PRETTAU® SKIN® ENAMEL PRETTAU ® SKIN ® VENEER

Alex Lichtmannegger Enrico Steger Samuele Zanini

MINIMALLY INVASIVE DENTISTRY CLINICAL AND EPIDEMIOLOGICAL BACKGROUND The term “minimally invasive dentistry” (MID) has become in recent years a keyword in dentistry as well as in prosthetics and dental technology. Minimally invasive dentistry expresses an attitude: a “general respect for the original healthy tissue (tooth substance and soft tissues)”. This means that any restoration is of less biological value than the original healthy tissue. The aim is therefore tissue preservation, disease prophylaxis, interruption of the progression of already existing pathologies (e.g. caries) and tissue...

WHAT HAS CHANGED? Among our patients, we observe an increased number of caries-free dentitions, but also an increased loss of healthy tooth substance due to abrasion (mechanical interaction of tooth and material), attrition (mechanical interaction between teeth) and erosion (chemical interaction, mostly caused by acids). Loss of healthy tooth structure is a common condition that occurs in different degrees in up to 97 % of the population as normal physiological process which increases throughout life. With longer life expectancy and the growing tendency to preserve teeth in old age, the incidence...

WHY DO WE NEED MINIMALLY INVASIVE PROSTHETICS AND WHAT EXAMPLES DO WE KNOW? The healthy tooth, free of caries and restorations, represents the best starting situation for lifelong function regarding all aspects (structural and aesthetic), as long as natural tooth substance is not lost via physiological or pathological processes. It is therefore our primary goal to prevent or slow down such processes prophylactically or, in an advanced stage, to restore the tooth, as far as possible, to its original state by means of an additive procedure. Restorations such as veneer chips, incisal veneers, partial...

BASICS FOR TREATMENT PLANNING A successful minimally invasive prosthetic restoration is based on four main pillars: 1. A complete data collection, documentation and analysis of the initial biological, functional and aesthetic situation (diagnostics, measurements, photos/videos, X-rays, scans, etc.) from major elements (face, oral area, intermaxillary situation) to small details (tooth row, single tooth). These data are then compared with a standard (e.g. aesthetics checklist p. 37). 2. (direct or indirect mock-up), a temporary, a digital and analogue preparation guide (printed “prep guide” or...

A correct execution of the necessary working steps (photo documentation, preparation, impression, determination of the intermaxillary situation [vertical and horizontal dimension], restoration production [material selection: what? where? when? why? monolithic? veneered? Dispersive®?] and determination of the material thickness as well as colour the restoration) with the involvement of all dental disciplines – in particular conservative dentistry (e.g. bleaching), periodontology (e.g. correction of the gingival margin), orthodontics (e.g. correction of tooth position) etc. – Lifelong aftercare....

CLINICAL AND DENTAL TECHNICAL PROCEDURE BASED ON A PATIENT CASE ® Skin® Veneers) is described. The main focus is on teamwork and document evaluation, as well as understanding the dental and technical steps and their challenges. Please note: the importance of structured cooperation between clinic and laboratory increases The static initial situation is photographed frontally and laterally with the mouth closed in a relaxed position as well as diagonally at an angle of 45°. The same photographs are repeated when the patient smiles slightly. The photographs can be zoomed to reveal details. The static...

Frontal overview of the upper and lower jaw. Evaluation Frontal situation from canine to canine (perspective view of the dental arch and the occlusal planes. of the teeth to be restored). By means of the aesthetics checklist, an assessment can be carried out. A frontal view with relaxed lip shows the position of the incisal edges and lip support. An occlusal view adds another dimension: the horizontal line of the dental arch and its relationship to the upper lip.

A tangential image of teeth 11 and 21 shows an overbite and Minimally invasive dentistry requires healthy and clean intraoral conditions, as the smallest uncontrolled changes (e.g. gingival of the natural tooth 11 (left) in comparison with the previously recession) can negatively impact on the success of the treatment. restored tooth 21 (right). An intraoral scan of the upper and lower jaw as well as the digital recording of the intermaxillary situation complete the documentation for the diagnostic elaboration of the patient’s case.

DENTAL HISTORY at the age of 15, a non-prep veneer (avoiding preparation trauma) made of lithium disilicate was applied. At the age of 24, the patient decided to reassess value was too high. In addition, the gingiva recession exposed the transition between the veneer margin and the tooth. He asked for a restoration of tooth 21, as well as an aesthetic adjustment of tooth 11. The two central incisors needed to be adapted symmetrically, both in shape and colour. PROFESSIONAL TOOTH CLEANING 0.2 % or octenident 0.1 %; 2 – 3 times daily for 1 minute) for 7 – 10 days is recommended as additional therapy....

DIAGNOSTIC ASSESSMENT, DATA COLLECTION, PHOTO/VIDEO AND IMPRESSION/MODEL DOCUMENTATION In the clinic, dental, periodontal and radiological diagnostic assessments are always carried out. In case of aesthetic reconstructions in the anterior region, the patient’s individual initial situation must be documented with intraoral scans (or impressions and models), photos and videos. The image documentation is used for communication between patient, dentist and dental technician during the entire treatment process. The digital images can be easily edited in terms of detail (e.g. zoom). (natural head position):...