Tooth Prep with Finishing Line

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.

A 20 years old patient came to the clinic with two fractured ceramic crowns on his upper central incisors.

styleitaliano style italiano smile showing broken crown on central incisor

Fig.1
As a treatment, we planned to prepare the teeth to receive two new zirconia crowns on 11-21 and two veneers on 12 and 22 in order to restore the esthetics of a pleasant smile, and a healthy gingival architecture.

styleitaliano style italiano digital smile design

Fig.2
As a first step, smile design was performed to evaluate dimension, shape, and position of central and lateral incisors.

styleitaliano style italiano Old crown preparations after old crown removal

Fig.3
Old ceramic crowns were removed.

styleitaliano style italiano chamfer preparation for zirconia crowns

Fig.4
A chamfer tooth preparation was chosen for teeth 11 and 21, while a direct mock-up was performed at teeth 12, 22.

styleitaliano style italiano provisional crowns and mock up on upper incisors

Fig.5
Temporary crowns and mock-up at the end of the session.

styleitaliano style italiano smile with provisional restorations

Fig.6
Smile close-up with temporary crowns on 11 and 21, and direct mock-up of 12 and 22.

styleitaliano style italiano cast model for good control over finishing line

Fig.7
A Geller cast model was fabricated. CDT Franco Pozzi & Ateicos Quintavalla.

styleitaliano style italiano geller model for crown veneer case

Fig.8
Dental cast ready for the fabrication of the Zirconia crowns according to the wax-up.

styleitaliano style italiano dental wax up and preparations

Fig.9
Digital superimposition showing wax-up on model.

styleitaliano style italiano cemented zirconia crowns and veneers

Fig.10
Final picture shows the final zirconia crown restorations on 11 and 21, and the veneers cemented on 12 and 22.

aidite style italiano styleitaliano
aidite style italiano styleitaliano
styleitaliano style italiano side view of incisor restorations

Fig.11
Lateral view.

styleitaliano style italiano before and after zirconia smile restoration

Fig.12
Before and after.

Conclusions

Our patient want a natural look, but also strong and durable restorations. The two central incisors were restored with layered zirconia single crown, while the lateral incisors were restored with ceramic veneers.
Relative to anterior teeth, my preference continues to be layered zirconia, while in the posterior monolithic zirconia is still the best option. With layered zirconia and, a thin layering in the buccal area, a 3-dimensional color can be created and optimal esthetic outcomes can be achieved.

Acknowledgements
Lab. Pozzi Franco, Parma,Italy.

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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