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Replacing Old Veneers with Celtra Press Crowns - Lori Trost, DMD

Categories: Oral Medicine and Pathology


Date: 08-30-2021 19:09:08 pm

A 57-year-old patient presented with 18-year old veneers that were failing (Figures 1 and 2). Marginal breakdown, abfractions, and decay—particularly on the lingual aspect—were present. The treatment plan was to replace the veneers with full-coverage crowns to reduce the possibility of recurrent decay and marginal breakdown. The case called for esthetics, but also involved the selection of a ceramic material that would provide strength and resiliency for proper restorative demands.

Shade Matching and Crown Prep
Before beginning the crown preparations, a VITA shade guide (VITA North America) was used for shade matching (Figure 3). As shown, this patient had coloration fluctuations of A1 and B1. When determining which ceramic material would be used to fabricate the crowns, Celtra (Dentsply Sirona) was at the top of the list for not only the strength it provides, but also because of its chameleon esthetics.

To anesthetize the patient, 4% Septocaine (Septodont) was selected and an OptraGate facial dam (Ivoclar Vivadent) was used for retraction. The teeth were prepped using a minimum of 1 mm equigingival shoulder preparations (Figure 4). Care was taken to round all preparation angles per the laboratory and manufacturer’s guidelines. The preparations were also smoothed with fine diamonds and polished to remove any roughness and set the stage for improved impression capture. Knit-Pak retraction cord, size 0 (Premier Dental) was gently tucked into the sulcus of the tooth.

To aid the impression making, Traxodent (Premier Dental) was circumferentially syringed on top of the retraction cord/sulcus moat. After approximately 4 minutes, the retraction cord was removed and the preparations rinsed off and dried. A single step impression was made using Aquasil Ultra Heavy in the tray and Aquasil Ultra XLV Wash (Dentsply Sirona) syringed around each preparation. After the recommended 5-minute set time, the impression was removed, evaluated, and approved for lab submission.

The process of fabricating temporary crowns began. Before the preparation phase, an impression model was made of the patient’s initial presentation using an anterior tray filled with Algin-X (Dentsply Sirona). This impression served as a model for his anterior temporaries. Figure 5 shows the temporaries fabricated with Integrity Multi-Cure (Dentsply Sirona) and cemented with Integrity TempGrip (Dentsply Sirona).

Seating and Final Outcome
When the patient returned a week later for the final crowns, the temporaries were removed and each tooth preparation was cleansed with a generic chlorhexidine 0.12% scrub, with care taken to keep the dentin moist. Each Celtra crown was tried-in and slight adjustments were made interproximally.

A selective etch method was applied to the enamel of the exposed shoulder preparations using a 35% phosphoric acid for 15 seconds. The phosphoric etch was copiously rinsed for 5 seconds and a high vacuum suction was blanketed on each prep for 1 to 2 seconds, allowing each to remain moist. Prime & Bond Elect (Dentsply Sirona) was dispensed and agitated on each preparation for 20 seconds, followed by a gentle, clean air stream for 5 seconds. Each preparation was then independently light-cured for 10 seconds. Calibra Ceram (Dentsply Sirona) was expressed to an even flow and loaded into each Celtra crown (Figure 6). The crowns were seated in order of the centrals and then lateral teeth, with each receiving a tack or wave cure at the gingival margins—both facial and lingual aspects—for 5 seconds using the SmartLite Focus LED curing light (Dentsply Sirona).

The crowns were left undisturbed, and after 2 minutes, the Calibra Ceram was gently peeled off the margins using an explorer. All margins cleaned nicely without needing to use a finishing bur to remove any residual cement. All of the crowns were flossed and the occlusion was re-verified (Figure 7). The patient was dismissed and instructed to return soon for pictorial evaluation and for nightguard fabrication using Kombiplast (Denstply Sirona) (Figure 9). Both the patient and I were very happy with the results.

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