Esthetic make-over of maxillary anteriors with bleaching and layered zirconia crowns – A case report

Dr Surabhi Mahidhar (Madanapalle, India) is a prosthodontist and implantologist. He has received his Fellowship and Mastership in Surgical and Prosthetic implantology (Bangalore). Dr Mahidhar is a former Professor at Shyamala Reddy DC, Bangalore, India and a private practitioner since 12 years. He has conducted many workshops and courses in prosthodontic procedures and is a recipient of multiple national dental awards. He is one of the coveted speakers at DRDCA 2020 International.

Abstract

Teeth bleaching is a procedure of changing the shade of teeth to a better acceptable level. Layered zirconia crowns (zirconia crowns layered with ceramic) are given after the bleaching procedure to reinforce the strength and characterize the crowns for esthetics.

Case report

The patient reported to the clinic with discoloured teeth. On initial presentation of patient, there were no alarming symptoms and signs, except for a need of an esthetic makeover of the discoloured teeth (Image 1).

Observations

As seen in Image 1 & 2, teeth no.s 11,12,21 were discoloured. An old composite restoration was present in 12. There was a history of non- surgical root canal treatment (NS RCT) irt 11,12 and 21. No radiographic changes were seen. Gingival zeniths were different, and so were teeth inclinations.

Treatment plan

A step-wise treatment plan was formulated –

1. Oral prophylaxis
2. Teeth bleaching
3. Mock up on cast
4. Putty index
5. Removal of old composite restoration
6. Transfer into oral cavity
7. CLP irt 12 and guided tooth preparation
8. Temporization
9. Retraction and impression
10. Layered zirconia crowns with anterior guidance

1) Oral prophylaxis

2) Teeth whitening

3) Wax mock up on diagnostic cast

4) Putty index

5) Transfer onto teeth with provisional material

6) Temporary guided tooth preparation and CLP irt 12

7) Temporization

8) Gingival retraction and impression after healing

9) Bisque try in

10) Luting of layered zirconia crowns

11) Before and After!

Zenith, inclination and shade correction are achieved with this protocol.

Summary

1. Mock up is important to assess the final result before tooth preparation itself
2. Oral prophylaxis and bleaching should be considered in any esthetic makeover case
3. Guided tooth preparation is always helpful to achieve a conservative tooth preparation.
4. Selection of material is important for restoration keeping esthetics and function in mind.