It has been 15 years since this patient presented to Dr. Torbati with a missing right front tooth due to trauma. He also had a provisional composite restoration on the left front tooth that did not look good. His case perfectly represents the benefits of working with a prosthodontist who can deliver the best possible aesthetic and functional result that lasts decades.
Dr. Torbati was able to establish the correct form, function, and aesthetics and create a tooth match between both front teeth.
The real challenge wasn’t just replacing the two teeth and getting the ceramics to match. The real challenge was to preserve the beautiful soft tissue, the architecture, the scalloping, stippling, and the natural shaping of the soft tissues between the left and the right side so both sides looked natural. This is the challenge with any of our patients – creating a beautiful, natural-looking restoration.
On the right incisor, the tissue had collapsed because of the missing tooth. This first had to be built up with the help of a provisional to recreate the natural scallop of the gums before finishing the restoration. An important part of the treatment was creating the frame for the teeth, which in turn helped to make the new teeth look natural for this very young patient.
This case demonstrated the level of precision needed in helping our patients. For Keyvan, we created a wax-up, which helped to determine what the tooth should look like before we actually made the provisional. The provisional was then worn by the patient to determine if it was completely functional, and make sure he could eat and speak, and liked how it looked.
Once it was approved by the patient, the next step was to cut back the provisional in the wax form, the wax form was then converted to a coping, done with a traditional technique with a high-quality gold substructure, and then cast in the gold.
It is important when doing a cut back, to work back from the wax-up the patient approves. This allows us to apply only the ceramic needed. If we cut back too much ceramic, and don’t do a “controlled cut back”, we end up with a situation where the ceramic becomes weak and fractures. Keyvan’s restoration has lasted over 15 years because the provisional was made first, we provided a controlled cut back, just enough to create the right sized framework to provide the perfect support for the ceramic not to fracture.
If the controlled cutback technique is not used, and we under-reduce the framework, the restoration will look gray, and a lot of times will have a black-gray line around the margin. Keyvan’s restoration has no gray whatsoever, but has a beautiful shine-through and natural appearance, even though a strong metal substructure was used.
This all comes with working with a prosthodontist, who really understands all the different materials, what suits each patient, and what will be strong, aesthetic and functional, and will withstand the test of time. You can see from Keyvan’s final photos his teeth look absolutely stunning, and he was extremely satisfied.
At ArtLab Dentistry we are consistently on a daily basis providing highly aesthetic and functional care for our patients, and we hope to treat you with the level of care you deserve.
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