Single Central...What's the plan and how do you execute it?

Thomas Monahan Daniel Wilson
6 years ago

I'm sure many feel like anteriors can be a labor of love, especially handling single centrals.  I never feel like I charge enough for some of these cases.  Here's a case I completed today.  This was a college student who was heading back to school on Sunday and his family wanted me to complete his case before he headed back.  He had some trauma to #9 about 7 years ago and had it repaired by his pediatric dentist.  He also plays the clarinet competitively as well and the asymmetry between #8 and 9 was causing him some frustrations with his mouthpiece.  Because of his scholarship for music, he had zero interest in orthodontics.

So when I see cases like this, I'm trying to plan the case before I touch the tooth with a bur.  Mike, Sam and Flem really do a great job of getting you to develop a gameplan before you tackle these cases in Level 4.   Prep design, Facial reduction, core color, occlusion, block selection, characterization, etc...

As you can see, the VITA Classic Shade of A1 is close in color to the adjacent tooth #8.  I choose IPS Empress CAD Multi for this case and even though Empress to me tends to be a little brighter, I chose a B1 Multi block for this case.  I know that with less facial reduction and the goal of trying to preserve enamel, I will get a value drop on these cases.  Your facial thickness of porcelain is critical to take into account on all of these cases.  If you ignore it, you can get burned quickly, ask me how I know.

The preps look aggressive but the facial reduction is minimal 0.5-0.7mm.  I almost always break contacts and I try to have smooth, rounded margins to help allow the restorations to drop into place and have a great fit with CEREC.  This case was stained and glazed with Empress Stain and Glazes and fired on P4.  I missed the texture a little on this case and width could have been better as well.  Overall, I would call the case a success with a happy young man and family before he heads off to college.



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