Custom abutments have been a standard of care in our practice. With superior tissue support and response, better hygiene and fewer complications it’s a no brainer the custom abutment is better than a standard stock post. Manipulation of the tissue is essential prior to making an impression and selecting the right material can make or break the final esthetic result.
Often I get asked, “Why does a crown cost so much?” I simply reply, ” Would you rather have a tooth that looks like a crown? Or a crown that looks like a tooth?”
There are many factors that can influence a crown such as: materials (all porcelain ceramic vs a porcelain metal vs gold), the laboratory technician, and the skill of the dentist.
WE PUT THE DETAILS IN DETAILS:
Our goal is not to just give you a crown, but to deliver a product that mimics nature itself and has the esthetics and beauty of a natural looking tooth! Dentistry is an art and we set the bar high for our level of satisfaction. Some places may advertise a crown the same-day, but we’re not that type of office. We want your crown to look and feel amazing so we send it out to a laboratory where a skilled certified lab technician will spend the time to carefully craft your tooth. This means adding layers of porcelain, adding translucency and character. Each tooth has multiple shades, that is why we select up to three levels of shades per tooth to make sure we get that perfect match.
STRONGER, BETTER, BEAUTY:
When it comes to materials, we do everything we do everything we can to make your tooth look like a tooth. That means using materials and products such as Emax and Atlantis for our custom abutments that have been proven by research and literature be both strong and esthetically pleasing. Lets face it, some laboratories will cut corners to save on costs and thus provide an inferior looking crown or use a weaker material that may be prone to fracturing or chipping. We want our crowns to be an improvement over what was originally there.
Note: The last tooth is a crown recently done, compared to the older crown in front. Note the characterization and detail added on the side to match the characterization of the patients natural tooth.
To achieve optimal tissue manipulation, management begins at second stage once the implants are exposed. This allows for optimal healing, particularly around a provisional implant restoration to help mold and shape the tissue early on. A provisional restoration will help create a more natural emergency profile than a typical healing cap. In addition to anterior implant restorations, tissue management in the posterior is also recommended. It allows for better hygiene around implants through the use of a custom abutment.
Provisional restorations after 2 weeks.
Gold hue custom Atlantis abutments from Dentsply were used in combination of layered Emax HT crowns.
Treatment Goals: Restore proper vertical dimension of occlusion, restore proper canine guidance, establish proper gingival contours and tissue harmony, establish a stable occlusion and improved esthetics.
Prior to treatment, an occlusal splint was used to reestablish a comfortable jaw position and occlusal relationship. A diagnostic wax up was used to fabricate a guide to aid in the laser gum surgery. Gingival heights were based on esthetics and level of attachement. The wax-up as well as the unglazed bisque crowns were tried in to verify an accepted esthetic result. The final outcome took approximately 4 months to complete. Because of limited finances, the patient chose to complete the upper and lower 10 front crowns now and the back crowns at a later time. Temporary occlusal composites were used to stabilize the back teeth until further treatment.
Here is a cost effective way to treat a patient who had a history of periodontal disease followed by subsequent bone loss and recession. This patient’s current periodontal condition is now controlled. Pocketing depths are 2-3mm, tissue levels are stable and routine periodontal cleanings every 4-6months.
Treatment: We fabricated a removable cold cure acrylic resin prosthesis from a mock wax-up on a solid cast. The cast was carefully surveyed and blocked out to allow a path of insertion while still maintaining some retentive undercuts.
Advantages: Cost effective, predictable long term result, non-surgical alternative.
This patient presented with discolored composite veneers on #7-9. She was unhappy with the esthetics and wanted to improve her smile with a better type of restoration. There was a pre-existing diastema between #8-9 and midline discrepancy. Upper and lower teeth met edge to edge with only a slight horizontal discrepancy. Gingival harmony was within normal limits.
Treatment plan: We decided to whiten her teeth prior to replacing #7-9 with conservative porcelain veneers.