By Gregory A. Janikian, D.D.S.
The ease and availability of tooth whitening is a great thing. The number of people with the desire to brighten their teeth is increasing at the same time bleaching systems are becoming easier to use. Often, during a new patient exam, I will ask "If you had a magic wand, what, if anything, would you change about your smile?" Most people would like to see lighter, straighter teeth. As a dentist, I find it particularly rewarding to satisfy these cosmetic requests. The intrinsic reward of helping someone feel better about their smile and about themselves is immeasurable.
Unfortunately, for some, simple tooth whitening alone will not deliver the seamless, bright smile they desire. Stained, failing restorations will not be affected by a whitening system. The overall shape of the teeth and gingival contours can also have an undesirable effect. Full coverage crowns are indicated to smooth and recontour the smile.
The first case I will present lends a historical perspective to cosmetic dentistry. Note the bonding of the anteriors, a common solution to whitening a smile. With time, the bonding fails and will have stain and microleakage. The patient, desiring to preserve the brightness of his smile, used the Rembrandt tooth whitening system on a regular basis. A tribute to his diligence, the patient has whitened beyond the Vita shade guide (image 1)
Due to the irregular contours and size of existing composites we decided to place five all porcelain (Empress) crowns. All six anterior would normally be done, but in this case one of the canines served as a bridge abutment. (image 2,3,4).
As mentioned in previous articles, Empress crowns are the restoration of choice due to their translucency, strength and natural esthetics. The five anterior teeth were prepared utilizing a deep chamfer preparation. (image 5.) Note the depth of the chamfer (2 mm) on the die system (image 6.)
The Empress crowns were fabricated by Jim (a great artist/technician) of Gold Dust Dental labs of Tempe Arizona 1-800-513-6131 ( a great lab). In a cooperative effort a custom shade was achieved by blending pure white with B1 porcelain. Empress crowns are etched internally and bonded into place like an all porcelain veneer (image 7.) The porcelain is highly reflective and vital looking even on the die system (image 8.)
Preoperative models, photographs and a detailed prescription were given to the lab to assist in place of the incisal edge, shade, etc. The final cementation was completed with a light cured, resin bonding system. Contours and gingival embrasures were designed to eliminate the "black triangles" that can occur after gingival recession (image 9.)
As in case 1, failed bonding, caries, recession and stain contributed to an esthetic result which was not desirable to the patient (image 12, 13). Observe the lack of reflection in the dull, matted finish of the failed composite veneers. Pre-operative models were taken and the teeth were prepared for Empress crowns.
At finish the crowns gave a more esthetic, translucent, smoother smile (image 14).
Please look for upcoming articles on Ceromer bridges: A lower anterior bridge utilizing Targis and Vectris materials.