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Dental Tribune Asia Pacific Edition No. 1+2, 2017

12 Dental Tribune Asia Pacific Edition | 1+2/2017 TRENDS & APPLICATIONS Hybrid ceramics in practice A CAD/CAM material for patients with functional disorders By Dr Sjoerd Smeekens, Netherlands The treatment of patients with functional disorders is a challenge for dentists. The extent to which the VITA ENAMIC hybrid ceramic (VITA Zahnfabrik, Germany) with its dentine-like elasticity may be a suitable material for treating pa- tients with bruxism is described in this article. Although reconstruc- tions with VITA ENAMIC are still experimental for this indication, I have already implemented them with clinical success. Initial situation The 48-year-old patient had suffered for ten years from severe temporomandibular joint pain and headaches, resulting in de- pression, which had led to his inability to work. Numerous visits to the dentist and treatment at- tempts (including occlusal splint- ing) had brought no relief. The patient had rejected the corrective jaw surgery recommended for the existing Class III skeletal abnor- mality owing to the uncertain therapy outcome. Figures 1 to 3 show the initial situation. Preliminary treatment After the patient’s referral to our clinic, we first tried to stabilise the occlusion via a reversible cor- rection of tooth position. The opti- mal length of the incisal edges, the occlusal plane, and the horizontal and vertical dimensions were de- termined with a maxillary bite registration in wax (Fig. 4). It was shown that, through an elevation of the vertical dimension by 8 mm, a correction of the Angle Class III relationship was possible. For the long-term evaluation, a PMMA splint for permanent use was fabricated on the basis of the bite registration (Figs. 5 & 6). Ten hours after its insertion (Fig. 7), the patient reported, with tears of joy, that he was pain-free. This situation has been maintained for the wear time of two years. Material selection Only after successful eleva- tion of the vertical dimension were the permanent restorations fabricated. The objective was to preserve the healthy tooth sub- stance through a non-invasive procedure. In order to achieve an exact fit, a restorative material that could be milled very thinly at the edges was required. Further- more, a material with properties as close as possible to those of the natural teeth was needed. With its high durability and elasticity, as well as the possibility of adhesive bonding, VITA ENAMIC met these prerequisites. Fabrication of the definitive restorations For the precise transfer of the optimal tooth position, the digital moulding was performed once with and once without the splint. The superimposed scans formed the basis for the virtual design of the monolithic restorations made of VITA ENAMIC (Figs. 8 & 9). After fabrication, these were characterised and polished (Figs. 10 & 11). When tried in, they exhibited a high-precision fit, and the patient was very satisfied with the shade; therefore, the adhe- sive bonding was performed immediately. In order to create an invisible transition to the tooth substance, pre-warmed composite filling material was used. Summary With the integration of the VITA ENAMIC restorations (Figs. 12–14), the patient’s self-confi- dence increased and he took up a new profession. This example shows that the non-invasive treat- ment concept presented can achieve outstanding results, lead- ing to a significant increase in quality of life, even in patients with extreme functional prob- lems. Editorial note: This article was first pub- lished in the 1/2016 issue of the Digital Dentistry magazine (OEMUS MEDIA AG). Dr Sjoerd Smeekens is a well-known specialist in the field of restor- ative dentistry. He runs his own practice in Beuningen in the Netherlands and can be contacted at administratie@ reconstructieve-tandheelkunde.nl. Fig.1: Initial situation.—Fig.2: The extra-oral examination showed a reduced lower third of the face.—Fig.3: Intra-oral examination: Situation at maximum intercuspation.—Fig.4: Step-by-step determination of the optimal vertical dimension.—Fig.5: Frontal view of the therapeutic splint of PMMA on the model.—Fig.6: Occlusal view of the therapeutic splint on the model.—Fig.7: The splint in the patient’s mouth.— Fig. 8: Superimposition of the data sets of digital moulding with and without the splint.—Fig. 9: Virtual design of the individual tooth restorations using superimposed scans.—Fig. 10: Occlusal view of the restorations fabricated from VITA ENAMIC on the model.—Fig. 11: Frontal view of the restorations on the model.—Fig. 12: Situation immediately after integration.—Fig. 13: Occlusal view of the maxilla.— Fig. 14: End result. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 1234 567 8910 11121314

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