Update on aesthetic coronoradicular reconstructions of posterior teeth

The restoration of teeth treated endodontically and having undergone significant loss of substance remains a challenge for dental surgeons. It represents one of the most frequent clinical sequences of general practice on a daily basis. This act is so common and so repetitive that the practitioner often performs it automatically, almost reflexively, applying the same mode of restoration to most clinical situations. Metal coronoradicular restorations (RCR) have long been considered the standard for restoring depulpated posterior teeth, as this type of restorations offer increased mechanical resistance to the occlusal stresses to which posterior teeth are subjected. The advent of adhesive dentistry has revolutionized the restoration of depulpated posterior teeth. It has become possible today to combine aesthetics, mechanical resistance and biocompatibility thanks to the fiber-based coronoradicular restoration of the posterior sector. In this article, we will detail the clinical protocol for an esthetic restoration of two premolars treated endodontically and severely damaged.

Zirconia in the Service of Anterior Aesthetic Restorations

Introduction: Zirconia appears in odontology fifteen years ago under the form of a screed covered with feldspathic ceramic, as an alternative to the ceramic-metal crown. The success of zirconia stems from its biocompatibility and aesthetic potential in combination with optimized mechanical properties. For years, zirconia was the benchmark for the restoration of the posterior sector. Today translucent zirconia are offered to satisfy aesthetic demands even at the previous level Observation: The 54-year-old HA patient consulted for the replacement of her old ceramic-metal bridge in the anterior sector. Its motif was both aesthetic and functional. The therapeutic choice was directed towards the creation of metal ceramic bridge with a zirconia coping. The clinical steps necessary for this prosthetic design will be detailed step by step. Discussion: Several ceramics are now available to us for aesthetic anterior restorations. However, the choice of the appropriate ceramic is not only guided by aesthetic needs. Other parameters must be taken into consideration such as the situation of the finish line, the height of the stumps ... Zirconia may not seem like the ideal ceramic for anterior restorations. However, when the case requires, we can opt for an "improved" zirconia giving wide aesthetic satisfaction Key words: zirconia, aesthetics, translucency, opacity, density.

LOW DOSE CT SCAN FOLLOWING PERIACETABULAR OSTEOTOMY: ASSESSMENT OF REDUCTION AND CORRELATION WITH RADIOGRAPHIC MEASURES

Introduction: Periacetabular osteotomy (PAO) has become a favored treatment for symptomatic acetabular dysplasia worldwide. Nevertheless, the parameters for optimal correction to avoid residual instability or iatrogenic impingement have not been defined. Purpose: The purposes of this study were (1) to assess the ability of PAO to correct femoral head coverage to normal ranges as measured by 3D CT scan and (2) to determine if postoperative radiographic parameters of dysplasia are accurate markers of optimal acetabular correction. Methods: A total of 43 hips (in 38 patients, mean 27.7 years, 88.4% female) were enrolled in this prospective cohort study at minimum 1 year after PAO. Postoperative femoral head coverage was assessed via low-dose CT and compared to normative data of asymptomatic hips from the literature. Anterior (3:00-1:15), lateral (1:00-11:00), and posterior (11:25-9:00) sector coverage was defined by averaging the coverage at 15 minute increments in each zone. Postoperative radiographs were utilized to measure lateral center edge angle (LCEA), anterior wall index (AWI), posterior wall index (PWI), and anterior center edge angle (ACEA). Good correction for each sector was defined as coverage from 1 SD below mean to 2 SD above mean. Results: Postoperatively, the anterior sector was normalized in 84% of hips, lateral sector in 84% of hips, and posterior sector in 86% of hips. Sixty-seven percent of hips were corrected to normative range in all three sectors and 19% were corrected in two sectors (86% in at least two sectors). LCEA and PWI showed the highest correlation with lateral and posterior sector coverage with Pearson’s correlation coefficients of 0.67 and 0.71 (p < 0.001), respectively. Weaker correlations were found between anterior coverage and the AWI and ACEA coverage (-0.16 and 0.15, respectively). Good correction was best correlated with the following target values for acetabular correction: LCEA 28°, AI 1°, AWI 0.37, ACEA 32°, and PWI 1.0. Conclusion: PAO can effectively normalize femoral head coverage compared to normative data. Good correction of each sector coverage ranged from 84-86% of cases. The proposed set of radiographic parameter targets were found to be reliable markers of femoral head coverage.

Endosseous distal extension (EDE) blade implant technique useful to provide stable pillars in the ipotrophic lower posterior sector: 22 years statistical survey

The aim of this issue is to describe endosseous distal extension (EDE) surgical technique. This implant technique was conceived and applied since 1993 by Dr Luca Dal Carlo, as an evolution of the classical ramus blade implant technique. With this technique, you attain great stability of the blade implant, due to the following difference compared with the classical blade implant technique: the hard and soft tissues lying behind implant abutment are not being destroyed at all. A slot is made on the upper side of the bone ridge, and the blade is inserted into it and pushed backwards, so that the implant is embedded under untouched tissues. Using blade implants specially drawn for this particular surgery, the slot’s length turns out to be about half of the implant’s length. Piezo bistoury is useful to facilitate surgical proceedings. If we compare the regenerated bone on the mesial part of the implant and the bone that had remained untouched on the distal side, we will see a difference in the tissue density even after a long time. EDE technique is suitable for those cases in which the lower distal sector is characterized by scarceness of cancellous bone. Data collected during 22 years of clinical practice (97.7% 5-year success rate) allow to suggest employing this technique with asymmetric blades to treat D3-D4 narrow ridges located in the posterior mandible. Soft tissue response results are very good.