Mon: 10:00am - 7:00 pm
Tu/W: 8:00am - 5:00 pm
Thur: 9:00am - 4:00 pm
Fri - Sat 9:00 am - 3:00 pm (alternating)
20-year-old front crown with underlying decay replaced with a custom shade-matched crown - A cosmetic challenge.
The Problem: An upper front tooth with a 20 year old crown has developed a recurrent cavity and fractured. The crown also does not match the existing teeth: It is bulky, opaque, lacks natural translucency and texture.
The challenge: shade matching a single front tooth crown is one of the most challenging cases in restorative dentistry.
A pre-procedural assessment was completed.
1) We assess the depth of the decay, which is difficult to ascertain until the crown is removed.
2) The health of the nerve, bone levels, tissue and bite.
3) Pre-procedure radiograph is taken to assess the root and surrounding structure.
A plan is then fabricated as to what our goal is for the shape of the final crown, the emergence, the colour and texture. This dictates how the preparation is completed.
The old crown is removed under magnification and the decay treated.
Approximately 20-30 high resolution photographs were taken, along with a series of cross polarized images. Finally a crown map and visual prescription is prepared. This maps the details of the of the final crown such as texture, white spots, craze lines, areas of translucency, gingival warmth and etc.
When matching the shade a temp crown which was slightly dark was chosen, this allows us to match against an existing temporary crown with predefined translucency of a specific shade.
Zirconia Cutback: Given the darkness of the underlying tooth, a low translucency material, zirconia was used. To recreate natural features it was cut back and layered with porcelain of various shades.
The layering of porcelain is an art and was completed by a ceramist.
Try-in appointments are tricky. They are usually done with afternoon sun and with natural lighting. The crown is tried in with various tray in paste which allows changing and modifying the underlying crown colour slightly to obtain a natural match.
The final crown immediately following cementation.
The surrounding gingival tissue will heal and further integrate along the crown.
Additionally, the porcelain will hydrate over time and this will further increase the natural appearance of the crown.
Individual results vary; matching a single crown to natural teeth beside it is among the harder tasks in dentistry, and what is achievable depends on the tooth and its neighbours. This case is not meant to provide medical advice but documents a clinical case performed at sunny dental centre. Individuals should refer to their dentist or medical providers for individual or general medical/dental advice.
Sunny Dental Centre is a general dental practice. Dr. Mandip Puri, DDS, is registered with the Royal College of Dental Surgeons of Ontario as a general practitioner, not a specialist.
Individual results vary. This case illustrates work completed at Sunny Dental Centre and is shared with written patient consent. What is achievable in your own case depends on your teeth, your bite and your goals. Sunny Dental Centre is a general dental practice; Dr. Mandip Puri, DDS, is registered with the Royal College of Dental Surgeons of Ontario as a general practitioner, not a specialist.
Every case is different. Book a consultation and we will tell you what is realistic for your teeth.
Mon: 10:00am - 7:00 pm
Tu/W: 8:00am - 5:00 pm
Thur: 9:00am - 4:00 pm
Fri - Sat 9:00 am - 3:00 pm (alternating)