Esthetic restoration of an Intrinsically Stained Central Incisor with Digital Dentistry and TriLux Forte Feldspar

Chou, Jennifer K.
Faculty / Advisor: Conejo, Julian
University of Pennsylvania School of Dental Medicine, Department of Preventative and Restorative Sciences

Introduction

Trauma inflicted on tooth can have a lasting impact on not only vitality, but also esthetics due to the clinical challenge of restoring a tooth that is internally stained and structurally compromised. For a maxillary anterior tooth, this can have a dramatic impact on a patient’s confidence as well as a dentist’s ability to remedy the gingival-staining through a traditional porcelain-fused to metal restoration approach. A digital and CAD / CAM approach was used as an alternative to rehabilitating natural esthetics and color-correction of the stained tooth.

Methods

A 29 year old male presented to the Comprehensive Care Clinic with chief complaint: “My front tooth is stained at the top and it makes me not want to smile. I also have a gap in my front teeth that I don’t like”. Tooth #9 was endodontically treated more than three years prior and was restored with a post and core build up, as well as a porcelain fused to metal crown. The patient presented with dark green gingival staining around #9 as well as a 2 mm size difference between his maxillary central incisors with tooth #9 being the larger of the two. After clinical and radiographic examination and a full- mouth prophylaxis, a crown and veneer were treatment planned for sites #9 and #8 respectively. Diagnostic digital impressions of the teeth were taken with the CEREC intraoral scanner and a laboratory technician was consulted to fabricate the ideal wax up of the maxillary anterior teeth from premolar to premolar. A Zirconia anatomical coping of #9 was designed and milled with TriLux forte to mirror the veneer abutment of #8, and then identical veneer restorations were milled and fabricated with TriLux Forte for maximal stain block-out of #9. All restorations were cemented with Panavia 5 cementing following exact manufacturer’s instructions.

Results

The previous diastema of 1 mm between #7 and #8 was eliminated and gingival staining of #9 was addressed through use of CAD/CAM technology, milling and design of an anatomical coping, veneer, and crown in TriLuxe Forte.

Conclusion

One way that the esthetic restoration of a stained, endodontically-treated central incisor can be approached is through the use of digital dentistry, CAD/CAM design and milling, and TriLux Forte as a restoration material. Intrinsic staining due to pulpal hemorrhage commonly can present in previously traumatized teeth. Even after restoration with a PFM crown, intrinsic staining can still be visualized through the facial gingiva for a tooth in the esthetic zone. However, milled post and core and restoration in TriLuxe Forte Feldspar should be considered as a feasible option for the teeth in the esthetic zone.