Prosthodontic Case Study 2

The patient was a 38-year-old male in good general health who presented with a chief complaint of, “I do not like my smile, and my front tooth bleeds when I brush it”. Three years prior, a porcelain-to-metal crown had been placed on tooth # 8.

Upon clinical and radiographic examination, erythematous gingiva was noted over the crown on # 8; additionally, there were a large failing class III restorations on tooth # 9 (Figure 1).

After discussion with the patient, it was decided that the existing crown would be removed and subsequently replaced with an e.max Press crown. After caries / restoration removal on # 9, an e.max Press restoration would be prescribed. Photographs and study models were also taken.

At the next visit, the patient was anesthetized and the PFM on # 8 was removed intact. It was evident that the crown had been over-contoured. Additionally, the tooth had been prepared with an aggressive taper and had a feather-edge margin (Figure 2).

The preparation on # 8 was refined to improve the retention form and to create a chamfer margin. Caries and existing restorations were removed from # 9.
A splinted bis-acryl provisional restoration was fabricated and luted with a non-eugenol provisional cement (Figure 3).

Oral hygiene and care instruction were given to the patient. The patient was seen bi-weekly to assess the condition of the gingival tissue. 

Figure 4 demonstrates the situation at 4 weeks.

After 6 weeks, the decision was made to take the final impression. A PVS impression was made and photographs were taken for shade communication with the laboratory (Figure 5).

In discussing the case with the lab, it was decided that a Low Translucency (LT) e.max Press ingot would be utilized. At the following visit, the crowns were cemented with a Resin-Modified Glass Ionomer (RMGI) cement.

Figure 6 is a ten-day follow-up photograph. 

The patient was compliant with his home care, and Figure 7 demonstrates the situation at a five-year recall.

Author: Dr. Arthur Volker, DDS, MSEd, FAGD, FACD, DWCMID
Owner, Dent-Care Dental, LLC, Sunnyside, NY, USA