Publications

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    Linda Grütter, Francesca Vailati
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    ABSTRACT: A full-mouth adhesive rehabilitation in case of severe dental erosion may present a challenge for both the clinician and the laboratory technician, not only for the multiple teeth to be restored, but also for their time schedule, difficult to be included in a busy agenda of a private practice. Thanks to the simplicity of the 3-step technique, full-mouth rehabilitations become easier to handle. In this article the treatment of a very compromised case of dental erosion (ACE class V) is illustrated, implementing only adhesive techniques. The very pleasing clinical outcome was the result of the esthetic, mechanic and most of all biological success achieved, confirming that minimally invasive dentistry should always be the driving motor of any rehabilitation, especially in patients who have already suffered from conspicuous tooth destruction.
    European journal of esthetic dentistry : official journal of the European Academy of Esthetic Dentistry, The 01/2013; 8(3):358-75.
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    Francesca Vailati, Linda Gruetter, Urs Christoph Belser
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    ABSTRACT: In case of severe dental erosion, the maxillary anterior teeth are often particularly affected. Restoring such teeth conventionally (ie, crowns) would frequently involve elective endodontic therapy and major additional loss of tooth structure. A novel, minimally invasive approach to restore eroded teeth has been developed and is currently being tested in the form of a prospective clinical trial, termed The Geneva Erosion Study. To avoid crowns, two separate veneers with different paths of insertion have been used to restore the affected anterior maxillary teeth, regardless of clinical crown length and amount of remaining enamel. This treatment is called The Sandwich Approach. Objectives: The purpose of this case series study was to analyze the mid-term clinical outcome of maxillary anterior teeth affected by severe dental erosion that were restored following the Sandwich Approach. Materials and methods: Twelve consecutively consulting patients (mean age: 39.4 years) suffering from advanced dental erosion have been enrolled in the study and were subsequently treated. Due to the late interception of the disease, all patients needed a full-mouth rehabilitation, which was performed without any conventional crowns. At the level of the maxillary anterior teeth, a total of 70 palatal indirect composite restorations and 64 facial feldspathic ceramic veneers were delivered. Both types of veneers were adhesively luted with a hybrid composite. Clinical reevaluations were performed 6 months after insertion of the veneers, and then annually, using modified United States Public Health Service (USPHS) criteria. Marginal adaptation, marginal integrity (seal, absence of infiltration), status of pulp vitality, postoperative sensitivity, esthetics, and restoration success/failure, were the principal clinical parameters analyzed. Results: After an up to 6-year observation time (mean observation time 50.3 months for the palatal veneers and 49.6 months for the facial veneers), no complete or major failure of the restorations was encountered. On the basis of the criteria used, most of the veneers rated Alpha for marginal adaptation and marginal seal. Secondary caries or endodontic complications were not detected. Using visual analogue scale analysis, the patient-centered satisfaction revealed a high esthetic and functional acceptance of 94.6%. Conclusions: Compared to conventional crown preparation, restoring compromised maxillary anterior teeth by means of 2 veneers prevents excessive tooth structure removal and loss of tooth vitality. Questions on the longevity of this new treatment arise, due to the nonfavorable initial status of the teeth to be restored (eg, lack of enamel, sclerotic dentin substrate and short clinical crowns). The clinical performance of the teeth treated following the Sandwich Approach seems promising, since none of the treated teeth lost their vitality, no failure of any of the restorations was detected, and the patients' overall satisfaction was high. Even though further investigation is needed to determine the clinical long-term performance of the described treatment modality, the encouraging mid-term results (biological, esthetic, and mechanical success) clearly question if conventional crowns in the anterior maxillary segments can still continue to be considered the best and only option to treat this particular population of patients.
    European journal of esthetic dentistry : official journal of the European Academy of Esthetic Dentistry, The 01/2013; 8(4):506-30.
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    ABSTRACT: Dental erosion is increasing, and only recently are clinicians starting to acknowledge the problem. A prospective clinical trial investigating which therapeutic approach must be undertaken to treat erosion and when is under way at the University of Geneva (Geneva Erosion Study). All patients affected by dental erosion who present with signs of dentin exposure are immediately treated using only adhesive techniques. In this article, the full-mouth adhesive rehabilitation of one of these patients affected by severe dental erosion (ACE class IV) is illustrated. By the end of the therapy, a very pleasing esthetic outcome had been achieved (esthetic success), all of the patient's teeth maintained their vitality, and the amount of tooth structure sacrificed to complete the adhesive full-mouth rehabilitation was negligible (biological success).
    The journal of adhesive dentistry 06/2011; 14(1):83-92. · 1.44 Impact Factor
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    Francesca Vailati, Urs Christoph Belser
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    ABSTRACT: Minimally invasive principles should be the driving force behind rehabilitating young individuals affected by severe dental erosion. The maxillary anterior teeth of a patient, class ACE IV, has been treated following the most conservatory approach, the Sandwich Approach. These teeth, if restored by conventional dentistry (eg, crowns) would have required elective endodontic therapy and crown lengthening. To preserve the pulp vitality, six palatal resin composite veneers and four facial ceramic veneers were delivered instead with minimal, if any, removal of tooth structure. In this article, the details about the treatment are described.
    European journal of esthetic dentistry : official journal of the European Academy of Esthetic Dentistry, The 01/2011; 6(3):268-78.
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    Francesca Vailati, Urs Christoph Belser
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    ABSTRACT: Erosive tooth wear is a serious problem with very costly consequences. Intercepting patients at the initial stages of the disease is critical to avoid significant irreversible damages to their dentition and to benefit from still favorable conditions when it comes to clinical performance of the restorative measures proposed. In this article, a new classification is proposed to quantify the severity of the dental destruction and to guide clinicians and patients in the therapeutic decision-making process. The classification is based on several parameters relevant for both the selection of treatment and the assessment of the prognosis, such as dentin exposure in the palatal tooth contact areas, alterations at the level of the incisal edges, and ultimately, loss of pulp vitality.
    The International journal of periodontics & restorative dentistry 12/2010; 30(6):559-71. · 1.01 Impact Factor
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    ABSTRACT: To validate the concept of early implant placement for use in the esthetically sensitive anterior maxilla, clinical trials should ideally include objective esthetic criteria when assessing outcome parameters. In this cross-sectional, retrospective 2- to 4-year study involving 45 patients treated with maxillary anterior single-tooth implants according to the concept of early implant placement, a novel comprehensive index, comprising pink esthetic score and white esthetic score (PES/WES; the highest possible combined score is 20), was applied for the objective esthetic outcome assessment of anterior single-tooth implants. All 45 anterior maxillary single-tooth implants fulfilled strict success criteria for dental implants with regard to osseointegration, including the absence of peri-implant radiolucency, implant mobility, suppuration, and pain. The mean total PES/WES was 14.7 +/- 1.18 (range: 11 to 18). The mean total PES of 7.8 +/- 0.88 (range: 6 to 9) documents favorable overall peri-implant soft tissue conditions. The two PES variables facial mucosa curvature (1.9 +/- 0.29) and facial mucosa level (1.8 +/- 0.42) had the highest mean values, whereas the combination variable root convexity/soft tissue color and texture (1.2 +/- 0.53) proved to be the most difficult to fully satisfy. Mean scores were 1.6 +/- 0.5 for the mesial papilla and 1.3 +/- 0.5 for the distal papilla. A mean value of 6.9 +/- 1.47 (range: 4 to 10) was calculated for WES. This study demonstrated that anterior maxillary single-tooth replacement, according to the concept of early implant placement, is a successful and predictable treatment modality, in general, and from an esthetic point of view, in particular. The suitability of the PES/WES index for the objective outcome assessment of the esthetic dimension of anterior single-tooth implants was confirmed. However, prospective clinical trials are needed to further validate and refine this index.
    Journal of Periodontology 02/2009; 80(1):140-51. · 2.57 Impact Factor
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    Francesca Vailati, Urs Christoph Belser
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    ABSTRACT: Dental erosion is a frequently underestimated pathology that nowadays affects an increasing number of younger individuals. Often the advanced tooth destruction is the result of not only a difficult initial diagnosis (e.g. multifactorial etiology of tooth wear), but also a lack of timely intervention. A clinical trial testing a fully adhesive approach for patients affected by severe dental erosion is underway at the School of Dental Medicine of the University of Geneva. All the patients are systematically and exclusively treated with adhesive techniques, using onlays in the posterior region and a combination of facially bonded porcelain restorations and indirect palatal resin composite restorations in the anterior maxillary region. To achieve maximum preservation of tooth structure and predict the most esthetic and functional outcome, an innovative concept has been developed: the three-step technique. Three laboratory steps are alternated with three clinical steps, allowing the clinician and the dental technician to constantly interact during the planning and execution of a full-mouth adhesive rehabilitation. In this article, the third and last step of the three-step technique has been described in detail.
    European journal of esthetic dentistry : official journal of the European Academy of Esthetic Dentistry, The 02/2008; 3(3):236-57.
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    Francesca Vailati, Urs Christoph Belser
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    ABSTRACT: Traditionally, a full-mouth rehabilitation based on full-crown coverage has been recommended treatment for patients affected by severe dental erosion. Nowadays, thanks to improved adhesive techniques, the indications for crowns have decreased and a more conservative approach may be proposed. Even though adhesive treatments simplify both the clinical and laboratory procedures, restoring such patients still remains a challenge due to the great amount of tooth destruction. To facilitate the clinician's task during the planning and execution of a full-mouth adhesive rehabilitation, an innovative concept has been developed: the three-step technique. Three laboratory steps are alternated with three clinical steps, allowing the clinician and the laboratory technician to constantly interact to achieve the most predictable esthetic and functional outcome. During the first step, an esthetic evaluation is performed to establish the position of the plane of occlusion. In the second step, the patient's posterior quadrants are restored at an increased vertical dimension. Finally, the third step reestablishes the anterior guidance. Using the three-step technique, the clinician can transform a full-mouth rehabilitation into a rehabilitation for individual quadrants. The present article focuses on the second step, explaining all the laboratory and clinical steps necessary to restore the posterior quadrants with a defined occlusal scheme at an increased vertical dimension. A brief summary of the first step is also included.
    European journal of esthetic dentistry : official journal of the European Academy of Esthetic Dentistry, The 02/2008; 3(2):128-46.
  • Francesca Vailati, Urs Christoph Belser
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    ABSTRACT: The restoration of the missing maxillary incisors is a complex and delicate treatment challenge. When implant therapy is used, proper treatment planning is critical, as selecting the proper number, location, and dimension of the implants is a difficult task. Thus, this article discusses the issues that must be addressed during diagnosis and treatment planning to achieve a predictable esthetic outcome when using implants to replace the maxillary incisors. The advantages and disadvantages of several implant-supported treatment options-using a combination of regular- and narrow-neck implants-are presented. Ultimately, the use of narrow-neck implants at the lateral incisor sites is presented as the best option for ensuring excellent esthetic outcomes, and the corresponding indications and contraindications are discussed. Further, all treatment options are ranked based on the predictability of their esthetic outcomes.
    European journal of esthetic dentistry : official journal of the European Academy of Esthetic Dentistry, The 02/2007; 2(1):42-57.
  • Francesca Vailati
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    ABSTRACT: In this two-part treatment planning series, the case of a 63-year-old woman with severe attachment loss at the maxillary incisors is presented. In part 1, pretreatment strategies, eg, use of intra- and extraoral photographs, analysis of periapical radiographs, and examination of occlusal and periodontal status, are discussed. The advantages and disadvantages of six treatment options using both conventional and implant therapy are presented. In part 2, the treatment selected will be revealed and the rationale governing the decision will be discussed.
    European journal of esthetic dentistry : official journal of the European Academy of Esthetic Dentistry, The 09/2006; 1(2):166-76.
  • Francesca Vailati
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    ABSTRACT: In this two-part treatment planning series, the case of a 54-year-old woman with a failing four-unit fixed partial denture (FPD) is presented. Part 1 presented pretreatment strategies, occlusal and periodontal status, and the advantages and disadvantages of three treatment options: removable partial denture, tooth-supported FPD, and implant-supported FPD. In this follow-up article, the treatment selected for the case is revealed, and the rationale--including indications and contraindications for the different treatment options--is discussed. The treatment sequence is then outlined, and the final outcome is presented.
    European journal of esthetic dentistry : official journal of the European Academy of Esthetic Dentistry, The 09/2006; 1(2):158-64.
  • Francesca Vailati
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    ABSTRACT: In this two-part treatment planning series, the case of a 54-year-old woman with a failing four-unit fixed partial denture (FPD) is presented. In Part 1, pretreatment strategies, e.g., use of intra- and extraoral photographs, analysis of periapical radiographs, and examination of occlusal and periodontal status, are discussed. The advantages and disadvantages of three treatment options--removable partial denture, tooth-supported FPD, and implant-supported FPD-are presented. In Part 2, to be published in the next issue, the treatment selected will be revealed and the rationale governing the decision will be discussed.
    European journal of esthetic dentistry : official journal of the European Academy of Esthetic Dentistry, The 05/2006; 1(1):78-86.
  • Francesca Vailati
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    ABSTRACT: In this two-part treatment planning series, the case of a 63-year-old woman with severe attachment loss at the maxillary incisors is presented. In Part 1, pretreatment strategies, occlusal and periodontal status, and the advantages and disadvantages of six treatment options using both conventional and implant therapy were presented. In this follow-up article, the treatment selected for the case is revealed, and the rationale--including indications and contraindications for the different treatment options--is discussed. The treatment sequence is then outlined, and the final outcome is presented.
    European journal of esthetic dentistry : official journal of the European Academy of Esthetic Dentistry, The 02/2006; 1(3):248-55.
  • Francesca Vailati
    SoDM Masters Theses.

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