Single crown

Post eruptive color changes of dental hard tissues
,
Unsatisfactory restoration
Courtesy of Dr D. Colson, 2022
Highlighted picture of treatment

Treatment Summary

Patient Information

  • Age: 15
  • Gender: female

Diagnosis

  • Post eruptive color changes of dental hard tissues on 2.1 (UL1)
  • Unsatisfactory restoration on 2.1 (UL1), 3.4 (LL4)

Total Treatment Visits

  • 4

Treatment planning

First Appt
Reason for visit: Tooth #21 had a grey hue due to trauma from a swing accident several years prior to treatment. There was no tooth fracture or chipping of the tooth. The tooth remained vital and this was verified with an endodontist. The pulp receded significantly as a result of the trauma as seen on the radiograph. Extensive external whitening to improve the colour unfortunately did not achieve the results that we were seeking as we tried to be as minimally invasive as possible. Upon consultation with the patient and her mother it was decided that the best esthetic outcome would be a crown rather than bonding. The mother gave her consent to create a crown for tooth #21. This treatment followed Invisalign treatment and a temporary was fabricated during the last revision of treatment so that the patient would not be self-conscious upon smiling. After we aligned the teeth we began the final preparation for the crown on tooth #21.
A preliminary alginate impression was taken to fabricate a temporary after preparation. Local anaesthetic was administered, 1/2cc. Ultracaine 1:200,000. It was noted that while performing the crown prep there was remnant 'grey' colour on the labial wall of the preparation. It was a concern about the amount of reduction and the true position of the pulp horns not visible on the radiograph due to the age of the patient, 15 years old, as the vitality of the tooth may be in jeopardy to perform any further reduction.
Medial grade ozone gas was applied and a core buildup was performed with Fuji II, A/E, Universal All Bond,and Renamel SB1. A small grey line on the mesial surface was still visible. A temporary crown was made with Luxatemp BL, after the internal stained tooth structure was coated with pink opaque. On try in the temp was still slightly grey. We utilized Fynal cement to create opacity to match the colour of tooth 11

Second Appt
The temporary was removed and .5 cc Ultracaine DS 1:2000000 w epi was administered. The tooth was re-prepared for the final crown.
A gingivectomy was performed with Waterlase, Biolase, to create the gingival margin to be at the level of the tooth preparation.
At the preparation, it was noted that the stump shade was B1. Universal All Bond and pink opaquer was used to create the B1 stump shade. An Itero Scan was taken for fabrication of an Emax crown. The temporary was re-cemented with Flecks to ensure strong retention due to the aligner being utilized while the crown was fabricated. The case was submitted to the lab and custom shading appointment was requested.

Third Appt
#21 - Emax Crown Cementation.
Patient received .5cc Citanest Plain 4% without vasoconstrictior upon request.
The temporary was sectioned and removed due to the use of Flecks cement. The crown was tried in and the colour was not a good match to the adjacent teeth. A periapical xray was taken to check the adaptation of the crown to the preparation interproximal. Occlusion was checked in centric and excursions and modified. The patient went to the lab for a shade modification. A new temp crown with Luxatemp BL was fabricated but not cemented to remove easily at the lab. Crown held in place with aligner. Patient took the crown to the lab .

Fourth Appt
Crown Cementation appointment for tooth #21.
The temporary was removed the crown was placed. Patient was happy with the new shade, shape and look of the crown intraoral. Patient agreed to proceed with permanent cementation of the crown and a consent form was signed. The crown and tooth were microetched. MonoBond was applied to the crown and Multilink Primer A+ B was applied to the tooth. The crown was cemented with Multilink White.
The excess cement was removed and the occlusion was rechecked. No adjustments were required.
The patient was then scanned for her Vivera retainers with ramps on 11 and 21.
A beautiful functional and esthetic result was achieved.

Comments

An integrated approach with single crown restoration with Invisalign for a teenage girl for upper central incisor. A very time intensive case with a gratifying outcome. The patient smiles freely without any hesitation and is grateful for the attention to detail.

Images

Initial and final

InitialFinal
After picture of treatment
Before picture of treatment
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iTero Scans

Initial Final
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Radiographs

Initial Final
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Progress Images

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Publication