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Comparison of guided and non-guided implant placement accuracy – In vitro study with 3-D printing

April 5, 2019

The procedure of implantation is becoming an increasingly popular method for replacing teeth. The critical factor in the achievement of a therapeutic and aesthetic long-term effect is the accuracy and precision of implant placement, being the support for the future prosthetic work. Thanks to modern digital technologies, it is possible to plan the implantation virtually. Evaluation of this plan by 3-D printing in a subsequent step allows the creation of implant guides.

Implant retreatment

February 20, 2019

When working with dental implants, a number of specific rules must be followed regarding both the implant surgery and the prosthesis itself (fixed protheses tending to have a more favourable prognosis than overdentures). If these rules are not adhered to, the results are often unsatisfactory, requiring retreatment. In such cases, and despite the patient’s desire to quickly forget the previous treatment, a very strict protocol must be followed, specifically concerning the length of healing periods. Despite an increase in the overall treatment duration, this will ensure success of each stage of treatment. The implant retreatment case outlined in this article will emphasise these different stages in this type of clinical situation.

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How to give a second life to third molars: A case series with follow-up

February 1, 2019

Dental autotransplantation entails extracting and repositioning a tooth into a different site in the mouth of the same patient. A successfully transplanted tooth offers several advantages, given the preservation of the periodontal ligament: the proprioceptive function is maintained, the alveolar bone volume is preserved, orthodontics can be included in the treatment plan, and the dentofacial development and growth of the jaws are not impaired. Moreover, pulp regeneration and continued root development can be expected when a donor tooth with incomplete root formation is chosen and infection of the pulp tissue is prevented. [1, 2]

Successful communication in your daily practice

January 30, 2019

My dear readers, be cordially welcomed again to the series “Successful communication in your daily practice”. I am Dr Anna Maria Yiannikos, and I am in the happy position to present you the 4th part of this series filled with helpful communication protocols. This series includes the most popular and challenging scenarios that might occur at your dental practice, and how you can deal with them so that your patients always leave your practice feeling: “My dentist is THE BEST!”

Apical lesions: To treat or not to treat?

January 25, 2019

What do endodontic experts base their decisions on: intuition, experience or CBCT imaging? The following case report on a 10-year-old patient shows that an apical lesion does not necessarily mean the affected tooth has to go. Using flexible nickel-titanium (NiTi) files, even root canals with curves or special features can be cleaned safely and with long term success.

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Maxillary sinus and root canal therapy complications

January 25, 2019

The maxillary sinus is the largest paranasal sinus and overlies the maxillary alveolar process. The topographic anatomical relationship between the maxillary posterior teeth and the maxillary sinus necessitates great care in performing endodontic treatment. It has been suggested that the incidence of sinusitis of dental aetiology is increasing. One reason for this apparent increase may be the availability of improved imaging, specifically in-office cone beam computed tomography (CBCT) scanning.

Minimally invasive root canal shaping—A new protocol

January 23, 2019

Minimally invasive—the most well-known oxymoron in dentistry—is probably nowadays considered the new standard of care in almost every field of dental medicine, but more so in endodontics. Despite improved oral and dental health, the demand for endodontic treatment and restorations remains high among individuals with relatively complete dentition and dental awareness. The need for adequate endodontic treatment is most likely one of the driving forces behind all the improvements that have reached practitioners in recent years. The use of nickel-titanium (NiTi) rotary files in root canal preparation is one of those improvements and has provided a reduction in the frequency of procedural errors and the time required for chemomechanical preparation in relation to manual files.

Incorporating CAD/CAM solutions for full-mouth dental implant reconstructions

January 16, 2019

Patients facing the loss of their natural dentition have more treatment options than ever before. The traditional complete denture, once the standard of care for the fully edentulous patient, is slowly but surely giving way to fixed full-arch implant restorations as their superior stability, function and aesthetics become more well known. Further, prosthetic materials have advanced in leaps and bounds, and monolithic zirconia can now be milled for fixed full-arch indications. By moving beyond acrylic and its vulnerability to wear, chipping, stains and fracture, this adds long-term durability to the qualities that make the fixed implant prosthesis the ultimate restorative option for fully edentulous cases.

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Immediate implantation with CAD/CAM and functional restoration in the aesthetic zone

January 12, 2019

The aesthetics are always a significant challenge during implant restoration, especially in the aesthetic zone, in addition to the full consideration required regarding function. In this article, we present a case of multiple tooth fractures due to trauma. After tooth extraction, immediate implantation and guided bone regeneration (GBR) were performed. During the prosthetic procedure, the design and transfer of the emergence profile of the soft tissue, functional design and occlusal adjustment, as well as the CAD/CAM process, were satisfactorily realised to achieve the aesthetic and functional goals.

Fast, functional aesthetic solution for anterior tooth trauma

January 9, 2019

CEREC and oral surgery? In times when patients go to a practice to receive complete, aesthetic, state-of-the-art treatment as quickly as possible, I think they go together very well. I did not always think so. Certainly, CEREC was always interesting; I have used it since 2003, but I did not always find the results convincing. In 2014, I had a closer look at an event in Salzburg, Austria, and learnt two things: the system had been further developed, and in particular, the precision had been improved considerably. It fits well in my practice; I use it almost every day because I have many patients who have busy jobs and do not have much time. I experience a great workflow in the practice that gives me maximum flexibility. Depending on the indication and the patient’s wishes, I can decide whether to make the restoration myself or outsource it to a laboratory, which I often do for more elaborate bridges. Then, I send the scan directly to my partner laboratory via Sirona Connect—that is very reliable.

Immediate placement and restoration of a Straumann BLX implant replacing maxillary incisors

December 28, 2018

Placing an implant immediately after tooth extraction offers several advantages, including a reduced treatment time, fewer surgical sessions, possibility of fixed implant temporisation, and preservation of the soft-tissue contour and of the interdental papillae. Immediate implant placement into fresh extraction sites has been described as a predictable and successful procedure when proper protocols and case selection are followed. The success of immediate implant placement and the temporisation procedure relies greatly on sufficient primary stability of the implant. The latter depends on the volume of available bone beyond the root apex as classified by Kan et al. [1] and on the choice of the implant, its macro design and the drilling protocol. BLX implants (Straumann) were designed to achieve high primary stability when placed immediately after extraction.

Digital workflow and application of PRF and ozone therapy in oral rehabilitation

November 19, 2018

The digital revolution has changed the world and dental medicine is no exception. We live in the digital era: we have the materials and techniques that allow us to develop a totally digital workflow, allowing dental medicine to grow to a new level, becoming faster and more efficient, when combined with scientific and clinical knowledge. There are numerous technologies that simplify the daily work, such as intraoral, extraoral and face scanners, CBCT (cone beam computed tomography) with a low radiation dose, and software processing and production, better known as CAD/CAM (computer-aided design and manufacturing), which together with new aesthetic materials and prototyping tools (milling machines and 3-D printers) are radically transforming dental medicine. This case report has the aim of presenting an example of prosthetic digital workflow, with the integration of several technologies that help us achieve treatment success.

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Digital vs. analogue workflow on ten ceramic veneers in the maxilla

November 14, 2018

Different materials and treatment options are available in aesthetic and restorative dentistry for the anterior region. The conventional protocol, including an analogue impression with polyether or polyvinylsiloxane, a master cast and die fabrication, waxing and pressing of ceramic materials, requires exceptional skills and is technique-sensitive. Intraoral scanning and digital impression taking provide an accurate alternative method for transferring information from the mouth to the dental laboratory. The digital file is always on the computer and can be immediately processed or at any time, unlike with the conventional procedure.

Aesthetic Digital Smile Design: 2-D-/3-D-assisted communication and software design

November 12, 2018

The communication between dentist and patient is important, especially in cases of partial or complete aesthetic restoration in the anterior (smile makeover). Nowadays, it is important not only to treat oral pathology, but also to request an aesthetic evaluation of the patient’s smile to obtain results that respect the patient’s aesthetic expectation. The smile is our business card and represents the first thing that distinguishes us in human relationships, in work and in social life. It is necessary to know that a smile can appear unpleasant even if there are no evident issues or pathology, influencing people/patients’ psychologically. The clinician should understand the psychological needs of desire, perception and personality to explain in a better way the necessary therapeutics and/or aesthetic choices. When a smile is being designed, these parameters are fundamental and dependent on the communication with the patient and they should be considered in the evaluation of a 360° clinical approach. It often happens that patients are not able to identify their expectations, so dentists must be able to consider whether their exigencies can be satisfied.

Implants should only be inserted when periodontal conditions are stable

November 8, 2018

Biofilm is the most significant cause of inflammatory bone loss around teeth and implants. Diagnostics, biofilm management and, where necessary, treatment help in patients with this problem. The W&H No Implantology without Periodontology workflow should provide stable tissue prior to implantation through prevention, and implant success in the long term through aftercare—something that is advantageous to both the patient and the treatment team.

Incorporating CAD/CAM solutions for full-mouth dental implant reconstructions

November 7, 2018

Patients facing the loss of their natural dentition have more treatment options than ever before. The traditional complete denture, once the standard of care for the fully edentulous patient, is slowly but surely giving way to fixed full-arch implant restorations as their superior stability, function and aesthetics become more well known. Further, prosthetic materials have advanced in leaps and bounds, and monolithic zirconia can now be milled for fixed full-arch indications. By moving beyond acrylic and its vulnerability to wear, chipping, stains and fracture, this adds long-term durability to the qualities that make the fixed implant prosthesis the ultimate restorative option for fully edentulous cases.

Restoring function and aesthetics with monolithic zirconia restorations

November 6, 2018

With greater public awareness about cosmetic dental reconstructions, the dentist is often challenged with greater demands from the patient. This increased demand for aesthetic restorative treatment challenges the dentist, laboratory technician and dental manufacturers to develop techniques and materials to satisfy the discerning patient. Utilising digital planning, modern materials and effective techniques, the restorative team can succeed in restoring a smile to proper form, function and health. The case presented in this article demonstrates the significance of a systematic approach to planning, preparation and material selection in full-mouth reconstruction of a patient’s dentition.

A surgical approach to the management of periapical implant lesions

October 26, 2018

Periapical implant lesions may be a cause of early failure of implants. The purpose of this article is to describe the surgical treatment of the periapical implant lesion and its intraoperative approach.

New perspectives in periapical surgery: Hemostasis

October 22, 2018

The aim of the current investigation was to review techniques and materials available to achieve bleeding control during periapical surgery. An adequate bleeding control is crucial, since it improves vision in the surgical site, minimizes surgical time, enhances the root-end resection and filling, and reduces surgical blood loss, postsurgical hemorrhage and postsurgical swelling.

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Condylar retrusion on the horizontal plane associated with retrusive lateral excursion

October 20, 2018

The objective of this article was to describe the relationship between the movement of the interincisive point and the working temporomandibular joint condyle with regard to the horizontal plane during laterality movements.

Efficacy of a adhesive on the strength of a luting cement to leucite-reinforced glass-ceramic

October 17, 2018

The present study compared the efficacy of a universal adhesive containing silane, bis-GMA and 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) monomer with that of silane applied alone or combined with bis-GMA or 10-MDP, but in separate steps, on the microtensile bond strength of a CAD/CAM leucite-reinforced glass-ceramic to a resin cement.

Direct pulp capping as a conservative procedure to maintain pulp vitality

October 15, 2018

From a completely optimistic point of view, the ultimate goal for every dentist performing a restorative and/or endodontic procedure should be to maintain the pulp vitality and functionality of the tooth without any discomfort for the patient. The pulp tissue is needed to provide nutrition, innervation and immunocompetence, with these acting as a defence mechanism and alerting to the presence of any external aggression.(1)

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Orthograde apical application of an MTA plug in a tooth without constriction

October 8, 2018

The minor apical foramen should be maintained at its initial position and size after chemomechanical endodontic procedures. If the apical constriction is breached and transported, cleaning procedures will be compromised and obturation significantly difficult to carry out well.

Chairside CAD/CAM immediate restorations

October 5, 2018

No-preparation ultrathin veneer is one of the most minimally invasive restorations. Its thickness ranges from 0.3 to 0.5 mm. In the right circumstances (Figs. 1 & 2) it can show excellent aesthetic appearance and provide long-term stability and health of soft- and hard-tissue.

Dynamic navigation for reliable and predictable flapless implant placement

August 20, 2018

A 52-year-old female patient was concerned about the appearance of her smile. Her upper right first molar and second premolar had been missing for several years (Figs. 1 and 2). She was otherwise a fit and healthy non-smoker. The patient was unwilling to consider a denture and was not keen for the symptomless adjacent teeth to be prepared for bridgework, particularly the upper right first premolar, which was unfilled. She did not wish to have any form of removable prosthesis. She chose to have implant-supported crowns, as she wanted the final restoration to be as close as possible to having natural teeth.

Combined CAD/CAM-assisted treatment, for a new, beautiful smile

June 6, 2018

CEREC has become part of everyday life at our practice where I and three other general dentists work. We treat not only patients from the direct vicinity, but also patients from some 600 km away; indeed, these make up around 25 per cent of our client base today. Treatment in a single session is thus an important “added value” service for our patients. And that is reflected in our system’s take-up rate. As a practitioner, it is important to me not to have to compromise when it comes to restorations and, in particular, to have full control over the process at all times. That may sound trivial, but it has a major impact on the treatment itself, including the dental technology aspect, on my time management, as I can treat another patient during CAD/CAM production, and also on the cost-effectiveness of my practice. And, of course, one should not forget the high levels of patient satisfaction. Our patients couldn’t be more impressed with CEREC, especially when they realise the indications for which it can be used in implantology and orthodontics.

Implant restoration with CEREC

May 23, 2018

Dental implants are a fantastic addition to the repertoire of any restorative dentist and allow us to provide a tooth replacement in a way that minimises damage to remaining dentition. The restoration of dental implants requires a sound knowledge of restorative dentistry, prosthodontics and periodontology. Traditionally, this has been carried out with an analogue impression taken with an impression coping either via an open or closed tray impression technique. A skilled technician then fabricates this restoration over a 2- to 3-week period. The time and skill required for these restorations both from the clinician and technician command high fees for the patient.

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The use of CBCT and CAD/CAM techniques in implant-supported rehabilitation of maxilla—Part II

May 18, 2018

In the first part of this article (published in CAD/CAM 1/2017) the different phases of diagnostics, planning and implantological treatment were presented. In the process of planning, the necessity of creating temporary restorations in order to increase the patient’s comfort was taken into consideration, keeping in mind the fact that augmentative procedures must be performed.

Using CAD/CAM for a combination approach to full mouth reconstruction

May 9, 2018

Now more than ever, it behoves dentists and laboratories to work together as part of an interdisciplinary and collaborative team to coordinate treatment, select ideal restorative material(s), and plan cases, particularly those involving full-mouth reconstructions. Fortunately, a number of digitally based technologies can be incorporated into the treatment thorough diagnostic and treatment planning processes, as well as used for fabricating various components of treatments. When used in combination with a systematic and collaborative plan for preparing and executing treatment, these tools can enable the team to achieve success when restoring a patient’s smile to proper form, function, and health.

Brain-guided implant reconstruction: Who makes the decisions?

May 5, 2018

It appears that there is still a great divide between those who utilise 3-D technology for dental implant planning and surgical placement of dental implants and those who do not. Clearly, decisions as to how to diagnose and treatment plan our patients may be the difference between success and failure. Recently an internet advertisement promoting an educational programme stated that ‘Implant surgery is not complicated, easier than most other dentistry, and every dentist has the skills to surgically place implants. If you can take teeth out, you can put a dental implant in! You don’t need expensive equipment for brain-guided surgery, you can learn it with no initial investment!’ Implant dentistry has become one of the most predictable and successful treatment modalities in all of dentistry. If the only imaging modality utilised is a two-dimensional panoramic or periapical radiograph how can a clinician really know if a procedure will be complicated?

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