MODERATORS: Giovanni Zucchelli, Nicolas Arnould
Even in the age of adhesive techniques and digital approach to the prosthetic treatment, dental preparations represent a decisive moment to guarantee therapeutic success.
The preparation of a dental element is not an exercise of only pure manuality, but the result of a mental process that brings the dental professional to create a shape that, contrasting all factors that can lead to therapeutic failure, can highlight the merceological characteristics of the restorative materials that will be used, and that can efficiently adapt to the laboratory technologies that will be used for realizing the restoration.
Another decisive factor is that a well-designed preparation needs to allow the procedures of impression-taking, being digital or analogic, to transfer perfectly to the laboratory all anatomical data that the dental-technician requires for the development of the technical phases.
The collaboration between dentist and dental-technician, and the reciprocal knowledge of the poblematics linked to clinical and laboratory factors, will permit to obtain the most from the therapeutic possibilities that are available today, and to create prosthetic restorations that can be integrated in a correct way in the biological system of the oral cavity, minimizing the operative invasively.
Anterior tooth replacement with dental implants in young and demanding patients entails high esthetic risks. Any misalignment or asymmetry of the gingival margin or metallic translucency will be visible during smiling thus compromising patient esthetics. In this clinical scenario there is a very high risk of not fulfilling the patient’s expectations. Post-extraction implant placement with immediate provisionalization represents the treatment of choice for maximizing the predictability of an esthetic outcome and for reducing both the number of surgical procedures and overall treatment time. Nevertheless, this approach must comprise a surgical procedure which addresses the augmentation of the soft tissues at the time of implant placement.
Over the past 25 years dentistry has undergone important changes following the development and advancements made in the field of adhesive dentistry. New prosthetic materials and techniques have been developed, clinical and technical workflows have been perfected, intraoral and extraoral digital scanners are in use and classical prosthetic preparation designs of indirect restorations have been modified The introduction of adhesive procedures in prosthetic treatment planning has become a valid alternative to traditional procedures opening the way for a series of new materials, new operative techniques, and an array of materials (porcleain, lithium disilicate, reinforced resins) that can be used with different types of marginal preparations along with numerous types of adhesive cements always with respect to the surrounding periodontal tissues.
These huge changes with an increase in treatment options has certainly created confusion and REALISTIC DOUBTS for the clinician often deriving from the limitations of the materials and techniques and they require PRACTICAL SOLUTIONS.
This presentation will examine the REALISTIC DOUBTS about treatment planning, the role of the occlusion, type of preparations, materials to be used in combination with adhesive procedures, adhesive cementation, clinical/scientific evidence available in literature, costs and benefits along with their PRACTICAL SOLUTIONS.
The increasing demand from numerous patients that don’t have a lot of time to devote to dental care but at the same time are note also willing to give up the quality of dental services, has led us to review our procedures by offering more and more frequently sessions that include more services performed in a single chairside outpatient session.
Even during this particular period chacterized by the diffusion of Covid-19, the full compliance with outpatient strategies and rehabilitation protocols, requires Dentists to further optimized protocols to justify the use of PPE necessary for the patient reception (pre-triage and triage) and to perform patient therapies in total safety. In this scenario, digital technologies ,such as CAD_CAM Systems for the in-house production of coronal restorations and I.O.S. for non-contact impressions, offer good opportunities for greater control of cross-infections.
It is therefore possible to satisfy all the constantly changing patient needs by significantly reducing the number of outpatient sessions that the patient must undergo even to solve an important problem such as the fracture of a dental element. The results obtained in a single outpatient session demonstrate the enormous possibilities offered by the new digitized modern protocols.
A starting point to talk about how times have changed and how the new frontier of dentistry is represented by the digitization of most of the therapeutic protocols concerns the CAD-CAM Systems that in recent years have forcefully entered the daily work of the dentist, completely changing the workflow. Thanks to the wide range of millable materials currently available on the market, there are multiple solutions that guarantee safe and reliable protocols, for every type of individual.
The correlation between the choice of the material and the clinical indication is the key to success for the prosthetic rehabilitation and the knowledge of materials allows the realization of predictable rehabilitations over time, where the aim is the aesthetic result, the biological and functional integration and last but not least, the maximum patient satisfaction.
We will therefore talk about how digital technology can support the clinician in daily practice and especially in rehabilitations in a single outpatient session.
Restorations in the esthetic zone can be very challenging.
In this lecture basic principles and highlights of esthetic parameters will be presented along with how dento-alveolar changes relate to facial changes. A checklist will be presented for the inter-disciplinary group to evaluate and envision prior to developing a treatment plan and ceramic materials and restoration types reviewed.
What is the current evidence for decision-making in esthetic areas? Also explored will be materials and restoration types in implant supported fixed restorations in the anterior area. The biological characteristics of the peri-implant soft tissues and how to evaluate and diagnose anterior esthetic implant sites aimed at achieving more predictable outcomes will be looked at along with a review of crown and abutment complexes and how to prosthetically deal with various compromised sites.