Facial esthetics significantly impact self-confidence and quality of life, motivating patients to seek prosthetic rehabilitation of the anterior maxilla. Treatment options typically include restorative-only or combined orthodontic-restorative therapies, influenced by patient expectations, invasiveness, duration, and clinical recommendations. Historically, orthodontic pretreatment faced resistance due to prolonged treatment time and social stigma. However, advancements such as clear aligners and minimally invasive techniques have overcome many barriers, optimizing tooth alignment and enabling conservative preparations. This article presents a case involving interdisciplinary orthodontic and minimally invasive prosthetic therapy. A 33-year-old patient dissatisfied with previous veneers underwent clear aligner therapy, minimally invasive veneer preparations guided by digital wax-ups, and definitive lithium disilicate restorations. Advanced digital tools facilitated precise interdisciplinary planning and enhanced patient communication. Material selection prioritized esthetics and durability, complemented by comprehensive maintenance to ensure long-term success. This approach highlights the advantages of interdisciplinary collaboration in achieving superior esthetic outcomes while preserving natural tooth structure.
BACKGROUND:This report presents a multidisciplinary approach combining orthodontic clear aligners and minimally invasive ceramic laminate veneers in the esthetic zone. METHODS:The patient expressed dissatisfaction with her smile due to the overlap of the left central incisor over the right central incisor, mild incisal wear, and the shade of her teeth. The treatment plan involved the use of clear aligners to improve the alignment of the anterior teeth, followed by minimally invasive tooth preparations to accommodate ultrathin ceramic laminate veneers. Clear aligners have become a popular treatment option due to their discreet appearance compared to traditional orthodontic brackets, which are visible on the facial surfaces of teeth. Additionally, clear aligners offer greater comfort, as they can be placed and removed easily by the patient. Minimally invasive ceramic veneers further enhanced the esthetics by significantly improving the shade and shape of the anterior teeth. Using novel techniques and technologies, ultrathin restorations were fabricated to blend with the adjacent natural dentition. RESULTS:The interdisciplinary approach, combining orthodontic treatment with clear aligners to improve the position of the teeth within the arch, followed by ultrathin laminate veneers bonded under total dental dam isolation, offered a minimally invasive approach with predictable results. CONCLUSIONS:The combination of clear aligners and ultrathin ceramic veneers successfully met the patient's esthetic and functional expectations.
OBJECTIVES:To evaluate patient-reported outcome measures (PROMs) and prosthetic outcomes in patients receiving a definitive restoration after extraction and immediate implant placement in the esthetic zone. MATERIALS AND METHODS:Twelve patients in need of tooth extraction and immediate implant placement and provisionalization in the esthetic zone were consecutively recruited. Restoration-based treatment planning was performed applying a fully digital workflow including the fabrication of a prefabricated definitive monolithic zirconia crown prior to the surgery. Tooth extraction and guided surgery was performed in all patients and immediate placement and loading was carried out with the prefabricated definitive restoration on the day of surgery. The restoration was evaluated by the patients and by two experienced and calibrated clinicians using modified USPHS (United States Public Health Service) criteria to evaluate the treatment outcome. CLINICAL CONSIDERATIONS:In 9 out of 12 patients, the crowns were inserted at the same visit without any adjustments. Two crowns required minor adjustment-one at the incisal edge position and another at the distal contact area. These were delivered at the same clinical visit after the necessary adjustments had been made. One crown showed a misfit and was in need of a new scan and an adjustment in the laboratory prior to insertion at the next visit on the following day. Patient satisfaction was 9.41 ± 0.49 at baseline and 9.6 ± 0.47 at the 6-month follow-up. Clinical outcomes in terms of periimplant soft tissue health, interdental papillae levels, and midfacial mucosal levels were assessed at the time of implant placement (baseline) and 6 months postoperatively. All patients reported highly satisfactory results for all the parameters assessed. CONCLUSIONS:Digitally driven immediate implant placement and loading with prefabricated definitive restorations in the esthetic zone may serve as a valid clinical protocol. However, further randomized controlled clinical trials are needed to prove the efficacy of this protocol. CLINICAL SIGNIFICANCE:Immediate definitive restorations were inserted on the day of immediate implant placement following digital protocols. However, clinicians should be cautious when applying the immediate implant protocol in the esthetic zone as the prosthesis may need minor adjustments.
AIM:The objective of the present study was to assess tooth color changes over a 5-year period after at-home bleaching protocols with 10% carbamide peroxide. MATERIALS AND METHODS:A 4-week overnight at-home bleaching protocol using whitening trays and 10% carbamide peroxide was performed on a total of 49 patients. Tooth color was analyzed in 49 patients using standardized photographs at the beginning of treatment, the end of treatment, after 4 months, after 2 years, and again after 5 years for the 19 still-remaining patients. The values for the color coordinates L*, a*, and b* were recorded and used to calculate the whiteness index (WID) as well as the color difference (ΔE 00), luminosity (L*), chroma (C*), and hue (h°) variation using the CIEDE2000 formula. Statistical analysis was conducted at a significance level of P 0.05, by means of paired Student's t tests. RESULTS:The color difference and the whiteness index difference were greatest during the first week of treatment and decreased progressively in the subsequent weeks and months. The relapse in color observed 4 months after stabilization showed a noticeable difference compared with the color prior to stabilization. Luminosity showed a significant difference between the beginning and the end of treatment as well as a marked relapse. Similarly, chroma underwent substantial variation during treatment in the teeth of both arches, yet showed only minimal relapse. In contrast, hue displayed only minor changes throughout the treatment and stabilization periods. CONCLUSIONS:The present study confirms the long-term efficacy of at-home bleaching with 10% carbamide peroxide. The whitening effect remained clinically noticeable after 5 years, despite a gradual and expected relapse. Among the color parameters, chroma was the most stable, while luminosity showed an early relapse, and hue showed a minimal relapse. Standardized digital photography proved reliable for long-term color monitoring.
OBJECTIVE:This article presents the incisal first technique (IFT) as a systematic and conservative approach to restoring larger anterior diastemas using direct composite resin. It is the second part of a two-part series published in IJED; the first part being 'Efficient diastema closure, Part 1: The modified Mylar pull technique for small diastema closure.' The present article emphasizes precise incisal edge placement as the initial step in guiding tooth proportion, contact point positioning, and the emergence profile. CLINICAL CONSIDERATIONS:Conventional techniques for larger diastema closure may rely on wax-ups, mock-ups, or full-surface composite veneering, which can complicate workflow and compromise natural esthetics. The IFT simplifies the process by establishing the incisal edge and final tooth width from the outset, using this reference to guide proportion, contact point positioning, and the emergence profile. The technique builds composite sequentially-starting from the incisal edge and progressing palatally and buccally-while preserving gingival health and tooth anatomy. The modified Mylar pull technique (MMPT) is performed from both palatal and buccal directions to achieve seamless, void-free proximal contact and controlled line angle placement. The IFT allows clinicians to restore complex spaces conservatively, without altering the buccal surface too much or requiring additional preparatory and finishing steps. CONCLUSIONS:The IFT offers a conservative and predictable method that focuses on incisal edge positioning and maintaining biologic and optical parameters. It simplifies tooth proportion control and contact formation and enhances workflow efficiency while maintaining esthetic and biologic integrity. Anatomically correct, void-free larger diastema closure with highly predictable esthetic outcomes can be achieved with a simplified clinical execution while preserving tissue health and structural integrity.
The advent of adhesive techniques has shifted dental restoration toward highly conservative strategies, emphasizing preservation of natural tooth structure to maintain oral health and reduce future interventions. In managing dental wear, additive methods offer predictable outcomes while safeguarding the longevity of restored teeth. Direct restorations are suitable for minor to moderate lesions due to their reversibility and cost-effectiveness, whereas deeper or functionally and esthetically significant defects often require indirect solutions. Minimally invasive approaches, particularly ceramic veneers, prioritize enamel preservation and aim to minimize unnecessary tissue removal. For severe anterior wear, three adhesive strategies stand out: the bilaminate approach (palatal and vestibular veneers), V-shaped veneers, and 360-degree peripheral veneers. This two-part article reviews these techniques, clarifying their indications and methodology through scientific evidence and detailed clinical illustrations.
The use of facial scan data with digitally designed rims facilitates a predictable facially driven treatment plan and restorative procedures for patients with severe atrophy, failing dentition, and a reduced lower facial third. This clinical report describes a digital workflow for the rehabilitation of a patient with a severely diminished lower facial third by incorporating facial scans with full-arch digitally designed occlusal rims for the vertical dimension, guided by a modified intraoral scan body (AFT Dental System; Seville, Spain). As a result, functional and esthetic parameters established through try-in of the rims can be transferred to the fa cial scan during the digitization process of the patient. This technique facilitates a predictable facially generated treatment plan, digital design, and manufacturing of interim prostheses in the determined vertical dimension of occlusion. On the other hand, taking a conventional facial scan with the intraoral device placed in the initial interocclusal relationship would not provide a facial reference that would allow the technical team to create a digital plan, considering key aspects such as the amount of tooth exposure at rest, the relationship of the maxillary incisal edges with the lower lip, and the distribution of the posterior planes in relation to the horizontal reference planes.
A correct emergence profile is fundamental for achieving a natural result to transition from an implant with a circular neck to a cervical area that replicates a natural tooth. The shape of the critical contour must allow the reproduction of the emergence profile from the natural tooth: its design is linked to the desired tooth shape and gingival architecture. However, the absence of horizontal and vertical soft tissue references in the anterior edentulous area may present a clinical challenge in terms of both surgery and prosthetics. Digital workflows are an active trend in dentistry. The generation of 3D models is fundamental to make an accurate diagnosis, create a virtual plan, and predict the outcome. Segmentation is the isolation and individualization of the anatomical structure from one initial CBCT scan. A new artificial intelligence-convolutional neural network system was developed to automatically segment CBCT images. In delayed implant placement, the peri-implant soft tissue is progressively shaped through sequential modification of the critical contour. By copy-pasting the segmented root and through a mirror effect, the dental technician will be able to copy the natural critical contour of the contralateral tooth and replicate it exactly. CAD/CAM fabricated temporization using new artificial intelligence application enables consistent results in the reproduction of the natural critical contour in implant restoration. This innovative technique thus allows for the recreation with mirror effect of soft tissue architecture and a natural tooth contour using artificial intelligence-convolutional neural network. It facilitates the fabrication of the temporary tooth in cases of delayed implant placement in the anterior sector. No adjustment is required since the shape is mimetic to the contralateral natural tooth.
In the esthetic zone, while there may be a structural, mechanical, or health problem to manage, the patient's esthetic concerns will also significantly influence the treatment possibilities. A consequence of this is the need to use tooth-colored restorative materials. Treatment choices are frequently limited to direct or indirect techniques using either ceramics or composite resin-based materials. The inclusion of orthodontics and perio-plastic procedures may also influence the selection of the treatment approach. In the 'gray zone,' a patient will have a number of possible treatment options, and the treating clinician may have difficulty deciding on the most appropriate treatment plan. While there is often no right or wrong treatment plan, this author hopes to present more clarity around developing the best one for a particular patient. The indications for direct and indirect techniques often coincide. However, they have entered the same space from opposite positions, which has created certain 'legacy issues' and treatment-planning confusion. As far as the gray zone in esthetic restorative dentistry is concerned, the area of greatest overlap is of most interest. The primary emphasis of this article is the appropriate application of direct materials.
The patient-related clinical and socioeconomic factors that influence the final decision in selecting the preferred restorative material for each situation may be confusing for both the patient and the dentist. The hereby proposed 'spider graph' assessing and scaling important clinical parameters can act as an indicative communication tool that can facilitate the final decision.
Minimally invasive anterior veneer restorations have become a cornerstone of contemporary esthetic dentistry, with both direct composite resin and indirect ceramic veneers offering effective and conservative treatment solutions. This article provides a comprehensive clinical and scientific overview, outlining indications, preparation protocols, adhesive procedures, esthetic and functional outcomes, and long-term performance. For indirect ceramic veneers, key clinical concepts such as additive design philosophy, project-guided preparations, and mock-up-driven techniques are explored in detail. The importance of enamel preservation is highlighted. Adhesive protocols are critically reviewed, including ceramic conditioning with hydrofluoric acid, silanization, and tooth surface treatment under rubber dam isolation. Long-term survival and success data from the literature are discussed, showing superior longevity for ceramic veneers but also showing the advantages of modern composite resin materials. Ultimately, when used appropriately and according to clinical indications, both composite resin and ceramic veneers represent viable treatment options that provide predictable outcomes and high patient satisfaction.
There are many options for restoring or improving a smile, including various tooth-colored biomaterials and clinical protocols. Some simple and limited tooth form or color corrections in young patients with healthy teeth logically call for a direct approach using composite resins, whereas more extensive smile rehabilitation in older patients with high esthetic demands should rationally be performed with ceramics. The various patient conditions that comprise these 'simple' examples, for which all practitioners may apply the same decision-making rationale, do not apply in increasingly complicated situations when more options appear feasible; this is exactly what the 'gray zone' in esthetic restorative dentistry is about. This introductory article presents and analyzes the multitude of factors to be considered in adopting a rational approach to this 'complex' situation faced daily by clinicians. The other articles in this publication develop first the arguments of the invited experts in favor of direct or indirect techniques and composite resin or ceramic materials, prior to a description of the state of the art in each treatment approach and restorative materials. This is followed by the conclusive outcome of a general discussion summarizing the recommendations of EAED's Active Members and conference moderators to select more rationally the most appropriate treatment modalities and biomaterials for excellence in esthetic restorative dentistry.
Esthetic restorative dentistry has seen a paradigm shift toward conservative approaches that prioritize tooth preservation, functional longevity, and patient-specific customization. Biomaterials play a pivotal role in this transformation. From traditional feldspathic ceramics and lithium-reinforced glass-ceramics to zirconia, CAD/CAM composites, PICN (hybrid ceramic), and 3D-printed materials, the spectrum of options continues to expand. However, an ideal material capable of meeting all requirements simultaneously does not exist. Clinical success therefore depends on judicious material selection and a thorough understanding of the advantages and limitations of each biomaterial class. This review synthesizes the available data across material families, evaluating their properties and clinical behavior, with particular emphasis on minimally invasive protocols and bruxism-prone patients.
