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CLINICAL RESEARCH
Update on the ‘index technique’ in
worn dentition: a no-prep restorative
approach with a digital workflow
Riccardo Ammannato, DDS
Private Practice, Genova, Italy
Daniele Rondoni, CDT
Private Practice, Savona, Italy
Federico Ferraris, DDS
Private Practice, Alessandria, Italy
Correspondence to: Dr Riccardo Ammannato
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AMMANNATO ET AL
prep restorative approach to the man
minimal, moderate, and severe hard tis
vasive adhesive composite restorations
to each tooth: direct and indirect partial
composite resin directly onto the tooth
(Int J Esthet Dent 2018;13:516–537)
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This device
7,8 aiding the condyles
1 In recent years,
1
2
hygiene and maintenance protocol, in
3
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tion, and esthetics as well as to prevent
9 avoids or
Many
also that ceramic wears three times slow28
alternative to composite resin restor
present enamel and dentin, the endodontic and periodontal implications, and
that in some cases it is not necessary to
29
composite resin to restore worn dental 9
large and deep cavities are present on
30
9 However, with evolving technology there are now composites on the
tion stress, and a good chromatic inte
ties, and moderately worn posterior and
9
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the same time, depending on the time
ramic crowns, the conventional prosthet
when applying indirect restorations, since all the direct restorations will al
A clinical case
sion in the posterior teeth, and a slight ten
wanted to change the shape and size
proceed with treatment once this tension
jet prior to considering any restorative
tion interposition in CR at the new OVD
AMMANNATO ET AL
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Fig 1 Fig 2
Fig 3
Fig 4 Fig 5
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clinician and technician to choose the
CAM, where in this case a monochromat
Anterior and posterior temporary
the therapy, since the patient, clinician,
leading to a connected temporary res
AMMANNATO ET AL
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Fig 6
Fig 7
Fig 8 Fig 9
Fig 10 Fig 11
CLINICAL RESEARCH
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the clinician, technician, and patient a
phonetics, and static and dynamic oc
restorations
the material over the digital restorative
Fig 12
Fig 13
Fig 14
AMMANNATO ET AL
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Fig 15 Fig 16
Fig 17
Fig 18
CLINICAL RESEARCH
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The teeth were not prepared with ro
adhesion31
32,33
The preheated composite was ap
enamel on the perimeter and the dentin
two matrices that were placed to protect
composite shape while molding, and to
Fig 19 Fig 20
AMMANNATO ET AL
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Fig 21 Fig 22
Fig 23 Fig 24
Fig 25
CLINICAL RESEARCH
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missing the patient, to provisionally re
Fig 26 Fig 27
Fig 28 Fig 29
restorations
9 there are three options to manage
AMMANNATO ET AL
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Fig 30 Fig 31
enamel, whereas on the eroded dentin
31
to protect the adjacent teeth, and to have
CLINICAL RESEARCH
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32,33
Composite shades were chosen prior to
Fig 32
Fig 33 Fig 34
prior to placing the increments on each
composite resin was then layered with a
AMMANNATO ET AL
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Fig 35 Fig 36
Fig 37
emergence level near the gingival mar
9
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Fig 38 Fig 39
Fig 40
Fig 41
AMMANNATO ET AL
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Fig 42 Fig 43
Fig 44
Fig 45
canines,36 and only a shimming contact
CLINICAL RESEARCH
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Complications and repair
Fig 46 Fig 47
Fig 48
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2
wear characteristics,37
it is very easy to repolish this material
Fig 49
Fig 50 Fig 51
Fig 52 Fig 53
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CLINICAL RESEARCH
poses a conservative and alternative
38 Adhesion and com39
ing strength and composite chromatic
1
prehensive and conservative
concepts and clinical ration
Approaches to Vertical
ment Planning: Principles,
severely worn dentition with minimally invasive prosthetic
Periodontics Restorative Dent
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tion: a new and conservative
ior toothwear with composite restorations at an increased
tooth loss with composite
protecting worn palatal
Periodontics Aesthet Dent
treated with direct composite restorations at an increased
and direct resin composites
HS, Kelleher MG, Porter RW,
direct composite restorations
anterior dentition – clinic
and indirect restorations
J Prosthodont Restor Dent
R, Cenci MS, Opdam NJ,
worn teeth: A systematic
Esthetic restorative materials
toward the light? J Dent Res
approach in direct class IV
