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drawing tomorrow's smile,
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If you have worn front tooth crowns for a long time, even when there is nothing wrong with the crowns themselves,
you may be bothered by the length, width or tilt of the teeth, or how they blend with the neighboring teeth,
and start thinking about having them redone.
For the front teeth in particular, it is important to look not at a single tooth alone but at the length and width of the left and right teeth, the tooth axis, symmetry,
the gum line and so on, together.
Today we introduce, for a woman in her 40s who visited because she was concerned about the shape and alignment of her existing front tooth restorations,
a case in which we planned the shape of four front teeth together and retreated them with zirconia
crowns— this is the case we introduce here.
Table of contents
She Was Concerned About the Shape and Alignment of Her Existing Front Crowns
She is a woman in her early 40s.
She had previously had front tooth crown treatment, but she came because she was bothered by the shape and
alignment of her front teeth.
Front photo before treatment
Looking at the front teeth from the front, the axis of the existing restorations was tilted compared with the neighboring teeth, and there were also differences in the shape and width of the left and right front teeth.
One front tooth had an existing resin restoration, which also made that tooth look
relatively wider.
When we compare by marking lines on the photo, the tilt of each front tooth and the differences in shape between left and right
can be seen more easily.
Why Did We Treat Four Front Teeth Together Instead of Just the Two Existing Crowns?
One could also think of simply replacing the crowns the patient already had.
However, in front tooth prosthetic treatment, rather than looking at a single tooth alone,
we have to consider the length and width of the left and right front teeth, the tooth axis, symmetry, and the sense of connection with the neighboring teeth
together.
For this patient, we discussed an approach that adjusts not only the existing crowns but also the shape and proportions of the adjacent front teeth,
and after talking through the scope of treatment with the patient, we decided to treat
four upper front teeth together.
A wider scope of treatment is not always better.
Considering the current condition of the teeth, the existing restorations and the extent of change the patient wants,
it is important to decide the necessary scope of treatment.
X-rays before / after root canal retreatment
We Also Rechecked the Condition of the Existing Root Canal Treatment.
Before starting the prosthetic treatment, we also checked the condition of the teeth that had previously had root canal treatment.
When we evaluated the X-rays together with the clinical findings, there were teeth whose existing root canal treatment needed to be checked again,
so we carried out the necessary root canal treatment on those teeth
and then continued with the prosthetic treatment.
For the teeth that had root canal retreatment, we removed the existing root canal filling material, rechecked the length and shape of the canal, and then cleaned, disinfected and filled the canal.
After that, we moved on to the next step for the prosthetic treatment.
Computer design
Photo of the temporary teeth
After an Intraoral Scan, We Designed the Shape of the Four Front Teeth
After finishing the necessary treatment, we scanned the front teeth and the surrounding teeth with the intraoral scanner.
Based on the scanned data, we designed the shape of the four front teeth in our in-house lab.
In this process, rather than simply making the same shape as the existing crowns,
we planned a new shape considering the length and width of the front teeth, the tooth axis, left-right symmetry, and the relationship with the neighboring teeth,
and so on.
Before the Final Crowns, We Checked the Shape With Temporary Teeth
Based on the digitally designed shape, we first made temporary teeth
and checked them in the patient's mouth.
The temporary teeth were not meant to reproduce the color and translucency of the final zirconia crowns exactly,
but were used as a step to check in advance, before making the final restoration, the length, width, overall shape and alignment,
and so on.
This is because what you see in a photo or on a computer screen can feel
different from what you see in the actual mouth.
With the patient wearing the temporary teeth herself, we checked the shape,
reflected her opinions on the parts that needed it, and then proceeded to make the final restorations.
We Reflected the Shape Confirmed With the Temporary Teeth in the Final Zirconia Crowns.
Referring to the shape confirmed at the temporary stage,
made the final zirconia crowns.
Zirconia is one of the ceramic materials that can be made in a tooth color,
and in this case we used it as the material for the front tooth restorations.
Before final placement, we checked not only the shape and color of the crowns but also the contact with adjacent teeth and
the bite.
Let's Compare Before and After Treatment.
On the left is before treatment, and on the right is after treatment with the final zirconia crowns.
Before treatment, the tilt of the existing restorations and differences in the width and shape of each tooth were observed.
After treatment, as the axis, length and width of the four front teeth were planned again, we can see that the shape on both sides and
the alignment have changed.
In addition, the final crowns were made considering the color and shape of the surrounding natural teeth.
With Front Tooth Crowns, Checking the Shape Before Making the Final Restoration Is Also Important.
Front tooth prosthetic treatment is not simply a matter of matching the color of one crown.
We have to consider together the length and width of the teeth, the tooth axis and left-right symmetry, the gum line, and the harmony of color and
shape with the neighboring teeth.
In particular, when treating several front teeth at the same time, rather than making the final zirconia crowns right away, we can use temporary teeth to check the planned shape in the actual mouth and
make the necessary adjustments before making the final restorations.
This patient's course was as follows:
checking the existing front crowns and tooth shape → X-ray examination and necessary root canal treatment
→ intraoral scan → digital design of the four front teeth → checking the shape with temporary teeth
→ making and placing the final zirconia crowns
in that order.
If you are concerned about the shape or alignment of your front tooth crowns, it is important not only to replace the old crowns with new ones, but to make sure before treatment
which parts of the current restorations you want to change and how they should blend with the neighboring front teeth.
The before-and-after photos in this case were published with the patient's consent.
Treatment methods and results vary from person to person. Depending on the condition of the existing teeth and root canal treatment, the remaining tooth structure, the periodontal tissue and the bite, additional root canal treatment or other treatment may be needed. Even after crown treatment, fracture, loss, secondary decay and periodontal problems can occur, so regular checkups and care are needed.
Related cases:
Front Tooth Crown in Busan Seomyeon: Retreating an Old PFM Crown with a Zirconia Crown
Front Tooth Crown Retreatment in Busan Seomyeon: A Case With Root Canal Retreatment and Non-Vital Whitening
Front Tooth Crown in Seomyeon, Busan: A Gum Contouring Case for a Patient From Canada
Related information: Same-day crown & one-day restoration guide · General dental information is also available on the Korean Dental Association.
