Simple Smile Makeover Discussion - CEREC crowns 7-10

Welcome back everyone. This is Dave King DDS. I am a general dentist practicing in O'Falun and St. Charles, Missouri. I wanted to go over a quick cosmetic case with you. What I consider the bread and butter dentistry of what I like to do. Let me start out by saying I don't really consider myself a cosmetic dentist. I enjoy doing the cosmetic work but I don't feel like I have any specialized training or formal education along those lines. A quick shout out to all those general dentists who've gone through advanced training and had some significant increase in their training and abilities with cosmetic dentistry. I just haven't done any of that specifically but I certainly respect all of those that have. I'm just a general dentist. I to me is a bread and butter dental case. Let's talk about this. Generally speaking, this gentleman was in his early 20s. I mean obviously you can see he's got some pretty significant tooth decay here and all this demoralization just about everywhere. These are obviously the same pictures. Really nice guy. Stand up guy. Just hard on his luck. Down on his luck. Having a hard time making ends meet. Wanted to do something about his smile. He really couldn't eat anything with all the decay in here. It was so sensitive. Interestingly enough, he really didn't have any interproximal decay posteriorly. His interproximal decay was all anterior. We decided we're going to go ahead and do four crowns. We're just going to focus on these front four right here. See if we can get him a smile. It's a little more attractive. Then consider giving him the ability to eat normally. After we prepped his teeth, here's what the preps look like. I like to try when I can to be real conservative. You can see on the lingual that I tried to leave all of this area on the lingual so that we had that wide band of enamel as much as possible to bond to. You can see where the contact was. Perhaps I should have tried to stay a little higher, maybe a little lower, or perhaps gone all the way down to the gingival margin. But these are the preps. You can see there was a significant amount of decay in several areas. I think I used an 856-018 burr. In looking back at these cases, oftentimes I feel like perhaps I should have prepped a little less. Maybe a smaller burr. Maybe this is a little over prepped, but in the end it turned out just fine. But I think that's one of the things that maybe a lot of you feel the same way. Sometimes these preps, at least to me, sometimes my preps may turn out a little more aggressive than I originally intended. So, that being said, these are the final restoration design. This is the final design, I should say. We'll show some before and afters, but a couple of things I want to point out to you. I enjoy using the incisal variation tool, and you can see in his situation we've got some real nice depressed areas in these areas that are reflecting the light through the CEREC design. It turned out really good. I think I probably spent about 15 minutes designing this case. One of the challenges I had, as you can see here, is his gingival was pretty inflamed, so those papilla tend to get in the way of the design sometimes. So, looking at these papillas, perhaps cutting into these papillas just a little bit more, or maybe extending a little deeper so I could get more of an emergence profile, a little more control over the emergence profile, the embrasures, the gingival embrasure form. So, you can see it comes up, it's a little flat here, then it rounds out. Yeah, one thing I would have liked to do is create a little better emergence profile, but the gingival is obviously in the way. So, one of the challenges, of course, we always come across is do we try to straighten these teeth? You can see that there's a little step anterior-posterior AP from where the canine is oriented to where that lateral is. So, it was a challenge. I didn't want to make him appear to have buck teeth. I wanted the teeth to be lined up nicely, but we did end up with a little bit of a step, and you can see the embrasure here is a little bit larger than that embrasure there. But anyway, the case turned out really nicely. It turned out to be a very, it was a big step forward, a big leap forward in his cosmetics. Here are the restorations themselves. I mentioned, you know, where I placed the contact point. Ideally, perhaps I should have maybe kept that contact on natural teeth. It wouldn't have been difficult. You know, I could have marked that and then prepped around it, making more of a partial crown on the lingual surface. I didn't have much to do, but sometimes having those contact points right next to the margin can create a potential risk for a fracture in that area. So, it's a good idea when you're doing these to take stock of what the situation looks like in advance, and then really plan, treatment plan, according to the current situation. So, here is immediate post-op. I apologize, you know, once we got all the etchant and adhesive and stuff on there, his gums went totally bonkers, you know, crazy. I couldn't get him to stop bleeding. Otherwise, I certainly would have taken a better photo then. A little detritus here. Sorry, we got some, you know, this is probably from the viscostat I was using to try to settle that bleeding down, but I couldn't get it to stop bleeding, at least not within a few minutes. So, the case turned out really nicely. You know, shade-wise, these are LT blocks, and I know there's been some commentary about using a low-translucent, the more opaque blocks. Sometimes, they may not be as aesthetic as using a medium or a high-translucent anteriorly. For this case, I think it turned out really nice, but yes, I definitely, I appreciate and identify with that. I feel like, you know, a little more translucency along the inside ledge, whether it was painted translucency, you know, from the standpoint of putting some stain on there, or actual translucence of the block material. Yes, I think we could have done better there. Anyway, let's show you what the post-op is. This picture, I apologize, I haven't been able to get this guy back in, so he actually texted me a picture, and despite all my instructions for pulling his lips back and trying not to leave saliva bubbles, this is the best I could get. You can see his gums have actually recovered. The swelling that was there, probably because of the decay that was interproximal, has gone down quite a bit. You know, in the end, they turned out really nice. They are a little more opaque than his adjacent teeth. So yeah, an MT, I think, would have been great. I wouldn't necessarily have gone to an HT, but the HT would have mimicked this grayness you're seeing on his lower anterior. In the end, for him, this was a life-changing smile. He really, really appreciated it. Not that he came to tears or anything, this young man in his 20s, early 20s, but it was a solid step forward in his aesthetics. So here's a before and an after. You know, lots of decay, decalcification all over the place, full crowns, just these four. It turned out really nice, provided him a solid opportunity to get healthier and improve his aesthetics, his smile. So anyway, thank you for watching. I enjoyed making this, putting this together. I think the total elapsed time start to finish was, let's see, what was it? It was probably about two and a half hours, two, two and a half hours. We used standard Empress crowns, the LT Empress crowns. I don't think they were Emacs now that I think about it. I think we used standard Empress LTs, but it turned out great. Thanks again for watching these videos. Let me know your comments, suggestions, feedback. Please like and share if you're interested in more videos. Thank you very much and have a great day.