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Special Issues
July/August 2019
Volume 40, Issue 1
Peer-Reviewed

Failed Crowns Open up New Possibilities for Full-Arch Rehabilitation

Apolinar Madrigal, DDS

When a 58-year-old woman presented to the author's practice she had two failed crowns, a previously identified infection, failing composites, and other esthetic concerns that needed attention. Due to the complexity of the patient's oral condition and the requirement for various types of restorations, the clinician needed the expertise of a dental laboratory that could help execute the case with flawless precision. Because of the wide variety of restorative options it offers, as well as products and services such as Trial Smile and the Additive-Reductive Template (A.R.T.®) technique, the clinician sent the case to DenMat® Laboratory (denmat.com/laboratory). For this case, the dental team relied on placement of a Hahn™ Tapered Implant (Glidewell Direct, hahnimplant.com) and a DenMat lithium-disilicate screw-retained crown on tooth No. 8; DenMat lithium-disilicate crowns on teeth Nos. 7, 9, and 10; and minimally invasive Lumineers® veneers (DenMat) on teeth Nos. 4 through 6, 11, and 12. The full-arch rehabilitation was completed with the delivery of other necessary restorative work, including removal of failing amalgams and placement of Nuance® universal composite (DenMat). DenMat's A.R.T. technique guided the clinician during the preparation of teeth Nos. 4 through 6, 11, and 12, and the use of Trial Smile simplified the temporization process.

Key Takeaways

Dental lab partner-DenMat Laboratory offers products and services, ranging from restorative solutions to instruments to final restorations, that allow clinicians to treat the most esthetically demanding patients and is an excellent partner for dental practices that demand high-quality service and beautiful lab work.

First-class service-All restorations are fabricated in the company's California headquarters, and clinicians have real-time interaction with expert dental technicians to allow for complete oversight, which is especially critical
when restoring complex cases.

Implant restorations-These are the latest product offerings from DenMat Laboratory, which continues to evolve and provide customers with complete top-to-bottom services and everyday solutions.

About the Author

Apolinar Madrigal, DDS
Private Practice
Ceres, California and León
Guanajuato, Mexico
Presenter
Dental Trinity Advanced Dental Education
Ceres, California

Fig 1. The patient presented with two debonded anterior crowns. She mentioned that her previous endodontist had said tooth No. 8 was infected past the point of being restored and required tooth extraction.

Figure 1

Fig 2. Existing crowns on teeth Nos. 9 and 10 with recurrent decay were removed using a tapered bur (847KRXC, Komet USA, kometusa.com).

Figure 2

Fig 3. Tooth No. 8 was extracted and the lesion removed. The lesion was encapsulated, signifying the infection was contained and osseointegration may occur.

Figure 3

Fig 4. The implant (Hahn Tapered Implant, Ø3.5 mm x 11.5 mm) was placed in the extraction site, with a bias toward the palate. Particulate bone and a resorbable collagen membrane (creos™ xenoprotect, Nobel Biocare, nobelbiocare.com) were placed in the remaining area.

Figure 4

Fig 5. A healing cap was placed on the implant to secure the collagen membrane, which acts as a barrier to promote bone regeneration, and to ensure an appropriate emergence profile for the final restoration.

Figure 5

Fig 6. With the use of the Additive-Reductive Template (A.R.T.) provided by DenMat, the teeth were strategically prepared for veneers using this technique’s step-by-step instructions.

Figure 6

Fig 7. With the A.R.T. technique complete, final preparation of the tooth structure was achieved. Build-ups were completed on teeth Nos. 7, 9, and 10 and an impression (SplashMax®, DenMat) captured.

Figure 7

Fig 8. Bite registration (Vanilla Bite™, DenMat) was captured, which, along with the impression, was sent to the lab with a prescription for a screw-retained crown (No. 8), single-unit lithium-disilicate crowns (Nos. 7, 9, and 10), and Lumineers (Nos. 4 through 6, 11, and 12).

Figure 8

Fig 9. The Trial Smile (DenMat), made from a previous wax-up and which is included with the A.R.T. technique, was tried in. Temporaries (Perfectemp® 10, DenMat) will remain until the implant is ready to be restored.

Figure 9

Fig 10. The teeth were prepared for delivery using Etch ’N Seal® (DenMat), Tenure® Multi-Purpose Bonding Solution (DenMat), and Tenure® S Bond Enhancer with Dab-Eze® (DenMat).

Figure 10

Fig 11. Lithium-disilicate crowns were cemented on teeth Nos. 7, 9, and 10 using Infinity® SE self-adhesive, all-purpose cement (DenMat). Excess cement was easily removed in the gel phase. Fig 12. The screw-retained implant crown was placed on tooth No. 8. Lumineers minimally invasive veneers had been placed using Ultra-Bond® Plus (DenMat) and the LumiGrip® Suction Tip (DenMat).

Figure 11

Fig 12. The screw-retained implant crown was placed on tooth No. 8. Lumineers minimally invasive veneers had been placed using Ultra-Bond® Plus (DenMat) and the LumiGrip® Suction Tip (DenMat).

Figure 12

Fig 13. With all final restorations placed, the lithium-disilicate crowns and Lumineers were light-cured in 20-second increments using the Flashlite Magna® 4.0 LED Curing Light (DenMat).

Figure 13

Fig 14. The patient was thrilled with the outcome of her case. The complexity of the case was simplified thanks to DenMat’s products, services, and expertise.

Figure 14

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