Clinical Compromise is the key
to a successful treatment
Restoring the maxillary lateral incisor can present real challenges. In these aesthetic cases, discussing the pros and cons of different treatment options is the best way to keep the patient satisfied
T
he maxi l lary lateral incisor r e g u l a r l y causes a treat- ment planning
di lemma. Structural ly speaking, it’s one of the smallest teeth in the mouth, so there doesn’t have to be much restorative dentistry before the tooth is severely compromised. Even in a disease-free
mouth, restoration is frequently required due to trauma. In all but the lowest lip-line, there are significant aesthetic challenges: our restorative arsenal of mate- rials all have minimum space
requirements if they are to recreate natural shading. And with a structurally small tooth, the space is rarely available, resulting in either an even weaker tooth, over- contoured restoration or poor colour match (Fig 1). Pulpal involvement and
root canal treatment are also regular requirements bringing additional consider- ations. For example, is a post required? If so, what type? Or how do we avoid the ‘shine through’ of a dark root (Fig 2)? Other considerations
include considering if a lateral incisor should be used as a bridge abutment.
What are the chances of root canal treatment being required after preparation? How successful is a bridge if a root canal filling (RCF) has to be carried out through the crown? What is the likelihood of fracture (Fig 3) ? How are we supposed to
explain our decision-making processes to the patient? As more and more patients look for aesthetic restorations, smile enhancements, and the North American approach which aims for pure white and perfect symmetry (Fig 4), difficult treatment plan- ning decisions for the lateral incisor are often required.
Unfortunately, a compli-
cated but necessary decision-making process can often be by-passed in the planning process of the ‘smile design’ in order to get to what the patient wants. In such cases, the lateral is either re-veneered or re-crowned in the hope that it will struc- turally hold out and that the technician will sort out the aesthetics (Fig 5). These decisions can lead to
significant problems and, as much of this treatment is elec- tive and costly, an unhappy patient is often not far behind.
Continued »
Fig 1
Overcontoured crown on UL2 with poor colour match
Scottish Dental magazine 47
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