Extensive restorations
Extensive restoration are very complex restorations because they replace the major part of the crown due to deep decay processes, fracture of the tooth or fracture of both the tooth and the existing restoration. Such severely compromised teeth require the cementation of indirect restorations which are fabricated by the dental laboratory. However, this procedure necessitates the removal of sound remaining tooth structure and it is more expensive for the patient.
Dr Deliperi has published clinical protocol for the reconstruction of severely damaged teeth with tooth-colored resin composite fillings on peer reviewed journals. This procedure was adopted for both vital and non-vital teeth; Dr Deliperi presented the results of this conservative technique in the most important dental research meeting both in Europe and in the United States. The advantages of a similar approach are multiple: preservation of sound tooth structure, just one visit to complete the restoration, chromatic and anatomic integration with residual tooth and reduced fee for the patient.
De-vital teeth
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Click on thumbnail to see 'before' and 'after'
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Before
Devital first upper molar before starting the filling. The gutta-percha pink material is visible at the root canal entrance; please, note the severe destruction of the tooth crown showing very thin residual walls.After
Dr Deliperi operative protocols for the restoration of devital teeth allowed avoiding the preparation of the tooth for a crown. An extensive fiber-reinforced tooth-colored restoration was performed; fibers reinforce residual tooth structure and better support the composite material.
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Before
Upper premolar presenting a temporary filling because the existing amalgam filling and lingual cusp fractured. The palatal fracture line was below the gum line and a gingival plastic surgery was required.After
Dr Deliperi completed a fiber-reinforced tooth-colored filling; the original anatomy of the tooth was restored.
This clinical case and the operative protocol were published in the Journal of Adhesive Dentistry 2005 and were translated by the publisher in Russian the same year.
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Before
Patient presented with cusp fracture on the lower second molar and fracture of the filling on the first molar. The second molar also presented a decay process reaching the pulp; please, also note the abnormal gingiva growth inside the cavity.After
The same teeth following root canal on the second molar, crown lengthening and tooth colored restorations of the two molars. Dr Deliperi achieved the final result preserving the remaining sound tooth structure.
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Before
Upper devital premolar tooth showing an unaesthetic silver amalgam filling.After
The same tooth following replacement of the existing filling with a tooth- colored restoratione.
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Before
Silver amalgam filling on the first molar.After
The same tooth following replacement of the existing filling with a tooth- colored restoration. Although the major part of the tooth structure was missing, the final result was achieved with no sacrifice of sound tooth structure! No dental crown was required.
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Before
Devitalized upper molar tooth following isolation with rubber dam and placement of a dental matrix (metal ring). The tooth is ready to be restored; the major part of the tooth structure is missing.After
Once Dr. Deliperi completed the tooth-colored restoration, it is not possible to distinguish the tooth-restoration borderline; the filled tooth is perfectly integrated with the contiguous teeth.
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Before
Patient’s smile showing both gingival recession and incongruous full-ceramic crowns. Please, note either tooth color discoloration or ceramic crowns unnatural shade.After
The canine and premolar teeth tooth whitening plus the gingival and prosthetic therapy allowed to select a whiter and brighter crown shade. A brilliant smile was achieved!
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Before
Patient presented to the dental office to improve the aesthetics of her back teeth. She complained the presence of two huge amalgam fillings in her lower jaw. The first molar is a devital tooth; both teeth are structurally compromised and may require the placement of two dental crowns.After
Dr Deliperi avoided the placement of a dental crown on both teeth. Dental caries was removed; two large composite resin fillings were performed by using the remaining sound tooth structure. The correct tooth anatomy and aesthetics were re-established. By adopting Dr Deliperi’s protocol, the remaining thin dental walls were reinforced with polyethylene fibers. These fibers are the same used to fabricate bulletproof vests.
Vital teeth
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After |
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Click on thumbnail to see 'before' and 'after'
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Prima
Patient presented at the dental office with an existing white filling lacking of both function and aesthetics. Please, note the concentration of the occlusal forces (black spots) on the remaining weak facial cusps without any contact (black spot) on the filling. The tooth is at high risk of either cracking or breaking.Dopo
Dr Deliperi was able to conserve the remaining sound tooth structure, balance the occlusal load and keep the tooth vital throughout the application of clinical protocols he published into the international dental literature. Please, note a better distribution of the forces on the occlusal surface; blue spots are distributed on both the new filling and residual tooth structure. It means the residual tooth structure is not overloaded anymore. This procedure greatly reduces tooth fracture thus avoiding the need for more invasive treatments in the future (crowns, root canals, extractions, implants).
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Before
Extensive amalgam filling including a lingual cusp on a lower molar tooth. Patient expressed the desire to replace the amalgam filling with a tooth-colored restoration.After
Final result after completing the aesthetic filling. It is not possible to distinguish the tooth-restoration borderline; the filled tooth is perfectly integrated with the contiguous teeth.
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Before
Patient presented to the dental office with fracture of the facial wall on her first lower molar. Please, note the existing amalgam filling; most of the coronal dental tissue is missing.After
Dr Deliperi avoided to place a dental crown on the tooth; by using the remaining sound tooth structure, he was able to perform a large composite reconstruction re-establishing the correct tooth anatomy and aesthetics.
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Before
Large silver amalgam filling on the upper first molar; patient was feeling pain due to an ongoing decay process under the filling.After
Dr Deliperi removed both the old restoration and decay; the new tooth-colored restoration is perfectly integrated with the remaining portion of the tooth. Dr Deliperi preserved the sound tooth structure and avoided the preparation of the tooth for a crown.
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Before
Pre-operative view of thelower second molar presenting an incongruous restoration and decay and first molar presenting an incongruous tooth colored restoration with no anatomic cusp design.After
Dr Deliperi completed two large tooth colored fillings restoring both the correct tooth anatomy and shade. Once again a dental crown was avoided!
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Before
Pre-operative view of thelower first and second molar presenting incongruous large white restorations; please, note the lack of anatomical cusp design plus marginal discoloration,decay and fracture of the composite on the second molar.After
Dr Deliperi completed two large tooth colored fillings restoring both the correct tooth anatomy and shade. Once again a dental crown was avoided!
Please, read the attached pdf file and watch the BALTIMORE 2005 video
Extensive restorations vital teeth
