Floss Dental is first of its kind “no wait” dental clinic in Noida. Since its establishment in 2018, Floss Dental has been a leader in providing world class dental services to its patients. It has also maintained high standards of sterilization and disinfection protocols to prevent transmission of communicable diseases. Top notch treatment is a forte of this clinic. The doctors specialize in Smile Designing using a combination of LASER and Zirconia crowns which are Tooth coloured crowns with superior esthetics. Here is a case of Smile makeover with a combination of Zirconia Crowns and Laser Gingivectomy done at Floss Dental Noida:
Chief Complaint: A forty year old male patient reported to the out-patient department of Floss Dental Noida with a chief complaint of pain in upper front teeth region since 1 week. Pain was dull and intermittent in nature. Patient presented a negative history of nocturnal pain, postural pain and sensitivity.
On intraoral examination, it was observed that the pain was present in the buccal vestibule in relation to upper central incisors which aggravated on palpation. Also, Porcelain fused to metal crowns were present in relation to upper central incisors (11,21) which had an artificial and flat appearance. Also, the gingival margin with respect to 11 was far lower as compared to its neighbouring tooth, 21.
Radiographic examination with radiovisuagraphy(RVG) revealed partially filled root canals below the crowns with respect to 11 & 21.This finding suggested the obvious cause of pain being reinfection in upper central incisors in the root canal system and beyond it.
Treatment Advised: Removal of Old Crowns followed by Re- Root Canal Treatment and replacement of old crowns with new Zirconia crowns which have a natural appearance was advised for 11 & 21. Furthermore, gingivectomy with LASER was advised with respect to upper central incisors to equalise the gingival margins for a smile with superior esthetics.
Treatment Done:
On the first visit, removal of old crowns in relation to upper central incisors was performed. To start with, a putty index was recorded for fabricating temporary crowns in the clinic. Due to the prolonged infection, there was a tendency of the root canal treated teeth i.e. 11 and 21 to fracture while removal of old crowns. The old Porcelain Fused to Metal Crowns were carefully cut with high speed rotary machine to expose the underlying tooth structure. Once the crowns were removed, the exposed tooth structure was cleaned of any debris and left over cement. An access was made into the root canal system from the lingual surfaces of both the teeth to Re- Root Canal Treatment. Gutta was then removed from the root canals which were cleaned and re-shaped with rotary shaping files using endomotor. The canals were filled with an antiseptic medicament and closed with a temporary filling in the crown. The patient was recalled after 1 week for further treatment. On the second visit, complete obturation with single cone technique was performed followed by Composite filling in relation 11,21. Gingivectomy was subsequently performed with LASER on 21 and 11 to make the gingival margins equal to each other for a natural look. The tooth preparation was then modified for Zirconia crowns followed by recording the impression with putty and light body for both upper and lower arches. Natural Shade of the patient’s teeth was selected. A wax bite was also registered for establishing occlusion in the lab. Once the procedure was over, putty index recorded at the start of the appointment was used to fabricated temporary crowns in relation to 11 & 21 using protemp material which were then finished and cemented.
On the Second Visit, temporary crowns were removed from upper central incisors and coping trial for layered Zirconia Crowns was performed to check fit, shade and margins. Healing of Gingiva after gingivectomy was analysed which was as expected. Temporary crowns were cemented back and the patient was recalled for final cementation of the crowns.
On the third visit, temporary crowns were again removed and finished & polished high esthetic Layering Zirconia Crowns were tried to check for any irregularities in 11 and 12. Once the patient was satisfied, both the crowns were cemented using Dual cure resin cement for superior adhesion.
Instructions: Post crown placement instructions were given to the patient to increase the longevity of the treatment. Patient was instructed to clean the interdental area with floss or water flosser. He was also instructed to maintain proper oral hygiene.
Follow up: A Follow up visit was kept after a week to check for any problems which could be faced by the patient. On his visit, patient has gingival margins nicely approximated with margins of the Zirconia crowns. Patient was advised a follow check up along with scaling and polishing after every 6 months.
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