Restoring a Single Central Incisor: How One Dentist Meets the ChallengeSeptember 3, 2019 by AACD Executive Office
By Hanno Venter, BDS, FICOI
Restoring a single central incisor is one of the most demanding esthetic challenges a dentist can face. The central incisors represent the focal point of the esthetic zone, and even minor asymmetries in form or shade match can lead to an esthetic failure. Additionally, as a result of patients’ esthetic expectations today, the pressure to recreate nature is high. However, with thorough planning, clinical skills, knowledge of dental materials, and collaboration with a skilled technician, practitioners can achieve a beautiful dental result in these demanding cases. In my Accreditation Essentials article titled “The Challenges of Restoring a Single Central Incisor” (JCD Winter 2019, Volume 34, Number 4), I describe the steps I take to meet this challenge in a detailed case report.
In this case, a 48-year-old female presented for treatment wishing to replace a Class IV composite restoration on tooth #9, a restoration which had already been replaced a few times previously. Patients presenting for retreatment may have established opinions based on their past treatment experiences that further challenge the clinician’s current treatment options. In this case, while composite resin was a viable option for retreatment, the patient rejected the material on the basis of past negative experiences with composite due to how previous restorations tended to discolor and wear at a different rate than the surrounding dentition (Figs 1 & 2). Instead, the patient preferred porcelain with at least full buccal coverage.
Other than some signs of incisal enamel wear, most of the tooth structure was intact and undamaged, so a minimally invasive laminate porcelain veneer that would wrap around the incisal edge was proposed. For this, IPS e.max lithium disilicate (Ivoclar Vivadent; Amherst, NY) was selected. This material selection would allow me to meet the patient’s esthetic demands due to its excellent light optical properties, which would address the flat appearance of the old composite restoration; its strength, which would address the unequal incisal wearing and chipping; and its translucency, which would provide a lifelike appearance able to blend seamlessly with the surrounding dentition.
In addition to alginate impressions, the AACD’s required 12 preoperative photographs were taken and sent to the dental technician for shade and texture communication. Digital photography is an excellent communication and diagnostic tool in determining surface texture and all the nuances present in adjacent tooth structure we see when observing a restored tooth. It also helps with relaying line angles by means of light reflection (Figs 3 & 4).
Delivering a single anterior restoration that mimics nature can be a significant challenge, but with the many diagnostic and planning tools in modern dentistry at our disposal, it has become a more predictable procedure. With the careful selection of materials, it is possible to deliver an esthetically pleasing restoration to a very satisfied patient (Figs 7-9).
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