CASE STUDY BY

Frank C. Layng, Jr., DDS, FICD Laying Senior & Associates Dentistry State College, Pennsylvania

 

DIAGNOSIS AND TREATMENT PLANNING

Suzanne is a 36-year old homemaker and mother of three boys who has a very pleasant and outgoing personality with a wide demonstrative smile. Suzanne presented with four maxillary incisors that were in various stages of disrepair ranging from a poorly fitting crown on her right lateral incisor to endodontically treated and heavily filled right and left central incisors. Suzanne's gingival architecture was somewhat uneven which further took away from a potentially wonderful smile.

Before

 

TREATMENT

Upper and lower preliminary impressions were taken and poured in stone. After removal of the old PFM on the right lateral incisor this tooth was re-prepped for a new Argen crown. Brasseler posts were placed in the right and left central incisors and core build-ups were placed over the posts with Luxacore. A small amount of tissue was removed above the left central and lateral incisors with an electrosurge tip to enhance the eveness of the gingival architecture. The right and left central incisors as well as the left lateral incisor were then prepared for Argen crowns.

After the placement of retraction cord, two master impressions were taken using light and medium body wash and heavy body putty. Following the removal of the second impression a bite registration was taken using Vanilla Bite registration. Prior to the set of this material, a straight wooden stick was incorporated into the bite material in order to provide parallelism to the pupils for the patient. This would give useful information to the technician in establishing the incisal plane. Temporaries were fabricated and cemented with NE Temrex. The patient was to return in three weeks for insertion.

The laboratory instructions included specific color-mapping scheme with a basic body shade of Vita D-2.

At the seating appointment, the four temporaries were carefully removed and the teeth cleaned. The four crowns were placed on the teeth starting from the right in order to the left. Contacts were tested with floss and found acceptable. Occlusion was then checked with no adjustments needed at all. Finally, the margins were carefully inspected with loupes and an explorer, and were found to be excellent. The patient was given a mirror for final approval. She was elated.

After proper cleansing of the teeth and the insides of the crowns, the crowns were then inserted with Panavia 21. Excess material was removed and a very happy patient was dismissed. Post treatment photos were taken 10 days later.

RESULT

Suzanne's goal of an improved smile was achieved through careful planning and attention to detail. Having a compliant patient, a technician who pays close attention to written instructions, the utilization of the very best materials and a staff who knows how to handle those materials are the main ingredients for the successful completion of the typical esthetic case.

After