CHIEF COMPLAINT:
The patient did not like the crowns she had placed on her central incisors. I didn't like to see the “dark of the roots”. I also didn't like the shade of the other teeth, they were “very yellow”
DIAGNOSIS:
Female patient, 41 years old, non-smoker. It featured two crowns on cast post and core on teeth 1.1 and 2.1. The crowns presented with cervical infiltrations with exposure of the root surface. The median gingival papilla was slightly retracted. The mesiodistal space corresponding to the two crowns was high and narrow. She had a slight crowding of the lower incisors, as well as a small gingival retraction. In the smile, the cervical area of the crowns was clearly visible, showing a grayish appearance corresponding to the darkening of the roots. In the imaging exam it was verified that the endodontic treatment was not technically satisfactory, but asymptomatic for almost 10 years.
TREATMENT PLAN:
The replacement of the two crowns of the cast poste and core after tooth whitening was proposed. The possibility of redoing endodontic treatments was also considered, but it was concluded that the removal of cast post and core would have a very high risk. Thus, the proposed treatment plan consisted of performing an outpatient tooth whitening and placing two crowns with a ceramic-coated Zr infrastructure on teeth 1.1 and 2.1
TREATMENT NOTES:
The treatment began with the making of transparent silicone trays for the application of 16% carbamide peroxide. Spacers placed on the buccal surface were carefully prepared in resin on plaster models. The treatment was done by applying the product 2 hours a day for 8 days. After bleaching we wait 4 weeks and start prosthodontic treatment. A pre-print on silicone was performed to make a temporary bridge with dual-cured composite resin. Then we start removing the crowns. A vertical cut was made in the middle zone of the crown until finding the surface of the cast post and core. On the incisal edge, the same cut was also made. Then, with a fine luxator, the distal parts of the crowns were separated. To remove the mesial parts, a cut was made in the midline covering both crowns. At the end of the atraumatic removal of the old crowns, the cores were re-prepared. In the re-preparation of the cores, the finishing line was placed at the intra-sulcular level. In the same consultation, the definitive impression was made. Gingival retraction was performed using the technique of kaolin paste compressed by the temporary bridge. The impression was made using the double-mix technique with double viscosity with quick-setting silicone. In the laboratory, 2 crowns with Zr infrastructure were made and covered with ceramic. In order to avoid the appearance of “too high” crowns, the mesio-distal diameter was slightly increased, slightly overlapping the adjacent teeth. The provisional bridge was removed, the cores were polished and the crowns were placed for final verification. After confirming their fit and approved by the patient, they were definitively cemented with resin-reinforced glass ionomer cement.