A 48-year-old man presented with the complaint that a "front tooth looks ugly." Clinical examination revealed that tooth No. 9 had a composite resin
labial veneer with significant esthetic aberrations.
The tooth had an overall triangular appearance compared to the ovoid contralateral tooth.
The proposed treatment plan called for removal of the old composite restoration, fabrication of a provisional crown to be worn for 1 month to evaluate cosmetics, then fabrication of a zirconia-based all-ceramic crown.
After obtaining anesthesia, all original composite resin material was removed with a GENTLEpower LUX 25LPR handpiece (KaVo). This electric handpiece features a triple-gear system for little vibration and more control over the preparation. A tapered chamfer diamond bur 6878K-016 (Brasseler) was used to reduce the occlusal, proximal, facial and lingual surfaces to a minimum depth of 1.5 mm. A football diamond 6368-023 (Brasseler) ensured adequate reduction on the lingual aspect of the prepared tooth from the cingulum area to the incisal contour. Undercuts were present on the mesial and distal from the removal of the original composite resin. To avoid sharp line angles that could hinder scanning and fabrication of the zirconia core, undercuts can be filled in with bonded core material or eliminated with a bur.
A provisional crown was fabricated by injecting Integrity (DENTSPLY Caulk) into a preoperative alginate impression. The contours of the provisional were adjusted chairside. The provisional restoration was cemented with Temp-Grip (DENTSPLY Caulk).
After 1 month, the patient returned for an esthetic evaluation and impression taking. The patient-approved contours of the provisional were recorded photographically and with an alginate impression. Anesthesia was delivered, a polyvinyl siloxane impression was taken of the healthy tissues, and the provisional crown was re-cemented.
Marotta Dental Studio poured up the impression and scanned the die using a NobelProcera Scanner (Nobel Biocare). The core was designed on NobelProcera Software and milled from a solid block of zirconia. The laboratory then applied feldspathic porcelain to the zirconia core for maximum esthetics.
The patient approved the final esthetics of the NobelProcera Zirconia crown (Nobel Biocare) and the restoration was permanently cemented with Rely-X Unicem 2 (3M ESPE). Excess cement was removed and healthy, stable gingiva were noted.
ABOUT THE LAB
Marotta Dental Studio
One of the most frustrating aspects of restorative dentistry is an insertion visit that doesn?t go well. Perhaps the crown has open margins or the porcelain work looks like it was done in the dark. Inconsistent work is a genuine concern as the business model for dental laboratories continues to undergo radical changes.
I enjoy working with Marotta Dental Studio because of their impressive knowledge of material science and prosthetics. I often invite them into the treatment planning stage of challenging cases to save myself headaches down the road. They employ a great team of lab technicians that I can get on the phone when necessary. This simply cannot be done with labs who outsource their cases to the far ends of the world. I know they use the best materials and monitor the progress of my cases with great precision. Marotta takes the stress out of my insertion visits.