One-Step No-Prep Treatment of Worn Dentition Using PICNs

Objectives: The objective of this study was to evaluate a one-step treatment approach of worn dentition (One-step No-prep), using a Polymer Infiltrated Ceramic Network (PICN) CAD-CAM composite material, (Vita Enamic,Vita Zahnfabrik, Germany).
Methods: Seven patients with severe tooth wear (BEWE score>13), a maximum of two missing teeth and a significant VDO loss were included. Etiology of tooth wear was determined by a closed questionnaire and full diagnosis of temporo-mandibular disorders (TMD). An occlusal analysis and a full-mouth wax-up on plaster casts were performed. After replacement of old fillings by direct composites, PICN restorations (posterior restorations and palatal veneers) were bonded on non-prepared teeth, with respect to the initial wax-up. The restorations (n=192) were placed during two consecutive visits within 24 hours. Buccal direct composites were performed to mask the limit between palatal veneers and the anterior tooth buccal face. In case of TMD disorder diagnosis, patients were treated by a maxillo-facial physiotherapist and a posturologist. Restorations were clinically evaluated after 1, 6 and 12 months following FDI criteria. The treatment influence on TMD and patient-centered outcomes following OHIP-49 were assessed.
Results: Tooth wear was mainly attributed to sodas consumption and bruxism, and loss of tissue was higher than 50% on most teeth. Mean VDO increase, as estimated with the wax-up, was 5.09±0.85-mm on the front teeth. The mean restoration thickness was 1.22±0.42-mm on anterior teeth and 0.56±0.21-mm on molars. Questionnaires showed a high satisfaction rate of patients with the whole procedure, the absence of provisional restorations, the one-step VDO increase, the functional and esthetic results and the restorative material. The treatment showed a significantly positive effect on pain (tooth, muscular, articular), posture, as on the psychological well-being.
Conclusions: The one-step and no-prep approach is particularly straightforward, minimally invasive, cost-effective and highly appreciated by patients. Present results need to be confirmed by further research.