Journal of Applied Dental and Medical Sciences

NLM ID: 101671413 ISSN:2454-2288

Volume 5 Issue 1 January-March 2019
Case Report

Aesthetic management of discoloured anterior teeth with zirconia: A case report

Preeti Budhwar1 , Reeta Yadav2 , P Laxman Rao3
1
Post-graduate Student, Department Of Prosthodontics, Army College of Dental Sciences Secunderabad, India
2
Post graduate student, Department Of Prosthodontics, Army College of Dental Sciences Secunderabad, India
3
Head of department Of Prosthodontics, Army College of Dental Sciences Secunderabad, India

ARTICLE INFO ABSTRACT

Introduction: The aim of this paper is to present a case with a discoloured anterior teeth with spacing and
functional application of zirconia based crowns for a smile make over.
Case presentation: A 24 year old male patient reported to department of prosthodontics with a
discoloration and spacing in upper front teeth region and desired for an esthetic smile with white teeth.
After complete examination zirconia based crowns have been considered as a valid management option to
solve aesthetic and functional problems in the upper aesthetic zone.
Discussion: Smile rejuvenation can positively impact a patient's self-esteem and emotional health through
an improved appearance. This era of development and technology led to creation of different biomaterials.
zirconia- based ceramic crowns offer a good esthetic result with minimum tooth preparation combining
Keywords: strength and could be considered as a treatment option in selected clinical cases.
Zirconia crowns , aesthetics, fluorosis
,bleaching, glass ionomer cement

INTRODUCTION treatment option in selected clinical cases3. Additional

Tooth discolorations are associated with many clinical advantages are the esthetic characteristics, the
and esthetical challenges. They can have an impact on a biocompatibility and durability. They also show
person’s self-image and self-confidence in today’s increased abrasion resistance, color and contour stability,
society. The options and advances in esthetic dentistry to appropriate translucency and excellent tissue response
mask tooth discoloration and rehabilitation of an due to minimal plaque accumulation.
unaesthetic smile are increasing day by day. Decision
making is the fundamental aspect of clinical dentistry. CASE REPORT
For many years, the most predictable and durable A 24-year healthy male patient presented for restoring
aesthetic restoration of discoloured anterior teeth has his upper front teeth at the Department of prosthodontics,
been achieved with bleaching procedures. This approach Crown & Bridge, Aesthetic Dentistry and Implantology.
is not effective for all forms of discoloration and result He complained about discoloration and spacing in upper
aren’t permanent. Other procedure have been advocated front teeth region and desired for an esthetic smile with
e.g. metal ceramic full crowns, ceramic veneers, zirconia white teeth.
based system. Zirconia - based ceramic crowns offer a Complete history of the patient along with preoperative
good esthetic result with minimum tooth preparation photographs was taken. The patient's medical and family
combining strength and could be considered as a history was noncontributory. Intra oral examination

* Corresponding author: Dr. Preeti Budhwar, Post-graduate Student, Department Of Prosthodontics, Army College of Dental Sciences Secunderabad, India
 43

showed that patient had moderate dental fluorosis and is in agreement with shillinburg1 et al 1997 and those
spacing between upper anterior teeth. concluded that full crown restoration is the most type of
Following a detailed clinical examination and careful preparation with long services calculated by years. Also
evaluation of the objective parameters of the patient’s the most common esthetic problem associated with
age, profession, smile, esthetic and functional demands porcelain veneer is the impact of the luting cement on the
and to boost his confidence towards life, it was found final shade of the veneer4.
that zirconia crowns were best suited for this condition in According to Heffernan et al., Zirconia as compared to
maxillary anterior teeth from canine to canine. other all ceramic systems has the better opaque effect7.
With zirconia, crowns offer intense strength and
PROCEDURE durability and could last a lifetime. zirconia is naturally
Prior to beginning of teeth preparation, the shade compatible to body chemistry. Minimally invasive as
selection was done using vita shade guide. The axial require less removal of your enamel, more natural tooth
reduction of approximately 1.2 to 1.5 mm and incisal structure remains intact. Also less wear on antagonists8.
reduction of 1.5 to 2.0 mm was carried out1,2. All the The latest in dental crowns, the e-Max brand is made
line angles were rounded off. A circumferential chamfer from lithium disilicate ceramic — a strong, specially
finish line was prepared for all the teeth from canine to harvested material known for its strength and aesthetic
canine. qualities9. E-max is more translucent than Zirconia. The
Impression procedures were carried out with addition translucency of E-max crowns allows in more light. This
silicon and then sent to the laboratory. Provisional creates a more lifelike crown that requires no stain.
crowns were fabricated using tooth coloured auto However, for a dark tooth underneath, this characteristic
polymerizing acrylic resin and cemented with eugenol makes Zirconia the better choice10. But Multiple-unit
free temporary cement to the patient. Final restoration lithium disilicate restorations are not advised. The 360-
was cemented in place with glass ionomer cement. 400MPa flexural strength of lithium disilicate is
relatively weak compared to the 1,000MPa flexural
DISCUSSION strength of zirconia-based restorations11.
The zirconia based restoration was considered ideal in Also Zirconia materials are so strong, they can be made
this case as the patient’s desire for quick treatment and thin- more conservative in the preparation, saving more
closure of spacing between front teeth. of patient’s’ original tooth structure. Zirconia may be as
Bleaching procedure was prohibited as it required more thin as ½ mm; the minimum thickness of e.max Lithium
sessions. The effect of bleaching on natural tooth is not Disilicate materials is 1.5 mm to 2 mm. but E-max
permanent and is somewhat unpredictable to speculate crowns can fracture at the time of try-in or during
the colour change. Seepage of bleaching agent into the adjustment of the occlusion. The most common reason
surrounding periodontal tissues can lead to gingival for the ceramic to fracture is inadequate material
irritation or severe damage6. thickness12.
Zirconia full crown was selected over labial veneers
because of their clinical longevity and survival rate, this

Journal Of Applied Dental and Medical Sciences 5(1);2019

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E. max Lithium Disilicate materials need to be etched

and bonded to place, while Zirconia can be
conventionally cemented, making the process easier.

Fig 4: Final prosthesis

CONCLUSION
Fig 1: Pre-op Picture
Zirconia-based tooth-supported crowns showed
promising clinical results restoring anterior teeth.
CAD/CAM technology in the manufacture of Zirconia
has become a reality in dental practice that demonstrates
important physical and mechanical properties of high
strength, adequate fracture toughness, biocompatibility
and esthetics outcome.

REFERENCES
1. Shilingburg HT, Hobo S. Fundamentals of fixed
Prosthodontics, rd edition, Quintessence Publishing
Co Inc., IL, 1997.
Fig 2: Pre-op Picture
2. Miyazaki T, Nakamura T, Matsumura H, Ban S,
Kobayashi T. Current status of zirconia restoration. J
Prosthodont Res. 2013; 57:236-261.
3. Rosenstiel SF, Land MF, Crispin BJ. Dental luting
agents: a review of the current literature. J Prosthet
Dent. 1999; 80:280-301.
4. Dr. Nidha Madan, Dr. Deepak Raisinghanis,
Designing a smile: A case report. International
Fig 3: Final prosthesis (zirconia crowns)
Journal of Applied Dental Sciences. 2017; 3(2):01-
04
5. Ronald W. Bailey, Bleaching of vital teeth stained
with endemic dental fluorosis. OS. O.M. & O.P.
December, 1968, 26.

Journal Of Applied Dental and Medical Sciences 5(1);2019

 45

6. Michael J.Heffernar. Relative translucency of all six

ceramic restorations, Core and vaneer materials.the
journal ofprosthetic dentistry. 2002; 88(1):10-15
7. Stober T, Bermejo JL, Rammelsberg P, Schmitter
M. Enamel wear caused by monolithic zirconia
crowns after 6 months of clinical use. J Oral Rehabil
2014; 41:314-322.
8. Qamheya AH. Lithium Disilicate Restorations:
Overview and A Case Report. J Dent & Oral Disord
2(9):1047(2016)01-04.
9. Silva NR. Thompson Comparative reliability
analyses of zirconium oxide and lithium disilicate
restorations in vitro and in vivo. J Am Dent Assoc.
2011; 142 :4S-9S.
10. Tamar Dolidze, Ilona Bitarova. The advantages and
disadvantages of Emax and zirconia crowns.
European Scientific Journal December 2016
/SPECIAL/ edition ISSN: 1857-7881.
11. Steven morgana. Prescribing a dental ceramic
material: Zirconia vs lithium-disilicate. The Saudi
dental journal 2011; 23:165-166.
12. Petricevic N, Puhar. Porcelain Veneers and Zircon-
Porcelain Crowns for the Esthetic Treatment of
Severely Discoloured Anterior Teeth. JSM Oro
Facial Surg. 2017; 2(2):1010
13. M.V.S.R. Vineet Kumar, Deepthi Gulivindala Der
Pharmacia Lettre. 2014; 6(5):198-200.

Journal Of Applied Dental and Medical Sciences 5(1);2019