Seit Mitte der 1980er-Jahre mit dem Cerec-System das erste Chairside-CAD/CAM-System (Computer-Aided Design/Computer-Aided Manufacturing) etabliert wurde, erlebt diese Technologie - vor allem in jüngster Zeit - eine immer größer werdende Beliebtheit in der Zahnmedizin. Innerhalb der letzten Jahre hat sich das Angebot der Chairside-Systeme deutlich vergrößert. Das liegt vor allem an den immer besseren, handlicheren und schnelleren Intraoralscannern, der ständig benutzerfreundlicher werdenden Design-Software, welche viele Arbeitsschritte automatisiert hat, und an dem mittlerweile sehr großen Materialangebot für den Chairside-Einsatz. Dieser Fortschritt ist für die rasante Indikationserweiterung in den Bereichen der Prothetik, Implantologie und Kieferorthopädie verantwortlich und erlaubt neue Konzepte in der Patientenbehandlung und Planung. Zudem ist die digitale Abformung mittels Intraoralscannern der konventionellen Abformtechnik in manchen Punkten heute bereits überlegen. Zusätzlich führt die Weiterentwicklung der Schleifeinheiten zu qualitativ immer besser passenden Restaurationen. Durch diese Vielzahl an neuen Möglichkeiten wird es nur eine Frage der Zeit sein, bis die Chairside-Systeme ein selbstverständlicher Bestandteil der zahnärztlichen Tätigkeit werden. Mit dem vorliegenden Beitrag wird eine aktuelle Übersicht über die Vorteile und Einschränkungen des Chairside-Workflows gegeben. Zudem liefert er eine Zusammenfassung sämtlicher heutzutage verfügbarer Chairside-Systeme. Schlagwörter: Chairside-Systeme, digitale Abformung, Intraoralscanner, Schleifeinheiten, Übersicht

Vita Enamic ist eine robuste Hybridkeramik, die CAD/CAM-gestützt verarbeitet werden kann. Der porös gesinterte und mit Polymer infiltrierte Feldspatkeramikblock braucht nach dem Herausschleifen keinen Keramikofen, sondern muss lediglich ausgearbeitet und poliert werden, was eine einzeitige Chairside-Behandlung ermöglicht. Zusätzlich zu den bekannten monochromatischen Vita Enamic-Blöcken wurden nun eine multichromatische Variante mit integriertem Farbverlauf und eine supertransluzente Variante entwickelt. Ziel dieser Anwendungsstudie ist es, anhand von vier verschiedenen Kasuistiken diese neuen Indikationserweiterungen mit ihren werkstofflichen Vorteilen im Front- und Seitenzahnbereich aufzuzeigen. Schlagwörter: CAD/CAM, Hybridkeramik, multichromatisch, supertransluzent, Cerec

Adhesive bonding techniques in combination with tooth-colored restorative materials are one of the greatest achievements of restorative dentistry. Adhesively bonded veneers made from various silicate ceramic materials have contributed significantly to this. Ceramic veneers had long been considered to be only esthetic implements. However, their range of indications has been steadily increasing, making ceramic veneers a highly viable alternative to classic, far more invasive forms of restorative treatment. Today these veneers are used to restore the biomechanics of the dentition, to establish adequate function, to mask highly discolored endodontically treated teeth, and for many other purposes. The present article explains the principles of modern veneer technology based on clinical examples, with special emphasis on collaboration with the dental laboratory and communication within the dental team. This includes analyzing the case, defining the treatment goal, determining the right shade, selecting the most suitable ceramic material, finding the best preparation design, and choosing the most appropriate adhesive concept. The article will also explore the long-term prognosis of ceramic veneers as reported by a number of scientific studies. Schlagwörter: adhesive bonding, all-ceramics, analysis, material selection, preparation technique, preparation template, shade taking, try-in, veneer, wax-up

Objective: The aim of this article is to investigate, study, and summarize cone beam computed tomography (CBCT)-related guidelines offered by relevant organizations and associations within North America to provide the dental practitioner a clearer direction on the practice of CBCT-related procedures in North America. Data sources: Scientific databases including PubMed, Science Direct, Scopus, MedLine, and Web of Science were used for the search of relevant literature on the CBCT guidelines developed in North America. In addition, the World Wide Web was searched for comparative CBCT guidelines nationally or internationally using the same search strategies. Conclusion: In 1999, the American Dental Association (ADA) recognized Oral and Maxillofacial Radiology as the ninth dental specialty in the United States. The American Academy of Oral and Maxillofacial Radiology (AAOMR) issued their first statement on the use of CBCT in 2008. There have since been several statements issued, independently or jointly with other specialty organizations, related to the use and interpretation of the CBCT volumes. The guidelines identified Oral and Maxillofacial Radiologists (OMR) as providers of interpretative services, portrayed as key players in the dissemination of information related to CBCT, implementation of CBCT-related services and radiation protection, as well as interpretation assistance for CBCT volumes, especially medium to large volumes covering anatomical areas of head and neck, considered beyond the scope of a general dentist. Regulations concerning radiation-producing devices are promulgated through state health codes and practice acts. Selection criteria and interpretation of imaging studies are left to the clinician's choice and abilities. Schlagwörter: cone beam computed tomography, guidelines, radiography, selection criteria, x-rays

Purpose: To demonstrate the field of application and prospects of individually modeled indirect composite restorations for the treatment of children and adolescents based on a case of dentinogenesis imperfecta. Dental malformations can affect single or multiple teeth. In most cases, direct composite fillings can be placed. However, in severe cases, these restorations may be more challenging and error-prone, especially when occlusal adjustments are necessary. Since composite materials do not require a specific lamination strength and are easy to repair, they can be applied using the indirect technique, enabling conservation of more sound hard tissue than is possible when conventional restorations are used. Patient and Methods: A young patient with dentinogenesis imperfecta type II underwent interdisciplinary full-mouth rehabilitation due to massive tooth wear and loss of vertical occlusion. First, a check bite was taken, and vertical occlusion was increased using overdentures. Six months later, a construction bite was taken over the existing overdentures (focusing on the sagittal dimension) to move the mandibular position more towards the anterior, correcting the skeletal Class II malocclusion. This resulted in a Class I intercuspidation with harmonization of the facial proportions. After a further six months, all teeth were restored using individually modeled indirect composite restorations, which preserved most of the sound hard tissue and restored esthetics and function. Conclusion: Indirect composite restorations can be a valuable tool for improving occlusion, esthetics and function in the treatment of children and adolescents. Schlagwörter: severe tooth wear, dental malformations, full-mouth rehabilitation, individual lamination technique, fiber reinforced composite restorations, overdenture, hereditary disorder

The digital workflow - from the intraoral scanning, through the CAD design of the facially generated diagnostic digital wax-up, to the CAD-designed and 3D-printed silicone index with the diagnostic mock-up - provides a new approach that avoids the conventional manufacturing of casts. The development of the process requires a synchronized workflow and good communication between the dental technician, prosthodontist, and patient. This report describes a protocol for the diagnostic digital sequence for the treatment planning of an esthetic rehabilitation.

The buccal bone wall is the part of the socket of an anterior tooth that is most susceptible to resorption. Immediate implants offer advantages in terms of time, comfort, and esthetics, especially regarding the maintenance of the papillae architecture. However, the loss of the buccal bone wall is often a limitation for such a therapy. This case report describes a clinical procedure designed to reconstruct the buccal bone wall to restore an anterior tooth where this wall was absent. The approach involved a flapless immediate implant based on the principles of guided bone regeneration (GBR), and consisted of the preparation of a large, flapless recipient bed ad modum envelope, immediate implant placement, deposition of xenograft surrounding the implant surface, and coverage with a collagen membrane. Finally, a palatal connective tissue graft (CTG) was placed, and the natural tooth crown acting as a temporary restoration was delivered. One year later, a zirconia-ceramic crown was delivered. Two years after implant placement, the soft tissue level was stable. No signs of inflammation or bleeding were observed, and periapical radiographic examination revealed bone stability.

Tooth wear is generally a physiological process; however, it can also be a pathological condition associated with attrition, abrasion, and erosion processes in which the quantity of tooth loss is atypical for the patient's age. Tooth substance loss often causes functional problems, symptoms of discomfort/pain, and esthetic impairments. Patients presenting this condition frequently need restorative treatment, combined with an increase in the vertical dimension of occlusion (VDO). A diagnostic wax-up (DWU) provides assistance in determining a new occlusal plane and VDO, and is a fundamental tool considering the backward planning involved in the execution of a complex rehabilitation. In cases of severe tooth wear, preventive measures must be taken. Yet, when a restorative intervention is needed, the use of a DWU, in conjunction with a mock-up, helps to achieve a predictable and satisfactory outcome. This article presents a case report of a young female patient with pathological tooth wear, related symptomatology, and esthetic complaints. Initially, a DWU and a diagnostic mock-up were created. After esthetic and functional corrections, a second DWU was generated and transferred to the patient's mouth by means of a therapeutic mock-up. This mock-up was used as a trial restoration for the pretreatment phase, to evaluate the new VDO/esthetics/function and to guide tooth preparation. Lithium disilicate (LS2) occlusal onlays were used to stabilize the VDO, and anterior LS2 and feldspathic veneers, combined with direct composite restorations, were executed to reach the planned minimally invasive result.

Purpose: This study evaluated the shear bond strength (SBS) of resin cement to dentin after applying two adhesive (A) systems with a combination of four different immediate dentin sealing (IDS) strategies, and two surface conditioning (SC) methods. Material and methods: Human third molars (n = 140) were collected and randomly split (n = 70 each) between the two A systems (Clearfil SE Bond; Kuraray [AC] and Optibond FL; Kerr [AO]). The A groups were further divided into four IDS strategies (2 x one adhesive layer (IDS-1L); 2 x two adhesive layers (IDS-2L); 2 x one adhesive layer and one flowable layer (IDS-F); 2 x no adhesive layer (delayed dentin sealing [DDS]). Finally, each strategy group was categorized into one of the two SC methods (only pumice [SC-P] or pumice and silica coating [SC-PS]), except the DDS group, where only SC-P was used. This resulted in 14 groups of 10 specimens each. The occlusal coronal third was removed from each molar crown with a diamond saw (Isomet 1000), and IDS was applied, followed by temporary restorations. These were removed after 2 weeks of water storage, and the IDS surfaces were subsequently conditioned. The standard adhesive procedure (Syntac Primer and Adhesive, Heliobond; Ivoclar Vivadent) was executed, followed by the application of a resin cement (Variolink II; Ivoclar Vivadent) and photopolymerization. All specimens were subjected to thermocyclic aging (10,000 cycles, 5°C to 55°C). Shear force was applied to the adhesive interface in a universal testing machine (1 mm/min). Fracture types and locations after loading were classified. The data were analyzed using analysis of variance (ANOVA) and independent samples t tests. Results: AO groups exhibited higher mean SBS values (14.4 ± 6.43) than AC groups (12.85 ± 4.97) (P = 0.03). ANOVA showed the main effect of the applications on the SBS in the different groups (P = 0.00). Both DDS groups showed significantly lower SBS values compared with all the IDS groups (IDS-1L, IDS-2L, IDS-F). No significant differences in SBS results were found between the IDS groups (P = 0.43) and between the SC methods (P = 0.76). Dentin-cement interface failures diminished with the application of IDS. Conclusion: IDS improves the SBS compared with DDS. No significant differences were found between the tested conditioning methods.

The C-shaped configuration of the root and root canal system is an unusual anatomical variation in mandibular first and second premolars. It is categorised as a 'C' due to the transverse morphology of the root and the root canal. The main anatomical characteristic is the presence of an invagination groove caused by Hertwig epithelial sheath faults during root development. This case report describes the root canal treatment of a C-shaped configuration of a mandibular first premolar, identified by means of cone beam computed tomography. Schlagwörter: anatomical variation, C-shaped root, C-shaped root canal, cone beam computed tomography, dental anomalies, mandibular premolar, tomography, tooth morphology

This case report aimed to demonstrate the importance of cone beam computed tomography (CBCT) for the diagnosis, follow-up and treatment planning of internal root resorption (IRR). A 10-year-old male patient was referred for clinical examination, which revealed a dental fusion in the mandibular right lateral incisor (tooth 42). One year after the sectioning of the fused teeth, a well demarcated radiolucency in tooth 42 was observed by radiography, similar to IRR. CBCT scanning was performed in order to distinguish between external and internal root resorption. After the IRR diagnosis, root canal treatment was performed and no progression of the lesion was observed after 2 years. Thus, CBCT images were useful to delimit the extent of the IRR lesion, being able to identify possible communication sites with the periodontal space, and should be applied in IRR cases. Schlagwörter: cone beam computed tomography, diagnostic radiograph, resorption