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

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.


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).

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Image 1


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.

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Image 2

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

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Image 3

2) Teeth whitening

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Image 4
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Image 5

3) Wax mock up on diagnostic cast

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Image 6

4) Putty index

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Image 7

5) Transfer onto teeth with provisional material

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Image 8
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Image 9

6) Temporary guided tooth preparation and CLP irt 12

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Image 10

7) Temporization

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Image 11

8) Gingival retraction and impression after healing

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Image 12
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Image 13

9) Bisque try in

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Image 14
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Image 15

10) Luting of layered zirconia crowns

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Image 16

11) Before and After!

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Image 17
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Image 18

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


  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.

Dr Nupur Shrirao
Dr Nupur Shrirao is a consultant prosthodontist and a grammar Nazi! Besides dentistry, she enjoys giving stage performances and radio jockeying with All India Radio.

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