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Because of the time constraints, the case was milled using two different systems in the office: tooth #8 on the Sirona inLab MC XL and #7 on the chairside CEREC MC XL. Naraine chose VITA®’s RealLife Block for tooth #8 and, when designing the restoration, positioned the virtual crown within the dentinal core of the block (shown above). This blocked the stump shade while still giving the crown natural esthetics. For the veneer on tooth #7, he decided to use the stump to help achieve the final shade, and chose Vita Mark II, a less chromatic, all-enamel block.
When the PFM was removed and tooth #7 prepped, the dental team instantly realized it was going to be a very complex case. In addition to all the factors that make a single central so challenging, the patient’s stump shade on #8 was very dark and needed to be blocked out without changing the value of the final restoration.
After the crowns were milled, Naraine custom stained the restorations, using stump putty material on the cementing surface in order to achieve a predictable color match. The restorations were then glazed and seated in under three hours.
The patient was unhappy with the existing PFM on tooth #8 and the discoloration of natural tooth #7. Dr. Julie Hassid, Gallery 57, decided to replace #8 with an all-ceramic CAD/CAM-fabricated crown and place a veneer on #7.