No prep minimally invasive dentistry to treat erosion from reflux disease and high acid diet @ivoclaruk

As we close the first day at the Competence in Aesthetics conference in Vienna we get a superbly inspirational presentation called “From minimally to NON-invasive dentistry, a reality” by Dr Francesca Vailati. She talks about the ever increasing problem we see of tooth wear from Bullemia, Gastric reflux disease and the increased uses of sports energy drinks. She demonstrated a few “typical” cases of flattened posterior cusps, palatal erosion, Invisalign edge thinning / chipping and near pulpal exposures.
Quite often these patients present requesting repair of their chipped incisors and quite often we oblige. We wonder then if adhesive bonding is so good, why do the composite fail to readily? We then chamfer more enamel away to increase the surface area for bonding, the restoration lasts bit longer. We often ignore the lack of space caused by the reduction of Occlusal vertical dimension, the traumatic occlusion, loss of guidance.

A traditional approach is to do a full mouth rehabilitation. This means preparing every tooth, removing even more precious enamel. Exposures, endodontics, post crowns, complex high risk bridgework. High risk and very expensive – setting patients up for a lifetime of expensive dental bills.

Francesca detailed her approach.
Remove caries, place provisional restorations and treat any perio
Full CR wax up to open OVD and give space for anterior work.
NO DRILLING! NO ANAESTHESIA!
Fit CAD composite overlays to posteriors on one arch, over the top of amalgams, crowns, whatever is there.
Opposing arch direct composites offer the top of whatever is there
Palatal composite veneers with Invisalign edge lapping.
And leave as provisionals.

In just three visits. Great value to the patient but as no drill is used, patient “owns” those restorations, they pay for any replacements.

Wear will happen, so In future, replace restorations with pressed Emax veneers. Leave the palatal composite veneers, do a Snadwich technique of minimal prep emax veneers facially (so there is a line for the lab to press to, you can’t press to nothing), leaving the palatal composites in place. That way, no full crowns done, all mesial and distal enamel and dentine is left in place.

Incredibly low invasive dentistry. Francesca showed us two OPGs, one taken after approach, one taken after traditional approach, you can just see from the radiographs how much better things look. If endodontics is need lasted, no problem, you can make access holes where necessary, especially easy through the provisional composites.

Inspirational stuff, makes me want to put down my drill ASAP.

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The “PUPA” technique in Implant Aesthetics

Some great moments so far at the Aesthetic Conference in Vienna, the first one for me being introduced to the PUPA technique for increasing papilla height by laterally squeezing the papilla. We’ve known about using composite resin ok a provisional crown to guide papillary regeneration but the PUPA technique (push up papillary augment) uses a convex zirconia temporary abutment to create lateral pressure on the gum tissue.
Amazing stuff!

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Also looking at failure rated of all ceramic work over the last 5, 10 and 15 years. Studies are showing lots of failures of zirconia crowns and bridges with the layering ceramic delaminating. This can be reduced by ensuring that the layering ceramic is fully supported, so as much zirconia as possible.
Looking at chemically bonding air abraded Zirconia to tooth structure. Studies are showing that we can get a better enamel and dentine bond strength to zirconia than to metals, IF the zirconia is handled properly. Maryland zirconia frameworks with Lithium Disilicate Emax layering can be a really aesthetic long term solution to missing tooth.

Oh, and in the world of composites, much more cusp covering in posterior teeth, get rid of a margin being occluded on, the better the integrity.

More to follow……