Marcus B Blatz
Sevvanthiraja, Sivothayan, Conejo, Julian, Hariton-Gross, Karina, Blatz, Marcus B
University of Pennsylvania School of Dental Medicine, Department of Preventive and Restorative Sciences
With the increasing material options for restoring anterior teeth with full contour restorations, it is still a clinical challenge when previous history of trauma, endodontic treatment and risk of intrinsic discoloration are present. This presentation describes the chairside CAD/CAM workflow for restoring maxillary central incisor with a full contour ceramic crown with a history endodontic treatment and internal bleaching.Methods
In 2010, an 18-year-old female patient presented with avulsed tooth #8, Patient stated she got hit on her face by a horse. The tooth was repositioned and splinted to tooth #6 - #9. After 3 months endodontic treatment was performed due to pulpal necrosis. Internal bleaching was done following the endodontic treatment due to the coronal discoloration caused by pulpal hemorrhage. Composite restoration was placed as final restoration. During next 10 years, patient presented for periodic recall and the tooth was stable and functioning well. However, recently patient states the tooth started to chip off and she noticed some crack lines. Considering the esthetics and previous history of endodontic treatment, full coverage restoration was planned for tooth #8. Since the patient was interested to get whitening, external bleaching was completed using 10% carbamide peroxide. After 4 weeks stabilization period the final shade is confirmed as B2. Pre-operative Scan obtained using CEREC prime scan, digital wax-up is made, models are 3D printed and putty matrix is made to fabricate provisional restoration. Tooth preparation completed following minimal tooth reduction protocol. Tooth preparation is scanned using CEREC prime scan. Provisional restoration fabricated using putty matrix and integrity and contoured to create natural emergence profile. Final restoration designed using CEREC 5.1.3software in biogenetic copy mode. After the initial proposal by the software, the final design is completed using the CEREC software tools. Final restoration milled, stained manually, and glazed and bonded with PANAVIA 5. Follow-up x-rays and photographs obtained.Results
Patient was extremely pleased with the shape, color, and the esthetics of the final restoration.Conclusion
Although there are many possible options and materials for restoring the anterior teeth in esthetic zone, full contour ceramic crowns are feasible options for restoring the anterior teeth with history of endodontic treatment and trauma.