International Journal of Esthetic Dentistry (EN), 04/2024

The main goal of the modern dentist should be to address the urgent need to promote treatments focused on conservative dentistry, together with maintaining the health of the periodontium. Instead, iatrogenesis that results in the invasion of the biologic space is a significant and increasing problem in dentistry. The present case report illustrates a 5-year computed tomography follow-up of a successful minimally invasive rehabilitation involving ceramic veneers. The study highlights the importance of pretreatment planning as well as a step-by-step clinical execution to achieve long-term health, function, and esthetics, respecting both restorative and periodontal principles. Keywords: adhesive dentistry, prosthodontics, restorative dentistry

Background: Immediate implant placement (IIP) has shown predictable outcomes when specific requirements are met. The aim of the present study was to radiographically evaluate the dimensions of mandibular incisors and the alveolar bone to further determine the feasibility of IIP in this area. Materials and methods: A total of 404 intact mandibular incisor CBCT images from 101 patients (42 males, 59 females; mean age 49 ± 16.84 years) were analyzed. The mesiodistal tooth width and the distance between the incisal edge (IE), cementoenamel junction (CEJ), facial bone crest (BC), root apex (RA), and fenestration point (F) were registered, together with the alveolar bone width at 1 and 3 mm below BC. Finally, the angular discrepancy between the dental and the alveolar bone long axis (BLA) was recorded as the tooth torque (TT). Results: The CEJ to BC distance was 3.23 ± 1.67 mm. The RA to F mean distance was 15.02 ± 3.97 mm. The mean alveolar bone buccolingual widths at 1 and 3 mm below the facial BC were 7.12 ± 0.82 and 6.32 ± 0.71 mm in the lateral and central incisors, respectively (P 0.001). The buccolingual width was less than 6 mm in more than 33% of the central incisors, but only in 3% of the lateral incisors, displaying increased alveolar width. The average was 165.66 ± 7.47 degrees. Conclusions: The results presented in this study point toward the need for careful consideration of the requirements for anterior mandibular IIP for success and predictability purposes. Keywords: immediate implant placement, implantology, mandibular alveolar bone, mandibular anatomy, restorative dentistry

The objective of the present case report is to describe Icon resin infiltration as a treatment option for postorthodontic white spot lesions (WSLs). A 23-year-old male patient complained of white spots on his maxillary anterior teeth that caused him significant esthetic concern in terms of his smile and affected his self-esteem. During the anamnesis, the patient reported that he noticed white spots directly after the brackets were removed after orthodontic treatment, which had not yet been completed. Based on the information obtained through the anamnesis and the clinical examination, the spots were deemed to be remineralized WSLs. The proposed treatment consisted of supervised at-home tooth whitening through bleaching in combination with microabrasion and resin infiltration. The clinical results were successful, showing significant improvement in terms of esthetics and the patient’s self-esteem after only a single session of resin infiltration with Icon material. Treatment optimization and gain in clinical time were clearly demonstrated as well as the preservation of tooth tissue compared with other treatments. Keywords: Icon, orthodontic treatment, resin infiltration technique, white spot lesions

Aim: Current CAD/CAM techniques allow clinicians to design and 3D print tooth reduction guides that facilitate controlled preparations in the esthetic zone. The present case report describes the workflow for designing and printing a tooth reduction guide intended to assist ceramic veneer preparations. This 3D-printed guide divides the facial surface of the teeth into four areas and allows the measuring of all areas, including the incisal edge, with a periodontal probe. Using this 3D-printed appliance can simplify and expedite tooth preparation for ceramic veneers and reduce the risk of excessive tooth reduction. Clinical considerations: A 45-year-old female patient presented at the clinic with the primary concern of the esthetics of her smile, which she wanted to improve. The initial evaluation revealed clinical signs of wear, spaces between the teeth, and the lack of anterior tooth symmetry. Therefore, to improve the appearance of her anterior teeth, a treatment plan that consisted of veneer restorations from the maxillary right second premolar to the left second premolar was formulated and presented. The patient accepted the option of undergoing minimally invasive anterior tooth preparations with a digital tooth reduction guide. Materials and methods: A diagnostic intraoral scan was performed and a tooth reduction guide was digitally designed and 3D printed. Subsequently, the tooth preparations were performed with the aid of the guide. An intraoral scan of the preparations was performed and used to design and manufacture lithium disilicate ceramic veneers using subtractive techniques. Subsequently, the restorations were finished, treated, and cemented under rubber dam isolation. Conclusions: The treatment fulfilled the patient’s esthetic demands. This novel 3D-printed tooth reduction guide permits a more comprehensive assessment of the available tooth structure and provides ample access to more tooth surfaces than traditional silicone tooth reduction guides. Overall, this type of guide can significantly assist clinicians in performing tooth preparations in the esthetic zone. Keywords: ceramic restorations, esthetic dentistry, tooth reduction guide, veneers

This case report presents the conservative management of a malposed implant in the maxillary anterior region caused by craniofacial bone remodeling. The patient expressed dissatisfaction with the position and shade of an implant that was placed almost three decades previously. After evaluating different treatment options, the patient opted to replace the implant prosthesis. The selected treatment consisted of a zirconia crown layered with feldspathic porcelain (including pink porcelain) cemented onto a screw-retained customized zirconia abutment with an angled screw channel for the single-unit permanent fixed implant prosthesis. The report highlights the importance of informed decision making and patient preferences in treatment option selection. It emphasizes the conservative approach of replacing a malposed implant prosthesis with pink porcelain to address the patient’s esthetic concerns. Dental photographs and shade-matching protocols were crucial in achieving satisfactory esthetic outcomes. The report also underscores the potential for infraocclusion as well as proclination caused by craniofacial growth in implant therapy, and emphasizes the significance of patient education regarding long-term considerations. Keywords: bone remodeling, craniofacial abnormalities, dental esthetics, dental implants, implant-supported dental prosthesis, maxilla, patient preference, prosthesis design

Aim: Mandibular anterior deep gingival recessions are complex to manage in individuals who lack sufficient keratinized tissue. The aim of the present study was to evaluate the clinical and esthetic outcomes and tissue stability of mucogingival procedures performed by means of a free gingival graft (FGG) or subepithelial connective tissue graft (SCTG) 2- to 5-years post­operatively and to identify the esthetic outcome perception of the patients at follow-up. Materials and methods: Individuals presenting RT1 and RT2 gingival recessions treated with an FGG or SCTG in the mandibular anterior sextant were recalled to evaluate clinical outcomes and patient satisfaction postoperatively. A visual analog scale (VAS) and recession esthetic score (RES) were used for the evaluation. Results: A total of 32 consecutive individuals, 16 in each group (FGG/SCTG), responding to the follow-up appointment, entered this study. RT2 recessions were prevalent (87.5% FGG; 68.8% SCTG). Mean recession depth (RD) at baseline was 4.68 ± 0.76 (range: 4 to 6 mm) and 5.31 ± 1.35 (range: 4 to 10 mm) for the SCTG and FGG groups, respectively, and 0.18 ± 0.34 and 0.43 ± 0.49, respectively, at follow-up. Keratinized tissue width (KTW) was significantly greater in FGG individuals at follow-up: 5.25 ± 0.84 vs 2.84 ± 1.12 (P 0.0001; confidence interval [CI]: 1.70 to 3.12). The SCTG group showed a higher RES than the FGG group, but the difference was not significant (P = 0.067, CI: 0.007 to 1.94). The patients’ perception (VAS) of satisfactory esthetics was statistically significantly higher than the professional RES assessment for FGG individuals (P = 0.007, CI: 0.36 to 2.01), but the difference between the VAS and RES values was not statistically significant for the SCTG group. Conclusions: Both SCTGs and FGGs provide satisfactory esthetics and tissue stability. Patients’ esthetic perception of FGGs is significantly higher than the professional evaluation. Clinical relevance: When 100% root coverage is not achieved using an FGG, satisfactory esthetic outcomes with minimal residual recessions of ≤ 1 mm can be accomplished on the more challenging RT2 defects. Keywords: connective tissue graft, esthetic surgery, gingival recession, patient outcome assessment, plastic surgery