1. AbstractPorcelainveneershavelongbeenapopularrestorativeoptionthat haveevolvedintoawell-acceptedtreatmentthatcanbefabricated in various ways. Onlays are another common treatment modality usedincontemporarydentistrytorestorelargeareasofdecayand to replace old restorations. With the availability of newer highstrength materials such as lithium disilicate and processing technologies like CAD/CAM and heat pressing, dental professionals arenowabletoproducehighlyesthetic,high-strengthrestorations that blend seamlessly with the natural dentition while also withstanding posterior occlusal forces.Atooth more complex restorationisrequiredafterendodontictreatmentwhencomparedtonor- mal tooth restoration, because of factors such as extensive caries, post-treatmentrootcanaldentinandeventheeconomicscondition ofthepatient.OnesuchdesignproposedbyDr.RonaldEGoldstein is“Veenerlay”or“Vonlay”.Vonlayisablendofanonlaywithan extended buccal veneer surface for use in premolar region, where there is sufficient enamel present to bond. This restorative option requires a much less invasive preparation than a full coverage crown but provides the same structural benefits. Thus, the aim of thiscasereportistopresentacaseofVonlayfollowingendodontic treatement of lower mandibular premolar
2. IntroductionPreserving tooth structure is critical for the longevity of teeth and restorations.Itisobviouslyadvantageoustosavethepulpvitality anddelaytheneedforendodontictreatment,dowels,andcores,
3. Case Reportbecausethesearemoreinvasivetreatmentsthatadverselyaffect the performance of restored teeth over time [1]. With the availability of newer high-strength materials like lithium disilicate ceramic along with the processing technologies like CAD/CAM and heat pressing, dental professionals are now able to offer their patients highly esthetic, high-strength restorations thatnotonlyblendseamlesslywiththeexistingdentition,butalso withstand occlusal forces even in thin sections [2]. In contemporary restorative dentistry, there are several ways for clinicians to enhance the shape, color, or position of teeth, and, moreover,variousmaterialsandprocessingmethodsareavailable to fabricate restorations. One such design proposed by Dr.Ronald E Goldstein is “Veenerlay”or “Vonlay”. Vonlay is a blend of an onlay with an extended buccal veneer surface for use in premolar region, where there is sufficientenamelpresenttobond.Thisrestorativeoptionrequires a much less invasive preparation than a full coverage crown but provides the same structural benefits. Simultaneously,withthecomponentsofanonlayandveneer-von- lay enhances the durability and esthetics of the preserved tooth structure [3, 4]. The purpose of the present paper is to present a clinical case, in which an esthetic and conservative posterior Vonlays are used to restoremulti-rootedteeththatpresentedendodontictreatmentand extensive coronal destruction.
3. Case ReportA26-year-oldfemalewasreferredtotheDepartmentofConserv- ative Dentistry and Endodontics at M.A.Rangoonwala College of Dental Sciences and Research Centre, Pune. She suffered from deepocclusalcariouslesionsuspectedofpulpalinvolvement.Af- ter through radiographic and clinical examinations to check the amount of remaining tooth structure and confirmation of pulpal involvement, non-surgical endodontic treatment was proposed to thepatientandperformed.ForPostendodontictreatmentplanning after patient’s oral hygiene considerations was acceptable and a favourable occlusion and aesthetic consideration vonlay restora tionfabricatedfrommonolithiclithiumdisilicate(IPSe.max)was proposed as an alternative to full crown which was agreed by the patient. Prior to commencement of preparation, shade selection was done (Figure 1 and 2). OcclusalPreparation(Onlay) Theaimwastoachieveoverallreductionsintheheightoftheocclusalsurfaces of at least 2mm in the axial direction and to get a Occlusal table or “Occlusal sidewalk” in the form of a butt joint. Occlusal Preparations were done using a flat ended tapered diamond bur to achieve a shoulder finish line for the seating of the ceramic onlay. BuccalPreparation(Veneer) Depthcutswereplacedonthebuccalsurfaceusingdiamonddepth cutting bur.The remaining enamel was removed using round end tapereddiamondburtoobtainasupragingivalchamferfinishline whichwillaidinplacementoftheveneer.Proximalreductionwas performed using round end tapered diamond bur parallel to the long axis of the tooth. The proximal reduction was stopped just shortofbreakingthecontact.Thefinalfinishingofthepreparation was done using fine grit diamond bur (Figure 3, 4 and 5). After the completion of tooth preparation impression was made withpolyvinylsiloxaneimpressionmaterialoflightandputtyconsistency using a double-mix single-stage technique. The Lithium DisilicatewasmilledusingCAD/CAMmillingtechnique(Figure 6). After verifying the fit, the vonlay was cemented intraorally using resinlutingcement.Theinnersurfacewasetchedwith10%hydrofluoric acid was washed with water and dried. Silane coupling agent was applied for 1 min and dried. The tooth wasetchedfor10secondsandwashedanddriedusingbottingpper.Adhesivewasappliedandcuredfor20secs.Resincementwas applied on the inner surface and vonlay was cemented using light cure. The gross occlusal discrepancies were marked with articulating paper strips and later removed before cementation (Figure7 and 8).
References 1. LarsonTD.25yearsofveneering:whathavewelearned?Northwest Dent. 2003; 82(4): 35-9.
2. Heffernan MJ,Aquilino SA, Diaz-ArnoldAM, et al. Relative translucencyofsixall-ceramicsystems.PartI:corematerials.JProsthet Dent. 2002; 88(1): 4-9.
3. McLarenEA,FigueiraJ,GoldsteinRE.Vonlays:aconservativeesthetic alternative to full-coverage crowns. Compend Contin Educ Dent. 2015; 36(4).282, 284, 286- 9.
4. RoccaGT,BonnafousF,RizcallaN,KrejciI.Atechniquetoimprove the esthetic aspects of CAD/CAM composite resin restorations. J Prosthet Dent. 2010; 104: 273-5.
5. Lin CL, Chang YH, Pa CA. Estimation of the risk of failure for an endodontically treated maxillary premolar with MODP preparation and CAD/CAM ceramic restorations. J Endod. 2009; 35: 1391-5
6. Elsaka SE, Elnaghy AM. Mechanical properties of zirconia reinforcedlithiumsilicateglass-ceramic.DentalMaterials.2016;32(7): 908-14
7. Yoshida T, Kurosaki Y, Mine A, Kimura-ono A, Mino T, Osaka S et al. Fifteen-year survival of resin-bonded vs full-coverage fi xed dental prostheses. Journal of Prosthodontic Research. 2019; 63(3): 374-82.
8. JiangW,BoH,YongchunG,LongxingN.Stressdistributioninmo- lars restored with inlays or onlays with or without endodontic treatment:Athree- dimensional finite element analysis. J Prosthet Dent. 2010; 103(1): 6-12
9. Bergmann CP, StumpfA. Dental ceramics: Microstructure, propertiesanddegradation.InDentalCeramics:Microstructure,Properties and Degradation. Springer Berlin Heidelberg. 2013.
10. Mainjot AKJ. 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. J Esthet Restor Dent. 2020; 32(2): 141-9.
11. Elsayed M, Sherif R, El-khodary N. Fracture resistance of Vita suprinity versus IPS e. max CAD vonlays restoring premolars (An in vitro study). Int J Appl Dent Sci. 2020.
12. Oğuz Eİ, Berksun S. Rehabilitation of a Severely Worn Dentition with Partial Lithium-Disilicate Glass Ceramic Restorations:ACase Report. European Annals of Dental Sciences. 2021; 48(1): 28-32.
13. Nadig RR, Garian R. Stress distribution pattern in endodontically treated mesio occlusally involved premolars restored with ceramic onlay, vonlay and full crown restorations.
14. Sultan S, Al Garni H, Al Onazi M, Gangi KK, Al Otha S, Al RuwailiF,etal.MinimallyInvasivePosteriorFullCrownCompetitors: Onlays,OcclusalVeneers,VonlaysandEndocrowns:AReviewand ProposedClassification.JournalofInternationalDentalandMedical Research. 2021; 14(4): 1617-22
MookhtiarH. Vonlay;A Paradigm Shiftin Post Endodontic Restoration:A Case Report. Annals of Clinical and Medical Case Reports 2022