Make a difference
It is relatively easy to convert a botched-up job into a satisfactory one. What is difficult is converting an ok job into an excellent one, satisfying a client who is thoroughly dissatisfied.
In dentistry, every year is a new one, for materials and occasionally for methodology. Scientific evidence guides us practitioners of course, but how difficult is it to convince a dissatisfied client to take on your suggestions and incur extra expenses whilst still being left with a doubt on the final result?
Take the following case study. This patient presents himself with two anterior all-ceramic crowns supported by underlying implants, done in London at a very reputable clinic. All- ceramic is certainly the way to go for an anterior tooth and if done in London it must surely be of a certain standard.
The patient assures me that the crown colour was chosen correctly on the adjacent teeth and that the patient even agreed to it, but that when cemented on the implants, the crowns changed
colour (Figure 1). The colour of the crown has changed because of the underlying metal intermediate attachment between the implant and crown. The metal shines through the crown and gives the present colour.
The solution is changing the metal intermediate attachment to a metal-free one composed of either zirconia or lithium di- silicate (Figure 2). The crown may then be either screwed onto the attachment or cemented to it. If cement is to be used, the right coloured cement (being transparent, yellow or opaque) must also be selected, to avoid any further change in colour to the final teeth.
Once in place, the aesthetics are not tarnished and the result speaks for itself (Figure 3). Learning the full range of options may allow you to make the right choice of material and subsequent aesthetic result. It is your right to know what choices you have and our duty to advise you on them. Ask your dentist!
