When I was a new E4D user I tried to fulfill a young woman’s wishes, as she was unhappy with #8, both the color and the morphology.
I decided to make an E-Max crown and started the prep. When I had removed the enamel I found he discoloration much more intense than expected. I decided to hide the darkest areas at the gingival with a thin layer of white opaque resin. Sorry I don’t have a photo before the resin but I can tell you it was dark. I was a little afraid to remove too much teeth taking the strength in account and thought that the thickness of the E-Max would hide the dark area in the middle.
I tried to use the “Ivoclar Natural die shade material Guide “to find the right color and finished the crown and it was cemented with Rely-X. I did not take photo.
Six months later at the rutine check I found the result disgusting and even worse that I remembered it to be and decided to try again and make a new one.
I removed the crown and decided to try to bleach the stump from the outside directly with ultraviolet light and bleaching agent but I was not happy about the gingival area as the root still was deeply discolored subgingival and was afraid the darkness would come through.
Then I decided to do the bleach inside the root 3mm subgingival in the Gutapeca with a mix of 20% H2O2 and NaBO3 sealed with resin and a provisorial crown. After 1 week the stump was pretty bleached
and I made the scan and final crown was cemented with Multilink yellow.
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Now she is happy and I’m pretty proud. I learned to be aware of discoloration, specially the grey ones, as the Emax tends to be grey in the front.
I still love my E4D.
What do you think?
That’s a great result Peter. Did you seal the canal with resin after you removed the GP? I know I’ve seen studies that said if you put the internal bleach right on the GP you can get internal resorption so very important to remove some GP, bond resin into the canal to seal the GP and then do the internal bleach. You probably did it that way and I’m just misreading your post.
Hi Mike, Yes I did but it was difficult due to lack of space.
Great results Dr. Eriksen! thanks for sharing.
Peter. this shows how when we are persistent and control the case, using all the tools we have…beautiful results!
Peter, I think what you did is gorgeous. You are such a good dentist it seems. I did a single dark tooth on a dentist last month and it turned out marvelously. I did not take her final photo yet because I wanted to see it after being in the mouth a while. She has not returned yet, but I know she will. Your final photo is a little dark so I can’t comment on the final value match, but your characterization looks stellar to me. Great job.
The grey of ht eMax is an issue for sure, thanx for posting.
Thank your for sharing your clinical experience with this case. It seems some of the photos that were posted are no longer there. Would it be possible to repost them?
Ps. I’m referring to the before shot and the after shots (stump shade after internal bleaching, and crown after final cementation) that were linked in your post.
Thank you 🙂