorative approach for treatment of patient with extremely worn dentition. N Y State Dent J 2009;75:52–55. 5. Schmidlin PR, Filli T, Imfeld C, Tepper S, Attin
CAM-generated adhesive inlays fabricated
T. Three-year evaluation of posterior vertical bite
either from composite or ceramic, no signifi-
reconstruction using direct resin composite—
cant differences relative to margin adaptation could be found between groups.18 For
PMMA-based
high-density
poly-
mer materials used for provisional ultrathin onlays and veneers, no scientific clinical data are available yet. Until the first positive results of clinical midterm trials, this new restorative approach has to be considered experimental.
A case series. Oper Dent 2009;34:102–108. 6. Magne P, Cascione D, Donovan TE. Immediate dentin sealing improves bond strength of indirect restorations. Prosthet Dent 2005;94:511–519. 7. Bartlett DW, Blunt L, Smith BGN. Measurement of tooth wear in patients with palatinal erosions. Br Dent J 1997;182:179–184. 8. Passos SP, Ozcan M, Vanderlei AD, Leite FP, Kimpara ET, Bottino MA. Bond strength durability of direct and indirect composite systems following surface conditioning for repair. J Adhes Dent 2007;9:443–447. 9. Hattab FN, Othman MY. Etiology and diagnosis of tooth wear: A literature review and presentation of
SUMMARY
selected cases. Int J Prosthodont 2000;13:101–107. 10. Rieder CE. The use of provisional restorations to develop and achieve esthetic expectations. Int J
8JUI
UIF
JOUSPEVDUJPO
PG
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manufactured, high-density polymer materials, high-quality provisional restorations became available. These provisionals help
Periodontontics Restorative Dent 1989;9:122–139. 11. Litonjua LA, Andreana S, Bush PJ, et al. Tooth wear: Attrition, erosion, and abrasion. Quintessence Int 2003; 34:435–446. 12. Schmidlin PR, Filli T, Imfeld C, Tepper S, Attin
gather valuable information for the fabri-
T. Three-year evaluation of posterior vertical bite
cation of the definitive restorations. They
reconstruction using direct resin composite—
therefore represent a key component in a
A case series. Oper Dent 2009;34:102–108.
complex treatment strategy. The possibility
13. Stumbaum M, Konec D, Schweiger J, Gernet W.
of modifying and fine-tuning the restorations
Reconstruction of the vertical jaw relation using
helps the dental team achieve an optimal definitive restoration with active involvement of the patient. Occlusal conditions and material thickness may be used as essential criteria for selecting the materials
CAD/CAM. Int J Comput Dent 2010;13:9–25. 14. Magne P, Schlichting LH, Maia HP, Baratieri LN. In vitro fatigue resistance of CAD/CAM composite resin and ceramic posterior occlusal veneers. J Prosthet Dent 2010;104:149–157. 15. Schlichting LH, Maia HP, Baratieri LN, Magne P.
for the definitive restoration. Combined with
Novel-design ultra-thin CAD/CAM composite resin
the possibility of implementing the definitive
and ceramic occlusal veneers for the treatment of
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