Advanced prosthodontics – no cut & drill dentistry

Monolithic porcelain veneers with micro-layering

50-year-old patient with severe orthodontic problems (crooked teeth) and malocclusion (tightening and grinding of her teeth).

Due to clenching and grinding, her teeth had significantly abraded and shortened, causing serious aesthetic problems.

Patient requested to improve the appearance of her mouth.

Case was assessed as high-risk and of high-demands as there was peril of porcelain fractures and potential issues with the temporomandibular joints.

Careful raise of vertical dimension  was initially performed using bonded resins (mock-up) to help gain prosthetic space without drilling teeth.

At second phase long-term temporary restorations replaced bonded mock up.

Partial coverage restorations as well as full coverage veneers were chosen as treatment plan dictated.

Teeth were not drilled and state-of-the-art porcelain restorations were bonded using a strict protocol (use of dental isolation).

Monolithic emax restorations were used with micro-layering to provide both strength and aesthetics.

Shade was Bleach1

Maryland bonded bridge – No cut&drill dentistry

Female patient referred by peer dentist to restore her lost tooth.

Patient was informed of all possible solutions to her issue.
It was mutually decided upon to proceed with a fixed Maryland bridge , that is full-ceramic bonded bridge.

Maryland bridges or bonded bridges are fully non-invasive, that being no drilling employed.
Inner part of canine was thoroughly cleaned and prepared. Full upper and lower arch were scanned and stl file sent to cad/cam lab.

A state-of-the-art Maryland bridge designed and fabricated.

Gum site was conditioned with a removable soft splint that was placed and used for almost a week (Essix splint).

Finally ceramic bridge sandblasted and chemically cleaned. No drilling involved.
State-of-the-art bonding system was used (Tokuyama Universal bond)

Impressive one-day makeover with bonded composites

Female patient requested elongation of front teeth. She complaint for inadequate tooth exposure both at lip rest and at smile.

Aesthetic evaluation confirmed patient’s remarks. Functional assessment showed a difficult class II occlusion i.e. lower teeth located far back and inward as compared to the position of the upper. Such occlusion scheme regularly calls for a preliminary orthodontic treatment as a start off phase. However as stated by patient, she had already had been treated with brackets all to no avail. Therefore a second ortho treatment was denied

Moreover extended tooth wear made the restorative treatment even more difficult to handle and to safely design with a new occlusal scheme. Tooth-wear patients are regarded high-risk in terms of sustaining restorations free of chipping or catastrophic fractures

Due to her limited stay in Athens, we decided to proceed to complete aesthetic and functional analysis and to bond the simulated new dentition on her native teeth with composites. Hardly any teeth showed at smile. Aesthetic assessment showed a need for 2.00 mm elongation of the upper. However that would be considered an easy-to-break restoration due to the unfavourable occlusal scheme.

A limited raise of the vertical dimension of occlusion (VDO) was decided however not to the ideal assumed height, because of the exaggerated class II occlusion.

thickening of the upper teeth was ,too, decided to hold up the upper lip thus to help show more tooth volume

An increase of the lower front teeth was not an option because they , too, showed too much

An increase of the height of the lower posterior was designed to somehow help gain prosthetic space for the upper front

Porcelain 360 veneers in the front and porcelain onlays on the posterior are planned as definitive restorations

Transparent templates were fabricated from the models of the intended new dentition. Being the ‘‘negative” replicates of the intended upper and lower teeth, they were filled up with flowable composites and seated on each jaw. Light cure was followed to help bond and to harden the composites therefore new dentition was a acquired in 5′ on adequately primed teeth without any drill or cut at all

Tooth contacts were adjusted and bonded prototypes will now serve their versatile role for the next months as the perfect trial dentition