Q # 4, FEBRUARY 2020, PART II

QUESTION :

A 25 YEAR OLD FEMALE PRESENTED TO YOU WITH COMPLAINT OF UNASTHETIC AND UNREAL LOOKING
ANTERIOR VENEERS .SHE HAD A HISTORY OF TRAUMA 2 YEARS AGO WHICH RESULTED IN YELLOWISH
DISCOLOURATION OF THE UPPER CENTRAL INCISORS A FEW MONTHS LATER .ON EXAMINATION YOU
FOUND THAT HER DENTIST HAS MASKED THE DISCOLOURATION WITH OPAQUE INDIRECT COMPOSITE
VENEERS ,HOWEVER THE PATIENT WAS DISSATISFIED WITH THE ASTHETIC RESULT AND BEING A NEWS
CASTER SHE WAS VERY PARTICULAR ABOUT HER APPEARANCE .

A ) WHAT FACTOR DID THE PREVIOUS DENTIST FAIL TO CONSIDER WHILE RESTORING THESE TEETH
WHICH RESULTED IN PATIENT DISSATISFACTION AND WHY IS IT IMPORTANT ?

B ) HOW WILL YOU RESTORE THESE TEETH SO AS TO SATISFY THE ASTHETIC DEMANDS OF THIS
PATIENT ?

A)

 When planning aesthetic restorative procedures, a detailed preoperative assessment is

essential to allow accurate diagnosis of functional and aesthetic features and to determine
which areas may be improved using direct restorative techniques.
 This is where the concept of layering composite resins of varying opacities, hue, chroma
and value can begin to mimic the layers contained within the natural tooth.

OTHER ASPECTS THAT SHOULD BE CONSIDERED INCLUDE:

1. Tooth shape (morphology);

2. Proportions of individual teeth;
3. Relationships of tooth sizes;
4. Primary surface texture features, eg line angles and transition lines;
5. Secondary surface texture features, eg developmental lobes/grooves, mamelons;
6. Tertiary surface texture features, eg perikymata, craze lines
7. Hue (basic tooth colour);
8. Chroma (saturation/intensity of hue);
9. Value (brightness/amount of light reflected from tooth surface;
10. Translucency/opacity;Incisal effects, eg translucency, opalescence;
11. Dentinal morphology;
12. Relative thicknesses of enamel and dentine layers;
13. Interproximal contacts;
14. Embrasure forms;
15. Soft tissue factors;
16. Material selection;
17. Placement techniques;
18. Shaping, finishing, polishing requirements.
B)

 Emax veneers ideal treatment

 Veneer crowns second option
 For single-unit restorations, lithium-disilicate glass ceramic is the material of choice for
many dental practitioners because of its good mechanical strength , excellent aesthetic
properties and its versatility.
 It can be used in monolithic form, when maximum strength is required (eg for increasing
vertical dimension of occlusion or posterior crowns),
 or in a layered form (pressed LS2 coping with additional veneering ceramic) when
aesthetics is of utmost importance. Single-unit LS2- crowns demonstrate an excellent
longevity for anterior

REFRENCE
DU MAY 2018
The Ultimate Aesthetic Challenge in Dentistry: A Single Crown on a Maxillary
Central Incisor
DU APRIL 2019
Restoration of Anterior Teeth using Polychromatic Layering Techniques