In past articles I have written for the PAC newsletter, I have presented complex aesthetic cases, full mouth reconstruction cases, anterior crowding cases, as well as severe discoloration and combination cases. I have also written on minimal cases involving two to four anterior teeth. The harmony the veneer restorations have with the natural dentition in form, function, and beauty is critical.
Today, I will present a case involving a single upper anterior tooth, #8. The difficulty of creating a natural, undetectable and harmonious match to tooth #9 cannot be underestimated. When doing a single central, the requirements necessary to achieving an excellent result can be more demanding than doing multiple teeth in a smile design case. Matching a single anterior tooth involves precise tooth preparation, extensive photography, detailed temporization and excellent communication.
Tooth preparation requires appropriate removal of tooth structure in the correct planes and depth. We must take several things into consideration including facial reduction in three planes, line angle creations, incisal edge, and interproximal reductions as well as precise margination. All the above must be mentally reviewed before the bur touches the tooth. Attention to detail allows the ceramist the foundation to create depth of color and value, correct line angles, and incisal characterizations as well as secondary anatomy, mammelons, and texture. All which are necessary in achieving an excellent match. I believe the contours, shape, and matching anatomy of the tooth in detail is equally as important as the actual shade match.
Many photographs should be taken using different angles and light setting to capture hue, chroma, and most importantly value. Photos of different shade tabs both lighter and darker will help the ceramist to choose the appropriate ingot and layering porcelain. Photos of the preparation shade and multiple photos of the matching tooth are mandatory. Photos of temporary restoration that you painstakingly made for both patient satisfaction as well as laboratory communication are also taken and submitted. And for yourself, the patient and the ceramist, take photos of the cemented finished case for all to share and take pride in the extensive efforts each made to assure an excellent result.
Excellent communication begins with the patient. Their desires and expectations must be heard and reviewed to assure they are realistic and that you feel capable of satisfying them or possibly not accepting the case. I have on a few cases worth thousands of dollars politely refused to treat the patient due to unrealistic demands and expectations and I do not regret those decisions.
In this case, I advised the patient that I would do a veneer on tooth #8 and charge her 50% more due to the difficulty. I also advised her that her cooperation was necessary to allow me the time to re-do or refine the case if needed to create the best possible match to #9. She had been advised by other dentists to do both #8 and #9, which she refused. She sought me out as a specialist to match her single anterior tooth and gladly accepted the higher fee and my requirements.
At the prep appointment I took multiple photographs, correctly and intelligently prepared tooth #8 and took more photographs. Impressions with all details were made. I spent extra time making the provisional veneer as she is a very social person and had meetings and events to attend. I also wanted to guide the ceramist in his fabrication of the final product. Multiple photographs were taken for laboratory communication as well as a study model to aid the ceramist. The patient was very impressed, pleased and appreciated my attention to detail.
All was sent to the laboratory with detailed written instructions. I also had a verbal discussion with their excellent ceramists. Figures 1-7 depict the process and the excellent final result. I give much credit and appreciation to the expert technicians and ceramists at Corr Dental Designs.
If you have questions about my article or if you would like to send a case, please contact the Pacific Aesthetic Laboratory Group at www.pacificaestheticdentalstudio.com, Gary Vaughn, CDT, CTO, (888) 461-3331, or via email gvaughn@thePAC.org.