I know us as dentist always are concerned with single central incisors. Yes, they can be exceedingly difficult to do and we also have to manage expectations. However, we often forget material selection. What material should we use given the clinical scenerio.

I want to present a quick case that I did several years ago to show some of the things that I think about when doing these cases.

Here is a 22 year old female that experienced a trauma as a young teen:

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We can see that tooth #9 is severly discolored and it has been very hard for this patient. Often times the first thing that we think of in a case like this is internal/external bleaching combination. That may have been doable in some hands, but it made me nervous because her canal was completely calcified shut. In these cases endo can be difficult if not impossible and creates potential weakening of tooth structure trying to execute it.

For that reason, my choice was a single veneer on tooth #9. Once that decision was made I have to start thinking about the next set of issues:

How much am I going to have to prep to block out the discoloration
Am I going to have to do any blockout that could affect my restoraration thickness?
Will I have to remove an excess amount of enamel with the preparation that could affect the longevity of my restoration?
What material should I use? Esthetics is at a premium, but I also have to manage value

Some of these you can answer based on experience doing cases like this. I know that the two most popular materials on the market are e.max (lithium disilicate) and zirconia. Would either be appropriate here? Right away I ruled out all 3 of these because of the following:

e.max HT is way too translucent and low value… would never block anything out
e.max LT is too opaque and the patient has fairly translucent teeth
e.max MT works great in some scenarios but often the value is too bright making shade selection difficult
Zirconia (even translucent zirconia) generally has value issues in cases like this

Before we decide, here is the preparation:

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Since I'm making this chairside with CEREC, I broke the contacts completely and used soflex disks to "round" some of the transitions and edges (more of a rounded veneer preparation)… the milling unit tends to like this better.

We also noticed that the discoloration after preparing the tooth is more "mild" than I originally suspected. Also, even though the preparation was 2mm incisally to create more translucency, the facial reduction was mostly still in enamel.

Because of this preparation (mild discoloration and mostly in enamel), I chose to use Feldspathic ceramic (Vita Mark 2). It's a wonderful material in the right situation because even though the material is weak, the grain structure allows it to block out mild discolorations while still being esthetic. The weakness of the material can also be offset by the fact that there is still a ton of enamel present (the material itself does not have to be super strong).

Here is the final result:

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I think I got pretty close…

You can see from the BW photo, the value is also pretty close:

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One trick if you are staining and glazing your own restorations is that you can use a photo program (I just use photoshop) to lower the brightness and increase the contrast. This allows the colors and characteristics to "pop" and you get a better roadmap on staining and glazing

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Hope this helps you all!

Mike