International Journal of Esthetic Dentistry (EN), 04/2023

An excellent clinical case as a product of masterful teamwork is presented in IJED Espresso. This section focusses especially on young talented professionals giving them the opportunity to share their clinical cases.

Aim: To describe a digital workflow utilizing 3D printing technology to guide esthetic crown lengthening and control tooth preparation. Clinical considerations: After the initial intraoral and face scans, an esthetic treatment plan was performed digitally based on the patient’s personality and face type using artificial intelligence-based 3D smile design software. A 3D-printed tray relined with silicone over a 3D-printed model was used for the mock-up. A 3D-printed guide was implemented to assist esthetic crown lengthening by incorporating, simultaneously, information about the desired free gingival line and the alveolar bone level. Based on the initial planning, a set of reduction guides was 3D printed to check and correct the tooth preparation. Prior to the start of construction of the final monolithic restorations, their design was verified using 3D-printed prototypes. A stabilization splint was digitally designed and 3D printed to protect and maintain the final result. Conclusions: Technologic advances can improve the predictability of an interdisciplinary esthetic approach. Digital planning can be transferred to clinical reality using a digital workflow, utilizing a set of appropriate 3D-printed guides, which can help to control clinical procedures based on the initial planning. Clinical significance: By following the proposed step-by-step workflow, clinicians can achieve predictable results through an interdisciplinary approach, guiding both the periodontal plastic surgery and the restorative treatment after an individualized CAD/CAD procedure for 3D-printed guides.

Restoration of posterior teeth with different extents of tissue loss has been a matter of debate in the literature. There are several recommendations and guidelines on when, how, and why to perform adhesive restorations (onlays, overlays, and endocrowns) or resistance form restorations (full-contour resistive crowns). In Part I of this three-part article series, the authors focused on adhesive partial restorations. In that article, the evidence was extensively described, and a clinically reasonable thought process was suggested for these decisions based on Coverage of susceptible cusps, Adhesion advantages and limitations, Resistance forms to be implemented, Esthetic concerns, and Subgingival management – the CARES concept. Now, in Part II, the focus is on clinical decisions for full-contour resistive crowns regarding their indications based on remaining tooth structure, materials, and different preparation designs as well as the particularities of vertical marginal preparations, perio-restorative considerations, and esthetic challenges.

There is a constantly growing prevalence of tooth wear in dentistry. The present case report describes a rehabilitation through ceramic restorations of a severely worn dentition based on a conservative intervention, adequate restorative material selection, and adhesive bonding strategies. A 36-year-old patient with a mainly esthetic complaint presented with signs of tooth wear caused by erosion and attrition. Preparations were performed guided by the diagnostic planning. The full-mouth rehabilitation, combined with the correction of the vertical dimension of occlusion, was split into quadrants, and lithium disilicate partial restorations were fabricated. The proposed rehabilitation was based on the maximal preservation of the remaining tooth structure and the adequate selection of restorative materials and adhesive bonding strategies.

Aim: The harmonious existence of the extraoral and intraoral attributes are critical and capable of enhancing smile esthetics. Therefore, the present study was planned as a gender-based evaluation and correlation of interpupillary width (IPW) and intercommisural width (ICOW) with the combined width of the maxillary central incisors and anterior teeth and gingival thickness (GT) in periodontally healthy patients.Materials and methods: A total of 120 patients within an age range of 20 to 40 years were divided equally into two groups based on gender. The extraoral parameters were recorded on digitized photographs, the intraoral parameters on a stone cast with dental floss and a digital caliper, and the GT clinically.Results: The mean values of IPW and GT in males and females were 63.95 ± 4.40 mm and 60.55 ± 2.43 mm, and 2.14 ± 0.37 mm and 1.07 ± 0.21 mm, respectively. Similarly, the mean combined width of the maxillary central incisors and anterior teeth in males and females differed significantly, being 18.69 ± 1.16 mm and 17.86 ± 1.09 mm, and 55.70 ± 3.14 mm and 51.46 ± 2.18 mm, respectively. Conclusions: Although the correlations between the parameters in the present study were found to be weak and positive, they can be accepted as preliminary findings that may require further exploration. The gender variability of the extraoral and intraoral parameters such as IPW, GT, combined width of the maxillary anterior teeth (CMA), and combined width of the maxillary central incisors (CMI) provide valuable guidelines that can be implemented in restorative procedures in the maxillary anterior sextant.

Tooth-reduction guides offer a more controlled and conservative tooth preparation. Many types of tooth-reduction guides are available such as those with horizontal or vertical reduction grooves. A transparent cross-shaped tooth-reduction guide allows the clinician to make vertical and horizontal depth grooves to evaluate tooth reduction in all directions. The reference grooves on the guide enable the clinician to use a periodontal probe to measure the reduction accurately, and the transparent material provides a clear view of the entire tooth. Controlled tooth reduction offers a more conservative approach that is key for long-term bonded ceramic restorations. The multiaxial rigid transparent tooth-reduction guide could facilitate the provision of ultrathin handcrafted porcelain veneers to predictably fulfill patients’ esthetic demands while preserving more tooth structure. The use of technically sound and artistically documented photographic evidence further underscores the effectiveness of this approach, particularly when intra-enamel preparations and adhesive luting under rubber dam isolation are employed. The present article describes a novel 3D-printed guide design that allows the clinician to perform the reduction grooves and evaluate the preparation in the horizontal and vertical directions within the same guide.

Managing teeth with hypoplasia stains or discoloration using composite resin materials is challenging. When appraising hypoplasia stains, the substrate color and thickness of the material must be considered. The non-Vita shading system has a reduced number of layers, primarily dentin and enamel, which is known as the natural layering concept. The incremental approach of this system allows the masking of substrates with color differences and the reproduction of the optical characteristics of chromaticity, translucency or opacity as well as the value (luminosity). The present study demonstrates and discusses the color sequence for the natural reproduction of tooth structures using an alternative composite resin system from the classical Vita scale.