CHIEF COMPLAINT:
Patient had a restoration on tooth 2.1 that kept falling off, and would like a solution to this problem.
DIAGNOSIS:
Male patient, 75 years old, non-smoker. Tooth 2.1 had a mesial restoration in composite resin (class IV), which fractured frequently. The upper jaw showed widespread gingival retraction and variable root wear. Palatal surfaces of upper incisors had worn out enamel, mainly on the incisal area. Patient kept good oral hygiene, and soft tissues presented no sign of inflammation.
TREATMENT PLAN:
The extent of composite resin restoration on the tooth, root exposure with associated wear, the patient's age, and especially the patient's desire for a conservative approach without overly complex treatments, all led to the choice of a full ceramic crown, also known as a 360 veneer. This therapeutic option would be conservative in a simple manner. Using a minimally invasive axial tooth preparation, the cervical finish line would be nearly 0.5 mm incisal to the cementum-enamel junction, while the clear advantages of bonding would achieve a balanced treatment proposal. A veneer without full coverage of the tooth surface was also considered, but abandoned because the little tooth structure that could be preserved would hardly justify the increased complexity.
TEAM PLAY ‘DENTIST – DENTAL TECHNICIAN’ NOTES:
Prior to dental preparation, a preliminary impression was made for a provisional crown in dual-cure resin. Tooth preparation was as little invasive as possible. Placement of the cervical finish line 0.5mm incisal to the cementum-enamel line enabled convergence in axial preparation, allowing enamel conservation. Tooth preparation assumed the cervical finish line to be in enamel and not cement. Colour assessment was done prior to impressions, based on the shade of remaining tooth substrate, and collecting information from adjacent teeth before dehydration. Printing was performed with putty soft and light, not using any gingival retraction technique. The impression yielded a Geller type work model, to support laboratory work. Confection of the ceramic full crown took into account the need to integrate both on the remaining tooth structure and the whole of the adjacent teeth. Crown bonding was made without absolute isolation, using teflon straps to achieve a working relative isolation. A conventional bonding technique was used, following the appropriate dental and prosthetic structure preparation process. This case sought a compromise between sophistication and simplicity, which the years have shown to be a good bet.