Smile Makeover: 8 Hybrid Ceramic Crowns 5-12 (CeraSmart)

Good morning. Today's case is kind of a follow-up on a video I've already posted about kind of a same-day smile makeover. So here's the panoramic of this gentleman. In the other video I posted previously, the most recent video, you can see the process of the scanning and designing of these upper anterior eight crowns. So here's his preoperative panoramic x-ray. You know, you can see there's a lot going on, carious lesions everywhere. He needs some wisdom teeth out. He had some periodontal disease needed treatment for, but he opted to choose, opted and chose to focus on his upper anterior smile with some help from his dad. So here's the preoperative photos. You know, we ultimately ended up doing eight crowns starting tooth number five around tooth number 12. Here's again the pre-op, another angle preoperative there. Significant decalcification and decay wrapping around these teeth. You know, sometimes if we can, I'll do a buckle five composite that wraps into a mesial occlusal distal or something like that, but these were just way too compromised for a composite resin restoration. So I ended up doing, you know, full-on crowns with this particular situation. Turned out really, really well as you'll see here in a minute. Another view, patient's left side. You can see just significant tooth decay. Now he didn't, at least he didn't admit to having, you know, an illicit drug issue. I suspect there was something going on there, but again, I can't be sure. I don't know. Have to take him in his word. I trust him. I believe him. He did admit to having a high soda intake habit. So here is some of the sequelae that you see from drinking a lot of soda constantly all day long and a lot of carbohydrates, you know, that just feeds the bacteria that causes this type of decalcification and decay. So here is the design process again. I have indicated in a previous video, you can see the entire design process. Pretty cool stuff. You know, nothing really new to report here that you haven't been able to see in the, in the video, in the other video, which I'll hopefully link in my comments below. Here's the design process. You can see it was about a 22 minute design. And that's pretty standard for, for me, at least I've done, you know, I've been using CEREC for how many years, 13 years now. So I've got a lot of really solid experience when it comes to designing restorations. So I'm comfortable doing these more complicated ones. I think I've mentioned this in other videos, but those of you who are interested in starting on a big anterior case like this, you want to be really cautious that you don't, I would suggest your first few cases, you do it in two steps. Don't make the patient wait and don't design them in front of the patient. It just ends up leading to a really stressful situation. So here we can see, you know, kind of the ghosted design and tooth number 12 is still opaque. But these teeth were really compromised and you can see how far up gingerly they went. Really, really significantly compromised. I opted not to do any root canals or any posts. I'm not sure, to be honest, how long these will last with how compromised and how much preparation we had to do to get past the decay. I should clarify, these are not over reduced. This was intentional because I had to excavate caries. So the reason the preps are so pointy and needle-like is because of the active decay that we had to get past. So again, here's the preparation. You can see where his occlusion is right on the palatal tissue. He wanted me to try to pull those teeth back. Of course, we're limited in what we can do because the roots in one position, we can angle the crown of the tooth a little bit, but oftentimes we end up compromising things beyond that if we do too much. So his outcome turned out really, really nice. You can see no occlusion on these anteriors, just some occlusion on the canines and the premolars there. So here's his post-op. You'll notice that he's got some residual inflammation irritation. There's a little, a couple of flecks of cement you'll see here in a couple of the photos. If I were to really dig into this design here, there are some things that I would do differently. For instance, I really like the contour of this distal line angle on tooth number seven, but here on number 10, it's pretty straight. It seems to be too flared. I probably would have brought these mesial line angles here a little bit lower in hopes of getting that dark triangle to close a little better. He's got some little knobs here, some little bumps on his canines, which were proposed by the computer. And when I used the incisal variation tool, which you can see again in the other video, and you can see some of the outcome of that incisal variation here, we ended up with some, you know, a little more bump than I would like. Now you can see also that he's got really long canines, which he preferred. When we got to the design process and I walked him through it, you can see, well, he could see, and he opted to go ahead and leave those that way. Now there's plenty of space if we want to reduce those. Go back here. We have quite a bit of space to reduce if we want to on that one, maybe not so much on this guy. But I did give him the option to go ahead and adjust those shorter if he would prefer. But he was totally fine, very happy with it. Again, here's a different angle of preparation. Turned out, you know, turned out really, really nice. Again, you know, it was a case that that went well. I don't think we'll have any follow-up issues aside from routine adjustments, maybe on the canines and bicuspids. Significant decalcification still remaining in a lot of other teeth. We're going to work through that after he goes through the SRP. I did text him. I try to text all my patients that I end up doing some significant work on to see if they're doing okay. So one thing I didn't mention is this is CeraSmart. So this is a hybrid material. So that's what these look like on the x-rays. You can see a little bubble within the cement there. They're semi-opaque hybrid CeraSmart anteriors here. Again, a couple little internal cement bubbles there. And then there's the other side. So this tooth, by the way, tested normally. I think what we're seeing is that incisive canal, you know, a shadowing over that tooth. But here's the pre-op and the post-op. The lighting's a little different, I apologize. The time of day change and some of ambient light altered the exposure, the white balance. So the yellows are a little off. He did opt for this as an A1 shade. These are HT CeraSmart blocks. We used eight of the HT size 14 CeraSmart blocks. Turned out nice. He was very happy with the outcome. This case, I want to say, took us about four hours, maybe five hours. I did allow my EFTA assistant to go and bond these in. She does excellent work. She's well-trained, and if she ever runs into any issues, she'll always come and get me. But this was a great case, a great opportunity to serve this patient. You know, anytime I do a case like this, I always want to talk to the patient about making sure that they understand that what got them to here with the tooth decay will ultimately be an ongoing issue to create further issues if they don't change their habits. So they have to be invested not only in their treatment, but in their maintenance. And as most of us know with orthodontics and ongoing periodontal treatment, the maintenance phase is the most critical portion of the phase of the treatment. So he acknowledged that. He was totally on board, and we ended up, you know, getting him a really nice outcome. So thanks for watching. Again, if there's any questions that you have, feel free to, you know, comment. Send me an email directly. Let me know what I can do to help. If there are any other videos you want me to try to put together, if and when I have time, I'll certainly do my best. Thanks.