The no prep approach, when and how

Indications for no prep protocols are quite strict and may be summarized as follows:

– Post orthodontic treatment needing some small improvement– Little smile design corrections (embrasures, diastemas, etc…)

The no prep concept is nowadays heavily trending, but for proper planning the practitioner should have a precise idea of dos and donts.

This article is made to highlight the use of chips in esthetic treatment.TIPS of the case:

– basic way of production in the lab restoration: press and polish

– bleach before starting the case to increase esthetic integration of chips

– bonding sequences starting by chips first and laminate after.

style italiano styleitaliano dentistry

Fig.1
Initial situation

style italiano styleitaliano dentistry

Fig.2
Intra-oral view: note the low value of the color, diastema between 11 and 21 and narrow shape of 12

style italiano styleitaliano dentistry

Fig.3
Occlusal check: incisal edge must be reduced during preparation to allow sufficient thickness for incisal ceramic (1,5 mm)

style italiano styleitaliano dentistry

Fig.4
Analysis of the shape

style italiano styleitaliano dentistry

Fig.5
Intra-oral view of upper arch (with flexipalette). Decision process should focus on the design of the augmentation of white tissue.

style italiano styleitaliano dentistry

Fig.6
A mock-up is created with chemical cure composite (Luxatemp Star DMG) to visualize the esthetic project. Of course the final choice must fulfill biological and functional criteria.

style italiano styleitaliano dentistry

Fig.7
Laminate veneering is chosen to enhance tooth 12.

style italiano styleitaliano dentistry

Fig.8
After bleaching with 5% carbamide peroxide (White Dental Beauty Teeth Whitening gels) slight preparation is performed to follow prep less concept in order to visualize cervical margin. Increasing the color value is key to improving esthetic integration and mimicry of restorations.

style italiano styleitaliano dentistry

Fig.9
A no prep approach was chosen for teeth 11 and 21.

style italiano styleitaliano dentistry

Fig.10
No prep restorations are made with emaX press and then polished. No stain is required.

style italiano styleitaliano dentistry

Fig.11
Here you can see the opalescence of the material.

style italiano styleitaliano dentistry

Fig.12
Try-in of the 3 restorations with glycerine paste (Vitique veneer B1 DMG )

style italiano styleitaliano dentistry

Fig.13
Individual dam (Nictone, 212 Hu-friedy)

style italiano styleitaliano dentistry

Fig.14
Placement of the chip prior to laminate veneer. Margins are polished with silicone wheel on low speed handpiece.

style italiano styleitaliano dentistry

Fig.15
Use of Optrasculpt pad (Ivoclar Vivadent) with a soft pressure on the restoration

style italiano styleitaliano dentistry

Fig.16
Individual dam for bonding procedure of the laminate after the chip because it is less fragile.

style italiano styleitaliano dentistry

Fig.17
Same procedure for the placement of the laminate veneer on tooth 1.2

style italiano styleitaliano dentistry

Fig.18
Optical integration of both restorations

style italiano styleitaliano dentistry

Fig.19
Close-up on the lateral

style italiano styleitaliano dentistry

Fig.20
Final (ceramist Gerald Ubassy).

style italiano styleitaliano dentistry

Fig.21
Before and after.

Conclusions

No prep restorations can be very precious in contemporary treatment planning to solve some everyday cases, though it is important to integrate this type restoration in a basic workflow where it is simple for both the lab and the dentist in order to do it in a feasible and repeatable way.
The role of the dentist as a smile architect is fundamental to visualize the ideal pink/black/white ratio for top quality esthetics and biological preservation.

Bibliography

1. Molina IC, Molina GC, Stanley K, Lago C, Xavier CF, Volpato CA. Partial-prep bonded restorations in the anterior dentition: Long-term gingival health and predictability. A case report. Quintessence Int. 2015 Sep 28.
2. Miro AJ, Shalman A, Morales R, Giannuzzi NJ. Esthetic Smile Design: Limited Orthodontic Therapy to Position Teeth for Minimally Invasive Veneer Preparation. Dent Clin North Am. 2015 Jul;59(3):675-87
3. Magne P, Hanna J, Magne M. The case for moderate “guided prep” indirect porcelain veneers in the anterior dentition. The pendulum of porcelain veneer preparations: from almost no-prep to over-prep to no-prep. Eur J Esthet Dent. 2013 Autumn;8(3):376-88.
4. Gresnigt M, Ozcan M. Esthetic rehabilitation of anterior teeth with porcelain laminates and sectional veneers. J Can Dent Assoc. 2011;77:b143.

RELATED CASES

Making a patient smile with diastema closure. A minimally invasive approach

With the direct composite technique that helps to preserve the tooth structure in a fast and comfortable way for the patient, diastema closure is no longer a difficult procedure in clinical, everyday work.