Introduction to the case
The dreaded single central. Patient was concerned because her “front tooth had been getting darker over the past three months”. Endodontic therapy had been performed 10 years prior. Sketchy mid-root region, endodontist confirmed resorption. Patient wouldn’t be able to get the exo for a while. This restoration is meant to be a long term provisional, but I saw no better way to address the situation given the circumstances.
Retracted view. Thought we might want to start with some internal bleaching, however…..
Pretty sketchy looking mid-root region. Advised of possible resorption, and possible need for extraction.
This view is through the microscope Still need practice taking pics with the scope. As soon as I had removed the existing access composite, there was a TON of bleeding. Never seen that before. Scared the heck out of me as I thought I might have perfed. Sent the patient to the endodontist to confirm.
The endodontist confirmed resorption. We already had an implant consult scheduled with our OS. A few days later she had informed us that she was moving back out of state, and would not be able to have the exo for while……ug, Now what to do?
Since the patient could not get the internal bleaching, and wanted something done, we opted for direct composite and hoped that opaquers and dentin shades might be of assistance in masking the dark tooth.
Placed cervical body shade first a la Stephen Kuzmak. then used a palatal putty matrix with Occlusal Clear from Cosmedent for the shell. Opaquers were to be placed next.
Final enamel layer via microfilled.
Immediate post-op. Would have preferred to “twin” the centrals more, but the occlusion would not allow it.
Immediate post-op retracted view. Will adjust as needed at the follow-up appointment. Lets see what happens…