International Journal of Esthetic Dentistry (EN), 01/2010

Restoration of non-carious cervical lesions (NCCLs) represents a major challenge for resin materials due to the different adhesive properties of the tooth structure, the biomechanical aspects of the cervical area, and the difficulties in the access and isolation of the operative field. Furthermore, NCCLs should be approached with a complete understanding of the role played by the marginal periodontal tissue. Whenever a cervical lesion is associated with a gingival recession, the interplay between restorative dentistry and periodontology is decisive for full esthetic and long-term success. A case report is presented dealing with the treatment of NCCLs associated with multiple gingival recessions using a combined restorative and periodontal treatment with a 12-month follow-up.

Eating disorders such as bulimia nervosa can have a significant impact on the structure of the teeth. Gastric acid not only causes enamel and dentin to dissolve but also causes a progressive deterioration of dental health, which leads to functional esthetic and biological consequences. According to the classic concepts of restorative dentistry, the rehabilitation of such clinical cases will involve numerous full crowns and root canal treatments, a process which is expensive financially, biologically, and in terms of time. However, the development of resin composite and adhesive systems has made it possible, today, to reconstruct teeth with minimal dental preparation. This article will look at the dental treatment of a bulimic patient who had numerous serious erosions with a significant loss of dental tissue. All teeth were reconstructed with a nano-hybrid resin composite and, as very little preparation was necessary, the teeth's vitality was maintained and did not require laboratory collaboration. Furthermore, all biological, functional, and esthetic requisites were successfully met in a very short period of time.

The aim of this article is to analyze some of the issues related to the adhesive restoration of teeth with deep cervical and/or subgingival margins in the posterior area. Three different problems tend to occur during restoration: loss of dental substance, detection of subgingival cervical margins, and dentin sealing of the cervical margins. These conditions, together with the presence of medium/large-sized cavities associated with cuspal involvement and absence of cervical enamel, are indications for indirect adhesive restorations. Subgingival margins are associated with biological and technical problems such as difficulty in isolating the working field with a dental dam, adhesion procedures, impression taking, and final positioning of the restoration itself. A new classification is suggested based on two clinical parameters: 1) a technicaloperative parameter (possibility of correct isolation through the dental dam) and 2) a biological parameter (depending on the biologic width). Three different clinical situations and three different therapeutic approaches are identified (1st, 2nd, and 3rd, respectively): coronal relocation of the margin, surgical exposure of the margin, and clinical crown lengthening. The latter is associated with three further operative sequences: immediate, early, or delayed impression taking. The different therapeutic options are described and illustrated by several clinical cases. The surgical-restorative approach, whereby surgery is strictly associated with buildup, onlay preparation, and impression taking is particularly interesting. The restoration is cemented after only 1 week. This approach makes it possible to speed up the therapy by eliminating the intermediate phases associated with positioning the provisional restorations, and with fast and efficient healing of the soft marginal tissue.

Clinical needs and growing patient expectations have forced modern dentistry to focus on finding ever simpler protocols and to develop materials which offer high performance in their mechanical resistance and esthetics. In recent years, the scientific community has been venturing into the world of CAD/CAM, a significant technological innovation imported from the world of engineering. This innovation has made it possible to exploit a material which has long been noted for its mechanical and mimetic qualities: zirconium oxide. While CAD/CAM is revolutionizing the laboratory work of dental technicians, the white color of zirconium has opened new avenues which may lead not only to new options for proper treatment planning, but also to new opportunities in the choice of materials to be used in prosthetic rehabilitation and variation of the types of preparations possible. The present paper will analyze the advantages and limitations of these methodologies, which are capable of simplifying clinical protocols and standardizing results. These technologies have instilled great enthusiasm in the profession due to their innovative nature, but this approach needs to be verified by further scientific evidence.

In daily practice, composites are the materials most commonly used for restorative dentistry. They are used for preventive seals, microinvasive restorations, build-ups and complex direct and indirect restorations in posterior sections. Indeed, it is in the anterior sections that composites have traditionally been used to the greatest effect, enabling clinicians to carry out complex restorations using direct techniques with notable esthetic and clinical results. Recent product developments combined with clinical research on stratification make it now possible to utilize new composites that have excellent opalescence and fluorescence characteristics and provide an excellent color range to choose from.1,2 It is however, a common complaint among clinicians that the layering techniques are rather complex and it is difficult to make the right color choice. Paradoxically, they say that the appearance on the market of sophisticated materials, designed to give ever better results in the medium and long term, only makes it more difficult to make the correct decision. Indeed, many of these colleagues, after the first buzz of enthusiasm, give up on the layering technique and opt for materials which they say are more simple or "mimetic." In the present article, the authors will discuss these topics and make suggestions on how to acheive high quality results every day, both from an esthetic and clinical point of view. However, predictability of the results is more important, as predictability provides advantages in terms of the quality of work and economy for clinicians and patients.