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Purpose: To evaluate the survival rates and technical outcomes of minimally invasive full-mouth rehabilitations in patients affected by dental erosion and attrition. Materials and Methods: For this retrospective study, 28 subjects (8 women, 20 men; mean age: 45.6 years) who suffered from generalized erosions and attrition and who were treated according to the 3-step technique were invited to participate. The patient records were reviewed, and the restorations were clinically and radiographically examined. This part of the study (Part 1) evaluated restoration survival and technical outcomes using the modified United States Public Health Service criteria (mUSPHS). Survival analysis was performed using Kaplan-Meier survival statistics, and comparison between subgroups was made using log-rank test. For all other comparisons, cross tabulations of occurrence were performed, and significance was tested using Pearson chi-square test. The level of statistical significance was set at P < .05. Results: A total of 19 patients (3 women, 16 men; mean age: 45.6 years) agreed to participate. In these patients, 406 restorations (149 direct composites, 110 onlays, 147 veneers) supported by 365 teeth were examined. The mean time in service was 71.8 ± 28.6 months. Six failed restorations were identified; all were direct composites. The 6-year survival rates were 97.3% for direct composites, 98.2% for onlays, and 100% for veneers (P > .05). No differences were found among materials or locations of the restorations. Nineteen technical complications included 14 partial fractures, 3 fissures, 1 wear, and 1 decementation. The mUSPHS evaluation showed good technical outcomes. Presence or absence of a nightguard influenced restoration survival (P = .003). Conclusion: Minimally invasive rehabilitations of patients with erosions/attrition with the 3-step technique are a reliable treatment option in the medium term. Protective nightguards are recommended. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the biologic and esthetic outcomes and the patient-reported outcome measures (PROMs) of full-mouth rehabilitations in patients suffering from generalized erosive and/or abrasive tooth wear following the 3-step technique. Materials and Methods: Patients who received a minimally invasive full-mouth rehabilitation according to the 3-step technique and who were treated at the University of Geneva and/or in a private practice were considered for inclusion. The minimum service time of the restorations was 12 months. The biologic outcomes were analyzed by assessing pocket probing depth (PPD), Plaque Index (PI), and bleeding on probing (BOP). Furthermore, secondary caries, tooth vitality, and sensitivity to temperature were evaluated using the modified United States Public Health Service (USPHS) criteria. The esthetic outcomes were rated with the White Esthetic Score (WES). Finally, PROMs were evaluated using visual analog scales (VAS). Results: A total of 19 patients with 406 restorations (149 direct composite resins, 110 indirect composite resin/ceramic onlays, and 147 composite resin/ceramic veneers) were examined after a mean follow-up of 71.8 ± 28.6 months. Periodontal parameters were good (mPPD = 2.9 ± 0.4; mPI = 0.1 ± 0.2; and mBOP = 0.05 ± 0.1). No secondary caries were found, and no abutment teeth had lost vitality. A total of 36 abutment teeth had moderate sensitivity, but none presented pronounced sensitivity. The rehabilitations exhibited good esthetic outcomes (mWES = 8.4 ± 1.9). Patients reported satisfying esthetic results of their rehabilitations (mean VAS = 9.2 ± 1.6) and considered their treatment as comfortable (mean VAS = 8.2 ± 2.1), while the least favorably rated parameter was the cost of treatment (mean VAS = 4.1 ± 3.2). Conclusion: Minimally invasive full-mouth rehabilitations of patients with generalized tooth wear by means of the 3-step technique exhibited very good clinical medium-term results with respect to biologic and objective/subjective esthetic outcomes. The patient satisfaction with this treatment was high. [ABSTRACT FROM AUTHOR]

Abstract Background There is no clear relationship between in vitro bactericidal activity tests and clinical outcome. We studied bactericidal activity of oxacillin, vancomycin and teicoplanin against Staphylococcus aureus isolates in patients with endocarditis and then we sought to determine if there was a relationship between in vitro bactericidal activity and clinical outcome. Methods Minimal bacteriostatic and minimal bactericidal concentrations were determined for Staphylococcus aureus strains isolated from patients with endocarditis following standardized methods. Medical records were reviewed retrospectively to collect data on antimicrobial susceptibility at admission, antimicrobial therapy, need for surgery, embolic events and outcome. Results and Discussion Sixty-two Staphylococcus aureus strains were studied in 62 patients with endocarditis. Overall, 91.9% definite, 21% methicillin resistant and 72.6% cured. Surgery was performed in 32.3% and embolic events were documented in 64.5%. Tolerance to oxacillin and teicoplanin was more common than vancomycin tolerance among methicillin susceptible Staphylococcus aureus. Among methicillin resistant Staphylococcus aureus teicoplanin was shown to have a higher rate of tolerance than vancomycin. No statistically significant differences on clinical outcome between oxacillin tolerant and oxacillin non tolerant Staphylococcus aureus infections were observed. Tolerance to oxacillin did not adversely affect clinical outcomes of patients with methicillin susceptible Staphylococcus aureus endocarditis treated with a combination of antimicrobials including oxacillin. The cure rate was significantly lower among patients with methicillin resistant Staphylococcus aureus endocarditis. Conclusions In vitro bactericidal test results were not valid predictors of clinical outcome. Physicians need to use additional parameters when treating patients with staphylococcal endocarditis.

In case of severe dental erosion, the maxillary anterior teeth are often particularly affected. Restoring such teeth conventionally (ie, crowns) would frequently involve elective endodontic therapy and major additional loss of tooth structure. A novel, minimally invasive approach to restore eroded teeth has been developed and is currently being tested in the form of a prospective clinical trial, termed The Geneva Erosion Study. To avoid crowns, two separate veneers with different paths of insertion have been used to restore the affected anterior maxillary teeth, regardless of clinical crown length and amount of remaining enamel. This treatment is called The Sandwich Approach. Objectives: The purpose of this case series study was to analyze the mid-term clinical outcome of maxillary anterior teeth affected by severe dental erosion that were restored following the Sandwich Approach. Materials and methods: Twelve consecutively consulting patients (mean age: 39.4 years) suffering from advanced dental erosion have been enrolled in the study and were subsequently treated. Due to the late interception of the disease, all patients needed a full-mouth rehabilitation, which was performed without any conventional crowns. At the level of the maxillary anterior teeth, a total of 70 palatal indirect composite restorations and 64 facial feldspathic ceramic veneers were delivered. Both types of veneers were adhesively luted with a hybrid composite. Clinical reevaluations were performed 6 months after insertion of the veneers, and then annually, using modified United States Public Health Service (USPHS) criteria. Marginal adaptation, marginal integrity (seal, absence of infiltration), status of pulp vitality, postoperative sensitivity, esthetics, and restoration success/failure, were the principal clinical parameters analyzed. Results: After an up to 6-year observation time (mean observation time 50.3 months for the palatal veneers and 49.6 months for the facial veneers), no complete or major failure of the restorations was encountered. On the basis of the criteria used, most of the veneers rated Alpha for marginal adaptation and marginal seal. Secondary caries or endodontic complications were not detected. Using visual analogue scale analysis, the patient-centered satisfaction revealed a high esthetic and functional acceptance of 94.6%. Conclusions: Compared to conventional crown preparation, restoring compromised maxillary anterior teeth by means of 2 veneers prevents excessive tooth structure removal and loss of tooth vitality. Questions on the longevity of this new treatment arise, due to the nonfavorable initial status of the teeth to be restored (eg, lack of enamel, sclerotic dentin substrate and short clinical crowns). The clinical performance of the teeth treated following the Sandwich Approach seems promising, since none of the treated teeth lost their vitality, no failure of any of the restorations was detected, and the patients' overall satisfaction was high. Even though further investigation is needed to determine the clinical long-term performance of the described treatment modality, the encouraging mid-term results (biological, esthetic, and mechanical success) clearly question if conventional crowns in the anterior maxillary segments can still continue to be considered the best and only option to treat this particular population of patients. [ABSTRACT FROM AUTHOR]

A full-mouth adhesive rehabilitation in case of severe dental erosion may present a challenge for both the clinician and the laboratory technician, not only for the multiple teeth to be restored, but also for their time schedule, difficult to be included in a busy agenda of a private practice. Thanks to the simplicity of the 3-step technique, full-mouth rehabilitations become easier to handle. In this article the treatment of a very compromised case of dental erosion (ACE class V) is illustrated, implementing only adhesive techniques. The very pleasing clinical outcome was the result of the esthetic, mechanic and most of all biological success achieved, confirming that minimally invasive dentistry should always be the driving motor of any rehabilitation, especially in patients who have already suffered from conspicuous tooth destruction. [ABSTRACT FROM AUTHOR]

Dental erosion is increasing, and only recently are clinicians starting to acknowledge the problem. A prospective clinical trial investigating which therapeutic approach must be undertaken to treat erosion and when is under way at the University of Geneva (Geneva Erosion Study). All patients affected by dental erosion who present with signs of dentin exposure are immediately treated using only adhesive techniques. In this article, the full-mouth adhesive rehabilitation of one of these patients affected by severe dental erosion (ACE class IV) is illustrated. By the end of the therapy, a very pleasing esthetic outcome had been achieved (esthetic success), all of the patient's teeth maintained their vitality, and the amount of tooth structure sacrificed to complete the adhesive full-mouth rehabilitation was negligible (biological success). [ABSTRACT FROM AUTHOR]

The article presents a case study of a 25-year-old male patient who had weakening and fracturing of the maxillary incisal edges. It comments that the patient showed generalized initial dental erosion and had an accelerated loss of dental enamel. It mentions that palatal and facial dental veneers were also used to restore incisors which showed darkening, and talks about the use of additive diagnostic wax-up to prepare for lithium disilicate ceramic onlays which were etched with hydrofluoric acid.

Minimally invasive principles should be the driving force behind rehabilitating young individuals affected by severe dental erosion. The maxillary anterior teeth of a patient, class ACE IV, has been treated following the most conservatory approach, the Sandwich Approach. These teeth, if restored by conventional dentistry (eg, crowns) would have required elective endodontic therapy and crown lengthening. To preserve the pulp vitality, six palatal resin composite veneers and four facial ceramic veneers were delivered instead with minimal, if any, removal of tooth structure. In this article, the details about the treatment are described. [ABSTRACT FROM AUTHOR]

Erosive tooth wear is a serious problem with very costly consequences. Intercepting patients at the initial stages of the disease is critical to avoid significant irreversible damages to their dentition and to benefit from still favorable conditions when it comes to clinical performance of the restorative measures proposed. In this article, a new classification is proposed to quantify the severity of the dental destruction and to guide clinicians and patients in the therapeutic decision-making process. The classification is based on several parameters relevant for both the selection of treatment and the assessment of the prognosis, such as dentin exposure in the palatal tooth contact areas, alterations at the level of the incisal edges, and ultimately, loss of pulp vitality. (Int J Periodontics Restorative Dent 2010;30:559-571.). [ABSTRACT FROM AUTHOR]

Dental erosion is a frequently underestimated pathology that nowadays affects an increasing number of younger individuals. Often the advanced tooth destruction is the result of not only a difficult initial diagnosis (e.g. multifactorial etiology of tooth wear), but also a lack of timely intervention. A clinical trial testing a fully adhesive approach for patients affected by severe dental erosion is underway at the School of Dental Medicine of the University of Geneva. All the patients are systematically and exclusively treated with adhesive techniques, using onlays in the posterior region and a combination of facially bonded porcelain restorations and indirect palatal resin composite restorations in the anterior maxillary region. To achieve maximum preservation of tooth structure and predict the most esthetic and functional outcome, an innovative concept has been developed: the threestep technique. Three laboratory steps are alternated with three clinical steps, allowing the clinician and the dental technician to constantly interact during the planning and execution of a full-mouth adhesive rehabilitation. In this article, the third and last step of the three-step technique has been described in detail. [ABSTRACT FROM AUTHOR]

Traditionally, a full-mouth rehabilitation based on full-crown coverage has been recommended treatment for patients affected by severe dental erosion. Nowadays, thanks to improved adhesive techniques, the indications for crowns have decreased and a more conservative approach may be proposed. Even though adhesive treatments simplify both the clinical and laboratory procedures, restoring such patients still remains a challenge due to the great amount of tooth destruction. To facilitate the clinician's task during the planning and execution of a full-mouth adhesive rehabilitation, an innovative concept has been developed: the three-step technique. Three laboratory steps are alternated with three clinical steps, allowing the clinician and the laboratory technician to constantly interact to achieve the most predictable esthetic and functional outcome. During the first step, an esthetic evaluation is performed to establish the position of the plane of occlusion. In the second step, the patient's posterior quadrants are restored at an increased vertical dimension. Finally, the third step reestablishes the anterior guidance. Using the three-step technique, the clinician can transform a full-mouth rehabilitation into a rehabilitation for individual quadrants. The present article focuses on the second step, explaining all the laboratory and clinical steps necessary to restore the posterior quadrants with a defined occlusal scheme at an increased vertical dimension. A brief summary of the first step is also included. [ABSTRACT FROM AUTHOR]

Traditionally, a full-mouth rehabilitation based on full-crown coverage has been the recommended treatment for patients affected by severe dental erosion. Nowadays, thanks to improved adhesive techniques, the indications for crowns have decreased and a more conservative approach may be proposed. Even though adhesive treatments simplify both the clinical and laboratory procedures, restoring such patients still remains a challenge due to the great amount of tooth destruction. To facilitate the clinician's task during the planning and execution of a full-mouth adhesive rehabilitation, an innovative concept has been developed: the three-step technique. Three laboratory steps are alternated with three clinical steps, allowing the clinician and the laboratory technician to constantly interact to achieve the most predictable esthetic and functional outcome. During the first step, an esthetic evaluation is performed to establish the position of the plane of occlusion. In the second step, the patient's posterior quadrants are restored at an increased vertical dimension. Finally, the third step reestablishes the anterior guidance. Using the three-step technique, the clinician can transform a full-mouth rehabilitation into a rehabilitation for individual quadrants. This article illustrates only the first step in detail, explaining all the clinical parameters that should be analyzed before initiating treatment. [ABSTRACT FROM AUTHOR]

The restoration of the missing maxillary incisors is a complex and delicate treatment challenge. When implant therapy is used, proper treatment planning is critical, as selecting the proper number, location, and dimension of the implants is a difficult task. Thus, this article discusses the issues that must be addressed during diagnosis and treatment planning to achieve a predictable esthetic outcome when using implants to replace the maxillary incisors. The advantages and disadvantages of several implant-supported treatment options-using a combination of regular- and narrow-neck implants-are presented. Ultimately, the use of narrow-neck implants at the lateral incisor sites is presented as the best option for ensuring excellent esthetic outcomes, and the corresponding indications and contraindications are discussed. Further, all treatment options are ranked based on the predictability of their esthetic outcomes. [ABSTRACT FROM AUTHOR]

In this two-part treatment planning series, the case of a 63-year-old woman with severe attachment loss at the maxillary incisors is presented. In Part 1, pretreatment strategies, occlusal and periodontal status, and the advantages and disadvantages of six treatment options using both conventional and implant therapy were presented. In this follow-up article, the treatment selected for the case is revealed, and the rationale- including indications and contraindications for the different treatment options-is discussed. The treatment sequence is then outlined, and the final outcome is presented. [ABSTRACT FROM AUTHOR]

In this two-part treatment planning series, the case of a 63-year-old woman with severe attachment loss at the maxillary incisors is presented. In Part 1, pretreatment strategies, eg, use of intra- and extraoral photographs, analysis of periapical radiographs, and examination of occlusal and periodontal status, are discussed. The advantages and disadvantages of six treatment options using both conventional and implant therapy are presented. In Part 2, the treatment selected will be revealed and the rationale governing the decision will be discussed. [ABSTRACT FROM AUTHOR]

In this two-part treatment planning series, the case of a 54-year-old woman with a failing four-unit fixed partial denture (FPD) is presented. Part 1 presented pretreatment strategies, occlusal and periodontal status, and the advantages and disadvantages of three treatment options: removable partial denture, tooth-supported FPD, and implant-supported FPD. In this follow-up article, the treatment selected for the case is revealed, and the rationale-including indications and contraindications for the different treatment options-is discussed. The treatment sequence is then outlined, and the final outcome is presented. [ABSTRACT FROM AUTHOR]

In this two-part treatment planning series, the case of a 54-year-old woman with a failing four-unit fixed partial denture (FPD) is presented. In Part 1, pretreatment strategies, eg, use of intra- and extraoral photographs, analysis of periapical radiographs, and examination of occlusal and periodontal status, are discussed. The advantages and disadvantages of three treatment options-removable partial denture, toothsupported FPD, and implant-supported FPD-are presented. In Part 2, to be published in the next issue, the treatment selected will be revealed and the rationale governing the decision will be discussed. [ABSTRACT FROM AUTHOR]

Objectives (1) To determine the survival rate of 10 four-unit fixed dental prostheses ( FDPs) replacing the four maxillary incisors, supported by 20 narrow-diameter implants ( NDIs), (2) to assess the incidence of mechanical and biological complications, and (3) to evaluate bone level changes longitudinally after final FDP insertion. Materials and methods Ten patients (six women, four men), mean age 49.4 ± 12.6 years, were treated with a four-unit anterior maxillary FDP (six screw-retained; four cemented). Biological parameters, eventual technical complications, radiographic measurements, and study casts were assessed at 1 (baseline), 3, and 5 years after implant placement. A multilevel logistic regression test was performed on clinical parameters and bone level changes (significance level P < 0.05). Results The 5-year implant and FDP survival rate was 100%. Mean modified plaque index (mPI) values were 0.03 and 0.02 at 3 and 5 years, significantly lower when compared to mPI (0.11 ± 0.31) at 1 year. Mean modified sulcus bleeding index (mSBI) was 0.08, 0.08, and 0.15 over time. Probing depth (PD) values were 1.57, 1.64, and 2.03 mm. Statistically significant differences were found between 1 vs. 5 year ( P = 0.0003) and 3 vs. 5 year ( P = 0.001). Keratinized mucosa (3.65 mm) remained stable during observation period. DIB mean values were 2.01 ± 0.34, 2.13 ± 0.13, and 2.17 ± 0.38 mm. Patient satisfaction based on visual analog scale revealed favorable fulfillment of overall treatment and esthetic expectations. Conclusions Two NDIs supporting a four-unit FDP to replace the four missing maxillary incisors may be considered a predictable treatment modality. [ABSTRACT FROM AUTHOR]

A full-mouth rehabilitation should be correctly planned from the start by using a diagnostic wax-up to reduce the potential for remakes, increased chair time, and laboratory costs. However, determining the clinical validity of an extensive wax-up can be complicated for clinicians who lack the experience of full-mouth rehabilitations. The three-step technique is a simplified approach that has been developed to facilitate the clinician's task. By following this technique, the diagnostic wax-up is progressively developed to the final outcome through the interaction between patient, clinician, and laboratory technician. This article provides guidelines aimed at helping clinicians and laboratory technicians to become more proactive in the treatment planning of full-mouth rehabilitations, by starting from the three major parameters of incisal edge position, occlusal plane position, and the vertical dimension of occlusion. (Int J Esthet Dent 2016;11:356-377) [ABSTRACT FROM AUTHOR]

Due to an increasing awareness about dental erosion, many clinicians would like to propose treatments even at the initial stages of the disease. However, when the loss of tooth structure is visible only to the professional eye, and it has not affected the esthetics of the smile, affected patients do not usually accept a full-mouth rehabilitation. Reducing the cost of the therapy, simplifying the clinical steps, and proposing noninvasive adhesive techniques may promote patient acceptance. In this article, the treatment of an ex-bulimic patient is illustrated. A modified approach of the three-step technique was followed. The patient completed the therapy in five short visits, including the initial one. No tooth preparation was required, no anesthesia was delivered, and the overall (clinical and laboratory) costs were kept low. At the end of the treatment, the patient was very satisfied from a biologic and functional point of view. [ABSTRACT FROM AUTHOR]

This two-part case presentation describes the prosthetic challenge of managing complications in a 50-yearold female patient after inadequate esthetic risk assessment, treatment planning, and implant placement in the anterior maxilla. In Part I, the clinical situation was described, and different restorative solutions were proposed to correct the extreme facial inclination of the implants, excluding major surgical procedures, namely implant removal. In Part II, different prosthetic options are discussed, and the final treatment is revealed. A noninvasive treatment protocol was applied to transform a severely compromised postsurgical situation into an esthetically acceptable result. An unconventional prosthesis design was implemented, including the use of ceramic veneers bonded to the CAD/CAM-generated screw-retained zirconia-based fixed dental prosthesis (FDP), to correct major axis-related problems and spatial discrepancies. [ABSTRACT FROM AUTHOR]

This two-part case presentation describes the prosthetic challenge of managing complications after inadequate esthetic risk assessment, treatment planning, and implant positioning in the anterior maxilla. Here, the case report of a 50-year-old woman, referred after inappropriate execution of immediate implant placement, is presented. Different restorative treatment alternatives are proposed, excluding major surgical procedures. In the next part of the article, the advantages and shortcomings of the various prosthetic options will be discussed and the selected treatment revealed. The aim of this part of the article is to illustrate the importance of treatment planning, emphasizing that the correction of esthetic implant failures consistently leads to compromised results when compared to what could have been achieved first time round. [ABSTRACT FROM AUTHOR]

Amelogenesis imperfecta (AI) is a hereditary disorder caused by mutations of genes primarily involved in the enamel formation. Several different types of AI have been identified, based on the phenotype and on the mode of inheritance. Regardless of the type, the dental treatment tends to be the same, favoring the complete removal of the compromised enamel late in the patient's life. With the new dentistry guidelines that orient clinicians towards minimal invasiveness, it should be mandatory to intercept patients affected by AI earlier, not only to protect the dentition from further degradation but also to help patients improve their self-esteem. This article examines the restorative dentistry performed on a 24-year-old Caucasian female suffering from the hypoplastic type of AI, using only adhesive procedures. Due to the complex needs of the patient, an interdisciplinary approach was followed, involving orthodontics, periodontics, and restorative dentistry. A full-mouth adhesive rehabilitation was achieved by means of direct composite restorations, veneer/onlays and facial/palatal veneers. No elective endodontic therapy was necessary for restorative purposes. The esthetics, mechanics, and biological success were achieved and maintained. The bond to the enamel did not show signs of degradation (eg, discoloration or infiltration) even after 5 years of function. This is encouraging as it shows that adhesive techniques may be a reliable approach even in the presence of a compromised enamel layer. [ABSTRACT FROM AUTHOR]