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Categories Clinical Case

Fun with Staining and Glazing
CDT: 周星妤 (Sharon)

Every once in a while, we have patients who come in with broken teeth and are looking for immediate restoration. Barring complications that indicate otherwise, we are often able to provide the patient with same-day restorative treatment. Today I would like to share one of these cases that happened recently.

So this 90-year-old male had a minor chewing mishap, and his tooth #21 (with previous endodontic treatment) snapped off quite cleanly as shown in the following photo.

Initial state with exposed GP and previous temporary filling.

The patient was over 90 years old and completely uninterested in fixing his multiple non-carious cervical lesions. After some back and forth, my final treatment plan was to simply restore #21.

Abutment built with fiber-post and resin core. The white smudge on #11 is excess vaseline.

The only remaining tooth structure was on the palatal side, but the patient also had a very deep bite, so really not the best combination of circumstances. After a precarious act of balancing occlusal clearance and tooth structure removal, the abutment was ready for gingival retraction and scanning.

Various views during the restoration design step in the CEREC software.
Shade alignment in the Triluxe Forte block.

There was a lot of design flexibility for this restoration, thanks to the severity and angle of fracture. With sufficient space to play around with, a physical indentation near the cervical region was possible to mimic the cervical lesion. We chose the Triluxe Forte due to the large shade gradient between cervical and incisal regions.

Same-day delivery with Variolink cement.

After cementation, I noticed that the cervical areas on the natural teeth are slightly less reflective, so I de-glazed the cervical regions with a twist polisher. Unfortunately, the instrument slipped a bit and lacerated the gingiva. My bad.

Follow up photo after 2 weeks.

Luckily, things seemed to have healed over decently after a couple of weeks.

Remarks

Of course, this wouldn’t have been possible without Sharon, one of our wonderful in-house dental technicians. The reference shade used for this crown was 4R2.5, and with such an unusual color, we were fairly fortunate to get the color very close in one try; for a case like this, I typically set aside enough chair time for two attempts. The total chair time for this patient is about 90 minutes, not including endodontic re-treatment.

We are still getting the hang of CEREC! So while this case may not be perfect, it was definitely an interesting learning experience.

 

About Hsuan

Hsuan is a lecturer at CEREC Asia Training Facility. He is from Vancouver, Canada, and is a big fan of prosthodontics and profanity.
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