Fine Art Ceramics

Replacement of a fractured porcelain jacket crown using an aesthetic 3M(TM) ESPE(TM) Lava(TM) Crown

Case History

The patient, a 62 year old male complained of a sharp edge following fracture of the palatal aspect of an existing porcelain jacket crown (PJC) on the upper right central incisor (UR1).

After discussion with the patient, a decision was made to replace the crown with a 3M™ ESPE™ Lava™ Crown due to its superior strength and aesthetics. The existing PJC was found to be mono-chromatic and lacking vitality next to the upper left central incisor which had a complex surface anatomy.

This case follows the clinical procedure undertaken to restore the tooth both functionally and aesthetically.

 

 

 

 

 

 

 

 

Pre-Operative Assessment

The UR1 had been previously root filled 10 years earlier and restored with a separate post/core crown. Radiographically the root filling was satisfactory with a long and well placed post. The patient was advised of the risk of root fracture if removal of the post/core was attempted and it was agreed that the new restoration was to be placed on the existing post/core.

The remaining dentition was sound and oral hygiene good. The periodontal condition around the existing crown was excellent with a favourable occlusion.

Shade Selection

The shade was chosen using the Vita 3D shade guide prior to commencement of treatment to avoid the natural change in tooth shade following washing and drying.

Shade taking was complicated by the presence of surface enamel cracks and morphology on the UL1. After discussion with the patient, a decision was made to attempt to recreate the surface features of the UL1 in the new crown.

Due to the complex nature of the UL1, the laboratory prescription also required a digital photograph to supplement the written instructions. Conventional colour photography proved to be ineffective in highlighting the exact anatomy of the UL1 to which the crown was to be matched. Using the 3M™ ESPE™ Freelight 2™ to trans-illuminate the tooth, all surgery lights were switched off and a black and white digital photograph was taken which proved very effective in conveying the fracture line size and location to the technician.

Shade 2M2 was selected and specification drawn onto the written prescription.

 

 

 

 

 

 

 

Tooth Preparation

After application of local anaesthetic, a 501 crown preparation diamond was used to cut a vertical groove through the existing PJC. A flat plastic instrument was then inserted into the groove and twisted gently to separate the crown which was removed without trauma to the gingival tissue.

The existing post/core was left undamaged and conventional preparation of the tooth completed leaving a chamfered margin.

Black silk suture was used to initially retract the gingivae which was then followed by conventional retraction cord. Astringent was not required.

 

 

 

 

 

 

 

Impression Technique

A two-stage putty wash technique was employed to take the impression of the preparation. 3M™ ESPE™ Penta Express 2™ putty was dispensed into an upper stainless steel size 3 Rimlock tray. A thin piece of polythene sheet was cut to shape and placed over the tray prior to seating the tray in the mouth. The polythene sheet acts as a separator and spacer to form a custom special tray within the Rimlock tray.

Once the putty had set, the impression was filled with a light body silicone and re-seated in the mouth using gentle pressure.

A lower opposing impression was taken in alginate.

Provisional Restoration

Using a preoperative A- Silicone mould of the original tooth, Supreme XT was chosen to provisionalise the restoration due to its superior aesthetics. The corresponding dentine, body and enamel shades were selected using the supreme shade wheel and the tooth temporised. The occlusion was checked and restoration polished. A follow-up appointment was made for the crown fit ten days later. Fine Art Ceramics (Market Bosworth) was chosen to carry out the laboratory work.

 

 

 

 

 

 

 

Crown Fit

The patient was recalled 10 days after preparation to fit the crown. The supreme provisional was removed using the same method as the original PJC. The crown was tried in and check for marginal fit, occlusion, aesthetics and colour match.

Using the trans-illuminated photograph, the technician was able to recreate the fracture lines and incisal chipping. The patient was happy with the final appearance.

The inner aspect of the crown was sand-blasted using Co-jet and cemented using Rely-X.

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Testimonials

Why should you use Fine Art Ceramics?

Just a short note to thank you for the labwork you have provided for my Mother. The quality of both the crown and bridge is superb. The shades are a perfect match, and they look really natural when compared to the adjacent teeth. The occlusion was absolutely fine, and my Mother is really pleased with the result as well.

Oasis Dental Care, Nuneaton 02 July 2009

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