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Emergency EMax Crown

March 15, 2014 | Posted in Cerec | Be the first one to comment

This patient presented for an emergency assessment of a fractured laterla incisor. The tooth had been previously endodontically treated (i.e. root canal) and had a large composite resin filling that encompassed all tooth surfaces. Due to the extent of these restorations, the tooth was in a highly compromised state and predisposed to fracture. (Sorry, the pre-operative photo did not save properly).

Luckily for this patient, there was enough tooth structure and healthy supporting tissues remaining to allow for a new restoration. The large amount of coronal tooth structure missing meant osseous crown lengthening was required achieve a stable crown margin that would not interfere with the biologic width (i.e. irritate the supporting tissues and bone causing chronic inflammation and premature failure of the restoration). 

Crown lengthening was achieved using the Waterlase iPlus. The bone was moved apically 1-2mm as required and the soft tissues were recontoured. There was no need to delay placing the restoration 6-8 weeks as is normally required with traditional crown lengthening, because there is minimal risk of recession following this treatment with the Waterlase.

There is a video of this process at http://basinviewdental.com/dental-videos/

To increase retention, a Fiber Lux Parapost was placed into the root canal space of the tooth. This radiograph shows the post drill inserted into the canal as a reference to guage both the width and length of the canal space. The final post was placed 5mm from the root apex. 

Once the post and resin core complex were completed, the final Cerec crown was fabricated using EMax (lithium disilicate) material. The crown was sintered in a ceramic furnace and stained to match the adjacent teeth. Two layers of glaze and polish were completed to stabilize this color.

Here is the post-operative view at two weeks following treatment.Other than minor healing still visible along the buccal margin, it is difficult to tell which tooth was restored. The disto-buccal tilt of the tooth is a product of the patient's occlusion and could not be corrected without significant alteration of the opposing lateral and canine teeth. The patient was happy to simply dupliacte the appearance of his tooth prior to the fracture. He is now going to return to have the same treatment completed for the upper left canine which currently has a large composite filling, 4 stainless steel pins and has been endodontically treated. The patient has chosen to proactively restore this tooth before it fractues

Thanks to the Cerec chairside system, the Waterlase iPlus and our Programat CS sintering furnace, this treatment was completed for this patient in a single appointment. No temporary crowns were required and there was no post-operative healing period following the minor crown lengthening. With traditional methods of treatment, this case would have taken months to complete. Crown lengthening would require 4-6 weeks of healing at a minimum while the patient wore a temporary crown. Once healing was complete, the temporary would be removed and a final impression fabricated to be sent to a dental laboratory. The temporary would be replaced and the patient would return in another 2 weeks for crown try-in. If the esthetics or fit were not acceptable, the crown would be sent back to the laboratory for adjustments while the patient wore the temporary for an additional week. In total, this could have taken 9+ weeks to complete! 

At Basinview Dental Centre, Dr. Luke Haslam was able to complete this case in 2 hours! With these technolgies, we will not only see a reduction in treatment time, but also a reduction in treatment cost. In this case, the patient did not require referral to a periodontist to have the crown lengthening completed (as would be traditionally required). There was no commercial laboratory used to fabricate the restoration so there was no third party bill to pay. The patient was resposible for the treatment time and materials only which saved this patient close to $1000.00.

To learn more about our technology, please feel free to schedule a consultation with Dr, Luke Haslam at Basinview Dental Centre.

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