DENTAL EROSION TREATED WITH LITHIUM DISILICATE PALATAL VENEERS USING A DIGITAL WORKFLOW
Antonia Sotiropoulou1, Nefelie Laghios2, Asst. Prof. Aspasia Sarafianou3
1 School of Dentistry, National and Kapodistrian University of Athens,
2 School of Dentistry, University of California, Los Angeles,
3 Department of Prosthodontics, School of Dentistry, National and Kapodistrian University of Athens
Introduction
Dental erosion prevalence has recently increased. Excessive intake of soft drinks, bruxism, gastric reflux and eating disorders are the most common etiological factors. Prosthetic treatment needs to be initiated as soon as dentin is exposed. With the current adhesive systems, a minimally invasive approach is possible using a fully digital workflow.
Case Description
A 70-years old male presented to our clinic with dental erosion seeking for rehabilitation. His chief complain was the deterioration of his anterior teeth especially on the palatal side. He had previously restored these teeth with direct composite veneers but by that time they were heavily eroded. The clinical and radiographic examination revealed erosive lesions and excessive dentin exposure (ACE CLASS III), but no periodontal or endodontic problem. Posterior teeth had already been treated with zirconia crowns. In the meanwhile, patient was diagnosed with gastric reflux. Photos and digital impressions were taken to study the occlusion and the existence of the adequate prosthetic space. After the evaluation it was revealed that there was no need to increase the vertical dimension of occlusion as the existing space was sufficient for a minimally invasive rehabilitation with lithium disilicate palatal veneers. After designing and printing a 3D model, a mock-up to evaluate occlusion (anterior guidance, canine guidance) was performed. Through the mock-up a minimal preparation was achieved emphasizing in cervical enamel preservation. The final restorations were CAD/CAM produced with vhf E4 milling machine and cemented with a highly filled flow resin material.
Discussion
The conservative preparation technique associated with all-ceramic materials establish them as an excellent rehabilitative option for situations where an additive approach is required. Thin palatal veneers promoted a stable anterior and canine guidance. Periodontal health and marginal stability were observed at a 6-month follow-up. The use of sectional veneers could be a suitable alternative to conventional restorative approaches.