Prosthetics with e.max crowns and veneers (lithium disilicate ceramic)

Prosthetics with e.max crowns and veneers

A patient came to our clinic with a complaint about an aesthetic defect of her teeth. She was unhappy with the shape, size, position and colour of the upper anterior teeth.

On examination, the dentist found that teeth 1.2, 1.1, 2.1 and 2.2 had been restored with zirconium dioxide crowns; the posterior teeth 3.6, 3.7, 4.6, 4.7, 1.6, 1.7, 2.6 and 2.7 had ceramic onlays; and tooth 4.2 had a vestibular tilt. The patient immediately declined orthodontic alignment of tooth 4.2 because of the long treatment time involved.

According to the patient, the ideal solution would be full prosthetic restoration with dental crowns. The dentist also performed X-ray diagnostics. The teeth were in good condition; only teeth 1.2, 1.1 and 2.1 required endodontic retreatment before prosthetics.

The dentist proposed the following treatment plan:

Endodontic retreatment of teeth 1.2, 1.1 and 2.1
Depulpation of tooth 4.2 before prosthetics, as it requires significant preparation
Restore not only with crowns but also with veneers on the teeth where the maximum amount of tooth tissue can be preserved
Carry out the prosthetic work using a mock-up model
Use e.max glass-ceramic (lithium disilicate press ceramic) for the restorations

        STAGE 1
        
Patient consultationThe dentist examined the patient, reviewed the X-ray images and drew up a treatment plan. Once the plan was approved, professional oral hygiene was performed straight away as a mandatory step before treatment.

        STAGE 2
        
Endodontic treatmentThe endodontist removed the crowns from the three upper teeth, opened them up, cleaned the root canals and filled them. At the next visit, tooth 4.2 was prepared for prosthetics by depulpation.

        STAGE 3
        
Scanning and mock-up modellingImmediately after the endodontic treatment the prosthodontist scanned the jaws and designed and produced a mock-up of the future teeth. The next day this mock-up was transferred into the patient’s mouth.

        STAGE 4
        
Temporary prostheticsThe patient wore the mock-up for half a week with no complaints, only asking to make the front teeth slightly larger. The dentist took this into account before the temporary prosthetics. The teeth were prepared under local anaesthesia, impressions of the prepared teeth were taken, temporary crowns were fixed, and the patient was sent to rest.