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TOWNIE CLINICAL: The Old Single Central Crown Arturo R. Garcia, DMD

This patient wanted a better smile but was only willing to do whitening and replace #9. I was thinking smile makeover, but she did not want that. Silly me, I took it on. #9 was restored with Empress (by BecDen dental, one remake) after a RCT and composite core. I used BriteSmile whitening before the shade match.

The gingiva took a long time to look normal after the replacement. I think this is one of those situations where she had some allergy to the non precious (?) metal in the PFM.

Anyhow, the lab did an awesome job and a less-is-better situation actually came out nicely.






Townie Comments

windmill 8/13/2003 10:00:08 AM
Which tooth needed the RCT? #9? If so, was it elective or was it abscessing/painful? Nice work. Simple and rewarding.
arturo5203 8/13/2003 10:28:10 AM
#9 had lots of decay under the old PJC. I did not want to wind up doing the RCT through the Empress as has happened before with these types of situations (old, leaky crown). I originally stated that this was a PFM, in looking at the radiographs it is a PJC. The gingival irritation was from the poor fit not from a metal allergy. Windmill, thanks for making me take a new look at it.
drnaz 8/13/2003 2:35:14 PM
You did a wonderful service for this patient. Great Job! Did you use any type of luscent post in the tooth, I couldn’t quite tell from the PA?
jrtmolar 8/13/2003 7:55:47 PM
Do you guys ever worry about these RCT teeth discoloring over time and showing through the pressed ceramic?
arturo5203 8/14/2003 6:06:38 AM
I did not use a post at all. I used a composite core build-up into the access. IMO, there was enough tooth structure left to hold a core and not use a post. From what I know of the mechanism of discoloration it is likely to happen if there is traumatic injury and/or incomplete instrumentation. There was no physical trauma to this tooth, vital pulp, and I think I instrumented adequately. But, no guarantees. There was however a dark stump which was masked out with a more opaque ingot. Also, I did a laser gingivectomy at the time of the prep and then ditched the facial of the tooth to eliminate the dark facial margin and help prevent cyanotic looking gingiva. This was a great microscope case in the sense that I used the microscope from beginning to end. I don’t think that I would have been able to get as good a result without it.
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