Advanced Techniques and Materials for Natural Aesthetic Restoration in Dischromic Teeth

A clinical case by our Community member Dr Stefano Conti

This article and its content are published under the Author’s responsibility as an expression of the Author’s own ideas and practice. Styleitaliano denies any responsibility about the visual and written content of this work.

21-year-old patient presenting with unpleasant dyschromia and gingival color changes in the upper right central incisor, along with incisal chipping in the upper left central incisor due to trauma.

Treatment Plan:

  1. Zirconia crown with buccal veneer for the upper right central incisor.
  2. Ceramic No-Prep veneer for the upper left central incisor and upper right lateral incisor.
    Vertical tooth preparation for the upper right central incisor will employ the VF concept (Vertical Freedom Concept) to establish ideal gingival architecture with symmetrical zeniths, and importantly, to diminish gingival color changes around the upper right central incisor.
    No-prep ceramic veneers will be applied to the upper right lateral incisor and upper left central incisor.
aidite style italiano styleitaliano
aidite style italiano styleitaliano
styleitaliano style italiano dental dyschromia dischromic teeth indirect restoration

Fig.1
We decided to move forward with a zirconia crown for the upper right central incisor due to its pronounced discoloration (dyschromia).

styleitaliano style italiano dental dyschromia dischromic teeth indirect restoration

Fig.2
Additionally, we believe that vertical tooth preparation offers the best option to diminish gingival color changes and achieve precise, symmetrical zeniths in both central incisors.

styleitaliano style italiano dental dyschromia dischromic teeth indirect restoration

Fig.3
Vertical tooth preparation with gingitage is performed and temporary crown, after relining and finishing, is cemented with Temp Bond.

styleitaliano style italiano dental dyschromia dischromic teeth indirect restoration

Fig.4
After 4 weeks, we can observe thicker healed soft tissue (biotype conversion) and symmetrical gingival architecture.

styleitaliano style italiano dental dyschromia dischromic teeth indirect restoration

Fig.5
We proceeded with the final digital impression, employing a double cord technique with a cord (size 000) placed deep into the sulcus.

styleitaliano style italiano dental dyschromia dischromic teeth indirect restoration

Fig.6
We used a retraction cord (size 0), placed shallowly with the temporary crown in place, to displace the gingiva and ensure an accurate impression.

styleitaliano style italiano zirconia crown ceramic veneers indirect restoration

Fig.7
The final restoration consisted of a zirconia crown with a buccal ceramic veneer for the upper right central incisor. Additionally, no-prep veneers were applied to the upper left central incisor and upper right lateral incisor.

styleitaliano style italiano zirconia crown ceramic veneers indirect restoration

Fig.8
Before and after.

styleitaliano style italiano dental dyschromia dischromic teeth before and after indirect restoration

Fig.9
Before and after.

styleitaliano style italiano dental dyschromia dischromic teeth before and after indirect restoration

Fig.10
One year later, we can observe natural soft tissue coloration and symmetrical gingival architecture.

Conclusions

Dealing with discolored teeth presents a continual challenge, and ceramic veneers aren’t always the ideal solution for addressing significant discoloration. Fortunately, today we have access to effective techniques and beautiful materials that can assist us in achieving natural-looking results.
Vertical tooth preparation using a Vertical Freedom (VF) approach allows us to increase soft tissue thickness, which is crucial for significantly reducing soft tissue color changes. With thicker tissue, we can manipulate the soft tissue and create ideal gingival architecture by reshaping the temporary crown. The margin of the final crown for upper right central incisor is simply a replica of the margin of the temporary crown; the finishing line is the crown’s margin itself.
The upper right central incisor is restored with a zirconia single crown and buccal ceramic veneer, while upper left central incisor and upper right lateral incisor are restored with no-prep ceramic veneers. In the aesthetic zone, my preference leans towards layered zirconia and/or zirconia with buccal ceramic veneer, while in the posterior region, monolithic zirconia remains the optimal option. With these advanced high-performance materials, a three-dimensional color can be created, leading to optimal aesthetic outcomes.

Bibliography

  1. Rekow ED, Silva NR, Coelho PG, Zhang Y, Guess P, Thompson VP. Performance of dental ceramics: challenges for improvements. J Dent Res, 90 (2011), pp. 937-952.
  2. Guess PC, Schultheis S, Bonfante EA, Coelho PG, Ferencz JL, Silva NR. All-ceramic systems: laboratory and clinical performance. Dent Clin North Am. 2011 Apr;55(2):333-52, ix.
  3. Koenig V, Vanheusden AJ, Le Goff SO, Mainjot AK. Clinical risk factors related to failures with zirconia-based restorations: an up to 9-year retrospective study. J Dent, 41 (2013), pp. 1164-1174.
  4. Pjetursson BE, Sailer I, Zwahlen M, Hammerle CH. A systematic review of the survival and complication rates of all-ceramic and metal-ceramic reconstructions after an observation period of at least 3 years. Part I: Single crowns. Clin Oral Implants Res., 18 (2007), pp. 73-85.

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