griptab crown clinical case study by dr graeme milicich

Griptab Crown CaseBy Dr Graeme Milicich, BDS

1 A 21-year-old female patient presented with a central incisor that had previously had an incisal 1/3 fracture restored with a bonded composite (Fig 1). She had suffered another blow to the tooth and the restoration and all the palatal enamel had been lost. The palatal fracture was sub-gingival and down to the bone in one area.

2 The tooth was prepared for an E4D CAD/CAM crown and the sub-gingival margin was exposed (Fig 2) using a Waterlase MD. The bone in the region of the fracture was lowered (Fig 3 & 4) to re-establish biological width using a closed flap approach.

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An impression was taken and the patient released with a temporary crown. A model was poured and scanned into the E4D design center and a crown was designed and milled using an A1 IPS Empress multi-block

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7 The milled restoration was then contoured to create the surface micro anatomy, stained and glazed.

8 Prior to trying in the crown, a Griptab was bonded to the incisal region of the labial surface. This was then used to control the crown while a correct shade of Variolink Veneer bonding resin was chosen using the try-in pastes. The position of the Griptab did not interfere with the selection of the correct shade of bonding resin cement.

9 Once the correct shade had been selected, the Griptab was re-engaged with pin-tweezers and the crown removed from the tooth. The try-in paste was rinsed out prior to HF etching and silanation.

10Immediately post-cementation, the adjacent teeth were slightly desiccated, which highlighted the white spots in the enamel.

11A couple of minutes of rehydration began to reduce the intensity of the enamel white spots on the adjacent teeth