A cases of aesthethic makeover (III) with full porcelain crowns – Closing Gaps

February 25, 2014 by Dr. Ng HW

A young lady came to our clinic wanted all the gaps between her front teeth to be closed. She stopped her braces treatment about a year ago (due to studying oversea) leaving all her front teeth moving by themselves creating gaps and misalignment..

After examination and assessment of her teeth, we came out with a few treatment plans:

Restart orthodontic treatment /braces again (Require time)
Resin composite veneer or full porcelain veneer on right lateral and central incisor only (Imbalance of the width for the front central incisors)
Crown all the front teeth.

After discussed with her, we finally decided to have her upper four incisors crowned and resin composite on both of her upper canine to reduce the distance between the canines to accommodate the incisors.

Possible problems/risks for crowding the teeth:

The front teeth will look sightly bigger
Possible of devitalizing the teeth during preparation of teeth ending up needed root canal treatment.

How do we do it?…

1) Model planning

We executed our plan on a study model. We used wax to modify the teeth and close the gaps.

The final outcome was shown to the patient. After she agreed, we began to prepare the front teeth for crowning.

2) Shade selection

Before preparation for crown, the colour/shade were taken. To be as natural as possible, the colour of the crowns must be almost similar to the colour of the adjacent teeth.

3) Teeth preparation

After the teeth were anesthetized, resin composite was added to the side of both canine to increase their width. The front teeth were made smaller (pic above) by grinding them. Later, the teeth were checked if there was enough reduction for crown later (pic below).

4) Impression taking

A duplication of the teeth were taken and was sent to the lab technician for porcelain crowns fabrication.

5) Temporary bridge fabrication

A temporary bridge was made onto the prepared teeth base on the model planing. With this, the patient can really appreciate the final outcome of the crowns. She was allowed to go back home with the temporary bridge.

6) Full porcelain crowns back from Lab Technician

10 days later, the crowns finally came back to be fit into patient’s mouth. The fitting and margin were check on the model before patient come.

7) Cementation of full porcelain crown

Patient came back for fitting and cementation of the crowns. After been anesthetized, the temporary bridge in the mouth was removed, and the teeth were cleaned with a scaler. Fitting, biting and colour of the crowns were all checked. And the patient was allowed to see the crowns in the mouth for the first time!! After she was satisfied with the shape and colour of the crowns, they are cemented with virolink II cement – coloured resin cement!! Final Result (pic below)!!