Publications

Our continuously updated list of publications offers interesting and new insights into technologies and treatments related to innovative dentistry. Make sure to check it out!

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Le Fort I osteotomy

Interdisciplinary full-mouth rehabilitation for redefining esthetics and function (Le-Fort)

2019 May;31(3):179-189. doi: 10.1111/jerd.12455. Epub 2019 Jan 4.

Interdisciplinary full-mouth rehabilitation for redefining esthetics, function, and orofacial harmony

Cleft lip and palate are the most common congenital craniofacial anomalies. Affected patients often require multiple craniomaxillofacial surgeries during their childhood and adolescence to restore function and esthetics. In addition, there are often different levels of dental involvement, prosthodontics treatment can be a valuable option for adults. The management of these complex patients presents a great interdisciplinary challenge. Depending on the form and severity of the anomaly as well as the esthetic demands of the patients, the necessary prosthetic treatment plan can vary immensely. It can range from simple restorative therapy to complex full-mouth rehabilitation.

Learn more about innovative treatment concepts and their detailed application in our stories and tutorials.

Publication - Systematic Development of Esthetics and Function in a Young Patient with Maxillary Dental Aplasia

Systematic Development of Esthetics and Function in a Young Patient with Maxillary Dental Aplasia

2017 Jul 8;29(4):247-255. doi: 10.1111/jerd.12315. Epub 2017 Jul 6.

Complete jaw reconstructions in young patients who suffer from multiple dental agenesis pose great challenges for both the patient and the treatment team. In most cases, these patients and their family members are under massive psychological strain, which is characterized by hope and uncertainty. An early decision on therapy determines the long-term dental health and physical appearance of the patient for his or her entire life.

Thanks to better restorative materials and adhesive techniques and the increased knowledge of maintaining healthy tooth structures, prosthetic dentistry has increasingly shifted to minimally invasive procedures. The present clinical case documents a minimally/non-invasive maxillary full arch rehabilitation of an agenesis patient with multiple dental aplasia, primary tooth persistence, and deficits in bone growth.The patient was pretreated with a tooth-colored CAD/CAM polycarbonate splint. Adequate esthetics and function were achieved with two adhesive, single-wing zirconia-based adhesive bridges to replace the upper lateral incisiva, lithium disilicate ceramic partial crowns for the posterior areas and two feldspathic veneers for the upper central incisors.

Conclusions:
Non-invasive pretreatment with a removable tooth-colored splint easily and safely achieves the treatment goal, reduces treatment time, increases predictability, and facilitates the transfer of the prototype to the final restorations. New restorative options allow the minimally invasive treatment of such patients.

Learn more about innovative treatment concepts and their application in our Stories and Tutorials!

CAD/CAM splints dentistry technology, Otto Prandtner, rezotto production

CAD/CAM splints for evaluation of the vertical dimension of occlusion

CAD/CAM splints for functional and aesthetic evaluation of a newly defined vertical dimension of the occlusion

Prandtner OSchweiger JTrimpl JStimmelmayr MGüth J-FEdelhoff D,

A splint therapy is usually carried out as an initial treatment as part of a functional therapy, as it can promptly achieve a reduction in tone of the masticatory muscles aswell as a reversible correction of an occlusion that deviates from the norm.

Generally, occlusal splints made of polycarbonate (Munich splint concept) are distinguished from other bite aids according to the different areas of indication. These occlusal splints are primarily used to clinically test a newly defined bite position in static and dynamic occlusion. This functional evaluation is preceded by an esthetic evaluation derived from the wax-up.

Summary:

Tooth-coloured occlusal splints made of polycarbonate can be produced in very thin layers due to their flexibility without increased risk of fracture. The division into an upper and a lower splint for larger changes in the vertical dimension allows the aesthetic and functional aspects defined in the wax-up to be transferred completely to the occlusal splints and tested realistically and reversibly by the patient. This “two-splint concept” also facilitates segmental implementation in the subsequent definitive restoration.

See the keynote for the publication!

Learn more about innovative treatment concepts in our stories and tutorials!

 

CAD/CAM supported immediate implant - comparison

Historical development of root analogue implants: a review of published papers

R. Saeidi Pour a, C. Freitas Rafael b, M.L.P.D. Engler b, D. Edelhoff c, G. Klaus d, O. Prandtner e, M. Berthold c, A. Liebermann c,
DOI: https://doi.org/10.1016/j.bjoms.2019.01.021
Dental implants are an optimal way of replacing missing teeth.

The purpose of this paper is to provide an overview of the historical development of root analogue implants from their beginning to the present day.

After a tooth has been extracted there is an inevitable remodelling of the socket. As a result, it can limit the placing of an implant. The continuous resorption can reach up to 63% on horizontal and 11%-22% on vertical alveolar bone within six months. Alterations of the dimensions of the alveolar socket on the buccal wall are related to the resorption of the bundle bone a tooth-dependent structure that is left after the extraction with few or no vessels for its blood supply.

Immediate use of implants might control these alterations to the ridge by reducing the speed of resorption of the socket.

Usually the operator has to face some surgical challenges in this approach, including: difficulty in achieving primary stability and controlling the 3-dimensional position of the implant; discrepancies between the sizes of the implant and the socket; poor quality of bone that is often present in the extraction socket; and the need to prepare the socket with drilling burrs that can overheat the bone.

These challenges are related to the characteristics of conventional implants, mainly the standardized sizes and shapes.

Root-analog implants, however, represent an innovative concept to possibly circumvent these problems.

In order to be able to decide whether, in certain cases, biological and functional requirements are met, it is important for the dental team to have a detailed overview of the analogue root implant systems.

Learn more about innovative treatment concepts and their application in our stories and tutorials!

metal-free implant-supported single-tooth restorations

Possibilities and limitations of metal-free implant-supported single-tooth restorations

Edelhoff D, Schweiger J, Prandtner O, Stimmelmayr M, Güth JF.
2019;50(3):176-184. doi: 10.3290/j.qi.a41906.

Metal-free materials offer an alternative to metal-based restorations while ensuring high levels of biocompatibility and esthetics. Rapidly evolving CAD/CAM technology has significantly expanded the range of materials available. In addition, digital methods offer previously unavailable options in diagnostics and greater planning reliability. There is also a better material quality through standardization of the manufacturing process, and reproducibility available. This significant benefits can be used to advantage, especially in oral implantology.

Even though technological progress in the field of metal-free materials has given rise to considerable improvements in their mechanical properties over the decades, their clinical longterm success is still very much dependent on an appropriate indication and proper material selection. For instance, on the knowledge and skills of the dental practitioner and dental technician, and on an adequate occlusion concept. The high rate of innovation – both with regard to the materials themselves and to CAD/CAM technology.

Therefore, it requires an adequate level of prior knowledge to sensibly and successfully implement the wide range of possibilities now open. This review article provides an up-to-date overview of the possibilities and limitations of metal-free implant-supported single-tooth restorations. The first part discusses abutments and cemented crowns.

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Key words: abutments, CAD/CAM, hybrid abutments, implant prosthetics, implant-supported crowns, lithium disilicate, lithium silicate, monolithic restorations, polymers, titanium adhesive bases, zirconia, zirconium oxide.

Watch a relating metal-free implant story.

 

Porcelain veneers and CAD:CAM polymer restorations for amelogenesis imperfecta

Amelogenesis Imperfecta – Full-Mouth Rehabilitation with Porcelain Veneers

Saeidi Pour R, Edelhoff D, Prandtner O, Liebermann A.

Rehabilitation of a patient with amelogenesis imperfecta using porcelain veneers and CAD/CAM polymer restorations: A clinical report

2015 Nov-Dec;46(10):843-52. doi: 10.3290/j.qi.a34721.

Amelogenesis imperfecta represents a group of genetically determined dental diseases characterized by a defect in enamel formation. It can affect individual teeth or the entire milk or permanent dentition. Most frequently, patients complain about aesthetic problems, sensitivity to mechanical and chemical stimuli and impaired phonetics due to the loss of the vertical dimension of the occlusion.

The complete dental rehabilitation of patients with a vertical dimension loss caused by structural enamel deficits associated with amelogenesis imperfecta represents a difficult challenge for restorative teams. Therefore, an accurate analysis and treatment planning is important prerequisites for successful results. That includes esthetic and functional evaluations and adequate material selection.

Longterm provisional restorations play an important role in exploring and elucidating the patient’s esthetic demands and functional needs.

Restorative treatment options can vary from requiring only oralhygiene instructions to extensive dental restorations that include composite fillings, ceramic veneers, metal-ceramic, or all-ceramic crowns.

Watch the patient feedback 5 years post treatment

Learn more about innovative treatment concepts and their application in our Stories and Tutorials!

Veneers & Onlays bei Zahnhartsubstanzverlust

Veneers & onlays for loss of tooth structure with impaired aesthetics and function

The individual wax-up as the basis of a patient-oriented treatment concept for abrasive dentures

Dr. med. dent. Saeidi Pour, RDDS, MSc, Dias Engler, MProf. Dr. med. dent. Edelhoff, DZTM Prandtner, OZTM Frei, SDr.med. dent. MSc, Liebermann, A,

The wear and tear of hard tooth substance is generally a physiological process caused by normal chewing function. The influences of attrition, abrasion and/or erosion exceed a certain extent and are untypically high for the patient age in this article.

The severe loss of hard tooth substance has taken on a pathological form, making preventive measures indispensable.

Introduction to the article:

Abraded teeth and the resulting consequences are a great challenge for the dental treatment team. Generally, tooth wear is a physiological process with a small loss of tooth structure, generally ranging from 0.02 to 0.04 mm per year.

Epidemiological studies show that the prevalence of moderate tooth structure loss tends to increase with age. However, the loss of hard tooth substance can also assume a pathological dimension (“pathological abrasion”), in which the amount of hard tooth substance loss is atypical for the patient’s age. The consequences are discomfort and/or pain, functional problems and aesthetic and functional impairments.

Learn more about innovative treatment concepts in our relating patients stories and video-tutorials !

Ankylosed tooth - Minimally Invasive Treatment with a Ceramic Veneer

Minimally Invasive Treatment of an Ankylosed Tooth with a Ceramic Veneer

Minimally Invasive Treatment of an Ankylosed, Severely Discolored, and Intruded Central Incisor with a Masking Ceramic Veneer: A Clinical Report

2018 Jan/Feb;38(1):121-126. doi: 10.11607/prd.2874.

The therapy of traumatically ankylosed anterior teeth with additional root resorption presents the restoration team with a significant challenge. This requires intensive planning and communication between patient, dentist, orthodontist, periodontist and dental technician. The inadequate vertical growth of a tooth often makes dental intervention indispensable.

Despite all risk factors, including the endodontic treatment, the 3-mm intruded position, and the slight root resorption, the patient and the restorative team decided to restore the situation of the ankylosed tooth with two feldspathic ceramic veneers. The treatment goal was an esthetic, functional, time saving, nonsurgical process for the patient. Nevertheless, intense pre- prosthetic planning with a digital approach to the width-length ratio and red-white esthetics was necessary.

Learn more about innovative treatment concepts and their application in our tutorials and stories.

Frontzahnrestauration mit Keramikveneers

Anterior restorations: The performance of ceramic veneers

 2018;49(2):89-101. doi: 10.3290/j.qi.a39509.

Anterior restorations: The performance of ceramic veneers.

The establishment of the adhesive techniques in combination with tooth-coloured restorative materials is among the greatest achievements in restorative dentistry.

Adhesively luted veneers based on various silicate ceramic materials have made a major contribution to this. Ceramic veneers, which for a long time had the nimbus of purely aesthetic restorations, are still being used for a growing number of indications. They have developed into a serious treatment alternative to classical, far more invasive forms of restoration. Today, they are used in addition to numerous other applications to reconstruct the biomechanics of teeth. They can also be used to set an appropriate function and even mask heavily discoloured endodontically treated teeth.

The article describes the principles of modern veneering technology using clinical examples, with special emphasis on the cooperation with the dental technician in the analysis, definition of the treatment objective, colour determination, decision in favour of a suitable ceramic, preparation design and determination of the luting material for adhesive placement. In addition, the long-term behaviour of ceramic veneers is evaluated on the basis of the existing scientific literature.

Analysis and determination of the restorative objective

The analysis of function, aesthetics and biomechanics as well as the definition of the restoration goal requires very close communication with the dental technician. The following documents should be available for the laboratory analysis for fabricating the diagnostic wax-up:

  • Portrait photographs frontally and laterally with and without facebow
  • Recordings with slightly opened mouth and relaxed upper lip as well as video recordings (smartphone is sufficient)
  • Recordings in which the patient speaks freely and counts once, for example, from “50” to “55
  • intraoral photos of both jaws (photo status)

These images support the determination of the length and inclination of the maxillary middle incisors. This is the central starting point of any anterior tooth- or more complex rehabilitation. Furthermore, impressions of both jaws showing the vestibulum including the jugae alveolaria and a jaw relation determination are required.

Make sure to also check out our relating treatment concepts and video-tutorials!

Soft Tissue Regeneration for Dental Restorations

Soft Tissue Regeneration in the Esthetic Zone

Liebermann A1, Frei S2, Pinheiro Dias Engler ML1, Zuhr O3, Prandtner O2, Edelhoff D1, Saeidi Pour R1.
2018 Jan;30(1):22-29. doi: 10.1111/jerd.12336. Epub 2017 Sep 19.

Multidisciplinary full-mouth rehabilitation with soft tissue regeneration in the esthetic zone.

Oral rehabilitation often requires a multidisciplinary approach in restorative dentistry, prosthodontics, and periodontology to fulfill high esthetic and functional demands, frequently combined with changes in the vertical dimension.

The presence of gingival recessions can be associated with numerous factors

  • such as brushing
  • smoking
  • preparation trauma
  • persistent inflammation of the gingiva
  • inadequate marginal fit of restorations
  • functional problems
  • Metabolic diseases

Because gingival recessions can cause major esthetic and functional problems, obtaining stability of the gingival tissue around prosthetic restorations is of essential concern. Modifications of the occlusal vertical dimension require sufficient experience of the whole dental team. Patients with functional problems and craniomandibular dysfunction, a newly defined occlusal position should be adequately tested and possibly adjusted.

Our patient was dissatisfied with the appearance of her anterior restorations and also complained about functional problems. This publication provides a documented overview of the planning and implementation of a multidisciplinary treatment concept.

Clinical considerations: This case report presents a complete prosthetic rehabilitation combined with a periodontal surgical approach for a patient with gingival recessions and functional/esthetic related problems. The vertical dimension was carefully defined through long-term polymethyl methacrylate provisionals as a communication tool between all parts involved.

An essential part of the treatment is the regeneration of soft tissue by means of connective tissue transplants. Only after successful periodontal healing could all-ceramic crowns be used as definitive rehabilitation.

Learn more about multidisciplinary treatment concepts and their application in our tutorials and stories!

Innovative Single Tooth Replacement with the Replicate Immediate Implant

Innovative Single Tooth Replacement with the Replicate Tooth Hybrid Implant – Case Report

Innovative Single-Tooth Replacement with an Individual Root-Analog Hybrid Implant in the Esthetic Zone: Case Report.
2017 May/Jun;32(3):e153-e160. doi: 10.11607/jomi.5562.

Innovative single tooth replacement requires creative approaches to combine state-of-the-art technology and human imagination to provide patient-oriented yet functionally efficient treatment.

This publication contains an original approach to single tooth replacement with a custom-made root-analog hybrid dental implant. It avoids the micro gap and micro movements between the implant and abutment.  The process requires capturing accurate root geometry through combined CAD/CAM and a three-dimensional 3D visualization digital volume tomography of the tooth in situation.

Learn more about modern treatment concepts and their application in our tutorials and stories!

Replident München Website >

preparation of occlusal onlays

Preparation of occlusal onlays with Prof. Edelhoff and Dr. Ahlers

Quintessenz 69 (2018), Nr. 5  (04.05.2018)

Edelhoff, D.Ahlers, M. Oliver

Innovative techniques for the preparation of occlusal onlays

  • During preparation, it is typically assumed that the first step is to decide whether additional substance removal in the occlusal area is necessary. If this is the case, it should be carried out using appropriate depth markers.
  • In the further course of the procedure, a preliminary preparation is often required in appropriate cases in order to prepare the basic shape of an occlusal inlay for the partially destroyed occlusal surfaces.
  • The actual shaping should then take place. Instruments that determine the shape of the later restoration in one single step are particularly suitable for this purpose.

Learn more about innovative treatment concepts and their application in our stories and tutorials.

Preventing Ceramic Chipping in Dental Restorations

Option to Prevent Ceramic Chipping of Veneers

A Veneering Option to Prevent Ceramic Chipping.

Saeidi Pour R, Edelhoff D, Rafael CF, Prandtner O, Frei S, Maziero Volpato CA, Liebermann A.
2017 Jul/Aug;37(4):561-569. doi: 10.11607/prd.3043.

Chipping of veneering porcelain is the most frequent complication in all ceramic restorations with zirconia frameworks. In cases of major chipping, replacement of the affected restoration may be necessary.

Complications after the placement of implant supported fixed dental prostheses occur over time as a result of fatigue and stress. High strength ceramics offers new options to serve as veneering material in a sintering technique with zirconia frameworks.

In conclusion the purpose of three case presentations here was to describe the use of lithium disilicate ceramic on zirconia frameworks.

Learn more about innovative applications of ceramic veneers in our Tutorials and learn the step-by-step planning and treatment of ceramic-based restoration concepts in our Stories.

3D Printing of Dental Structures

3D Printing of Dental Structures

BDJ volume 221, pages 555–560 (04 November 2016)

Histo-anatomic 3D printing of dental structures

J. Schweiger, F. Beuer, M. Stimmelmayr, D. Edelhoff, P. Magne & J. F. Güth

Approaches to digital design of dental restorations and dentures using 3D printing

This publication contains a general description of the workflow for creating dental restorations using 3D printing with natural appearance and biomechanics. Through 3D capturing of external and internal tooth structures, additive manufacturing technology can reproduce an accurate image of the natural tooth.

The creation of dental restorations with natural appearance and biomechanics represents a major challenge for the restorative team. The manufacturing-process of high-aesthetic restorations from tooth coloured restorative materials is currently dominated by manual manufacturing procedures and the outcome is highly dependent on the knowledge and skills of the performing dental technician. Multilayer restorations show significant esthetic advantages over monolithic ones, but are difficult to produce with digital technologies.

This article describes the possibilities and technologies available for so-called ‘4D-printing’. It introduces the digital manufacturing process of multilayered anterior teeth using 3D multipart printing, taking the example of manufacturing replicas of extracted intact natural teeth.

Learn more about the application of 3D-based digital manufacturing processes in our tutorials and see the detailed documented application of the techniques in our stories!

Immediate Implant Socket Shield Technique

Immediate Implant Socket Shield Technique – Clinical Benefits

2017 Apr;29(2):93-101. doi: 10.1111/jerd.12291. Epub 2017 Feb 12.

Clinical Benefits of the Immediate Implant Socket Shield Technique.

Extraction-socket resorption is considered a major problem that can limit implantological rehabilitation options and compromise the esthetic outcome. Surgical techniques to reduce remodeling are of restricted predictability and commonly require several surgical interventions and grafting.This increases the treatment cost and places a physical and psychological strain on the patient.This clinical case report presents a replacement of an upper canine using the socket- shield technique with a CAD/CAM surgical guide, resulting in a predictable, high esthetic, and functional result.

Learn more about innovative treatment methods for immediate implants in our tutorials or take a look at our detailed stories to follow the treatment step-by-step.

 

Digitally Produced Dentin Cores for Multilayer Anterior Restorations

Digitally Produced Dentin Cores for Multilayer Anterior Restorations

Quintessence of dental technology 38(2015):207-220 · January 2015

Automated Production of Multilayer Anterior Restorations with Digitally Produced Dentin Cores

When making digital dentures, it is now possible to copy and mirror the geometry of dentin structures. As a result, the data set is used to mill monolithic dentine core structures from tooth-coloured blanks.

Learn more about dentin cores, CAD/CAM controlled production processes and the planning of treatment concepts in our tutorials and the corresponding stories.

 

Ceramic Veneer (Anterior Dental Restoration)

The Performance of Veneers – Anterior Restorations

2018;49(2):89-101. doi: 10.3290/j.qi.a39509.

Anterior restorations: The performance of ceramic veneers.

Bonding techniques in combination with tooth colored restorative materials are one of the greatest achievements in restorative dentistry.

Keywords:
Adhesive bonding, all-ceramics, analysis, material selection, tooth preparation , wax-up, preparation template, shade taking, veneer

Ceramic veneers had long been considered to be only esthetic implements. However, their range of indications have been steadily increasing, making ceramic veneers a highly viable alternative to the classic and far more invasive forms of restorative treatment. Today these veneers are used to restore the biomechanics of the dentition. This establishes adequate function to mask highly discolored treated teeth, and for many other purposes. The present article explains the principles of modern veneer technology based on clinical examples.

 The article will also explore the longterm prognosis of ceramic veneers as reported by a number of scientific studies.

Watch a relating onlay & veneer story
Partial Anodontia Treatment

Partial Anodontia – Consequences and solutions in agenesis of the lateral incisors

Partial anodontia: Innovative treatment approaches, consequences and solutions

Published in spectrum dialogue and EDI Dental Magazin

Agenesis of permanent teeth, also known as partial anodontia, is a common problem. Recent studies have shown that the incidence of anodontia is increasing. When lateral incisors are missing, parents, dentists and orthodontists are tasked to make the right decisions at an early stage – i.e. during the early years of the young patient’s life. This early decision will determine the dental health and physical appearance of the patient for a whole lifetime. This article presents three different implant treatment cases.

Watch a relating partial anodontia story.

Dental Restoration Step by Step

Patient Oriented Treatment Concept for Pathological Tooth Wear

2018;13(4):476-492.

A patient-calibrated individual wax-up as an essential tool for planning and creating a patient-oriented treatment concept for pathological tooth wear.

Saeidi Pour R, Engler MLPD, Edelhoff D, Prandtner O, Frei S, Liebermann A.

Tooth wear is generally a physiological process. However, it can also be a pathological condition associated with attrition, abrasion, and erosion processes. Quantity of tooth loss is atypical and often causes functional problems, symptoms of discomfort/pain. This condition frequently needs restorative treatment, combined with an increase in the vertical dimension of occlusion. The mock-up to determine the new occlusal plane and vertical dimension of occlusion is a fundamental tool considering the backward planning involved in the execution of a complex rehabilitation.

We strive to make our articles alive! How are we going to do that? The patient creates the inspiration for the restoration. As a result we started to make videos about patient story’s aligned with tutorials.

Please watch the relating story!