Published Nov 10, 2015. Updated Jul 29, 2016.
Hi everyone, welcome to my very first post! I am very excited to bring to you this excellent case.
This was a patient, we shall just call the Motorcycle man, who came to me a few months ago for an emergency visit. It was planned correctly, executed flawlessly, and the end result speaks for itself. I was lucky enough to have the opportunity to work on this patient who was made it so easy.
He told me he was in minor motorcycle accident and hit his face on the front when he hit a jump. He knew he was lucky because he said it could have been much worse. It had been a few days and he was only feeling soreness, but no extreme pain. The case was diagnosed for crowns due to the type of fracture. If the fracture had been smaller then he may have been an ideal candidate for the more conservative porcelain laminate, AKA veneers. If the fracture had been larger then the teeth may not have been restorable at all and may be indicated for extraction and bridge/implants.
After anesthesia, I made a quick buildup in composite resin and made a putty matrix for fabrication of the temporary crowns. Then I prepared (drilled) the teeth for all ceramic crowns. It is important to check the health of the teeth prior to preparation to determine wether the teeth are indicated for root canal treatment. There was no indication for it after diagnosis, so the patient was lucky.
There are many specific steps that must be followed in order to achieve the best results: Ideal preparation design and clearance, conservative soft tissue management (no damage to the soft tissue, good hemostasis, gingival retraction), excellent shade pictures for the lab, and ideal temporary crowns. If any of these are looked over then you will have problems with home care, post op sensitivity, and diminished overall outcome. I also must stress that the lab technician must be proficient in these types of esthetic restoration. If you end up going to a dentist who does not personally know his master ceramist technician then there is a high likelihood you will dislike your crowns, especially if they are on your two front teeth!
After two and a half weeks I received the crowns from the lab and delivered them on the third week. There were absolutely no adjustments. This was as ideal as it gets. Sometimes I do need to adjust some tight contacts for the crowns, but after checking on the solid casts (there were two) I already knew there was just no need for any adjustments. During the delivery you can see that there was some blanching of the mid papilla due to the temporary crowns being splinted together. This is common and normal. At the sixth week you can see how it has completely healed.
The patient was pleasantly surprised as the color shade and shape were perfect. The transition from the gingival to the crowns were seamless. There was a perfect balance of incisal translucency with the adjacent teeth. Protrusive guidance was checked and it matched evenly with the laterals and canines. No palatal adjustments were made. The picture below was made at week 3. Unfortunately I didn’t have time to take an extra oral picture outside that day at week 6 (only intraoral). Maybe in the near future I will. I hope to have more opportunities for similar cases, document them, and present them to you all. Thanks for viewing!
1 year later I was able to follow up with my patient and take pictures. He had no issues with his crowns and it felt like a natural part of his mouth. Along with new update photos I also added a few extras I found and never posted. This includes his original and delivery periapical radiographs, cord packing, and PVS final impression (Deli-Kit/I-Sil)!