old crown on upper left incisor

Perfecting smiles with tooth whitening

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.

smile with yellow teeth and old crown restoration

Fig.1

Initial smile of the patient.

intraoral picture of mouth to be restored

Fig.2

Initial occlusion.

detail of crown before removal

Fig.3

Close-up of the central incisors.

cut ceramic crown for removal

Fig.4

Cutting the old single crown by a diamond fissure bur.

dark abutment of central incisor

Fig.5

After removal of the old crown.

crown and veneer preparations with retraction cord

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.

vita shade guide samples for veneer color selection

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.

ND shade guide for crown color selection

Fig.8

Shade selection using the ND shade guide for the crown. For the crown also a lighter shade was selected.

veneer and crown lab work and incisal details

Fig.9

Lab work and photos by DT Kevork Karageozian (Al-Najah dental lab. in Dubai).

non-restored teeth needing whitening

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.

soft

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.

cutting bleaching tray

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.

adapted dental bleaching tray for upper arch

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.

bleached teeth after two weeks

Fig.14

The result after 15 days bleaching was satisfying for the patient.

steps to bright and beautiful smile

Fig.15

The sequence of clinical workflow.

before and after

Fig.16

Before & after, intra-oral and smile.

before and after smile restoration

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.