To highlight the application of digitally fabricated Snap-On PMMA provisional restorations as a minimally invasive and adaptable methodology for assessing the vertical dimension of occlusion and occlusal stability during the comprehensive rehabilitation of worn dentition.
A clinical case is presented involving a 58-year-old male with severe anterior tooth wear, multiple edentulous spaces, and occlusal dysfunction. The patient underwent full-arch digital rehabilitation through a workflow incorporating intraoral scanning, facial scanning, cone-beam computed tomography (CBCT), and virtual smile design. Snap-On PMMA milled provisional restorations enabled real-time evaluation of the proposed VDO, phonetics, esthetics, and centric occlusion in a reversible, non-invasive manner. Their use also enabled immediate implant loading at site #22 and facilitated the digital transfer of the validated occlusal scheme from the provisional stage to the definitive CAD/CAM restorations. Definitive restorations were fabricated using monolithic zirconia and lithium disilicate, selected for their superior mechanical strength, longevity, and esthetic potential.
Snap-On PMMA provisional restorations represent an effective diagnostic and transitional tool in the management of worn dentition. Integrated into a fully digital workflow, they enhance treatment predictability by allowing reversible clinical validation and direct digital transfer of occlusal parameters to the final prostheses. Combined with advanced restorative materials, this approach improves treatment predictability, patient satisfaction, and the long-term clinical success of managing complex cases of worn dentition.
Snap-On PMMA provisionals offer a minimally invasive, reversible way to assess occlusion, function, and esthetics before final restoration. This technique enhances accuracy and predictability in full-mouth rehabilitations, making it highly valuable in esthetic dentistry.
Objective: This study evaluated the probability of survival, failure modes, and fatigue-induced wear progression, as well as assessed damage tolerance under simulated mastication in two resin matrix ceramics (polymer-infiltrated ceramic networks (PICN) and resin nanoceramic (RNC)).
Methodology: Specimens underwent step-stress accelerated life testing (SSALT) (n = 21), mouth-motion simulation (n = 12), followed by wear analysis and flexural strength testing. Probability of survival and flexural strength were analyzed using Weibull statistical modeling. Damage mechanisms were characterized by optical microscopy, scanning electron microscopy (SEM), and high-resolution 3D quantitative analysis of wear depth and volumetric loss after mouth motion simulation. Two-way ANOVA was used, followed by Tukey Post Hoc with a significance level of 5% (α = 0.05).
Results: At 600 N, PICN exhibited significantly lower probability of survival (6%) compared to RNC (60%). SEM images showed delamination and radial cracking for both groups, being more frequent in PICN. Both materials demonstrated progressively significant increases in volumetric wear with the increase in the number of cycles and showed 0.014 mm3 for PICN and 0.016 mm3 for RNC after 100,000. Flexural strength was higher for RNC (303 MPa) than for PICN (189 MPa). Also, it decreased after 1,000 cycles for PICN, while for RNC it decreased only after 100,000 cycles, and it was always higher than for PICN. SEM images showed that fracture originated at wear craters.
Conclusions: RNC exhibited superior probability of survival, particularly under more demanding conditions compared to PICN. Both materials showed a progressive increase in surface wear as the number of cycles increased. The flexural strength of RNC remained consistently higher over time. Regarding failure mechanisms, both materials experienced delamination and crack formation; however, radial cracks were more frequently observed in PICN, indicating a higher susceptibility to structural failure under fatigue conditions.
Clinical significance: Selection of restorative materials must balance mechanical performance and long-term durability under functional loading. Resin nanoceramic appears to be a more reliable option than polymer-infiltrated ceramic networks for restorations in high-stress areas, such as posterior teeth or patients with parafunctional habits.
The cover image is based on the article The Multilayer Flowable Injection Technique for Highly Esthetic Restorations by Yolanda M. Liaropoulou et al., https://doi.org/10.1111/jerd.13500.
This case report elucidates the application of an integrated digital workflow in which diagnosis, planning, and execution were enhanced by artificial intelligence (AI), enabling an assertive interdisciplinary esthetic-functional rehabilitation. With AI-powered software, the sequence from orthodontic treatment to the final rehabilitation achieved high predictability, addressing patient's chief complaints.
A patient presented with a missing maxillary left central incisor (tooth 11) and dissatisfaction with a removable partial denture. Clinical examination revealed a gummy smile, a deviated midline, and a disproportionate mesiodistal space relative to the midline. Initial documentation included photographs, intraoral scanning, and cone-beam computed tomography of the maxilla. These data were integrated into a digital planning software to create an interdisciplinary plan. This workflow included prosthetically guided orthodontic treatment with aligners, a motivational mockup, guided implant surgery, peri-implant soft tissue management, and final prosthetic rehabilitation using a CAD/CAM approach.
This digital workflow enhanced communication among the multidisciplinary team and with the patient, ensuring highly predictable esthetic and functional outcomes.
Comprehensive digital workflows improve diagnostic accuracy, streamline planning with AI, and facilitate patient understanding. This approach increases patient satisfaction, supports interdisciplinary collaboration, and promotes treatment adherence.
Objectives: To evaluate nanozeolite (NZ)-modified 3D-printed hybrid ceramics at 0.25%, 0.5%, and 1% versus milled hybrid resin-ceramics, focusing on fracture toughness, surface roughness, microhardness, degree of conversion (DC), water sorption, and color stability.
Materials and methods: NZ was incorporated into 3D-printed ceramic-filled resin (VarseoSmile Crown Plus, VA) and tested alongside unmodified VA (control) and milled CAD-CAM ceramic (Vita Enamic, VE). Bars (18 × 3.6 × 1.8 mm) were prepared for fracture toughness, and discs (10 × 2 mm) for roughness, microhardness, water sorption, and color/translucency. Fracture toughness was measured by the single-edge notched beam (SENB) method, roughness and microhardness by profilometer and Vickers test, and DC by FTIR. Water sorption/solubility was gravimetrically measured, and ΔE00 and translucency parameter (TP) by spectrophotometry. Tests were conducted before and after thermocycling (1000 cycles, 5°C-55°C). Data were analyzed using ANOVA, Kruskal-Wallis, t-tests, and Wilcoxon signed-rank tests (p < 0.05).
Results: VE exhibited the highest fracture toughness and microhardness, which decreased after thermocycling (p < 0.001). NZ-0.25% improved toughness versus VA both before and after aging (p = 0.04), while NZ-0.5% and 1% slightly reduced toughness but increased microhardness and decreased roughness after aging (p < 0.01). All NZ groups showed higher DC than control (p < 0.001). Thermocycling reduced toughness in VE and VA, but not NZ-VA. Water sorption and solubility were significantly lower in all NZ groups (p < 0.0001). ΔE00 remained < 1.8 for all groups after thermocycling, with 0.25% NZ-VA showing the most color stability and 1% NZ-VA showing minimal TP changes (p < 0.05).
Conclusion: Milled hybrid ceramic (VE) outperformed printed hybrid ceramic (VA). Nanozeolite improved VA, with 0.25% providing the best balance of fracture toughness and microhardness, while preserving color and aging stability. Higher concentrations (0.5%-1%) mainly enhanced surface characteristics but added little to bulk properties and translucency.
Clinical significance: Nanozeolite integration at 0.25% enhances strength, durability, and color stability in 3D-printed hybrid ceramics, improving their reliability for dental restorations. Higher loadings enhance surface properties but may modestly reduce bulk toughness and translucency, relevant for clinical decision-making.
To present a digital workflow for rehabilitating terminal dentition patients with complete arch maxillary (FP-2) and mandibular (FP-3) implant-supported restorations through a staged approach.
Staging extractions in these patients offers a valuable treatment option, allowing patients to retain fixed prostheses throughout the treatment. In this way, both function and esthetics can be evaluated, without relying on transitional complete dentures or the need for immediate implant placement and loading. Interim fixed restorations, such as tripod prostheses, can assist in the preservation of soft tissue anatomy and increase patient comfort, compared to removable prostheses. Prosthetic-driven implant placement and loading can be facilitated by implementing a stackable surgical template system.
To overcome the challenges of digital implant position acquisition in edentulous areas, a dual-purpose implant scan body system can be implemented. Finally, monolithic zirconia titanium-supported prostheses are delivered to meet both esthetic and mechanical requirements.
To evaluate the impact of non-thermal atmospheric plasma (NTAP) treatment on the bonding performance of different digital methods (full-digital vs. semi-digital) fabricated customized ceramic post-and-core.
Ceramic blocks treated with NTAP in different configurations were bonded with resin cement and tested by shear bond strength (SBS) and tensile bond strength (TBS) tests: on the ceramic surfaces (X-Pl-Pr-C), on primer-applied surfaces (X-Pr-Pl-C), on cement-applied surfaces (X-Pr-C-Pl), and on both ceramic and cement-applied surfaces (X-Pl-Pr-C-Pl). Contact angle and FTIR-ATR analyses were performed to examine the effects of NTAP on the selected zirconia-resin interface. The precision of full-digital and semi-digital fabrication methods was evaluated by comparing the linear discrepancy during the fabrication of zirconia post-and-cores. Push-out bond strength (PBS) testing was then used to assess the influence of NTAP treatment on zirconia post-and-cores bonded to extracted single root canals.
Appropriate NTAP treatment parameters/procedures significantly improved the immediate TBS and SBS of all ceramic samples, except for the primer-treated group (X-Pr-Pl-C), with the most pronounced enhancement observed for zirconia. Semi-digital fabrication exhibited a smaller linear discrepancy at the apical third of the root compared to the full-digital method. NTAP treatment increased the PBS to both immediate and aged zirconia post-and-cores fabricated via semi-digital or full-digital bonded to root canals.
NTAP treatment enhanced ceramic's wettability and resin polymerization, thereby improving surface bonding. Semi-digital fabrication demonstrated better precision at the apical third of the root. Overall, appropriate NTAP treatment significantly improved the bonding performance of customized ceramic post-and-cores with root canals, with optimal efficacy achieved through concurrent application on both ceramic surfaces and cement-applied surfaces.
NTAP treatment improves customized ceramic post-and-core bonding, overcoming its surface inertness and reducing debonding risks, ensuring long-term stability.
To present a digital workflow approach for the full-mouth rehabilitation of severely worn dentition and to evaluate the impact of vertical dimension of occlusion (VDO) rehabilitation on facial parameters assessed by 3D stereophotogrammetry throughout all treatment steps.
Extensive tooth wear frequently demands the determination of a new VDO for the prosthodontic treatment. While digital tools have been used to establish hybrid or fully digital workflows in prosthodontics, a validation of accuracy between the planification stage and final VDO, as well as resulting linear and volumetric changes in the soft tissues after treatment, has not been reported utilizing tridimensional facial reconstruction systems. The clinical report describes the case of a 34-year-old patient with generalized erosive tooth wear and severe tooth sensitivity. After diagnosis, the patient was treated with a minimally invasive digitally driven full-mouth rehabilitation using lithium–disilicate bonded restorations, and stereophotogrammetry was used for the evaluation of facial changes before, at the planning stage, and after VDO rehabilitation.
The fully digital workflow allowed for a predictable rehabilitation of the VDO, where similar stereophotogrammetric measurements were observed during the mock-up and at the end of the treatment. 3D stereophotogrammetry imaging allowed to quantitatively assess differences in facial appearance after VDO rehabilitation.
The conscious application of fully digital workflows enables predictable achievement of both functional and esthetic parameters in the rehabilitation of VDO. 3D stereophotogrammetry confirmed similar facial measurements between the initial condition, mock-up stage, and treatment outcome.
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