The One step-No prep technique: A straightforward and minimally invasive approach for full-mouth rehabilitation of worn dentition using polymer-infiltrated ceramic network (PICN) CAD-CAM prostheses

Objectives: To introduce a novel approach for full-mouth rehabilitation of severely worn dentition
using polymer-infiltrated ceramic network (PICN) computer-aided-design and manufacturing
(CAD-CAM) restorations, without tooth tissue preparation and provisional phase.
Clinical considerations: Three patients with generalized tooth wear, suffering from dental pain,
masticatory dysfunction, bruxism and neck and back pain, were selected and treated in collaboration
with physiotherapists. Occlusal analyses were performed and full-mouth diagnostic waxups
were designed on the basis of estimated tissue loss. Deficient direct restorations were
replaced and low-thickness PICN (Vita Enamic) restorations (up to 0.2 mm) were CAD-CAM
designed from wax-ups, milled, tried-in and then bonded within two consecutive days. To mask
palatal veneers, either buccal direct composites or glass-ceramic veneers were later performed.
An occlusal splint was realized. Clinical results were shown to be successful after a follow-up of
22, 18, and 13 months, respectively. The absence of provisional phase did not engender any
inconveniences. Patient reported outcomes were very positive, showing a reduction in neck and
back pain and a well-being increase.
Conclusion: The proposed protocol is particularly minimally invasive and straightforward compared
to classical techniques. PICNs exhibit several advantages compared to other materials.
Preliminary results of this multidisciplinary approach are promising but deserve further clinical
research.