The One step-No prep technique: A straightforward and minimally invasive approach for full-mouth rehabilitation of worn dentition using polymer-infiltrated ceramic network (PICN) CAD-CAM prostheses.

Abstract

To introduce a novel approach for full-mouth rehabilitation of severely worn dentition using polymer-infiltrated ceramic network (PICN) computer-aided-design and manufacturing (CAD-CAM) restorations, without tooth tissue preparation and provisional phase. Three patients with generalized tooth wear, suffering from dental pain, masticatory dysfunction, bruxism and neck and back pain, were selected and treated in collaboration with physiotherapists. Occlusal analyses were performed and full-mouth diagnostic wax-ups were designed on the basis of estimated tissue loss. Deficient direct restorations were replaced and low-thickness PICN (Vita Enamic) restorations (up to 0.2 mm) were CAD-CAM designed from wax-ups, milled, tried-in and then bonded within two consecutive days. To mask palatal veneers, either buccal direct composites or glass-ceramic veneers were later performed. An occlusal splint was realized. Clinical results were shown to be successful after a follow-up of 22, 18, and 13 months, respectively. The absence of provisional phase did not engender any inconveniences. Patient reported outcomes were very positive, showing a reduction in neck and back pain and a well-being increase. The proposed protocol is particularly minimally invasive and straightforward compared to classical techniques. PICNs exhibit several advantages compared to other materials. Preliminary results of this multidisciplinary approach are promising but deserve further clinical research. The development of CAD-CAM technologies offers the possibility of improving treatment of severe worn dentition, reducing chairtime and need of tooth tissue preparation, and introducing a new class of composite materials (hybrid ceramics), which exhibit interesting properties for this indication. The influence of the proposed multidisciplinary approach, particularly the collaboration with physiotherapists, needs to be further explored with respect to treatment of associated symptoms, such as masticatory muscles hypertrophy and neck pain.