Milling and Try-in
IPS Empress CAD Multi shade A2 was chosen for the final restoration, which has a built-in shade gradient to match the contralateral central. It took approximately 7 minutes for the restoration to be milled with the inLab MC XL mill (Dentsply Sirona).
The sprue was removed and the restoration was tried in, checking for fit, esthetics, and marginal integrity (Figure 7). At this stage, desired refinements to the crown were done with a fine diamond bur. Once the final shape, emergence, line angles, and texture were satisfactory, the restoration was stained and glazed to match the appearance of the right central.
Before cementation, the intaglio of the restoration were etched with 4.5% hydrofluoric acid etch (Ultradent) for 60 seconds, washed, dried, and silaned for 60 seconds. The enamel was selectively etched for 15 seconds, washed, and dried. The NX3 Nexus™ cementation system and OptiBond™ XTR bonding system (Kerr Corporation, www.kerrdental.com) were used to cement the restoration. The crown was carefully placed in the correct orientation. When the cement reached gel stage, the restoration was tack-cured for 2 seconds and the excess cement was removed with an explorer. All surfaces were then cured for 20 seconds each. The proximal surfaces were flossed and any remaining cement was cleaned up. Occlusion was checked and the margins were polished. The paste was rinsed and the immediate postoperative result was evaluated from the facial surface. The all-ceramic crown on the maxillary left central incisor was well received by the patient (Figure 8).
There are several ways to treat discolored teeth, which include neutralizing the stump with an opaque, using low translucency porcelain blocks, using high opaque cements, and increasing the spacer for the restorations. Clinicians must decide to use one or a combination of these techniques to ensure the best final outcome of masking the discolored tooth and creating the correct optical properties that match the contralateral tooth.
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For more information, contact:
Pacific Dental Services
About the AUthor
Dhaval Patel, DDS
PDS®-Supported Owner Dentist