History of present complaints (HPC): Discoloured, eroded & fractured unaesthetic anterior teeth; Aesthetically disturbing smile line.
Clinical presentations: 1. Discoloured fractured unaesthetic anterior teeth; 2. Attrition & Erosion, 3. Deflective lateral group function.
Specialist treatment schedule: 1) Full mouth hygienist & Air-flow treatment & stable periodontal health; 2) Combined home-office teeth whitening with Carbamide peroxide; 3) Restoration of canine rise/guidance; 4) Restoration of all teeth surfaces with erosion & attrition; 5) Provisional labial restorations for 2 months to achieve & establish anatomic biologic width & smile design; 6) New aesthetic natural laminate porcelain veneers 12- 11 – 21 – 22
History of the present complaint: Aesthetically disturbing severely discoloured tooth UR1.
Radiographic examination: 11 Apicectomy, 11 & 21 apical root resorption.
Differential diagnosis of tooth discolouration: Intra/extracoronal amalgam- & intracoronal GP- induced discolouration.
Clinical intervention: External in-office bleaching technique as a supplement to the walking bleaching technique was repeated under the first 2 visits
Scientific evidence: The evidence from the literature suggest that the management of discoloured endodontically treated teeth by means of combined intracoronal bleaching technique bleaching is a valid treatment modality in terms of safety, efficacy, time efficiency and aesthetic outcome (Goldstein et al 1989, Amato et al. 2006). The result from the 16-year prospective study by Amato et al. (2006) also demonstrated the chromatic stability of nonvital discoloured teeth, when subjected to the combined intracoronal bleaching technique. The clinical outcome has vastly improved the poor appearance of the upper right central incisor. Further follow-up of chromatic stability and shade recording is required.
Extrinsic dental discolouration: External teeth discolouration caused by age, beverages (e.g. red wine).
Intrinsic dental discolouration: Internal teeth discolouration caused by amalgam fillings and chronic decays.
Office teeth-whitening: Pre-operative Shade recording: shade guide/ Vita Classic Lumin Vacum: A3.5/A3. Office teeth-whitening gel & plasma arch light (Optident; Carbamide peroxide CP 15% x 2. Post-operative Shade recording: shade guide/ Vita Classic Lumin Vacum: A3. Chromatic stabilisation & effusion of the free oxygen radicals; 3 weeks (Lim KC. 2004)
Restorative treatment: Provision of a new E.max-ceramic crown UR1.
History of present complaints (HPC): Discoloured, shortened, fractured unaesthetic anterior teeth; collapsed bite.
Diagnosis: Restorative failures; fractured incisal tips; compromised canine guidance/protection.
Treatment: 1. Restoration of canine rise/guidance 2. Home teeth whitening 16% Carbamide peroxide 3. Posterior composite restorations 4. Provision of aesthetic E-Max laminate veneers 12 . 11 . 21 . 22.
History of present complaints (HPC): Discoloured fractured unaesthetic anterior teeth; black cervical stains.
Diagnosis: Restorative failures; fractured incisal tips; compromised canine guidance/protection; arrested cervical caries.
Treatment: 1. Restoration of canine rise/guidance 2. Home teeth whitening 15% Carbamide peroxide 3. Composite restorations 4. Provision of aesthetic E-Max laminate veneers 12 . 11 . 21. 22.