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‘Chairside Live’ Case of the Week: Replacing Worn Direct Composite Restorations with Highly Esthetic Veneers

Justin Chi, DDS, CDT

article by Justin Chi, DDS, CDT

chairside@glidewelldental.com

In the Case of the Week for Episode 201 of “Chairside Live,” I addressed the esthetic concerns of Ryan, a CNC operator here at Glidewell Dental. Ryan explained that he suffered a traumatic bicycle accident at age 13. He turned a corner, a car clipped his back tire, and he flew over the handlebars, avulsing tooth #9 and luxating teeth #7, #8 and #10 upon impact with the pavement. By luck, a dental hygienist quickly arrived at the scene and submerged the tooth in milk. ER physicians repositioned the tooth and referred him to an oral surgeon to splint the teeth by bonding them to his existing orthodontic appliances. Ryan wore his braces in this manner for approximately six months in order to stabilize the teeth. Eight months later, he received four root canals, and the dentist placed composite restorations. He was told that these restorations would need to be redone at some point.

Indeed, upon the initial consultation, Ryan stated that his front teeth bothered him esthetically, and he noted that his gums were “always puffy.” He had recently celebrated his 30th birthday, and he wanted to restore his smile before appearing as a groomsman in his friend’s wedding. Upon evaluation, I noted that the composite was discoloring and deteriorating between the centrals. Gingival inflammation, especially around teeth #7 and #8, was caused by overhangs along the margins. The treatment plan for Ryan was to replace the old composites with Obsidian® lithium silicate ceramic veneers (Glidewell Laboratories; Newport Beach, Calif.). I chose this method because the alternative, placing composite directly on the anterior teeth, is very challenging and technique-sensitive. Composite tends to discolor with age and may deteriorate more quickly over time. Obsidian veneers have superior strength and esthetic properties, and produce very predictable results.

Composite tends to discolor with age and may deteriorate more quickly over time. Obsidian veneers have superior strength and esthetic properties, and produce very predictable results.

Before the preparation appointment, I sent the pretreatment models to Glidewell Laboratories, where technicians designed a digital diagnostic wax-up to help us review the case and determine if there were any limitations. Once the designs were approved and finalized, BioTemps® Provisionals were fabricated.

Follow along through the case below to see how I utilized Obsidian and a minimally invasive technique to reconstruct Ryan’s smile.

Conclusion

When Ryan first visited the office, his worn restorations from an unfortunate incident 17 years ago required reevaluation and repair. Restoring with Obsidian veneers provided him with a natural appearance and confidence that he can enjoy for many years to come. With 385 MPa of flexural strength, Obsidian offers a great combination of esthetics and durability, and it’s my material of choice for esthetically demanding cases.

Chairside Magazine: Volume 12, Issue 1

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