quired in this case, a benefit of the high-strength HDM material is its
color stability, without distortion or a drop in value even after multiple
firings ( figure 6).
The result in this case ( figures 8 and 9) demonstrates the chameleon- and
lifelike esthetics that can be achieved when restoring severely tetracycline-stained teeth. The imperceptible quality of this restoration adjacent to
natural dentition was predicated on selecting a highly esthetic and durable
lithium disilicate material and placing the crown using a color-stable
and esthetic universal, dual-cure adhesive resin cement.
1. Arhun N, Onay EO, Ungor M. Rehydration of a reattached fractured tooth fragment
after prolonged dehydration. Gen Dent. 2012; 60( 3):e173-177.
2. Pires LA, Novais PM, Araújo VD, Pegoraro LF. Effects of the type and thickness of
ceramic, substrate, and cement on the optical color of a lithium disilicate ceramic.
J Prosthet Dent. 2017;117( 1):144-149.
MILES R. CONE, DMD, CDT, is a board-certified
prosthodontist practicing in Portland, Maine, and a certified
dental technician. In addition to authoring articles in
peer-reviewed publications, Dr. Cone is the editor-in-chief of ACP
Messenger. He is also a key opinion leader and speaker on
behalf of GC America, Amann Girrbach, and Straumann
Implants. He may be reached at firstname.lastname@example.org.
LUCAS LAMMOTT is the owner of M31 Dental Studios in
Gloucester, Massachusetts. His technical expertise and
knowledge have been featured in numerous publications,
including the Journal of Cosmetic Dentistry, Journal of
Prosthetic Dentistry, and Journal of Dental Technology. Mr.
Lammott is a key opinion leader and speaker on behalf of GC
America, Amann Girrbach, and Wagner Rotary. He may be
reached via email at email@example.com.
Figure 6: Example
of a conventional
drop in value due to
Figure 7: G-Cem LinkForce universal dual-cure adhesive resin
cement was extruded into the crown.
In preparation for cementation, the internal surface of the crown was
etched with hydrofluoric acid for 20 seconds, rinsed, and aggressively
air-dried. After removing the provisional restoration, the preparation
was thoroughly cleaned.
Because the final restoration was fabricated to incorporate the
underlying stump shade for more lifelike esthetics, a translucent cement
(G-Cem LinkForce, GC America) was used that would not interfere
with or affect the color or value of the crown, rather than an A2 or
opaque cement. The restoration was tried in to confirm fit and esthetics
using the corresponding translucent try-in paste, then removed. The
paste was rinsed from the restoration with water. The preparation was
also rinsed and dried, and meticulous isolation was established.
A total-etch technique was performed on the preparation, which
was then rinsed and dried. The intaglio surface of the crown was
conditioned using G-Multi Primer (GC America) and dried using an
air syringe. A universal adhesive bonding agent, G-Premio Bond (GC
America) was applied to the preparation, allowed to sit for 10 seconds,
air-dried for five seconds, and then light-cured for 10 seconds.
The translucent shade of cement was extruded directly into the
crown (figure 7), after which it was immediately seated onto the
preparation while maintaining pressure. The crown and extruded
cement along the margins were tack-cured for two seconds to facilitate
easier cleanup (i.e., simply peeling off excess), and the crown was
light-cured from each surface/margin for 20 seconds.
Figure 8: The first thing
the patient asked after
the crown was seated
was, “Which tooth
is it?” She could not
differentiate the crown
from her natural teeth.
Figure 9: Close-up
of the completed GC
Initial LiSi restoration
cemented on tooth
No. 6 using G-Cem