Anthony Ponzio Just thought I would present a case where I had screwed up(I have plenty) earlier on in my CEREC career and I finally had a chance to make it right. Ironically, I am speaking to our dental students next month on Iatrogenic dentistry, so I have been putting the presentation together, and this case will be in it. This patient presented in early 2013 for a crown on #8 due to a "dark tooth" after some trauma he had several years earlier. He also had some old bonding on 9 but he wanted that left alone as he had it replaced multiple times before and it was now stable. I was just starting to play around with anteriors with CEREC, and obviously I had a lot to learn. I took a quick shade, decided A-2 seemed to match, and we went forward with an Empress Multi block in A-2. I still love Empress Multi for anteriors, but when I first started using it I was almost trying to force fit it into situations where maybe it wasn't appropriate. At the time, the patient was very happy as his tooth had been pretty dark and so he was happy just to have a significant change. Once I heard he was happy, I couldn't bond it in fast enough! When I saw him for a follow-up, he was still happy, but I could tell that I clearly had missed...I discussed with him trying to replace it but he didn't feel there was any reason to.
Fast forward to this week, and he is unfortunately getting divorced, which is causing him to re-assess everything. He mentioned that in pictures he noticed his tooth looked dark, and he was wondering if I would still be willing and able to replace the crown. Of course, considering I always hated his crown more than he did, I was happy to oblige...these patients are our advertisements to the world, so I would much rather have him looking as good as possible. The lessons learned here and in Scottsdale gave me a totally different way to assess the case and think about the final restoration, especially with regards to material choice and focusing on the value, texture, etc. So, we removed his existing crown, refined the preparation, and fabricated a new crown in e.max A-1 MT and bonded it in place using VarioLink Esthetic Light:
While it isn't perfect, and looking at the pictures I may need to adjust the length slightly when he comes in for a follow-up, this is obviously a much more acceptable result...hopefully this helps his confidence as he moves into the next phase of his life. I was only out a little time and the cost of materials, which is a small price to pay to be able to sleep at night knowing that I have done right by my patient. Now if I could get him to let me replace that bonding...
The real takeaway is to focus on value and texture, especially when it comes to anteriors...if you haven't taken Level 4, it is an amazing course that can really help out with these aspects. And if something isn't up to your standards, don't be afraid to make it right. We have such an advantage in being able to control the cost and the outcomes we obtain, so take advantage of it! Your patients will appreciate it, your team will have more respect for you, and you will feel better about your practice as well.
