Symmetry and Function : Best of both worlds

I would like to share one of my post that was published in the 2017 Q1 Cerec Doctors magazine.

Edith Wharton quoted “ The desire for symmetry and balance is one of the most inveterate of human instincts.

The desire for symmetry goes to a whole new level when you are restoring a central incisor. the goal is to keep the central symmetrical in height, width, shape and look.One thing that most dentists doing adhesive dentistry would unanimously agree would be that enamel should be conserved wherever possible. The bond strengths that can be achieved with enamel has been largely documented and published.
When doing veneers in the anterior zone we try to keep our margins on enamel as much as possible for multiple reasons:
Best bond strengths on enamel leads to better longevity compared to margins on cementum.
Margins on enamel would also mean teeth not looking excessively long compared to when the margins are on cementum when a patient presents with moderate to severe recession.

Recently , I came across a case where my 90 year old female patient presented with a fractured incised edge on # 9. I apologize for the lack of the pre- op picture.
One can clearly see that the patient has generalized moderate to severe recession. My dilemma at this point was where to place my finishing line. Had I placed it at the gum line, I would have covered up the recession but in the process would have created a restoration that looked longer and would be the odd man out among the other front teeth which also demonstrated the same amount of recession. The concept of symmetry would have been violated. I had a lengthy discussion with the patient as well as her daughter and their desire was to make sure that the front teeth look symmetrical and uniform after the restoration and have a functional and long lasting restoration.

Veneer Prep keeping the finishing margin in Enamel

So I decided to keep the margin on the enamel and not encroach on the cementum. Doing this I got the best bond strengths possible and still was able to keep a uniform look amongst the from teeth. The tooth was restored with a Empress Cad Multi Block and was stained and gazed for the desired result. Given her age, the patient has no desire to have soft tissue grafting done. But following this approach on a patient who is motivated to have grafting done, the option still remains open. I hope this technique helps you when you are doing your next veneer on a tooth with recession.
Keep Cerecing

Final post op picture. The margin blended really well and the symmetry was maintained.



About the Author:

Dr. Dhaval Patel has been practicing in Roseville, CA since 2006. He started using CEREC in 2008 and has quickly ascended to one of the top CEREC dentists in the US. His case studies have been published in numerous dental journals. Dhaval brings a real world approach to his training and speaking. As a owner of a private practice that works with HMO, PPO, and FFS patients - he uniquely understands the challenges associated with providing high quality CEREC in an efficient manner.

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