The One step‐No prep technique: A straightforward and minimally invasive approach for full‐mouth rehabilitation of worn dentition using polymer‐infiltrated ceramic network (PICN) CAD‐CAM prostheses

Abstract

Objectives To introduce a novel approach for full‐mouth rehabilitation of severely worn dentition using polymer‐infiltrated ceramic network (PICN) computer‐aided‐design and manufacturing (CAD‐CAM) restorations, without tooth tissue preparation and provisional phase. Clinical considerations Three patients with generalized tooth wear, suffering from dental pain, masticatory dysfunction, bruxism and neck and back pain, were selected and treated in collaboration with physiotherapists. Occlusal analyses were performed and full‐mouth diagnostic wax‐ups were designed on the basis of estimated tissue loss. Deficient direct restorations were replaced and low‐thickness PICN (Vita Enamic) restorations (up to 0.2 mm) were CAD‐CAM designed from wax‐ups, milled, tried‐in and then bonded within two consecutive days. To mask palatal veneers, either buccal direct composites or glass‐ceramic veneers were later performed. An occlusal splint was realized. Clinical results were shown to be successful after a follow‐up of 22, 18, and 13 months, respectively. The absence of provisional phase did not engender any inconveniences. Patient reported outcomes were very positive, showing a reduction in neck and back pain and a well‐being increase. Conclusion The proposed protocol is particularly minimally invasive and straightforward compared to classical techniques. PICNs exhibit several advantages compared to other materials. Preliminary results of this multidisciplinary approach are promising but deserve further clinical research. Clinical significance The development of CAD‐CAM technologies offers the possibility of improving treatment of severe worn dentition, reducing chairtime and need of tooth tissue preparation, and introducing a new class of composite materials (hybrid ceramics), which exhibit interesting properties for this indication. The influence of the proposed multidisciplinary approach, particularly the collaboration with physiotherapists, needs to be further explored with respect to treatment of associated symptoms, such as masticatory muscles hypertrophy and neck pain.

Orthodontic‐assisted one step‐ no prep technique: A straightforward and minimally‐invasive approach for localized tooth wear treatment using polymer‐infiltrated ceramic network CAD‐CAM prostheses

“…From a functional point of view, the one‐step and empirical VDO increase did not result in any complications. These results confirm previous findings of the one step‐no prep technique for generalized tooth wear, in which PICN restorations are bonded on all teeth, without testing the VDO with provisional restorations 7,29 . The VDO determination is always an inaccurate and empirical process 30 ; generally, it is based on dental restorative needs, and with the one step‐no prep approach, the principle is simply to recreate missing tissues based on the remaining tooth anatomy, since PICN materials can be used in low thickness.…”

“…The described minimally invasive approaches include the following: (a) direct techniques with light‐cured composites, which constitute the most commonly reported treatments; (b) indirect techniques with ceramic or composite partial bonded restorations; and (c) a combination of these two techniques 6 . Among the indirect techniques, a novel technique (one step‐no prep) for full‐mouth rehabilitation of worn dentition using computer‐aided designed and manufactured (CAD‐CAM) composite restorations has been recently introduced 7 . It is characterized by the absence of tooth tissue preparation (no prep) and provisional phase (one step), use of polymer‐infiltrated ceramic network (PICN) materials, occlusal analysis, and collaboration with physiotherapists to treat bruxism‐associated symptoms, such as muscular pain.…”

Comprehensive CAD/CAM Prosthetic Rehabilitation Management in a Young Patient with Agenesis: A Case Report

“…The interest of the CAD/CAM with the same procedure has already been shown in extensive erosive lesions [ 20 , 21 ] and traumatology [ 22 ]. For this patient, an improvement in masticatory performance is clearly visible.…”

Rehabilitation of a Severely Worn Dentition with Partial Lithium-disilicate Glass Ceramic Restorations: A Case Report

“…14 Restoring functional occlusal relationships with the reconstruction of OVD requires a complex, multistep treatment. 15 The increase in OVD can be provided by one-or twostep approaches. The one-step approach employs a treatment modality that the definitive indirect restorations being all bonded within the same or following day, whereas provisional restorations or nightguards are applied to test the new OVD with the two-step approach.…”

“…12 Previous studies reported that an increase in OVD up to 5 mm in the maxillo-mandibular interincisal distance is well tolerated by patients and that one-step approach is applicable. 15,16 On the other hand, OVD increase in patients with severe attrition induces signs of neuroplastic changes in corticomotor control of masseter muscles. 17 Therefore, when alteration in OVD is planned for patients with TMD, two-step approach is suggested regardless of the amount of increase.…”