Digital and analog techniques for cemento-enamel junction reconstruction: A case study

• Published in: Clinical advances in periodontics 2024-09
• Main Authors: Durán, Juan Carlos, Gómez, Valeria, Aguilera, Cristian, Pino, Rodrigo, Sáiz, Vasco, González, Nicolás, Cataldo, Yuri, Gauro, Murir, Urzúa, Iván, Solanes, Fernando, Madariaga, Catalina
• Format: Article
• Language: English
• ISSN: 2573-8046; 2163-0097; 2163-0097
• DOI: 10.1002/cap.10315

Non-carious cervical lesions (NCCLs) refer to the loss of dental hard tissue in the cervical region due to physical and/or chemical factors, often associated with the disappearance of the cemento-enamel junction (CEJ), posing challenges in both diagnosis and treatment of gingival recessions (GR). This case study introduces two protocols for multidisciplinary CEJ reconstruction prior to the root coverage therapy (RCT). Two patients with GR and NCCLs were treated using two CEJ reconstruction techniques: both, analogically and digitally guided. For each case, the position of the therapeutic CEJ was predetermined using a combination of the methods described by Zucchelli and Cairo. Then, an analog or digital diagnostic wax-up was performed accordingly. In the analogically guided technique, a transparent silicone guide matrix was used to transfer information from the dental wax-up. In contrast, the digitally guided technique employed a rigid, translucent resin prosthetic guide matrix that was designed and printed. Restorations were fabricated using direct composite resin and RCT was performed 1 week later in both techniques. At 6 months, both cases demonstrated complete root coverage and effective healing of the soft tissues surrounding the restorations. Dimensional changes in materials and precise guide adjustment in the analog technique are operator-dependent and can affect the outcomes. Digital procedures, though effective, are costly and may limit their use. The usage of these two CEJ reconstruction techniques enhances communication within the multidisciplinary team and ensures optimal aesthetic outcomes and precise placement of the gingival margin. There are no established clinical protocols described in the literature for reconstructing the cemento-enamel junction (CEJ) once the position of a therapeutic CEJ has been predetermined and prior root coverage therapy (RCT). Performing a diagnostic wax-up (analogically or digitally) to reconstruct the therapeutic CEJ is crucial and facilitates the creation of a prosthetic guide that accurately reproduces the defined CEJ position. The reconstruction of the CEJ may improve the prognosis of RCT. This study looked at a dental issue called non-carious cervical lesions, which happens when the hard tissue near the gum line of a tooth wears away, making it harder to treat gum recession. Two different approaches were tested to rebuild the lost tissue in the gum area before performing a procedure to cover the exposed root