Pegged for Crown

 A 26 yr. old girl is  unhappy with the dark shadows in between her front teeth. She wants crowns on  her peg laterals to fill up the gaps.

Minor preps are done on her laterals and impressions are sent for fabrication of 3M Lava crowns. 

3M Lava crowns on dental cast.

Crown after cementation with resin cement.

Final appearance after crown cementation.

Midline diastema closure is planned for Composite build-up.

Ceramic veneers

34 year old Female presents with generalized fluorosis and multiple restorations in posterior teeth. tooth # 35 is RC treated with a "gold" crown.

Patient wants 'caps on all teeth' to change her look. She also complains of sensitivity particularly in back teeth.

Clinical Assessment:


1. Fluorosis (Yellow- brown teeth).
2. Mild Attrition.
3. Inverse smile line.
4. Multiple restorations in Posterior teeth.
5. Sensitivity.

Treatment Plan:

1. Intentional RCT for posterior teeth and Lower Incisors followed by PFM Crowns.
2. Ceramic Veneers for Upper Anteriors.

PFM Crowns have been placed on 3 quadrants and crown preps can be seen in the first quadrant. The Crowns were placed one quadrant at a time.


The Lower anteriors have been prepared.


Occlusal view of Lower Anteriors after crown preparation.


After placement of Lower temporaries.

The Lower PFM Crowns.


Upper Veneer preparation has been done.


Upper anteriors with gingival cord in place to refine margins and before taking impressions.Lower PFM crowns have been cemented.


Upper temps in place.


E max veneers have been cemented.


The final visibility and smile line.

                                  PROCERA Bridge

       30 yr. old female reports with existing bridge from 13 to 23. History reveals congenitally missing Upper lateral incisors. Metal Ceramic bridge was used to replace missing teeth. Patient has the following problems with existing bridge:

• It is bulky.
• It is loose.
• The metal shows through and teeth do not have translucence.
• The shade is too white.
• Teeth seem to be joined together.
• Chipped ceramic.

 

There is spacing distal to upper left canine which has not been addressed.

Additionally she had swelling in upper lips a month ago.

Patient requests replacement with Zirconia crowns (she read about them on the internet).

IOPA radiograph reveals a improper RCT on 11 and PA radiolucency on 21. A single GP point can be seen in 11. It also seems to be over-filed.

Removal of the bridge reveals grossly over-reduced teeth, particularly canines. The margins are not smooth.

Endodontics is completed on 11 & 21. The existing bridge is being used for temporization in between appointments.

After completion of RCT's, the margins are improved. Impressions are taken and sent to the lab. Zirconia cores are checked for fit and margins and returned to the lab.

The Procera bridges are back from the lab. They are intentionally constructed in two parts.

The white Zirconia cores can be seen.

A tooth has been added distal to 23. It serves only aesthetic purpose and is not in function.

The new bridge is cemented in place using RelyX Unicem. The gingival contours will gradually adapt to the new bridge. Problems of shape, size, colour and contour have been addressed. The incisal edges follow the lower lip contour(smile line). The teeth do not appear joined together.

Space closure has been achieved distal to 23.

The patient is visibly happy with her new bridge in place.