Modern Concepts in Adhesive Dentistry - Dentistry

Full Immersion on Direct and Indirect Restorations on The Anterior and Posterior Area

The course is divided into 50% theoretical sessions and 50% hands-on training, with the aim of clearing any doubt the participant may have regarding the correct restorative approach for the treatment of the posterior area, from simple cases to the most complex rehabilitations with a multi-disciplinary approach.

The participants will be provided by the course organizers with most of the necessary equipment for the hands-on sessions. A list of required materials will be given to the participants at the registration.

Day 1 - Module 1: Direct Posterior Restorations

Direct posterior restorations represent one of the most frequent treatment in daily practice and the clinical scenario for this procedure can be very different in every single case, from simple and easy to manage situations to intra-surgical and very challenging restorations. During the course will be analyzed the indications and the right approaches step by step to obtain easy and predictable results with direct composite restorations, from proper isolation of the operative field, to choosing the correct adhesive procedure, to manage deep margins and emergency profiles, until the adequate layering and modeling techniques.

• Patient framing in direct restorative: critical factor of long term success.
• Decay profile risk and DMF-t index.
• How to organize the first appointment in restorative dentistry: formulate a correct diagnosis and a correct treatment plan.
• Diagnosis using visual, photographic, tactile, radiographic evaluation and fluorescence+transillumination: data collection as key prognostic factor.
• Treatment plan according to urgent order.
• Use of photography in modern restorative dentistry: communication and self improvement.
• Structural analysis and choosing criteria: direct, indirect or semi-direct?
• Vital and non-vital teeth, occlusal load, patient’s habits: decisional scheme and operative protocols related to different clinical scenarios.
• Procedures optimization: how to maximize operation and ergonomics.
• Importance of clinician-factor: how to standardize procedure to obtain successful and long-term direct restorations.
• Isolation: clamps, rubber dam sheets, different position techniques, ligature using, tips and tricks.
• Preparation and cavity design: classification of different carious lesions, residual decay control, end point remotion in deep decays, choice of cavity configuration for a favorable restorative prognosis.
• How to protect the teeth not involved in cavity preparation.
• Fissures sealants, PRR, slot or tunnel preparations, small, medium and large I and II class cavities, preservation of cervical enamel, II class cavities without cervical enamel, DME in direct restorative, direct surgical-restorative approach.
• Instrumentation in direct restorative dentistry: burs types, manual instruments, sonic and reciprocate inserts.
• Matrices: automatrices and sectional matrices, how and when to use them according to the results we want to reach.
• Retainer rings: how and when according to the different clinical situations.
• Interproximal edges: choosing ratio of different types.
• Adhesion: the key of success in direct restorative dentistry.
• Etch&Rinse, Etch&Dry, Universal: action modalities, differences, clinical indications and operative sequences. Orienting ways to obtain optimal adhesion values in any operative scenario.
• Curing lamps: how to choose and why.
• Composite materials in modern restorative dentistry, choosing criteria: flowable composites, which ones and when to use them? Modern composite resins, micro hybrids , nano hybrids and nanocluster.
• Handling, chromatic outcome, polishing and wear follow-up of composite materials.
• Anatomy of posterior teeth: shapes and characteristics to replace.
• Color in direct posterior adhesive restorations.
• Cervical sealing: how to manage the critical area in II classes.
• Marginal edge recover: centripetal build-up technique and proximal wall finishing.
• Modeling techniques: additive, subtractive, horizontal layering, oblique layering, cusp by cusp, SMT, stamp technique and build up and press. Advantages and limitations.
• Superficial characterizations and final curing of the restoration.
• Finishing: how to treat the transition areas tooth- restoration, over contouring management, how to give naturalness to direct restorations. • Polishing: essential steps to give long.-term to direct restorations.
• Occlusal and radiographic verification: how to avoid future problems

Hands On:

The participants will perform a complete anterior sextant isolation using the rubber dam.They will then create direct I class restorations on natural teeth, completing them with finishing and polishing steps, as well as multiple restorations of II class, on dental models. During this hands-on session the “stamp technique” will be illustrated and performed according to the procedures explained in the theoretical sessions.

Day 2 - Module 2: Indirect Posterior Restorations

The design of full-mouth rehabilitations for an optimal esthetic result requires correct treatment planning, evaluation of a suitable ceramic material and skillful application and techniques. Current technologies validly support the clinician in the definition of an ideal treatment plan and the optimization of time and costs. In particular the dentist can count on new digital tools guiding him/her in the step-by-step collection of all the necessary data. The selection of the ceramic material with the dental technician is another fundamental step in the management of complex rehabilitation cases.

Nowadays a systematic approach based on a 35-year experience allows the dentist to face highly com- promised clinical situations with the application of minimally invasive prosthetic procedures. Thanks to the alteration of the Vertical Dimension of Occlusion (VDO) it is possible to take advantage of the newly created space between the two arches: the result of this technique leads to a dramatic minimization of the invasiveness of the prosthetic treatment when using veneers, full-veneers, buccal-occlusal veneers and table tops, even with reduced ceramic thickness. This procedure also enables the clinician to re-establish an ideal occlusal relationship and avoid additional endodontic and/or surgical procedures, which traditionally were necessary in order to improve the retention of the restorations. Finally, the maintenance of a maximum amount of enamel combined with the use of the appropriate bonding technique guarantee a remarkable resistance of the restorations and a long-lasting result of the prosthetic rehabilitation.

A 12-year follow up of this technique will be presented through the presentation of clinical cases.

• Decisional scheme: choosing direct vs indirect partial restorations vs total restorations.
• Posterior restorations classification.
• Diagnostic scheme: X-rays evaluation and digital helps.
• Decays management: direct approach vs indirect approach, surgical approach, deep margin elevation procedures.
• Fractures management.
• Cracked tooth syndrome management.
• Discolored posterior teeth management.
• Buccal corridors and indirect partial posterior restorations.
• Worn dentition and indirect partial posterior restorations.
• Approach to the endodontically-treated teeth.
• Biomechanics and ferrule effect.
• Post or not post, that is the question!
• The use of rubber dam for a perfect isolation in any situation: instruments and techniques.
• Color matching in indirect posterior restorations.
• How to use dental photography in posterior cases: equipment, techniques, common mistakes.
• Classical preparations step by step: inlay, onlay and overlay.
• New preparations: Buccal Occlusal Veneers, table tops and full veneers.
• The role of indirect posterior restorations in case of complex treatment plans using minimally invasive techniques: MIPP (Minimally Invasive Prosthetic Procedures).
• Which burs? Finishing techniques of preparations: rotative, manual and ultrasonic instruments.
• Build-up: correct materials and techniques.
• Impressions: classical and innovative materials and techniques.
• Classical vs digital impressions: comparison, indications and limitations of both systems.
• Provisionals for indirect posterior restorations: materials and techniques.
• Restorative material choice. 2021
• Lab procedures: step by step techniques for different materials.
• Basics of adhesion: history, fundamentals, action mechanism, last researches, clinical experiences.
• Step by step cementation for different materials.
• Which cement?
• Occlusal check: how to detect occlusal wrong contacts and how to remove them.
• Maintenance of indirect partial posterior restorations.
• Common mistakes and failures: when and how to prevent them?

Hands On:

The participants will realize different types of tooth preparations on dental models provided by the course organizers. They will also build a composite overlay according to the methods explained during the theoretical sessions. The cementation of an overlay on a dental model will be performed live.

Day 3 - Module 3: Direct Anterior Restorations

The use of composite direct restorations in the anterior area is a valid treatment option and alternative to improve esthetics, function and biology.

The modern materials, together with valid bonding systems, allow the clinicians to perform well integrated, esthetic results that mimic the optic and physical behavior of the natural dentition.

Any aspect of the decision-making process and operative procedures will be covered to allow the partici- pants to realize high-impact direct composite restorations.

• Anterior elements anatomy.
• Optical properties of dental elements and composites.
• Direct vs indirect anterior restorations: how to choose.
• Different composite systems and characteristics.
• Wax up for direct anterior restorations.
• Palatal and sagittal silicone index.
• Multiple convexity matrices in the anterior area.
• Essential instruments in anterior direct restorations.
• The use of rubber dam for a perfect isolation in any situation: instruments and techniques.
• Preparation principles of anterior elements in direct restorative procedures.
• Basics of adhesion for direct anterior restorations.
• Layering technique (simplified, ibride, complex).
• Stains and their correct use.
• Finishing, polishing and glossing.
• Direct therapies in non-vital discolored teeth.

Hands On:

The participants will realize a correct isolation on the models using rubber dam; then they will create a IV class direct restoration on the same model. Then, the participants will build up of a central incisor entirely in composite, using a silicon matrix, given by the organizers.

Day 4 - Module 4: Indirect Anterior Restorations

The use of all-ceramic veneers represents a valid alternative to complete crown restorations.

The minimally invasive tooth preparation procedure allows the maximum preservation of health tooth structure thus guaranteeing vitality and higher overall resistance of restoration also thanks to the unde- niable advantages offered by the adhesive cementation technique. Nowadays a new clinical approach based on an innovative minimally invasive prosthetic procedure (MIPP) also applicable to full crown restorations allows preservation of vitality and tooth structure.The availability of a wide range of ceramic material (glass ceramic, alumina and zirconia) permits the achievement of excellent, long lasting esthetic results mixed rehabilitation on implants.

This prosthetic treatment workflow starts with an esthetic and functional plan which allows an ideal inte- gration of esthetics, biological and functional requirements. Classical and new digital trends will be analyzed in depth in order to reach the final goal.

• Augmented reality new systems.
• GETapp (Guided Esthetic Treatment application by Fradeani Education).
• Ideal dental composition.
• Mock-up materials and techniques.
• Classical and Modern principles of tooth preparation.
• Burs selection.
• Margins: supragingival, juxtagingival, intrasulcular, subgingival
• Minimally invasive tooth preparation (MIPP): new trend in prosthetic adhesive dentistry.
• No-prep veneers: myth or reality?
• Color matching in indirect anterior restorations and communication to the lab.
• Impressions: materials and techniques.
• Classical vs digital impressions: comparison, indications and limitations of both systems.
• Provisionals for indirect anterior restorations: materials and techniques.
• Materials choice: classification of all-ceramic systems.
• How to choose the right lithium disilicate ingot.
• Discolored anterior teeth management.
• What’s new? Bleach & Prosth workflow: how to connect dental bleaching and prosthetic procedures.
• Lab procedures: step-by-step techniques for different materials.
• Basics of adhesion: history, fundamentals, action mechanism, last researches, clinical experiences.
• Step by step cementation for different materials.
• Which cement?
• Occlusal check: how to detect occlusal wrong contacts and how to remove them.
• Maintenance of indirect anterior restorations.
• Common mistakes and failures: when and how to prevent them?
• Complex treatment plans using minimally invasive techniques: MIPP (Minimally Invasive Prosthetic Procedures).
• Worn dentition classification and modern prosthetic guidelines.
• Worn dentition and its management using minimally invasive prosthetic procedures.
• Mixed rehabilitations: teeth and implants.

Esthetic Analysis

• How to approach the esthetic case.
• First visit and decisional scheme
• How to use dental photography in anterior cases: equipment, techniques, common mistakes.
• How to communicate to the patients using images: marketing principles according to the specific patient.
• Facial analysis.
• Dento-labial analysis.
• Phonetic analysis.
• Dental analysis.
• Gingival analysis.

Functional Analysis

• Occlusal plane.
• Occlusal relationships (MI-CO-CR), vertical dimension (VDO).
• Changing VDO: when, how and why. Rationale, step by step workflow and common mistakes.
• Facebows and articulators. alysis.
• Dento-labial analysis.
• Phonetic analysis.
• Dental analysis.
• Gingival analysis.

Hands On:

The participants will create and customize a silicon index designed for the mock up and different silicons for preparation checking and measurements. They will also perform different preparation designs (contact point maintained and not maintained, chamfer, butt-joint...) and will print and finish the mock-up to be used as temporary restorations following the 6-anterior ideal dental composition.