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Lower anterior teeth crowns or veneers ?

Lower anterior teeth crowns or veneers ?


Lower anterior teeth , crowns or veneers? 

By: Dr. Kamsiah BDS, MDSc

 

 

Lower anterior teeth are rather small and narrow. Crowding may over preparation of the teeth which can ends up with root canal treatment and more treatment. 

These teeth appear to be  relatively sound teeth that are mildly discoloured, slightly mal positioned, spaced, mottled, show obvious stained enamel cracks, have mild-to-moderate caries on the facial and proximal surfaces, are short in length, or are in other ways unsightly.

Selecting crowns or veneers for treatment

Some important clinical characteristics relative to this decision is intact lingual surfaces . 

If the lingual surfaces are worn through to dentin or carious, veneers are not indicated, and crowns should be placed. Lingual surfaces should be intact for veneers . 

If there’s lack of enamel on facial surface of teeth, it would be difficult to etch the enamel properly . Enamel provides the most adequate retention of veneers. Occasionally, teeth have either very thin enamel developmentally, or the enamel has eroded or worn off . When the facial surface is more than 50% dentin, crowns are a better treatment choice. 

Mandibular anterior teeth often have minimal enamel, making long-term attachment of veneers questionable. Veneers require enamel for optimum retention. 

However in this case , we still have considerable amount of enamel because they were minimally prepared . 

Significant caries and tooth breakdown above the cervical margin indicated that the best decision for these six maxillary anterior teeth was lithium disilicate crowns.

Matching the color of veneers and crowns

This task should be strongly considered during treatment planning. If several adjacent teeth in a treatment plan require crowns and some adjacent teeth could have veneers, color matching can be difficult. 

If all of the veneers and crowns are made of lithium disilicate or similar materials, the challenge is reduced. If aesthetic requirements are high, a better result will be achieved by placing crowns on all of the teeth involved in spite of the more radical removal of enamel required for the less needy teeth. 

Treating one tooth or multiples.

Every dentist knows the difficulty of matching the color of one tooth in relation to the adjacent teeth. Crowns block the tooth stump color, while with a few exceptions, veneers take on some of the color of the tooth stump. The final color of a veneer is related to the remaining tooth structure, the cement used, and the color of the ceramic. This combination of three colors makes matching one veneer to adjacent teeth very difficult. Even though matching one crown to surrounding teeth is difficult, in my opinion, matching one veneer to surrounding teeth is more difficult. However we didn’t face this problem with the six veneers . 

Difficulty of placing veneers vs. crowns-Most clinicians agree that the veneer procedure is more difficult than the crown procedure. Prepping teeth for veneers is usually quite simple, but seating them requires meticulous attention for proper positioning and color, as well as avoiding breaking the veneers during cementation. With experience and repetition, veneer placement becomes relatively easy and predictable, and the results can be excellent.

Material type for veneers.

Currently, lithium disilicate is the most popular material for ceramic veneers.  Fabrication of veneers using lithium disilicate is a relatively easy task for laboratory technicians, and the esthetic and strength are excellent. 

Advantages of ceramic veneers when indicated

In mature adults, the teeth have usually stabilized in positions that are related to occlusal contacts, muscle and tongue activity, chewing habits, and presence of any peculiar oral habits. When veneers are placed on the stable teeth, there is minimal post-treatment tooth movement or occlusal change. Every dentist has seen significant tooth movement that occurs for several weeks after crowns are placed.

Veneers, where indicated and properly accomplished, technically have near-optimum esthetic appearance for many years .

This case 

Although these six anterior teeth had significant facial caries and discoloration and required facial and proximal reduction, they had intact lingual surfaces. Veneers instead of crowns were planned for the patient.

The six anterior ceramic veneers on the teeth will served this patient well for several years to come.

Summary

Ceramic veneers are fantastic restorations for this sort of a case.  Making the decision concerning which is best for specific patients requires consideration of the numerous clinical characteristics . The materials and techniques available today for either type of restoration are the best in the history of dentistry. With proper placement, either restorative procedure will provide many years of service for patients.

PORCELAIN DENTAL VENEERS

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All-on-4 Dental Implants with Computer Guided Surgery and Digital Smile Design

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Whom Do I Trust to Do my own Porcelain Veneers?

 

My patients often ask me who usually treats my teeth.  Since I was born with a good set of teeth, I hardly see any dentist. However, I had a few mandatory dental treatments as Continue reading “Whom Do I Trust to Do my own Porcelain Veneers?”

MAJALAHWM.COM : Datin Dr. Kamsiah G. Haider Pakar Pergigian Kosmetik & Digital Smile Design

I was created to create a beautiful smile.”

Saya menemui seorang doktor pergigian kosmetik yang tidak boleh duduk diam, beliau tidak berhenti belajar dan mempelajari teknik-teknik terbaru Continue reading “MAJALAHWM.COM : Datin Dr. Kamsiah G. Haider Pakar Pergigian Kosmetik & Digital Smile Design”

DSD Official Course in Malaysia 2018. 

Dr. Kamsiah is one of the official DSD Instructors and Masters who teach the Digital Smile Design courses.

DSD Malaysia official

I would like to share my experience with Malaysian dental surgeons. In my years in practising clinical dentistry I’ve come across so many instances of patients wanting to rush the end product without a reasonable idea of what it will be. I do my best with every case and try to envision what will please dentist and patient.

From simple to complex cases — DSD is the answer

Guessing is a recipe for failure.There’s an old adage I’ve often referred to: ‘there never seems to be time to do things right, but there’s always time to re-do it’.

Now, by incorporating the digital smile design in my clinal routine,. I am able to eliminate guesswork. I can’t emphasis enough about the importance of having a ‘blueprint’ to achieve the desired result of cosmetic treatment.With digital smile design it makes so much sense .

Since attending several lectures , courses and applying the technique in all my aesthetic cases  , I finally became the first to obtain Master in DSD in Malaysia and the  first DSD Instructor in South East Asia .

Recognise the complex case, how to apply in your daily dentistry .

Precision is the hallmark of every professional dentist. The objective must be to achieve a high degree of certainty. This will also enable both the patient and the dentist to know in advance what the final outcome in advance.

When things go awry from lack of planning and from the failure to work out details before starting an actual restoration, it may shake a patient’s faith in their dentist. To some, digital smile design seems time consuming and meticulous especially in treatment planning . However this was my missing link all these years . It is the secret to having a happy patient.

The Digital Smile Design Concept (DSD) seeks to present to the world a new face of Dentistry, more human, emotional and artistic, but also more efficient and precise through digital technology, further enhancing our noble profession in society, because after all there are not many things in this life that are more important than a healthy, natural, confident and beautiful SMILE.

Overview of the course:

Complex cases are not limited to the number of units in the case. They range from single unit cases to full mouth reconstruction cases. Even straight forward cases could be complex cases. To avoid unforeseen patient and dental problems, sound treatment knowledge and treatment planning skills are essential for managing these cases. Recognizing problems beyond the dental scope and expanding your view to the entire patient is especially important for a successful treatment outcome. Participants will have the opportunity to learn how the Digital Smile Design concept helps in their daily dentistry.

Course Objectives:

At the end of the Stage I course (Introduction level), you will be better able to:

  • Learn data collection and recognize the entire view of the patient from the DSD perspective
  • Know what the data , photos , videos collections are necessary to make sound sequential treatment plan
  • Recognize the complex case
  • Recognize your own limitation and determine whether to treat or refer the patient
  • Learn how to manage complex cases

Note:

This course will be followed by two other sessions . Each session will give participants the opportunity to discuss their own complex case treatment plan with the instructor and other participants.

At the end of the Stage II course (Intermediate level), you will be better able to:

  • Recognize wise use of mock provisionals
  • Learn advanced data collection and sequential treatment planning
  • Learn how to manage complex cases
  • Lean how to work with (other) specialists

At the end of the Stage III course (Advanced level), you will be better able to:

  • Understand the role of digital technology for treatment planning
  • Assess the risk of treating advanced complex cases
  • Learn how to manage complex cases
  • Lean how to work with (other) specialists

Teaching Method: Lecture, hands-on  and case discussion

Recommended for: General dentists and specialists