Dr Maysoon presents a BACD Award-winning single tooth ceramic case on the upper lateral incisors.
A 48-year-old male patient presented to the practice looking to replace the crowns on his upper lateral incisors. Grey lines were showing at the gingival margins and he was dissatisfied with their visibility when smiling. The patient was a regular attender and was diligent in brushing twice a day, performing interdental cleaning and attending dental hygienist appointments.
An assessment of the patient’s dentition was performed. There were no cavities, defective restorations or caries, and there were no signs of bruxism. His oral hygiene was good; he never smoked and had a moderate alcohol intake. The patient had a low lip line but the grey margins on the UR2 and UL2 showed when he smiled. The aesthetically compromised PFM crowns on these teeth had been fitted when the patient was 16 years old as his lateral incisors were peg-shaped. Generalised mild gingival recession was evident on the labial/buccal surfaces of both anterior and posterior teeth. The radiographical report found mild horizontal bone loss around the lateral incisors but the bone height was good in relation to the root length.
Weighing up options
Three treatment options were discussed with the patient. These were to replace the PFM crowns with either new feldspathic ceramic crowns or with lithium disilicate crowns, or to do nothing. The patient’s main concern, regardless of the cost, was for the new crowns to look as natural as possible so they blended in with the surrounding dentition.
The case was discussed with the ceramist. Feldspathic crowns were agreed on for providing the most aesthetically pleasing result, with a lot of artistry and different shades required. The patient was happy with the feldspathic crowns option and gave his consent.
Initial prep
The patient returned to the practice to begin treatment. To prepare the crowns, local anaesthetic was administered and a pre-op upper silicone impression was taken to be used for the temporary crowns. The PFM crowns and the old cement were removed, with no caries present.
The preparation margins were redefined and reshaped before triple zero retraction cords were placed on both upper lateral incisors. An upper silicone impression and a lower alginate impression were taken, along with the bite registration. Prep photos were taken with stump shades using cross-polarization filter. The pre-op and prep photos were sent to the ceramist. However, to get the optimal shade, the patient was sent to the ceramist at the dental laboratory for shade matching.
Temporary crowns were made with Luxatemp shade A1 and the occlusion was checked.
Final day
The patient returned one week later for the final crowns to be fitted. Local anaesthetic was again applied and the temporary crowns removed. The new crowns were tried with a try-in paste – these were a neutral shade. The patient checked the fit and the appearance and immediately approved. The crowns were removed and cleaned whilst the teeth were isolated and a rubber dam placed. Following cleaning and sandblasting of the teeth, the crowns were fitted with the resin cement Variolink in neutral shade. Excess cement was removed before being light cured and glycerine was applied before the final cure. A slight adjustment was made on the UR2 after the occlusion was checked with articulating paper – the patient was extremely happy with the final result.
24 hours post-op the patient was contacted by phone. He reported no complications and remained happy. The patient has returned to the dental practice consistently with no clinical abnormalities to report.
The case went smoothly. The patient’s commitment to regular dental appointments and his consistent oral hygiene routine minimised any extra treatment considerations and meant the treatment could begin quickly. His main goal was having a seamless natural result and this was achieved by working closely and communication well with my ceramist as well as choosing the right ceramic material.
For further information and enquiries about the British Academy of Cosmetic Dentistry visit www.bacd.com
Bio: Dr Maysoon Abdelmajeed is a member of the BACD and graduated from the University of Manchester in 2006. She has successfully earned postgraduate qualification by becoming a member of the Faculty of Dental Surgeons at the Royal College of Surgeons of Edinburgh in 2008. She has lived and worked in the UK for 12 years before moving to Dubai. Recently, she was recognised by the BACD for her expertise by winning a BACD Award for Single Tooth Ceramic, following a highly competitive submission of case presentations.
