Posted 1343 days ago
By Karyn M. Halpern DMD, MS
Sponsored by Ivoclar
A 40 -year -old healthy woman appeared for an initial exam with a main complaint of “I hate the color of my front tooth and I would like to fix.” He informed that his tooth had fractured after a fall when he was only thirteen. He said his previous dentist “united” and has not replaced him since then. She denied any discomfort or sensitivity. His motivation for treatment was cosmetic since he was aware of how it seemed.
The initial exam and X -ray findings revealed that the Maxillary left central incisor, Tooth #9, had a history of a class III composite restoration (MFL), as well as a facial compound sheet. The appearance of the tooth #9 was very dark in the shadow and stood out as a painful thumb between what would otherwise be a very aesthetic smile (Figure 1). A series of extraoral and intraoral diagnosis photos were tasks. The discolored and darkest value of #9 seemed to be visible from facial and palatal aspects (Figure 2). The value and the chroma seemed closer to the A4 shadow in the Vita Shadow Guide, where the renovative dentition was significant brighter, A1 (Figure 3).
Figure 1: Initial presentation with the main complaint of a tooth not linked to Unetic
Figure 2: Facial and intraoral and intraoral views of the initial presentation with a very dark tooth #9
Figure 3: Initial shadow and chroma or tooth #9 closest to the shadow A4
It was observed that there was also a minor incisal cunning present in #8 too. The patient rejected any restorative treatment to #8 and wanted to focus on treating #9 as a single unit.
Treat only one of the most challenging aesthetic treatments made by a dentist.
In this case, the challenges and the possible limitations of what can be achieved with retirement #9 were only equally more worrying, since it seemed very dark. The questions and concerns were many. Isn’t the tooth vital? How dark will the preparation be? What materials will work better to block it if necessary? How will I better block a very dark preparation and still imitate the high transludence present in your adjacent teeth? Perhaps endo pre-prosthetic internal, compound opaqueros or a mo?
Althegh often the most challenging thesis cases can also be the most rewarding for both the doctor and the patient. He was prepared for the challenge and after interviewing the patient, he was sure he could handle and meet his expectations.
Since the tooth seemed very dark and had a history of trauma, the patient was sent for an endodontic evaluation before processing. The endodontist reported that n. ° 9 proved vital within normal limits. However, he advised in case the preparation
The patient returned for digital impressions with primescan, and the case was sent to the laboratory technician for a digital diagnostic wax of the tooth #9. A printed model and a digital wax putty were manufactured.
Next, the patient presented a prior visit to the “preparation and temperature” prior to programming. The plan was to eliminate previous resin restorations and clinically evaluate what song below everything. Depending on how dark preparation, it would be determined which treatments would be better indicated to the lights as necessary. A provisional was planned to allow additional treatments.
I began to undress the union and prepare the tooth for a conservative cingulum that saves ¾ Corona. Once I removed the link, I began to smile at Myelf under my mask. The preparation was not dark after all! I was pleasantly surprised. It was actually A1 (Figure 4). The patient was advised, good news, I will not need to place a temporary crown after all. There is no need for pre-prosthetic root conduit therapy or internal whitening. I can make your permanent crown today.
Figure 4: The preparation light at the value closest to shade A1
The preparation was completed and scanned with the CEREC prioritize in the usual way. The digital diagnostic model was scanned and the final restoration designed with biocopy (Figure 5). The final restoration was manufactured with IPS E.MAX CAD MT A1 for the perfect balance of strength and transliety. Since the shadow of preparation was ideal in value, the MT block (average transclucence) was selected because it provides a very naturally translucent enamel replacement. The clinical experience has also demonstrated IPS E.Max CAD is certainly the test of time.
Figure 5: Cerec Digital Impressions Primeescan of the Digital Diagnosis Printed or Forera Sewed to Marginated Preparation
Once milling, line angles, contours and texture were even more improved using the Diamond Bur of the CDOC Meisinger finish kit. Giro polishing were used to prepare the restoration (Figure 6).
Figure 6: CDOC MEISINGER FINISH KIT Used to contribute and pre -patent the restoration
Glash and glass spots E.Max IPS were then applied to the crown before crystallization.
The blue incisal tone I1 was applied slightly in incisal 1/3 for incisal translucidity. Shadow 1 was applied to Cervical 1/3 for heat and gingival characterization to reflect visible discoloration in DF or #8. The white spot was applied framed, reflecting visible white spots on adjacent teeth and fashion lines (Figure 7).
Figure 7: A hand lent diagram in a photo of the restoration that illustrates where IPS Crystal Spots were applied before crystallization
The restoration was tested and the patient received a mirror. The patient was excited with the results and could not believe his eyes. I was also honestly surprised in this case and did not anticipate a tone of preparation A1 (Figures 8 and 9). The restoration was prepared and linked with translucent resin cement NX3.
Figure 8: Before and after treatment, retracted view of the tooth #9 with IPS United E.Max Cad MT A1 Restoration
Figure 9: Complete face smiling after the cementation of IPS E.Max Cad Mt A1 Restoration #9
The management of expectations and patient preparation for the patient for limitations and the possible need for additional treatments is always the best practice. However, occasionally, it may be pleasantly surprised when there is light discovered behind the dark.