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Founders

Walter Devoto
Dr. Walter Devoto Born in Chiavari on 29/03/1965 graduated in Dentistry in 1991
at Genova University.
Angelo Putignano
M.D. degree and D.D.S. post graduate certificate from University of Ancona-
Italy.

Members

Monaldo Saracinelli
Ive been a student of prof. Fabio Toffenetti and Riccardo Garberoglio.
Jordi Manauta
Was born in Mexico City, where he graduated cum laude. in dentistry from
UNITEC.
Daniele Rondoni
Born in Savona in 1961 where he lives and has worked in his own laboratory
since...
Vincenzo Musella
Vincenzo Musella graduated in dental technician. Proud friend and student of...
Giuseppe Marchetti
Giuseppe Marchetti was born in Parma (Italy) in October of 1972 and graduated
from...
Simone Grandini
Chair of Endodontics and Restorative Dentistry, University of Siena, Italy.
Giovanna Orsini
Giovanna Orsini is a well known researcher in Italy and internationally.
Paulo Monteiro
My passion for esthetic dentistry began when I attended the last year...
Louis Hardan
Head of Restorative and Esthetic department in Saint-Joseph University in...
Patrizia Lucchi
Patrizia Lucchi Graduated in Dentistry cum Laude in 1995 at the University of
Verona
Anna Salat
Dr Anna Salat graduated with a degree in dentistry from the International
University of Catalonia
Giulio Pavolucci
After graduation magna cum laude in Dentistry, I started focusing my daily work
on...
Marcos Vargas
Dr. Marcos Vargas attended Cayetano Heredia University School of Dentistry in
Lima...
Stefan Koubi
Dr. Koubi graduated from University of Marseille where he...
Engin Taviloglu
Dr. Taviloglu graduated from ?stanbul University School of Dentistry in...
Dimitar Filtchev
Co-founder of the Laser Dental Center and the Implant...
Angie Segatto
My commitment to arts has determined my specialisation.
Gregory Camaleonte
I was born in 1980 in Marseille-France and i have graduated in 2006 from...
Caroline Werkhoven
Caroline Werkhoven graduated in 2002 at ACTA, the dental faculty in Amsterdam..
Ajay Juneja
Ajay Juneja finished his BDS in the year 1995...
Carlos Fernndez Villares
Member of SEPES Spanish Soc...
Sulivan Leite
Sulivan Leite graduated from the Ribeirao...
Giuseppe Chiodera
My name is Giuseppe Chiodera , i was born born in 1979 in Brescia .
Maciej Zarow
Author of book edited by Quintessence: Endo-Prosthodontics: guidelines for
clinical practice ...
Dan Lazar
Dan Lazar, graduated from the Faculty of Dentistry in 2005 in Cluj-Napoca...
Murad Akhundov
Dr. Murad Akhundov graduated from the Faculty of Dentistry in Baku...
Janos Grosz
Graduated summa cum laude in 2006 from the University of Szeged, Faculty of
Dentistry, Hungary...
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Giano Ricci

Cases - Perio

Periodontal plastic surgery associated with orthodontic movement for root coverage
in a case of gingival recession of a buccally positioned tooth

4378 Views - Jul 2017

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In case of stabilized recessions orthodontic treatment, it is possible to at least

partly repair periodontal damage and to create the anatomical conditions for
spontaneous coronal migration of the attachement and the periodontal tissue or to
improve the outcome of surgical therapy.

Effective movements to achieve this result includes bodily movement and lingual
root torque.

A 27 years old female patient, non-diabetic and non-smoker, presented with severe
gingival recession of a lower incisor, complaining about esthetics e sensitivity.

She was also very concerned about losing her tooth.

Img. 1 - Illustration of recession classification proposed by Sullivan and Atkins.

The purpose of the orthodontic therapy involving tooth repositioning inside the
envelope of the bone is to entirely modify the recession or reduce it in order to
facilitate an optimal response to surgical therapy.

Img. 2 - Repositioning of a buccally displaced tooth inside the envelope of the

bone by means of orthodontic therapy and surgery. The initial case immediately
after the professional hygiene session. In the picture on the right, repositioning
of 31 inside the envelope of the bone.

Img. 3

Img. 4

Img. 5 - Probing of the area at the end of orthodontic treatment. Then the surgical
treatment of the area by means of a bilaminar procedure with a connective tissue
graft beneath a flap.

Img. 6 - The flap is sutured with suspended stitches and the use of cyanoacrylate.

Img. 7 - Comparison between before surgery and healing after 2 years, shows good
fading of gingival margins, root coverage, and normal probing depth.

Img. 8 - Radiographic examination shows repositioning of the toot in a buccolingual

direction as well as in a mesiodistal direction.
Conclusions
The combined ortho-periodontal therapeutical approach may give optimal esthetics
and functional results eliminating the risk of losing malpositioned and
periodontally involved teeth.

Bibliography

Artun J, Osterberg SK, Joondeph DR. Long-term periodontal status of labially

erupted canines following orthodontic treatment. J Clin Periodontol. 1986
Oct;13(9):856-61.
Zachrisson BU. Clinical implications of recent orthodontic-periodontic research
Findings. Semin. Orthod. 1996;2:412.
Pini Prato GP, Cozzani G, Magnani C, Baccetti T. Healing of gingival recession
following orthodontic treatment: a 30-year case report. Int J Periodontics
Restorative Dent. 2012 Feb;32(1):23-7.
Zachrisson BU. Periodontal changes during orthodontic treatment. In: McNamara
JA. Jr, Ribbens K.A, editors. Orthodontic Treatment and the Periodontium. Mongraph
15, Craniofacial Growth Series, Center for Human Growth and Development, The
University of Michigan, Ann Arbor. 1984;43-65.
Zachrisson BU, Zachrisson S. Gingival condition associated with orthodontic
treatment. Angle Orthod. 1972 Jan;42(1):26-34.
Melsen B, Agerbaek N, Eriksen J, Terp S. New attachment through periodontal
treatment and orthodontic intrusion. Am J Orthod Dentofacial Orthop. 1988; 94(2)
104-116.
Carvalho CV, Bauer FP, Romito GA, Pannuti CM, De Micheli Orthodontic extrusion
with or without circumferential supercrestal ?brotomy and root planing. Int J
Periodontics Restorative Dent. 2006 Feb;26(1):87-93.
Braga G, Bocchieri A. A new ?apless technique for crown lengthening after
orthodontic extrusion. J. Periodontics Restorative Dent. 2012 Feb;32(1):81-90.

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Founders

Walter Devoto
Dr. Walter Devoto Born in Chiavari on 29/03/1965 graduated in Dentistry in 1991
at Genova University.
Angelo Putignano
M.D. degree and D.D.S. post graduate certificate from University of Ancona-
Italy.

Members

Monaldo Saracinelli
Ive been a student of prof. Fabio Toffenetti and Riccardo Garberoglio.
Jordi Manauta
Was born in Mexico City, where he graduated cum laude. in dentistry from
UNITEC.
Daniele Rondoni
Born in Savona in 1961 where he lives and has worked in his own laboratory
since...
Vincenzo Musella
Vincenzo Musella graduated in dental technician. Proud friend and student of...
Giuseppe Marchetti
Giuseppe Marchetti was born in Parma (Italy) in October of 1972 and graduated
from...
Simone Grandini
Chair of Endodontics and Restorative Dentistry, University of Siena, Italy.
Giovanna Orsini
Giovanna Orsini is a well known researcher in Italy and internationally.
Paulo Monteiro
My passion for esthetic dentistry began when I attended the last year...
Louis Hardan
Head of Restorative and Esthetic department in Saint-Joseph University in...
Patrizia Lucchi
Patrizia Lucchi Graduated in Dentistry cum Laude in 1995 at the University of
Verona
Anna Salat
Dr Anna Salat graduated with a degree in dentistry from the International
University of Catalonia
Giulio Pavolucci
After graduation magna cum laude in Dentistry, I started focusing my daily work
on...
Marcos Vargas
Dr. Marcos Vargas attended Cayetano Heredia University School of Dentistry in
Lima...
Stefan Koubi
Dr. Koubi graduated from University of Marseille where he...
Engin Taviloglu
Dr. Taviloglu graduated from ?stanbul University School of Dentistry in...
Dimitar Filtchev
Co-founder of the Laser Dental Center and the Implant...
Angie Segatto
My commitment to arts has determined my specialisation.
Gregory Camaleonte
I was born in 1980 in Marseille-France and i have graduated in 2006 from...
Caroline Werkhoven
Caroline Werkhoven graduated in 2002 at ACTA, the dental faculty in Amsterdam..
Ajay Juneja
Ajay Juneja finished his BDS in the year 1995...
Carlos Fernndez Villares
Member of SEPES Spanish Soc...
Sulivan Leite
Sulivan Leite graduated from the Ribeirao...
Giuseppe Chiodera
My name is Giuseppe Chiodera , i was born born in 1979 in Brescia .
Maciej Zarow
Author of book edited by Quintessence: Endo-Prosthodontics: guidelines for
clinical practice ...
Dan Lazar
Dan Lazar, graduated from the Faculty of Dentistry in 2005 in Cluj-Napoca...
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Janos Grosz
Graduated summa cum laude in 2006 from the University of Szeged, Faculty of
Dentistry, Hungary...

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Engin Taviloglu

Indirect posteriors - Cases - Shadeguides - Digital

Inlay restoration using CAD/CAM

13105 Views - May 2017

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The purpose of this article is to underline the advantages of indirect posterior

restorations and to remind the usage of CAD/CAM Connect System requires a minimum
investment. Large, direct composite restorations take a long time, because of many
reasons; posterior teeth are difficult to reach and we have to use different
devices such as matrices, wedges, rings... this with an incremental technique, in
order to minimize polymerization shrinkage; sometimes it is difficult to make
proper occlusal adjustements, and to get well polished contact points. The
procedure is tiring, both for the patient and dentist. We can complete the same
procedure easily with a CAD/CAM system on the same day by using ceramic or hybrid
blocks.

Img. 1 - Patient presented with a large double surfaced amalgam restoration on

tooth number 16, complaining about mild sensitivity.

Img. 2 - X-ray of the initial position.

Img. 3 - After proper isolation of the field, the amalgam restoration was removed;
a deep dentin decay was detected under the mesial wall. After cleaning the decay,
an MO cavity preparation was done according to the indirect technique.

Img. 4 - A digital impression was taken and all data was sent to the Connect System
laboratory after having covered the whole dentin surface with a self-etching
adhesive system and a thin layer of flowable composite.

Img. 5 - Onlay designed by the Connect System laboratory.

Img. 6 - Design in occlusion.

Img. 7 - Polished hybrid onlay.

Img. 8 - We can easily add some occlusal characterizations if necessary, by using

composite stains.

Img. 9 - Before cementation we can use a sticky tipped placement tool in order to
handle the onlay easily.

Img. 10 - Occlusal check just after cementation. Note the small palatal cavity was
restored directly by using injectable composite.

Img. 11 - We can easily polish the trimmed parts of the hybrid onlay by using a two
step diamond impregnated rubber wheel set.

Img. 12 - Onlay in occlusion.

Img. 13 - X-ray after cementation.

Conclusions
The indirect technique offers a more comfortable procedure both for the patient and
the doctor. By using a CAD/CAM system on large single posterior restorations we can
minimize chair time, avoid using multiple materials, reduce polymerization
shrinkage complications, construct proper contacts and establish a good occlusal
relation. CAD/CAM Connect System enables us to use this procedure without investing
a lot of capital. You can contact a local dealer for further information.

Bibliography

Garber, David A. and Goldstein, Ronald E. Porcelain and Composite Inlays and
Onlays: Esthetic Posterior Restorations, Quintessence
Didier Dietschi, Roberto Spreafico, Metal-Free Restorations: Current Concepts
for the Esthetic Treatment of Posterior Teeth, Quintessence
Lauvahutanon S, Takahashi H, Shiozawa M, Iwasaki N, Asakawa Y, Oki M, Finger
WJ, Arksornnukit M. Mechanical properties of composite resin blocks for CAD/CAM.
Dent Mater 2014; 33(5):705-Ind
Lauvahutanon S, Takahashi H, Oki M, Arksornnukit M, KanehiraM,Finger WJ. In
vitro evaluation of the wear resistance of composite resin blocks for CAD/CAM. Dent
Mater 2015;34(4):495-502.
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