Practice Mauro Fradeani: Minimally invasive prosthetic procedures (MIPP) in partial and full rehabilitation

LEARNING OBJECTIVES

- Define an appropriate esthetic and functional treatment plan with a digital approach. - Learn how to minimize the invasiveness of the prosthetic treatment by altering the VDO, reducing the ceramic thickness and using appropriate bonding procedures. - Learn how to achieve a predictable and longlasting esthetic and functional result of the full-mouth prosthetic rehabilitation.

Program:

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 compromised 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.

Dr. Mauro FRADEANI | Dr. Leonardo BACHERINI | Dr. Roberto TURRINI

Day 1: Esthetic and Functional Analysis

FACIAL ANALYSIS

• Frontal view: interpupillary line, commissural line, midline related to the horizon• Lateral view: profile, nasolabial angle, e-line

DENTO-LABIAL ANALYSIS

• Tooth exposure at rest, incisal edge, smile line, smile width, labial corridor, interincisal vs. facial midline, occlusal plane vs. horizon

PHONETIC ANALYSIS

• Pronounciation of M-F-S-E sounds: prosthetic impact• Incisal edge position, tooth length, vertical dimension

DIRECT AND INDIRECT MOCK-UP

• Reversible additive technique, treatment preview for the patient, diagnostic confirmation for the clinician• Different types of mock-up fabrication according to the diagnostic wax-up

DENTAL ANALYSIS

• Key factors for the treatment plan and for anterior restorations: how to detect and overcome possible obstacles for the achievement of optimal esthetics• Tooth shape, proportions, position, arrangement and color• Transition line angles: how to give the impression of length and width variation

GINGIVAL ANALYSIS

• Ginvival margin outline• Parallelism and symmetry• Gingival zenith• Interdental papillae

ESTHETIC CHECKLIST

• Indispensable tool for the clinician• Simple, predictable and efficient method• Systematic approach to collect all the necessary data

GETApp (Guided Esthetic Treatment application by Fradeani Education)

• New trends: the use of GETApp for an ideal step-by-step approach to the digital treatment plan

FUNCTIONAL ANALYSIS AND OCCLUSAL CONSIDERATIONS

• Achieving, recording and verifying a repeatable mandibular position » CR: why, when and how » MI: why, when and how• Occlusal-vertical dimension (OVD): how and when to modify it?• Anterior guidance: how to optimize it?• Parafunctions: can the occlusion play a role in the bruxer patient?• Worn dentition: different etiology and related treatments

COMMUNICATING WITH THE LABORATORY

• Direct and indirect mock-up• Laboratory chart• Data transmission to the laboratory for the diagnostic wax-up• Facebow and esthetic orientation• Communication of the anterior guidance and occlusal schema to the technician with a customized incisal guide table• Mounting and setting the articulator

Day 2: the Minimally Invasive Prosthetic Procedures (MIPP)

ALL-CERAMICS

• The development of all-ceramic restorations

BONDED CERAMIC RESTORATIONS

• Indications, possibilities and limits• Clinical parameters for long-term success• Glass-ceramics• Alumina ceramics• Zirconia-based ceramics• How to avoid fractures or chipping• A 35-year clinical follow-up with different ceramic materials

MINIMALLY INVASIVE PROSTHETIC PROCEDURES (MIPP):

• Classification: » MIPP 0 » MIPP 1 » MIPP 2, A and B » MIPP 3, A and B• Basic principles and advantages• New trends in prosthodontics

MIPP 0: INDIRECT PARTIAL POSTERIOR RESTORATIONS

• Selection criteria for direct and indirect restoration in the posterior sectors• Indirect restorations: inlays, onlays, overlays, partial crowns, full crowns• Decay diagnosis: X-Ray evaluation (status and bite-wing), new diagnostic techniques• Approach to the endodontically-treated tooth• Biomechanics, ferrule effect, crown lengthening, restorations with or without posts• Particular cases: cracked-tooth syndrome, discoloration due to amalgam or other materials 6 /• How to restore a severely compromised tooth• Material choice: composite or ceramic?• Ceramic: which material? Ingot ceramic choice in case of discolored and nondiscolored teeth• Composite: which material? Traditional composites vs. new generation composites• Operative instruments• The use of rubber dam in any situation: fast and simplified approach, recommendations, tips and tricks• Build-up realization: when, how and why• Provisional restorations for inlays/onlays• Laboratory phases: step-by-step procedure for creating indirect posterior restorations• Halogen and led lamps: common problems and research• New trends: steps for simple and fast cementation

Day 3: MIPP 1 - MIPP 2 - MIPP 3

BUCCAL AND FULL VENEERS / MIPP 1 - MIPP 2

• Is it possible to treat the case by using buccal veneers?• The new concept of full veneers• The use of veneers and full veneers to optimize esthetic and function• Traditional diagnostic wax-up• Digital diagnostic wax-up• From the diagnostic wax-up to the mock-up

IMPRESSIONS

• Step-by-step fabrication of a customized tray• Traditional vs. digital impression

CERAMIC SELECTION

• Which ceramic material for veneers and full veneers: ingot selection• A systematic approach to color detection• Use of the Natural Die Material shadeguide for the definition of the color of the abutment• Discolored dentition: alternative and options in case of heavily discolored teeth• Simple management of provisional restorations with veneers

THE PROSTHETIC REVOLUTION / MIPP 3

• A 12-year experience• Mock-up and provisionals: keystone steps for a predictable esthetic and functional result• Tooth preparation: » When and why to perform a traditional technique » When and why to perform an innovative technique• Minimal preparation or no preparation at all?• Tooth structure maintenance: a key to success• Is anesthesia still needed?• An analysis of the perfect conditions• VDO alteration: how, when and why / 7• Bonding procedure• How new prosthetic steps can change your professional life• How the MIPP technique can dramatically improve the patient’s “chair experience”

HANDS-ON TRAINING BY THE COURSE PARTICIPANTS

• Facebow taking on patient• Centric relation and protrusive records• Occlusal records and facebow records on patient• Data collection and formulation of an ideal treatment plan using digital systems

LIVE DEMONSTRATION BY DR. FRADEANI

• Occlusal adjustment on patient

Day 4: Innovative Tooth Preparations and Adhesive Bonding Procedure

INNOVATIVE TOOTH PREPARATIONS

• Types of preparations: tradition vs. innovation. Which burs?• How to handle the cervical area• How to perform the final preparation design for crowns, veneers, full veneers, table-tops, inlays, onlays and buccal-occlusal veneers• Finishing techniques of tooth preparation: rotative, manual and ultrasonic instruments• Common mistakes: suggestions and clinical recommendations to avoid them• Restoration try-in: common mistakes and ways to prevent them• Different types of cements and clinical parameters for an appropriate choice

ADHESIVE BONDING

• Biscuit try-in and cement selection• Selection of the adequate bonding system• Step-by-step procedure of the adhesive bonding• Occlusal adjustment• Final polishing

HANDS-ON TRAINING BY THE COURSE PARTICIPANTS

• Step-by-step tooth preparation for: » Crowns » Veneers » Full veneers » Table-tops » Inlays » Onlays » Buccal-occlusal veneer• Step-by-step bonding procedure of the restorations

ACE Institute

The ACE Institute, Advanced Continuing Education Centre, was created in 2000 by Mauro Fradeani with the aim of expanding clinical knowledge and sharing professional skills and scientific update in esthetic dentistry. The course facility is located in a 17th century building, in the historical center of Pesaro, Italy and it can accommodate up to 36 participants. A professional Full-HD audio-visual equipment allows easy connection with the conference room for an optimal interface with the course participants during live-treatments. The second floor offers 18 lab stations for hands-on courses.