hello and welcome to chairside live I'm your host Megan strong thanks for joining us today
here's a look at what's going on in this episode dr. Shawn is discussing material
choices but when you need to cover that dark stump it's all about the
showdown between monolithic crowns and dark stump shades how can we mask them
let's check out her clinical battle strategy over to you dr. Mary Shawn
Thank You Megan on today's episode I would like to talk about challenges that any dentist could
face when presented with a discolored single tooth restoration in the aesthetic zone many
times after removing an old restoration from a tooth that has been previously treated and
identically we are confronted with the dark prep or a metal post this episode will compare
and contrast a metal ceramic obsidian pressed metal crown and a lithium silicate all ceramic
obsidian crown as feasible options to restore tooth number 9 this patient came to me with a
seven-year-old Oh ceramic crown on to number nine that has become noticeable when talking or smiling
during my initial examination I could tell that over time the stain has washed out enough to make
the crown stand out against the adjacent teeth a strong issue that shows up is the translucency
of the incisal edge the deep translucency and shade along with the surface texture and luster
did not match her natural contra lateral incisor looking at this photo you can also see that the
incisal edges didn't line up additionally the current radiograph shows an existing root canal
sealed with a magnum contributing to the overall low value of the existing crown as a dentist I
know that when restoring an interior single tooth aesthetics takes precedent and care must be taken
when selecting the material communication with the lab is critical as a certified dental technician I
have learned that a good photo showing information about surface texture and luster has as much
importance as the shade or value with every case you send to your lab I can't stress enough the
importance of including a free up impression or model initial photos of the existing dentition
photo of select a shade tabs and also pictures of final preps with the selected stamp shade in
my experience the success of a final restoration does not rely entirely on the selected material
itself but more so on the cap bility of the technician handling the material you will see
how crowns of two different classes of materials made by two different technicians have similar
results because proper tooth form surface texture and luster were created after pictures were taken
periodontal probings are recorded I proceed with the removal of the old restoration using
a circular burr to prevent harming the gingiva I sometimes use a tissue retractor very often when
removing bonding restoration in addition to the vertical cut I may need a supplementary horizontal
cut to be able to remove a more stubborn piece because of a dark dentin a layered porcelain over
an opaque core such as metal or zirconia could be an option however layer porcelain still seems
more likely to chip away from the layers econia or pfm crown then it does from an obsidian press
tomorrow however for a desirable outcome of an all ceramic restoration internal bleaching or opaque
application to mask the dark dentin are aspect to be addressed because the very large axis used
by the endodontist any attempt to remove this amalgam will be very risky therefore internal
bleaching didn't make sense to me literature reports relapse of a high as 50% after five years
with internal bleaching so I would be at risk if I use a translucent monolithic restoration the value
of such restorations would significantly decrease if the tooth relapses in this case since I have
a DP prep I decided to mask the dark prep with a product like pink opaque err and rebuild the
overly prepared abutment for a better retention as this will be a more predictable option when you
choose to mask an endodontic Lee dark prep a metal post or a tetracycline stained dentin in order to
avoid lowering the value of an all ceramic crown you may need to additionally prepare the tooth
in such cases more preparation may be required to provide restorative space to mask the dark stamped
coloration when utilizing OPEC masking resin this additional prepping will provide the room without
compromising the minimal material thickness of the final restoration but it could weaken the
tooth structural integrity a better option may just be to choose a metal ceramic crown after
preparing the dental surface for bonding I chose this light curing dental resin from Cosmo dent
to cover the darkest area of the dentin and this tooth was already overly prepped so after curing
the OPEC there was room for the titanium core to rebuild and form a more retentive preparation for
a long-lasting restoration now that the build-up material is cured I reshaped the prep with fine
diamonds and made sure I have sufficient clearance on the lingual here I'm using a 1.5 millimeter
thick silicon tab that my assistant will load with ink from a strip of troll foil articulation paper
if there is minimal bleeding then I can control it with a stringent then I will move on to take the
final impression using the dual core technique and anatomical comfort caps this cotton will control
moisture and provide pressure to further stop the bleeding and support the impression taking
process I use glide rails medium and heavy body capture impression material once the impression
material has set the tray was removed from the patient's mouth we can see the nice contrasting
colors between the two materials and that allows for a quick visual examination of the margins
and surface detail it is very difficult for the technician to make aesthetically pleasing
restoration if we don't provide them with good pictures of the preps and stamp shade additionally
there is a chance that the technician won't make a successful restoration if the pictures doesn't
provide surface detail of the contralateral tooth besides shade and tooth contour the surface
texture details are very important you can get away with discrepancy in value if this are done
correctly my RDA will Schmidt put the patient in temporary and asked to return in two weeks for the
delivery appointment the lab sent me to different restoration to choose from an obsidian pressed
metal crown with the labial bud margin and also a Presley TM silicate or ceramic obsidian crown
crowns were tryin here you can see the obsidian press two metal crown and here you can view them
both side by side and you can appreciate they have similar results note how two different technicians
were able to copy the surface texture the luster and the incisal edge details of the contra lateral
incisor the tooth on the top is metal ceramic with the label emerging and the one on the bottom is
all ceramic because I took the extra step to mask the dark prep I chose obsidian or ceramic as the
final restoration the prep was promised the crown was treated with IVA clean and the tooth surface
was prepared virial including cement was used for its good optical properties and continuous
fluoride release this treatment is a perfect example of how obsidian of ceramic would be a
viable option even with the dark stamp containing an existing amalgam while maintaining the desired
aesthetic outcome of the smile with just an extra touch of planning and masking utilizing opaque or
build up materials obsidian for ceramic performs beautifully and produces the end result in the
same manner due to the obsidian strength of 385 mega pascals it is similar to all other ceramic
monolithic options this material exhibits an ideal combination of aesthetics and strength
with translucency that mirrors the vitality of the natural tooth it is certainly my first choice
for single tooth anterior aesthetic whether it is monolithic or pressed to metal thank you for
watching take it away Megan thank you for that dr. Murray Shawn those are some good tips well
that about wraps it up in this episode of terrified live on behalf of everyone here
at fiber laboratory thank you for watching and I'll meet you right back here next time
you