In this month’s aesthetic dentistry expert column, Manrina Rhode tackles the tricky case of restoring a single central incisor.
The hardest treatment we do as aesthetic dentists is restoring a single central incisor.
We’re trying to create a restoration that mimics nature so well that it is indistinguishable in the most prominent part of us, the centre of our face.
Many dentists will make the decision to restore both central incisors to guarantee a match. It is up to us to understand our clinical ability and what will give the best aesthetic, functional outcome.
There is always an advantage to minimise the amount of treatment a patient has, where possible. So creating an aesthetic result with a single tooth is preferable.
Let’s talk about how to make a perfect single central ceramic restoration, whether it’s crown or veneer for your patient.
A wax up is useful to try out your design before committing to the final product. By taking alginates and a bite and some great dental photography you can ask your lab to wax up a design for the new tooth before commencing your preparation.
If you do not want to change the shape of the tooth but just the colour, then this is not necessary.
Usually the shape of the new restoration will closely mimic the adjacent natural tooth to create symmetry.
The next stage is preparation. It’s important that if you are changing the position of the tooth with your ceramic, then you prepare enough space to allow for this and also don’t overprep.
The lab can provide you with a stent that will show you the proposed position of the final ceramic. Then you’ll know if you have prepared the tooth correctly. They can also supply you with a prepped model to guide/help you.
Photography is really important at this stage to portray information to the lab about the shade of the prep.
Often there are many shades within a tooth. You can take photos with a prep shade guide, it’s different from a normal shade guide.
Keep several shades in the photo as appropriate so the lab has reference points.
Restoring the single central incisor
A good quality silicone impression of your preparation is vital to show your lab clear margins. This way they can create a close-fitting restoration. Always send an opposing model and a bite also.
Place a carefully created temporary crown that respects the patients gingival architecture.
Show the patient how to clean around their single temporary without dislodging it.
Usually for a single central restoration I will ask my lab ceramist to come and see the patient in person or send the patient to their lab for a shade. A single tooth can incorporate around 30 different shades of colour, white spots, translucency, to create that finish that is truly indecipherable from their natural tooth.
Use a good quality ceramist. This isn’t a treatment to go with a cheap lab, but to use a lab that will create your single ceramic with pride, regardless of price.
I’m not saying that cheaper labs are not effective, I’m saying don’t choose your ceramist based on price. Choose based on skill.
When it comes to cementation, make the patient aware that this ceramic is not always perfect the first time and we are not cementing anything less than perfect. You may need to place the ceramic in a temporary cement and send the patient to the lab for them to make small changes. This is when it is useful for your lab to be in close proximity to your practice.
Also have a variety of cement aides to change shades, try in cements, warmer and lighter, in case that’s what is needed to perfect your restoration.
Then go ahead and cement, voila!
All these steps take the stress out of restoring what is a complex procedure – restoration of a single central incisor.
I run a four-day course teaching dentists how to complete porcelain veneers in a minimally invasive, stress free way.
See my website for more details www.DRMR.co.uk.
Catch up with previous Aesthetic dentistry expert columns:
- Broken veneers
- Trust and communication
- The aesthetic dental consultation
- Aesthetic treatment of white spots
- Aesthetic treatment options for closing a midline diastema.
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