Dentaltown February 2020 - 33

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Interproximal caries on teeth #7, #9 and #10.
Patient presents with low smile line while in
maximum phase.
Tooth #8 previously endodontic treated with PFM,
excessive incisal length and poor contour/aesthetics.
Mismatched shades with natural teeth.
Occlusal wear facets on all anterior teeth, anterior crowding.
Angle's Class 1 malocclusion, minimal A-P overjet.

Preoperative phase
Appointment 1: Preliminary impressions, facebow,
photographic documentation, radiographic analysis
While our primary consideration was to provide the patient
with the highest possible aesthetic result, all available treatment
avenues were considered and weighed, including ceramic versus
composite and indirect versus direct veneers. Because of the
patient's high aesthetic desire and compromised tooth structure,
four full-coverage lithium disilicate crowns were selected for an
aesthetic and functional rehabilitation. During this appointment,
her consent was obtained and preliminary impressions, facebow,
photographic and radiographic analyses were captured (Figs. 1 and 2).
Because of the interproximal caries, the patient received a caries
risk assessment and was given an extensive oral hygiene regimen
that included a prescription of Clinpro 5000 toothpaste and daily
implementation of ACT mouthwash.

Fig. 1: Patient presents with a low smile line,
exposing only half of the teeth while in repose.

Fig. 2: Preoperative intraoral view, highlighting interproximal
caries, incisal anterior wear, uneven length of central incisors,
and inconsistent shade between restorations and natural teeth.

Restorative phase
Appointment 2: Restorative phase + provisional
Treatment was conducted as follows:
1. Profound anesthesia completed with two carpules of
2% lidocaine with 1:100,000 epinephrine via ASA nerve
block and local infiltration among teeth #7-10.
2. Sectioned previous PFM restoration on #8; excavacated
all carious lesions present on teeth #7-10. Rebuilt compromised tooth structure using glass ionomer (Fuji II LC)
resin-modified restorations.
3. Teeth #7-#10 were then prepared for lithium disilicate
all-ceramic restorations.
4. Shade was selected using Vita 3D Master Shade Guide.
All factors were assessed, including:
a. Value: Overall lightness, how light or dark a color is.
b. Hue: What we normally think of as "color": red, blue,
purple, etc.
c. Chroma: analogous to "saturation," the strength or
dominance of the hue.

Fig. 3: Preparation complete and stump shade selection.

dentaltown.com \\ FEBRUARY 2020

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Dentaltown February 2020

Table of Contents for the Digital Edition of Dentaltown February 2020

Dentaltown February 2020 - Intro
Dentaltown February 2020 - Cover1
Dentaltown February 2020 - Cover2
Dentaltown February 2020 - 1
Dentaltown February 2020 - 2
Dentaltown February 2020 - 3
Dentaltown February 2020 - 4
Dentaltown February 2020 - 5
Dentaltown February 2020 - 6
Dentaltown February 2020 - 7
Dentaltown February 2020 - 8
Dentaltown February 2020 - 9
Dentaltown February 2020 - 10
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Dentaltown February 2020 - Cover3
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