Mike Skramstad I treated a patient today that I thought would be a good learning case for everyone...
This 55 year old lady came to my office with veneers that were done 3 years ago. She had them done all at the same time, but was unhappy with 3 things:
- Color discrepancy between 8 and 9
- 9 was shorter than 8
- 9 had chipped and been repaired with composite
Here is her preop photos
Our plan today (due to finances) was just to replace 8 and 9 and solve her primary concern. I talked her into doing #7 and 10 over again as well later in the year because the inclination of #10 is wrong. I also used e.max MT because her wear on the lower teeth indicated bruxism and the probably caused the chipping.
After removing the ceramic on #8 and #9 I noticed the issue with the color discrepancy. Now, since she had them done at the same time, I can only assume that they were made out of the same exact material.... so why the color discrepancy?
As you can see from the photo, #8 was prepared more for a full coverage crown (3/4) and #9 was prepared for a super conservative veneer. The problem with this is that it created a major discrepancy in porcelain thickness...which affected the overall value and translucency difference between the two teeth. This is a major lesson to be learned. We always concentrate on symmetry of the centrals, but you also have to have symmetry of the preparations to get the best results with CEREC.
So we reprepped the teeth so that the thickness of the ceramic will be the same on both...
Here are the final "new" crown just with try in pastes before final finishing and polishing. I will post the finals at the healing check appt in a couple weeks. You can see the color and translucency is now similar between the two teeth.
PREP IS KEY!
