OBJECTIVE: This case report presents a direct composite inverse injection technique using a bi-layer clear mini-index fabricated with a digital workflow to restore extensive posterior occlusal cavities in a 13-year-old patient.
METHODS: After a root canal treatment in the right mandibular first molar and step-wise excavation of deep caries in the left mandibular first molar, the extensive occlusal restorations were digitally designed using CAD software, upon which digital wax-ups were 3D-printed. Bi-layer clear mini-indices consisting of a hard outer plastic layer and an elastic inner silicone layer were prepared from the 3D-printed cast. The bonding surfaces were deproteinized using a 6% sodium hypochlorite solution, and an antioxidant (Clearfil DC Activator; Kuraray Noritake) was utilized to improve the dentin bonding durability of a 2-step self-etch adhesive (Clearfil SE Bond 2; Kuraray Noritake). Subsequently, a highly filled universal-shade flowable resin composite (RC) was incrementally placed into the cavities. To create the final occlusal morphology, the same RC was inversely injected through the opening of the bi-layer indices.
RESULTS: The workflow was feasible, and the occlusal cavities were efficiently restored using the injection technique. Occlusal carving and adjustments of the morphology were not necessary, leading to less chair time. At the 1-year follow-up, the clinical outcome was excellent.
CONCLUSIONS: The injection technique with a bi-layer clear mini-index accurately translated the digital wax-ups into large, final restorations. Precise morphology and shortened chair time enhanced patient satisfaction, but at the expense of multiple visits.

The ability for clinicians to adequately obtain primary stability in host bone is critical to the success of dental implants. Numerous conditions require dentists to perform multistage approaches to rebuild deficient bone volume prior to surgically placing implants. In many instances, implant placement cannot be achieved due to a lack of primary implant stability. Recently, a novel mineral-organic resorbable bone adhesive (MORBA) has demonstrated promising results in animal studies. MORBA is a synthetic, injectable, self-setting, load-bearing adhesive biomaterial that exhibits osteopromotive properties and bonds bone to bone and metal within 10 minutes and can fully resorb in 30 weeks. Its unique novel formulation was developed from biomimetic proteins found in marine animal creatures that possess distinct adhesive properties underwater. Excellent long-term results have shown its potential use for achieving primary stability in immediate implants. The present case report demonstrates the first use of MORBA in a human patient, utilized on a nonrestorable mandibular first molar. MORBA was utilized after placement of a mobile 5.8-mm implant to achieve stabilization. At 3 months postsurgery, both clinical and CBCT evaluations showed maintained implant stability. One year after implant placement, radiographic bone was seen on the buccal surface of the implant with continued long-term stabilization. This case report extends to 3 years whereby the use of MORBA, in an initially unstable situation, demonstrated an excellent long-term follow-up. MORBA provided immediate implant stability with resorbable characteristics, leading to successful long-term clinical outcomes up to 3 years. This innovative biomaterial offers a more efficient solution to a critical problem in implant dentistry, allowing optimal primary stability during immediate implant placement, thus reducing treatment times and costs.

The aim of this case report is to describe the treatment of a maxillary right central incisor with pulpal necrosis and incomplete root formation. The 14-year-old patient had experienced trauma to both maxillary central incisors approximately 2 years earlier. Therapy consisted of apexification with a bioceramic reparative cement to form an apical plug. After the clinical and radiographic evaluations, the clinician opened the crown, performed the chemical-mechanical preparation, and placed calcium hydroxide-based medication. At the next appointment, 24 days later, the intracanal medication was removed through passive ultrasonic instrumentation; the canal was dried; and the bioceramic cement was inserted into the apical portion with the aid of a mineral trioxide aggregate holder. A sterile cotton ball, moistened with distilled water, was used to maneuver the material in the apical region, and a periapical radiograph was exposed to confirm the correct placement of the bioceramic reparative cement. The canal was filled with gutta percha cones and a bioceramic root canal sealer. All procedures were performed with the aid of microscopic magnification. Clinical and radiographic evaluations at the 18-month follow-up visit showed that the treated tooth was asymptomatic, suggesting that the bioceramic reparative cement is effective for apexification.

To describe a technique for performing an adhesive oral rehabilitation based on a digital workflow and focused on the integration between esthetic and occlusal aspects in a young patient with a worn dentition.
An adhesive oral rehabilitation with severe loss of dental structure in a 40-year-old male patient is described. The treatment was based on a fully digital workflow (including facial scanning), esthetic and occlusal virtual planning, guided implant surgeries, an adhesive resin prototype, and ceramic restorations. The technique integrates both esthetic and occlusal factors, splitting the dental arches into four sectors and following a stepped sequence with specific objectives for each one. The loss of dental structure was initially rebuilt by an adhesive composite resin full-mouth prototype rehabilitation. This step also helped to confirm the esthetic and occlusal digital planning. After 4 months, lithium disilicate restorations were delivered following the same order, sector by sector, to reduce possible errors when transferring the previously approved anatomy to the final ceramic oral rehabilitation. Lastly, an acrylic nightguard was installed and a 6-month recall program established.
An accurate integration between esthetic and occlusal aspects was achieved during digital planning, which was also corroborated by the adhesive resin prototype. The final ceramic restorations fulfilled the patient\'s esthetic expectations and recovered the occlusal anatomy.
The proposed esthetically guided and occlusally protected (EGOP) technique seems to be a reliable approach to treat patients with worn dentition. Further clinical research and additional proposals are necessary to assess the possible benefits associated with these procedures.

Many authors have advocated retentive tooth preparations for resin composite restorations intended to halt progression of incisal edge attrition with worn concave dentin, probably due to frustration with adhesive restorations being lost from these defects. Unfortunately, this technique further removes the dentin these restorations are intended to preserve. The purpose of this article is to demonstrate a purely adhesive, less invasive technique for restoration of worn concave incisal edges, which includes air particle abrasion and increased etching time for the sclerotic dentin and unprepared enamel. Favorable two-year results for mandibular anterior teeth opposed by natural teeth are reported.

Non-carious cervical lesions (NCCLs) can compromise the integrity to both hard and soft tissues of teeth. This case report introduces a novel interdisciplinary technique by utilizing bioceramics-based cement (BBC) and porcine collagen matrix (CM) to reconstruct the dentogingival complex where enamel, dentin, and soft tissues were involved.
A 38-year-old healthy male was referred to the periodontics department for gingival recessions teeth #27-29 and a deep (NCCL) on the facial (F) #28 involving the loss of the cementoenamel junction (CEJ). The F #28 was restored with BBC according to manufacturing instructions. Soft tissues of #27-29 were simultaneously augmented with two CM strips via a coronally advanced tunnel utilizing suspended sutures. At the 6-month follow-up, approximately 100% root coverages were obtained for #27 and 29. The F #28 gingival tissue stabilized at the anticipated level of maximum root coverage (MRC), 1 mm apical to the coronally displaced CEJ. The exposed layer of BBC, F #28, was veneered with resin-modified glass ionomer to re-establish the original position of the CEJ. At the one-year follow-up visit root coverage for #28 remained stable and probing depths remained unchanged at 2 mm F #27-29. A sectional cone beam computed tomography scan illustrated the BBC restoration remained intact and well adapted.
The 12-month follow-up illustrated that the BBC may be a viable restorable material while performing simultaneous gingival grafting with CM in deep NCCLs with gingival recessions.
Why is this case new information? A novel approach treating the deep non-carious cervical lesion with BBC and CM. What are the keys to successful management of this case? The BBC placement needs to be flat. Secure the surgical site with non-resorbable suspensory sutures fixed by flowable composite. What are the primary limitations to success in this case? The primary limitation to success is the blood moisture control which may limit the placement of collagen matrix strips via the portal entry.

Dental implant treatment has been proven to be a successful therapy to rehabilitate single, partial, and fully edentulous sites. Evidence shows that the use of implant-supported restorations is predictable and can deliver long-term success. However, discontinuation of implant systems can be challenging for prosthesis maintenance. In this case report, a 70-year-old female patient presented to the implant department at New York University College of Dentistry with a press-fit implant with a one-piece cementable abutment that was placed more than 30 years prior. The patient\'s chief complaint was that the crown kept falling off. Upon evaluation, it was found that the implant was well-integrated in bone with no signs of infection. Explantation and replacement of the well-integrated implant was not considered the best option. An alternative approach was to address the retention of the abutment. The purpose of this case report is to demonstrate an intraoral technique for fabricating a custom cement-retained crown over a non-retentive one-piece press-fit implant.

BACKGROUND: This study aimed to evaluate the long-term outcome of 16 permanent maxillary central incisors with nonvital pulps and open apices treated with apexification and corono-radicular adhesive restorations, within a follow-up span of 5 to 22 years.
METHODS: Fourteen patients providing a total of 16 teeth treated with mineral trioxide aggregate (n = 12), Biodentine (n = 3), or β-tricalcium phosphate (n = 1) apical barrier and corono-radicular restoration, with or without fiberglass post, were included. Clinical and radiographic criteria were defined for assessment at recall. Restoration and periapical tissue status evaluation were performed according to FDI World Dental Federation\'s esthetic, functional, and biological criteria and Ørstavik Periapical Index (PAI). Outcome was dichotomized as \"healed\" (PAI ≤ 2, asymptomatic with absence of signs of infection) or \"not healed\" (PAI ≥ 3, presence of clinical signs and/or symptoms).
RESULTS: Fourteen of 24 patients were available for the present study (recall rate = 58%). Within a follow-up of 5 to 22 years, 10 (62.5%) teeth were considered \"healed,\" fulfilling both strict clinical and radiographic success criteria. Only 1 tooth was missing due to root resorption and 1 patient was presenting with clinical signs and symptoms at recall, resulting in a survival rate of 93.8%.
CONCLUSIONS: Adhesive corono-radicular restoration in nonvital permanent immature teeth treated with apexification allows for favorable long-term outcomes, by ensuring structural reinforcement and coronal microleakage prevention. Teeth sustaining a substantial loss of coronal structure may require post/core placement. In the case of failure, this endodontic-restorative combination ensured teeth survival until growth phase conclusion, thus allowing for proper prosthetic rehabilitation approaches.

Localized anterior maxillary tooth wear caused by erosion and attrition with loss of interocclusal space is difficult to manage. This observational case-series study reports six cases with worn anterior dentition treated with labial ceramic and palatal direct resin composite veneers at an increased vertical dimension of occlusion without restoration of unaffected posterior teeth. Thirty-six palatal direct veneers were made in six patients from a nanohybrid resin composite with the help of a wax-up-based template at an increased vertical dimension. After the complete re-establishment of posterior occlusion, 40 labial lithium-disilicate ceramic veneers were fabricated with a mock-up-guided method. The sandwich veneers were evaluated according to the United States Public Health Service (USPHS) criteria after a mean service time of 22.7 months. Re-establishment of posterior contacts as well as subjective patient satisfaction and function were evaluated. The overall success of the labial ceramic veneers was excellent. The quality of the palatal resin composite restorations was found to be good with predominantly \"Alpha\" scores. The marginal quality (11.1% and 33.3% of integrity and discoloration, respectively) and surface roughness (16.7%) showed small deteriorations indicated by \"Beta\" scores. The resin composite showed, in general, signs of wear facets which resulted in \"Beta\" scores in 44.4% of the cases. Posterior contacts re-established firmly within 4 weeks in all cases. Patient satisfaction with esthetics and function was high. The short-term outcome of this non-invasive treatment option is favorable and promising.

Total nasal defects after injures or surgical interventions can negatively affect patient\'s quality of life. Maxillofacial prosthesis is a contemporarily and reliable solution. This method gives us opportunity to restore missing tissues and helps patients to overcome social and psychological difficulties. In this article we demonstrated advantages and disadvantages of the method in two clinical cases. The application of magnetic and adhesive retention in different cases is described. Also, we outlined clinical and technological steps of maxillofacial prosthesis manufacture. Modified procedure of impression obtaining is offered.
Возникновение тотального дефекта наружного носа вследствие хирургического вмешательства или травмы неизбежно приводит к снижению качества жизни пациента. Экзопротезирование — это современный надежный метод, позволяющий заместить утраченные ткани лица, в частности, наружного носа и помочь пациенту справиться с социальными сложностями и психологическими проблемами, возникшими из-за изъянов внешности. В статье на примере двух клинических случаев продемонстрированы преимущества и недостатки метода с учетом современного уровня развития прикладного материаловедения в челюстно-лицевом протезировании. Описаны аспекты применения магнитной и адгезивной фиксации экзопротеза в разных клинических ситуациях. Подробно изложены клинические и технологические этапы изготовления экзопротеза носа. Предложена модификация этапа снятия оттиска лица.