Doc, Can you fix my front dark tooth?

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4 years ago a 60 year old woman presented to my practice with a chief concern that she has hated her front tooth (#8) for years and has never felt comfortable taking pictures as she was very conscious of her dark tooth

Discolored #8

.

She had gone through internal bleaching a couple times and it still was very dark. When treating teeth for esthetic reasons I have found that it is very important to set expectations so I went through my normal questionaire process of what else was bothering her about her smile. I asked her if she was concerned about the severely rotated central incisors. She was not concerned about the rotation and only wanted to focus on matching tooth #8 to tooth #9.

Incisal view showing the rotated centrals

Once expectations were established it was a pretty simple case with Biogeneric Copy as I was able to copy the exact shape, position and rotation of the pre- existing condition. I believe choosing to design it with any other design method it would have been extremely difficult to replicate the pre-existing orientation of tooth #8.

Biocopy Scan to copy the existing shape and rotation.

 

Facial view of design proposal from Biocopy scan

 

Incisal view of design proposal from Biocopy scan

As far as the dark stump was concerned , I managed that by layering some opaque composite over the facial surface ( today I would use Pink opaquer from Cosmodent).

Discolored stump after prepping.

 

Composite layered to mask stump.

I chose Emax LT as my material of choice as this is a tailor made situation for it. With the right amount of facial thickness of the restorative material the low translucency does not allow the dark stump to shine through.
The patient was extremely happy with the final result and below is a 4 year Recall of this case.

 

4 year post of #8 Emax LT crown

 

Thank you and Keep CERECing.

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