Dimitri Kisel explores how the combination of correct shade and shape brought about a natural looking crown following a challenging implant restoration involving a right upper central incisor.
Opinions often differ: some dental technicians argue that pleasing, aesthetic results are dependent on the shape and morphology of the teeth. However, others believe that custom shade reproduction of the teeth is the key to success. To avoid an academic debate, I offer a compromise: both opinions are important.
A major challenge for all dental technicians is to fabricate a single anterior crown and define the different criteria to deliver the necessary aesthetics and function:
- Precision (incisal edge etc)
- Tooth shape (micro, macro texture and morphology)
- Tooth shade (both the basic shade of the tooth as well as the chroma characteristics).
In this article, we will focus on the determination of the shade of the teeth and their reproduction while considering the above criteria.
Case study
A 70-year-old patient presented to the dental practice with a chief complaint regarding their UR1.Clinical examination determined that the tooth was not viable for restoration. As a result, removal of the tooth was recommended.
Treatment options were then discussed with the patient in the presence of the clinical and technical team involved in the resolution of the case. A decision was made to restore the area with an implant and zirconia crown.
The superstructure would be a hybrid abutment (with a zirconia crown cemented on a titanium base). The material recommended for the two-part framework was zirconium oxide using a layered technique. We used an individual abutment as it allowed for a more natural emergence profile.
Hybrid footprint/model/abutment
After insertion and osseointegration of the implant, impressions were taken and models were fabricated.
The upper model was then scanned, and an individual abutment was designed (Figure 1*). In this case, the abutment was designed with the 3shape CAD software.
The computer-aided implant structure was milled with an in-house milling machine from multi-layered zirconium oxide and, by means of a universal composite extraoral composite, it was bonded to the titanium base in the laboratory.
*To read the rest of this article, view the photographs and gain CPD, visit cpd.dentistry.co.uk/courses/creating-a-natural-looking-crown
