The key to success with indirect restorations often resided in a minimally invasive approach. A 24-year-old young dentist reported with an old single crown and a small diastema between the central incisors. Moreover, the incisors were asymmetric. To achieve a a wider and more harmonious smile a combined approach was chosen.
Fig.1
Initial smile of the patient.
Fig.2
Initial occlusion.
Fig.3
Close-up of the central incisors.
Fig.4
Cutting the old single crown by a diamond fissure bur.
Fig.5
After removal of the old crown.
Fig.6
Preparation of both incisors. The left incisor was prepared for a crown and the right one for a veneer restoration. The dark core was lightened by adding a white composite layer after reduction.
Fig.7
Shade selection using the VITA 3D master shade guide, for the veneer. The patient, at this stage, asked for a brighter shade for his new teeth, so we followed his wishes, as we can use bleaching to balance the final result.
Fig.8
Shade selection using the ND shade guide for the crown. For the crown also a lighter shade was selected.
Fig.9
Lab work and photos by DT Kevork Karageozian (Al-Najah dental lab. in Dubai).
Fig.10
Two weeks after cementation, the remaining natural teeth needed whitening to perfect the result. Bleaching procedures shouldn’t be considered as an isolated treatment, but as a minimally invasive part of a more conservative treatment plan.
Fig.11
Home bleaching was selected this case. After professional tooth cleaning, alginate impressions were taken of the upper arch for office bleaching tray fabrication.
Fig.12
It’s optional to scallop the tray on each tooth or only one or two millimeters above the cervical area of each tooth. To fit the patient’s lifestyle, White Dental Beauty 16% carbamide peroxide gel (White Dental Beauty Teeth Whitening Gels) was selected for this case, to apply 1h a day. In case of sensitive teeth, I recommend using the 5% carbamide peroxide gel.
Fig.13
After the custom tray fit was checked in terms of accuracy, tissue adaptation, retention and occlusion, the patient is instructed how to insert the custom trays and to apply the 16% carbamide peroxide gel in the amount of a drop per tooth.
Fig.14
The result after 15 days bleaching was satisfying for the patient.
Fig.15
The sequence of clinical workflow.
Fig.16
Before & after, intra-oral and smile.
Fig.17
Before & after.
Conclusions
Lithium disilicate allow us to accomplish highly aesthetic results in the anterior area especially in challenging areas with dark core and in case of combined crown plus veneer treatments. This treatment with White Dental Beauty 16% 1h/day is proven to be effective and predictable. Teeth can achieve visible whitening in less than two weeks.
Bibliography
1. Bloom DR, Padayachy JN. Aesthetic changes with four anterior units. Br Dent J. 2006; 200:135–8.
2. Akal N, Over H, Olmez A, Bodur H. Effects of carbamide peroxide containing bleaching agents on the morphology and subsurface hardness of enamel. J Clin Pediatr Dent. 2001 Summer;25(4):293- 6.
