Objectives To evaluate the effect of thermomechanical aging on the flexural strength of different lithium disilicate-based CAD/CAM ceramics under clinically relevant processing conditions. Methods A total of 192 bar-shaped specimens (15 mm×4 mm x 1.5 mm) were prepared from three CAD/CAM ceramics: two lithium disilicate (Amber Mill (AM) and IPS e.max CAD (EM)) and one lithium di/alumina-silicate (CEREC Tessera (CT)). Specimens were glazed using IPS e.max CAD Crystall./Glaze Spray or Universal Spray Glaze Fluo and subsequently processed according to material-specific crystallization protocols (conventional crystallization (cc) vs. speed crystallization (sc)), and sequences for material variants with different optical properties (high translucency processing (ht) vs. medium opacity processing (mo)). For each group (n = 32), half of the specimens were tested initially (non-aged), while the other half was subjected to artificial aging in a chewing simulator (1.2 million cycles, 50 N, 5°C/55°C). Flexural strength was determined via three-point bending. Data were analyzed using Kolmogorov-Smirnov, Kruskal-Wallis, and Mann-Whitney U tests (α=0.05). The Kaplan-Meier estimates together with the Log-Rang-test, as well as Weibull moduli, were computed. Results Comparing processing protocols within each material, differences in flexural strength were observed only for artificially aged CEREC Tessera specimens (p < 0.05). Artificial aging significantly reduced flexural strength in both AMht, AMmo and CTcc. No differences were observed among non-aged groups. Among thermomechanically aged specimens, EMcc and EMsc, and CTsc demonstrated the highest flexural strength of all groups. Significance In most cases, the selected processing protocol did not influence the flexural strength, supporting the clinical feasibility of using faster or alternative crystallization programs when endorsed by the manufacturer. Artificial aging revealed material- and processing protocol-specific reductions in flexural strength, highlighting the importance of both material composition and processing conditions in ensuring long-term clinical durability. These findings emphasize that performance differences between materials may only become clinically relevant after exposure to simulated oral aging conditions.

OBJECTIVES:To present and compare several extrusion techniques in case of insufficient tooth structure to create a sufficient ferrule and consider the biological width. CLINICAL CONSIDERATIONS:Extrusion methods based on orthodontic or surgical techniques are commonly applied, well-described, and predictable extrusion methods. Elastics with the highest possible tensile forces, magnets, or orthodontic appliances (e.g., braces) can be used for orthodontic approaches. These procedures are minimally invasive and the extrusion distance to be achieved depends on the forces applied. For the surgical extrusion method, a vertical extraction system is used, and respective teeth are placed in a more coronal position within one appointment. The correct selection of the extrusion method depends on various factors, including inter alia the condition of the periodontal tissues and of the adjacent teeth, as well as the experience and preference of the clinicians. Nevertheless, the presented treatment options require a high level of patients compliance. CONCLUSIONS:Various extrusion techniques enable saving and restoring teeth with severely damaged crowns. They appear to deliver satisfying treatment results with low complication rates, even in the esthetic area. Medium-term follow-up data up to 5 years of the concepts are partially available and promising; results on long-term data are still pending.

OBJECTIVES:To investigate the edge chipping resistance (ECR) of four lithium silicate ceramics at different thicknesses and points of loading after various surface treatment, firing and aging protocols. METHODS:288 rectangular specimens were cut from CAD/CAM ceramics (lithium-di-silicate: Amber Mill, Amber Mill Direct, IPS e.max CAD; lithium-alumino-silicate: CEREC Tessera) in three thicknesses (1.5 mm, 2 mm, 3 mm) and underwent different surface treatments (polishing, glazing, no surface treatment) and/or firing protocols (high translucency, medium opacity). Specimens were bonded to 4 mm thick dentine analogues and loaded 0.25 mm or 0.30 mm from the edge using a Vickers diamond indenter. ECR was determined initially, after thermocycling (5/55 °C, 10,000 cycles) and after hydrothermal aging (134 °C, 0.2 MPa, 120min). Force when chipping occurred was recorded and ECR calculated. Data were analyzed with Kolmogorov-Smirnov, Kruskal-Wallis, Mann-Whitney U, Friedmann and Wilcoxon tests (p < 0.05). RESULTS:For 7/18 groups, glazed and medium opacity fired Amber Mill showed higher ECR than all other groups. In comparison with polishing or exclusive firing, a surface treatment with glazing led to the highest ECR. The influence of specimen thickness and point of loading was negligible. While aging reduced the ECR in 50 % of the glazed groups, the ECR of those groups remained among the highest. SIGNIFICANCE:With the majority of groups showing no impact of the specimen thickness, a reduced restoration thickness of 1.5 mm seems to present limited disadvantages and should thus be considered for minimal invasive treatments. With regards to ECR, glazing can be recommended as the preferred surface treatment method for CAD/CAM lithium silicate ceramics.

Severe pathologic tooth wear is perceived internationally as an increasing problem based on growing evidence of risks associated with dental hard tissue damage due to erosion, attrition, and abrasion. The defect morphology of these wear-related lesions is different from that of caries lesions. Modern evaluation systems provide detailed quantitative assessment and classification of tooth wear. Against this background, restorative treatment concepts have become significantly more differentiated in recent decades. Direct composite restorations might be preferred for smaller defects and younger patients as they are less expensive and allow for minimally invasive procedures. Indirect restorations such as those made of glass-ceramics provide better control over the optimal form and esthetics and thus facilitate a safer and more predictable implementation of a physiologic static and dynamic occlusion. 3D treatment planning by means of a wax-up provides orientation for the subsequent tooth preparation and allows a particularly economical approach to the removal of healthy dental hard tissue. Furthermore, the introduction of new preparation designs has contributed significantly to the preservation of dental hard tissue in the teeth to be restored. The present article describes the principles of minimally invasive treatment concepts with high-strength silicate glass-ceramic restorations using anterior full veneers and posterior occlusal onlays for the rehabilitation of the worn dentition, provides up-to-date data for scientific evaluation, and presents a clinical case.

To investigate the torque load (TL) and angular rotation (AR) of additively, subtractively and conventionally manufactured occlusal devices. Specimens (N = 120) were fabricated from four additive manufacturing resins (GR-10 guide, ProArt Print Splint clear, V-Print Splint, V-Print Splint comfort), five subtractively (BioniCut, EldyPlus, ProArt CAD Splint clear, Temp Premium Flexible, Thermeo) and one conventionally manufactured (Pro Base Cold) materials. The TL and AR were tested initially (24 h, 37 °C, H2O) as well as after thermal cycling (5,000 thermal cycles, 5/55°C). Data were analyzed using Kolmogorov–Smirnov, one-way ANOVA, Scheffé post-hoc, t-test, chi-square and Ciba-Geigy table (p < 0.05). Initially, the mean TL values ranged from 63.7 to 104 Ncm for additively, 39.2 to 265 Ncm for subtractively, and 204 Ncm for conventionally manufactured materials. The initial mean AR values were 41.7 to 143 deg for additively, 38.4 to 138 deg for subtractively, and 29.3 deg for conventionally manufactured materials. After thermal cycling, the mean TL values ranged from 45.7 to 88.1 Ncm for additively, 31.2 to 246 Ncm for subtractively, and 138 Ncm for conventionally manufactured materials. The mean AR values after aging ranged from 19.9 to 124 deg for additively, 48.1 to 131 deg for subtractively, and 19.5 deg for conventionally manufactured materials. The torsional resistance of additively, subtractively, and conventionally manufactured materials for occlusal devices varies and is affected by aging processes. Material selection for occlusal devices should be guided by the clinical needs of the patients.

Genetic dental disorders (GDDs) can occur either isolated or as part of syndromes. Clinically, deviations in tooth shape, size, or structure, as well as the absence of multiple teeth, lead to severe dysfunction and a reduced quality of life, requiring lifelong preventive, conservative, and prosthodontic dental care. The dental management of prevalent dental diseases, such as caries or periodontitis, has been based on decades of research, whereas scientific data on the dental management of GDDs are scarce. This lack of data is challenging for dental practitioners, who must primarily rely on empirical knowledge only. Therefore, a systematic literature search and review were conducted on the dental management of common GDDs, such as ectodermal dysplasia, amelogenesis imperfecta, dentinogenesis imperfecta, periodontitis as a manifestation of rare systemic diseases, and X-linked hypophosphatemia and hypophosphatasia. The review revealed that 468 of the 9,115 retrieved publications met the inclusion criteria, with most being case reports or case series, highlighting a lack of robust clinical trials. This critical review provides a brief summary of the genetic background, key clinical signs, and treatment options for these conditions. The dominance of case reports emphasizes the need for improved reporting standards and long-term follow-up to support comprehensive data synthesis and meta-analyses. In addition, the uneven global distribution of publications suggests disparities in access to advanced dental care for GDDs. Efforts to standardize reporting and improve treatment documentation globally are crucial to addressing these challenges. In this way, information on GDD management can be improved, and statistical analyses of the data can be performed.

Statement of problem To prevent chipping of zirconia restorations, thinner veneering techniques like microlayering ceramic (µLC) have been used; however, the wear of these materials requires further investigation. Purpose The purpose of this in vitro study was to measure the wear and particle size of µLCs and compare them with veneered and monolithic zirconia and human teeth. Material and methods Zirconia crowns (n=12) were microlayered with Ceramotion One Touch 3D (CER), IQ SQIN (IQS), MiYO structure (MIY), and Structure (STR). Veneered zirconia (VEN), monolithic zirconia (MZ), and human teeth (HUM) (n=12) were used as controls. After 60 000, 120 000, and 600 000 masticatory cycles, the 2-body wear of crowns and antagonists (steatite balls) and the particle size of the µLCs was measured. The specimens were qualitatively examined using a light microscope to visualize wear patterns. Data were analyzed using nonparametric statistical methods, including the Spearman and Kendall correlation, Kruskal-Wallis-, Mann-Whitney-U- (α=.05), and ANOVA-type statistics for longitudinal data, with pairwise comparison adjusted by Bonferroni correction (α=.0034). Results Material type and number of masticatory cycles affected volumetric loss for crowns and antagonists (P≤.003). MIY showed higher wear than STR (P≤.002), and the remaining µLCs were statistically similar (P≥.088). HUM also fell within the same range of values as CER, STR, IQS, and VEN (P=.191 to.950). HUM showed no wear on antagonists. The wear on MZ could not be quantified. Particle size was determined: MIY<IQS<CER<STR<VEN. A negative correlation was observed between volumetric material loss and particle size (P<.001). Conclusions The µLCs and VEN showed measurable wear in contrast with MZ; but VEN demonstrated material loss more similar to that of HUM, reflecting physiological behavior. Increased masticatory cycles led to greater wear, risking exposure of the zirconia substrate.

PURPOSE:To investigate, via questionnaire, how protocols for adhesive luting workflows of dental restorations are applied in three German-speaking countries. MATERIAL AND METHODS:A 47-item questionnaire gathered data on airborne particle abrasion (APA) unit characteristics, parameters, operating procedures, pretreatments in adhesive luting workflows for restorations, and participant demographics. The survey was distributed via trade journals, expert associations, universities, technical schools, and social media. Marginal absolute and relative frequencies were analyzed (95% confidence intervals), with Chi-squared tests comparing observed and expected frequencies (P0.05). Twenty-three experts voted on 23 recommendations regarding APA parameters and other pretreatments for bonding restorations. RESULTS:A total of 267 participants completed the survey. Access to an APA unit was linked to a higher likelihood of performing APA before placement. Approximately half of the participants used APA in their practice. For zirconia restorations, 47.2% applied alumina APA at 50 µm/0.1 MPa, while 36.7% used the same settings for polymer-based restorations. For alloys, 37.5% employed 110 µm/0.2 MPa. These preferences correlated with age (≥30 years), experience (≥10 years), profession (dental technician/dentist), prior instruction/training, and daily APA use. Adhesives with MDP were used for zirconia (63.8%) and those with silane for silicate-based ceramics (55.9%). Agreement on recommendations ranged between 52% and 100%, with 21/23 reaching an average of 93%. CONCLUSION:Access to APA influenced clinical decisions and the feasibility of adhesive luting workflows. Adequate APA equipment in dental facilities is essential for quality care. Standardized protocols, training, and education across dental professions are necessary to enhance understanding and proper use of APA.

The aim of this pilot in vitro study is to investigate the fracture strength of hybrid abutment crowns (HACs) made of a 3D-printable, tooth-colored, ceramic-reinforced composite (CRC). Based on an upper first premolar, a crown was designed, and specimens were additively fabricated from a composite material (VarseoSmile Crown plus) (N = 32). The crowns were bonded to standard abutments using a universal resin cement. Half (n = 16) of the samples were subjected to artificial aging, during which three samples suffered minor damage. All specimens were mechanically loaded at an angle of 30° to the implant axis. In addition, an FEM simulation was computed. Statistical analysis was performed at a significance level of p < 0.05. The mean fracture load without aging was 389.04 N (SD: 101.60 N). Two HACs suffered screw fracture, while the crowns itself failed in all other specimens. In the aged specimens, the mean fracture load was 391.19 N (SD: 143.30 N). The failure mode was predominantly catastrophic crown fracture. FEM analysis showed a maximum compressive stress of 39.79 MPa, a maximum tensile stress of 173.37 MPa and a shear stress of 60.29 MPa when loaded with 389 N. Within the limitations of this pilot study, the tested 3D-printed hybrid abutment crowns demonstrated fracture resistance above a clinically acceptable threshold, suggesting promising potential for clinical application. However, further investigations with larger sample sizes, control groups, and clinical follow-up are required.

PURPOSE:To investigate whether depth-gauge burs in veneer preparations influence preparation depth in a randomized, controlled, single-blinded trial and whether inexperienced operators can perform adequate veneer preparations. METHODS:Participants were 20 undergraduate dental students with no prior veneer preparation experience. The instruments used were the "Laminate Veneer System" (LVS), "Keramik-Veneers. de" (KVD), and a "Freehand" group (FH) for reference. All participants prepared three educational acrylic resin maxillae and three mandibular central incisors mounted in typodonts in patient simulators. The objectives were to achieve a preparation depth of 0.6 mm (tooth 11) and 0.4 mm (tooth 31). The sequences of the instruments used and prepared teeth were randomized. The measurements were performed using a laser triangulation coordinate-measuring machine. The data were stratified according to tooth location. RESULTS:The preparation depths of both depth-gauge-instrument-groups LVS and KVD achieved the objectives significantly better than did the instruments from the "Freehand" group (P < 0.001). The differences between the depth gauge groups were insignificant, although the maximum preparation depths were smaller in the KVD group. Regarding the prepared teeth, the preparation depths in the mandibular incisors were lower, and the differences were smaller. CONCLUSIONS:The use of special depth-gauge burs for initial veneer preparation leads to significantly lower preparation depths than "Freehand" preparations. The tapered instruments resulted in a lower incidence of extreme preparation depths. The inexperienced operators performed veneer preparation remarkably well.

PurposeHybrid abutment crowns (HACs) made from monolithic ceramics represent an efficient option for single restorations on implants. However, long-term data are scarce. The purpose of this clinical trial was to evaluate the survival and complication rates of CAD-CAM fabricated HACs over a time period of at least 3.5 years. Materials and MethodsTwenty-five patients with a total of 40 HACs made of monolithic lithium disilicate ceramic bonded to a titanium base CAD-CAM abutment were retrospectively evaluated. All implants and screw-retained restorations were placed and manufactured in the same department of a university hospital. Only crowns that had been in service for more than 3.5 years were included in the study. HACs were evaluated regarding technical and biological complications. Functional Implant Prosthodontic Scores (FIPS) were obtained. ResultsThe mean observation time was 5.9 +/- 1.4 years. Implant survival was 100%, and HAC survival was 97.5%. Over the observation period, one crown fracture was observed, necessitating refabricating of the restoration. Three minor biological complications were found. The overall mean FIPS score was 8.69 +/- 1.12 points. ConclusionsWithin the limitations of this study, monolithic screw-retained HACs milled from lithium disilicate ceramics and bonded to titanium bases appeared to be a reliable treatment option over more than 3.5 years due to their low biological and technical complication rates.

OBJECTIVE:This article highlights a CAD/CAM complete-mouth rehabilitation in an 82-year-old patient by means of a complete maxillary prosthesis and mandibular implant- and tooth-supported fixed restorations made from multilayered zirconia. CLINICAL CONSIDERATIONS:Comprehensive complete-mouth rehabilitations in elderly patients with adaptation of the occlusal vertical dimension (OVD) often present particular challenges. This applies especially when exacting functional and esthetic requirements are to be met and the treatment should not cause the patient too much effort, still ensuring the highest level of quality and efficiency and a low intervention rate. CONCLUSION:The digital approach used for the present patient allowed for an efficient treatment procedure, facilitated virtual evaluations using a face-scan, and enhanced the predictability of the prosthodontic outcome. The approach enabled some steps required in the conventional protocol to be omitted, resulting in a straightforward clinical treatment with minimal strain on the patient. CLINICAL SIGNIFICANCE:Because of the comprehensive recording of extraoral and intraoral data, for example with a facial scanner, it was possible to transfer a digital replica of the patient to the dental laboratory technician. With this protocol, many steps can be performed in the absence of the real patient.

ObjectivesTo investigate the flexural strength (FS), elastic modulus (E), Martens hardness (HM), water sorption (wsp), water solubility (wsl) and degree of conversion (DC) of 3D-printed, milled and injection molded splint materials.MethodsSpecimens (N = 1140) were fabricated from five 3D-printed (GR-22 flex, GR-10 guide, ProArt Print Splint clear, V-Print Splint, V-Print Splint comfort), five milled (BioniCut, EldyPlus, ProArt CAD Splint clear, Temp Premium Flexible, Thermeo) and two injection molded (PalaXPress clear, Pro Base Cold) materials. FS, E, HM, wsp, wsl and DC were tested initially (24 h, 37 °C, H2O), after water storage (90 d, 37 °C, H2O) as well as after thermal cycling (5000 thermal cycles, 5/55 °C). Data were analyzed with Kolmogorov-Smirnov, Kruskal- Wallis, Mann-Whitney U test and Spearman’s correlation (p < 0.05).ResultsInitially, the mean flexural strength values ranged from 1.9 to 90.7 MPa for printed, 3.8 to 107 MPa for milled and 99.7 to 102 MPa for injection molded materials. The initial mean elastic modulus values were 0.0 to 2.4 GPa for printed, 0.1 to 2.7 GPa for milled and 2.8 GPa for injection molded materials. The initial mean Martens hardness values were 14.5 to 126 N/mm2 for printed, 50.2 to 171 N/mm2 for milled and 143 to 151 N/mm2 for injection molded materials. Initially, the mean water sorption values ranged from 23.1 to 41.2 μg/mm3 for printed, 4.5 to 23.5 μg/mm3 for milled and from 22.5 to 23.3 μg/ mm3 for injection molded materials. The initial mean water solubility values ranged from 2.2 to 7.1 μg/mm3 for printed, 0.0 to 0.5 μg/mm3 for milled and 0.1 to 0.3 μg/mm3 for injection molded materials. After water storage and thermal cycling most of the values decreased and some increased. The mean DC values ranged initially from 72.3 to 94.5 %, after water storage from 74.2 to 96.8 % and after thermal cycling from 75.6 to 95.4 % for the printed materials.SignificanceThe mechanical and physical properties of printed, milled and injection molded materials for occlusal devices vary and are influenced by aging processes. For clinical applications, materials need to be chosen according to the specific indications.

To assess the clinical performance of tooth-supported 3-unit fixed dental prostheses (FDPs) made from shade-graded monolithic 5Y-PSZ (partly stabilized zirconia) zirconia in terms of survival rate and the quality of restorations based on modified FDI criteria over three-years. High-translucent shade-graded monolithic zirconia (Lava Esthetic, Solventum Dental Solutions) was used to manufacture maxillary or mandibular three-unit FDPs in the posterior region (N = 22) employing subtractive milling system (Amann Girrbach). All FDPs were bonded with a universal resin cement (Rely X Universal, Solventum Dental Solutions) and evaluated 4 weeks after cementation (baseline) and after 1, 2, and 3 years. The primary objective was to assess the survival and complication rates of the restorations. Furthermore, the quality of the restorations was evaluated based on selected and modified FDI (World Dental Federation) criteria, which encompass functional, aesthetic, and biological parameters. FDI criteria were analyzed using the Fisher-Freeman-Halton exact test. Twenty-one patients were examined at 1 year, 2 years, and 3 years. The survival rate was 100

OBJECTIVE:This article highlights the feasibility of the additive fabrication of ultra-thin veneers made of lithium disilicate using the lithography-based ceramic manufacturing (LCM) method.CLINICAL CONSIDERATIONS:An esthetical appealing restoration of anterior teeth with thin ceramic veneers is considered one of the ultimate challenges in restorative dental prosthetics. These sophisticated restorations can be fabricated in different ways. Both analog and digital subtractive manufacturing processes have been used to date. Either of the methods is highly demanding for the dental technician and dental engineering due to the required low ceramic layer thickness.CONCLUSION:Modern additive manufacturing methods, for example LCM technology, enable the production of ultra-thin lithium disilicate veneers with layer thicknesses of down to 0.2 mm and could therefore represent a viable alternative for this indication in the future.CLINICAL SIGNIFICANCE:Digital technologies can help streamline workflows, make the outcome more predictable and reproducible, and even further optimize therapeutic restorative options such as highly esthetic veneers for anterior teeth. The reduced material thickness allows for a true non-prep solution or minimally invasive preparation.

The purpose of this study was to examine the biocompatibility of 3D printed materials used for additive manufacturing of rigid and flexible oral devices. Oral splints were produced and finished from six printable resins (pairs of rigid/flexible materials: KeySplint Hard [KR], KeySplint Soft [KF], V-Print Splint [VR], V-Print Splint Comfort [VF], NextDent Ortho Rigid [NR], NextDent Ortho Flex [NF]), and two types of PMMA blocks for subtractive manufacturing (Tizian Blank PMMA [TR], Tizian Flex Splint Comfort [TF]) as controls. The specimens were eluted in a cell culture medium for 7d. Human gingival fibroblasts (hGF-1) and human oral mucosal keratinocytes (hOK) were exposed to the eluates for 24 h. Cell viability, glutathione levels, apoptosis, necrosis, the cellular inflammatory response (IL-6 and PGE2 secretion), and cell morphology were assessed. All eluates led to a slight reduction of hGF-1 viability and intracellular glutathione levels. The strongest cytotoxic response of hGF-1 was observed with KF, NF, and NR eluates (p < 0.05 compared to unexposed cells). Viability, caspase-3/7 activity, necrosis levels, and IL-6/PGE2 secretion of hOK were barely affected by the materials. All materials showed an overall acceptable biocompatibility. hOK appeared to be more resilient to noxious agents than hGF-1 in vitro. There is insufficient evidence to generalize that flexible materials are more cytotoxic than rigid materials. From a biological point of view, 3D printing seems to be a viable alternative to milling for producing oral devices.

Objective: Investigating the impact of different pretreatment methods, attachment materials and aging regimens on shear bond strength (SBS) between zirconia and indirectly bonded brackets using CAD/CAM transfer trays. Methods: Zirconia substrates were conditioned with silica coated alumina (CoJet) and a) Clearfil Ceramic Primer Plus (CF), b) RelyX Ceramic Primer (RXP), c) Futurabond U (FU). Brackets were virtually placed, transfer tray designed (OnyxCeph) and 3D-printed for indirect bonding with a) Transbond LV (TBL), b) Nexus NX3 (NX3), c) Maximum Cure (MC). SBS testing was performed with a universal testing machine after 24 h, 500 thermal cycles, 90 d. Directly bonded brackets to human enamel using Transbond XT Adhesive served as control. The adhesive remnant index (ARI) was evaluated. Data was analyzed with Shapiro-Wilk, Kruskal-Wallis and Dunn's post-hoc test with Bonferroni correction, Chi2 test (p < 0.05), and the Weibull modulus was calculated. Results: SBS ranged from 0.1 to 15.5 MPa and were influenced mostly by the attachment material. NX3 generally showed the highest values (9.5-15.8 MPa). Initially RXP/TBL and FU/TBL presented the lowest values (4.3/4.8 MPa). Aging regimens reduced SBS of MC irrespective of pretreatment, after 90 d values ranged from 0.1 to 0.9 MPa. ARI 1 was predominant in all MC groups and FU/NX3, 2 and 3 in the other groups. Weibull moduli ranged between 0.15 (MC/RXP/500 TC) and 6.24 (NX3/RXP/500 TC). Significance: MC seems not to be suitable for indirect bonding using CAD/CAM transfer trays to zirconia. NX3 showed similar SBS values compared to the control, TBL lower. (c) 2022 The Academy of Dental Materials. Published by Elsevier Inc. All rights reserved.

Implant-supported dentures in edentulous arches can be treated by removable restorations (HZE) or fixed restorations (FZE). The type and severity of the complications expected in the long term have a decisive influence on the treatment option. To provide a review, 14 fixed prostheses were followed-up and compared with 50 removable prostheses over a period of up to ten years. Technical (implant and abutment), biological (soft tissue and bone), and prosthetic (superstructures) complications were documented and statistically evaluated using descriptive statistics and the Breslowtest (p<0.00). Of the 328 implants placed, two implants had to be removed after 3.9 and 5.8 years. All superstructures were in situ. The mean complication rate was 0.24 for fixed prostheses and 0.37 for removable prostheses per restoration per year. There were no significant differences in ldiologicat or prosthetic complications between fixed and removable prostheses over ten years. However, prosthetic complications occurred approximately four to five times more frequently than biological complications

Zirconia ceramic is becoming increasingly popular not only in the restorative field, but also in the surgical field as a material for implants. The reasons for this are on the one hand the demand of patients for esthetics but at the same time for a material that does not have negative systemic side-effects. On the other hand, zirconia ceramic is also becoming increasingly popular with dentists because of its outstanding mechanical properties and biocompatibility. Therefore, more and more studies focus on zirconia ceramic implants, mostly in comparison with titanium as the gold standard material. In the following article, the authors provide a current overview and present a clinical case in which the patient was (re)restored with a zirconia ceramic implant.

Pronounced defects of the dental hard tissue can be caused by different etiologic factors. Most frequently, they are associated with changes in the vertical dimension of occlusion (VDO), which may also influence the condylar positions. These defects can lead to irreversible loss of tooth structure and have dramatic functional and esthetic consequences, often requiring complex rehabilitation. In this situation, CAD/CAM-fabricated occlusal splints made of tooth-colored polycarbonate are a proven and safe pretreatment approach in terms of esthetics and function. Rebuilding lost dental hard tissue to restore the occlusion and VDO to an adequate condylar position is a prerequisite for any sustainable and functional rehabilitation. In the future, digital systems will support this complex process, customizing it and making it simpler and more precise. The DMD-System (Ignident) provides patient-specific jaw movement data to optimize the CAD/CAM workflow. This system allows real movement patterns to be digitized and analyzed for functional and potential therapeutic purposes, integrating them into the dental and laboratory workflow. In the present case, the familiar tooth-colored CAD/CAM-fabricated occlusal splint is supplemented by digital centric jaw relation recording and individual movement data.