Dyschromia, decays and malpositions of the anterior teeth are the main reasons for esthetic consultations. The objectives in dental esthetics are on the one hand to create teeth with satisfactory proportions to each other, on the other hand to establish a harmonious relationship between the teeth, the gum and the face . For the dental surgeon, recreating a smile remains a delicate test that depends on his perception, that of the patient and the technical aspect of the physical modifications desired or sought. Therefore, it is significant clinical issue and of interest of various fields of dentistry.
A 65-year-old male patient reported to the Outpatient Care Service of the Department of Prosthodontics, School of Dentistry, Abidjan, Cote d’Ivoire, West Africa, with the chief complaint of unfavorable esthetic. Clinical examination revealed the presence of loss of vestibular substances and minor malpositions of maxillary anterior teeth (Fig 1). The radiographic examination revealed nothing of particular.
Several treatment options exist in this case. All-ceramic anterior veneers are considered to be the material of choice to replace lost natural enamel due to their favorable optical and mechanical properties . However, minimally invasive veneer preparation, provisionalization, and adhesive bonding set higher demands on the skills of the operator compared with complete coverage crown preparation and conventional cementation . In addition, the malposition of the maxillary lateral incisors contra-indicates the use of veneers. Thus, All-ceramic anterior veneers were ruled out. Finally, the complete coverage crown, preparation and conventional cementation was proposed . It was on maxillary incisors, ie # 7, 8, 9 and 10.
The first step was the preparation of dental abutments. Convergence angle, occlusal reduction, and finish line depth of full-crown preparations was made. Taper values of teeth preparation are acceptable despite the preservation of vitality of the dentin-pulp complex (Fig.2). The putty-wash technique was realized (Fig. 3), then the provisional prostheses previously fabricated in the dental laboratory (Fig. 4 and 5) were seated. The following steps consisted of fitting the casting metal framework (Fig. 6) and the ceramic material sintered (Fig. 7 and 8). Finally, the cementation of the fixed prostheses followed (Fig. 9,10 and 11) to the great satisfaction of the patient.
Conclusion and Clinical Application
The fixed prosthesis is a treatment solution to minor malpositions, especially when the esthetic needs is coupled with other reasons such as coronary decay. Complete coverage crown, although more invasive, is in some case to favor over fixed partial restorations.
KEY WORDS : fixed prosthesis, esthetics, complete coverage crown.
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