Can YOU spot the crown?

Here is an interesting case you will like. So first up a question... which tooth is a crown? 

We've shown this case many times during presentations and lectures and most people can correctly identify the Upper Right Central as a crown - it has that slightly brighter and more opaque look to it and lacks an element of vitality.

This aesthetic effect is common with porcelain fused to metal crowns and is caused by the inability for the restoration to allow light to pass through, as it does with a natural tooth.

Even if the shade of the restoration is perfect and the shape, contour and morphology are great this 'bright' effect is often difficult... no, let's say often impossible, to overcome.

OK, so here is the truth about this case.... both centrals are crowns, except one has a root treated tooth with gold post and core.

When we started this case we didn't know that the Upper Right Central had this underlying core, so we didn't take this in to account when making the 2 metal free crowns.

So, the 2 crowns are made together, the same shade and same morphology, yet one looks bright... all caused by the root treated tooth underneath.

What lessons should be learnt?

1. Dentists - Always tell the laboratory the condition of the underlying tooth with metal free crowns
2. Technicians - If the dentists doesn't tell you what the underlying tooth condition is, ask!
3. Dentists - Translucent Metal free is not the be all and end all. So be case selective about the material used.
4. Technicians - have a variety of restorations available with a variety of opacity levels, this way you can inform the dentist as to the best restoration for each individual case
5. Dentists - Send photos of preps, this gives the technician the best chance of choosing the best restoration
6. Dentists - prescribe a crown if necessary, but tell the technician the clinical situation around which you need to fit it. Tell the technician the requirements for strength, bonding technique and what the underlying tooth is... then let your technician inform you as to the best restoration
7. Technicians - Keep up to date with restoration options, know the issues facing a dentist and be prepared to offer an alternative if you feel the prescription may be less than perfect.

 To discuss restoration options for your patient, please call Keith on 01707 663293 for a friendly chat.