Crown Restorations for Esthetic Correction of a Single Anterior Tooth
0

CASE REPORT

A 22 year old patient reported to our clinic with discolored and fractured maxillary right central incisor. As he was a front desk official, he was very uncomfortable to speak freely with his customers and hence wanted to get the tooth repaired rather than extracting it.

The real challenge was to get the exact shade match as that of adjacent natural tooth because the discoloration of maxillary right central incisor was long standing. You can learn more about shade matching in a single central incisor here.

On examination, 11 showed discoloration (which was close to C4 Vitapan Classic Shade Guide) and Ellis Class 4 fracture along with a little buccal proclination. The tooth was fractured 10 years ago. The pain on percussion was negative as pulp orifice was open and radiographic examination revealed that 11 had a periapical radiolucency.

Picture1 b5e24bf044e1fbc3db234f276109fce6 800
Preoperative – 11 shows Ellis Class 4 fracture & Vitapan C4 shade discoloration.
Picture2 a497fe8506147a33292faf4ed5f36eaf 800
Preoperative view in occlusion

The patient was informed about all treatment modalities and finally the treatment plan was –

  1. Thorough prophylaxis
  2. Endodontics and restoration of 11, followed by
  3. Layered zirconia ceramic crown.

According to the plan, 11 was treated endodontically and prepared for walking bleach (Pola Office Plus) to lessen the degree of discoloration. After 2 weeks, the tooth orifice was restored with composite. (A3 body, 3M Z350 and A2 flow). Now the tooth was prepared for the layered zirconia crown , retraction chord (Ultradent 000) was placed in the gingival sulcus for 3 to 4 minutes so that the gingiva moves away from the prepared margins and allows the elastomeric material to record all the details. An elastomeric impression was made (3M ESPE Monophase Soft Polyether) and sent to the laboratory for the further work.

Picture3 aba60d3d33c41c57ee1be1a18e4102d5 800
After the tooth was endodontically treated and bleached, the tooth was prepared to receive the crown.
Picture4 87b78471b1be6eb2d16f30ee4877a181 800
The shade was selected using Vitapan Classic shade guide.

After the labwork was received the crown was tried for its fit intraorally and made ready for further steps of cementation.

Picture1 12f35ad985af0178a8cb19af553bc889 800
The polyether impressions were sent to the lab and the layered zirconia crown was received .
Picture2 ca9bbffa8650b3ac9b008416888aca52 800
Fit and shade of the crown was checked. Note the prepared tooth margins shown on which the crown ultimately rests.

For cementation –

  • The intaglio surface of the crown was treated with Ivoclean (Ivoclar) for 20 seconds, rinsed with water and then dried.
Screenshot2020 07 01at11 49 31AM 2fff35f3a27f2f0bf111b376f0226ea0 800
Prosthesis cleaned with Ivoclean and made ready for further processing
  • The silane coupling agent (Monobond Plus, Ivoclar) was applied and allowed to air dry for 60 seconds.
Picture1 a3fb96ad8714ec369f674d5d3c71a4eb 800
The intaglio surface was treated with a silane coupling agent/ primer for 60 secs and allowed to air dry.
  • Intra orally, the tooth was isolated with rubber dam and etched with 37% phosphoric acid for 15 seconds and dried.
Picture5 869d14e352c8896073b14ab827608ccb 800
Rubber dam isolation of prepared tooth intra orally
Picture7 368ab8f51316b7020b71ceb47798dc5d 800
Tooth was acid etched with 37% phosphoric acid and air dried.

· A dual cure bond (Palifique Universal bond, Tokuyama) was applied on both the prosthesis as well as the tooth.

Picture2 cb3f75a0032c7dff79a7eb715d2ea68b 800
Dual cure bonding agent was applied on the intaglio surface of the prosthesis
Picture8 c864e8017a0d35a9fa205f400222327e 800
Dual cure bonding agent was applied on the prepared surface of tooth
  • The crown was cemented using a dual cure resin cement (Ultimate Relyx 3M), the crown was seated properly and tack cured for 5 seconds and excess was removed.

To know why resin cement was chosen, you can click here.

Picture3 9fd0660833deb8fbac596dc5d09591ae 800
The dual cure resin cement which was used for cementation
Picture9 f964bc4b7a261a3ff4006f88357d8141 800
The prosthesis was cemented.
  • The final curing was done through KY Jelly to remove oxygen inhibition layer and thus avoid further staining of resin cement.
Picture10 0dfb1122597c021c2ecb229caedb28a5 800
Final cure is done through the KY Jelly.

After the rubber dam was removed, the working area was cleaned for extra cement patient was allowed to see these end results.

Picture1 294e74528bfad868a591b87ff52d2735 800
Any excess cement was removed from interdental areas using floss.
Picture2 a102d0ae1d6dfcd1548fffd876590735 800
Immediate post operative view after cementation.
Picture3 b8bb410fa7f87a30833123ee3cbb9ac3 800
Final post-op view after removal of rubber dam.

He was extremely happy with his tooth back with the same color and natural form as that of adjacent tooth , he further concluded that the work done has definitely improved his confidence.

Screenshot2020 07 01at12 00 46PM 2b40d2674fd2a84d139005ae93851d31 800
Pre-operative & post-operative view at a glance

(This was a case report of an adult patient, but crown restorations can be used for esthetic correction of teeth in pediatric patients also.

Even composite restorations can be used for esthetic correction of a single anterior tooth.)

Disclaimer – DentalReach does not endorse, promote or associate with any product or material mentioned in this article. This article is meant for informative purposes only.

Dr Smita Kole
Dr Smita Kole (BDS, Mumbai), Masters In Esthetics (Japan), treating patients globally Completed. She has been a speaker for IDA and a private practitioner since 15 years with a special interest in esthetic dentistry.

    Composite Restorations for Aesthetic Correction of a Single Anterior Tooth

    Previous article

    Letter of Gratitude

    Next article

    Comments

    Leave a reply

    Your email address will not be published. Required fields are marked *

    You may also like