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Esthetic
Restorations—
When Cost Is a Factor
The
Clinician is sometimes faced with the dilemma of creating an esthetic
and functional restoration for patients who cannot afford optimal
dentistry.
One
such patient, Figure 1, asked to have his upper right peg lateral
incisor corrected. Full coverage with either a porcelain jacket
crown or a porcelain fused to gold crown was not feasible for
financial reasons, so an alternative method was devised to provide
esthetics with moderate functional capabilities.
TECHNIQUE
An
acid-etch type composite material was used in this procedure.*
The preparation of the tooth consisted of cutting a chamfer below
the gingival margin and also roughening the enamel slightly over
the entire tooth. Since the margin is below the gingiva, this
allows an optimal caries-free environment at the interface between
the material and the tooth.
Contrary
to the manufacturer's instructions, the acid was applied to the
entire enamel surface twice to afford greater etching. The material
was mixed and placed in a clear plastic crown form and seated
slightly past the chamfer.
It
was allowed to set an extra two minutes, due to the bulk of the
material, before the crown form was cut off.
The
restoration was then shaped and finished. For assurance against
fracture of the incisal edge, 1mm of material was left over the
incisal edge of the prepared tooth, Figure 2.
The
patient has been instructed to avoid incision of hard food with
this anterior tooth and avoid stain-producing foods. The restoration
has been in the mouth more than ten months with no signs of deterioration
or decay.
*Restodent,
Lee Pharmaceuticals, S. El Monte, California.
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