Our case of the month for July 2021 is quite a complex one involving multiple ceramic crowns after an accident during the first lockdown. Our patient, Xavier, had a cycling accident where he cracked 3 of his front teeth. Now with any trauma case, there is a certain way to handle the situation and it is important not to rush into a specific treatment. The reason being is that once the teeth and gums have been damaged, the consequences may not be apparent for several weeks or months. Hence the use of provisional materials such as composite and temporary crowns are vital during this healing phase.

Periodontal or gum health is paramount also and we needed to spend some time stabilising the gum health with conventional and laser treatments. Beata Kynsak did a wonderful job using Waterlase i Plus and the Epic 10 diode laser with a complete transformation from inflamed , swollen gums to a pink, firm attached gum line. Laser dentistry, although not new, is still a rarity across our profession but we are firm believers in the technology and have many years of experience highlighting great results. 

Once the gums were stable, provisional crowns were made using a diagnostic wax up. This is where our laboratory, Ceramic Studios, re create the teeth using digital means to provide us with a prototype of the final teeth. We can use this guide to define our preparations of the teeth, make the temporary teeth and allow our patients to see what the final crowns can look like. Our temporary crown material of choice is Luxatemp; the gold standard. 

After some time in the temporary crowns, we were ready to proceed with the final crowns which were E Max all ceramic crowns, again the gold standard when it comes to aesthetics. There is no better. Ceramic Studios did a great job and just take a look at the before and after results:
 

Our case of the month for April was one involving E Max crowns by Ivoclar, which is our opinion, give the best aesthetic results. In the past, tooth coloured dental crowns had a layer of metal underneath for strength with the ceramic bonded on the outside. Now these could look perfectly acceptable but there were issues. Having two layers means that more of the underlying tooth has to be cut down to accommodate the material. For any of you that has read any of our posts knows that we believe in minimally invasive dentistry, cutting away more tooth than necessary just does not sit right with us. Another issue with metal ceramic crowns is that the metal layer may become visible over time as the gums recede which gives that classic grey line around the tooth. Not very desirable. One of the main advantages of ceramic crowns is that there is no metal underneath and this grey line will never be an issue. 

The aesthetic qualities of E max crowns are second to none. Our case shows that the crowns can be fully customised with translucency at the edges, varying shades, light reflection and opaque areas to name a few. The skill of the dental technician plays a huge role here and we work with some excellent laboratories know for excellence. 

For our case, Ceramic Studios in Kensington made the wonderful E max crowns fully which were fully customised.
 

In general, we adopt a metal free policy wherever possible. This is especially the case at the front of the mouth where aesthetics are highly important. We now routinely use all ceramic crowns for front teeth. The great advantage of these crowns is that with no metal, the aesthetics are excellent and there is no issue with the dreaded 'black' line visible at the gum level. The photograph below shows a super close up view of some front teeth. One of them has an all ceramic crown. Can you tell which one?
 

We pride ourselves on being progressive and leading the way in modern cosmetic dentistry. In the old days, cosmetic dentistry was more about being invasive and cutting healthy tooth enamel for multiple veneers or crowns. Due to the advances in technology and materials this has all changed. These days, if a tooth does need a veneer or crown, then we will match this tooth with the other teeth as best as possible. This way, the adjacent teeth do not need to be harmed in anyway. Here is a classic example. Our patient required a front tooth crown. After some tooth whitening, a new crown was made in all ceramic. Just look at the result:
 

Our case of the month for June involves dental implants and ceramic crowns. Dental implants are without question, the very best option to replace teeth. Whether you are missing one tooth, several teeth or all of your teeth, dental implants should be considered as the first line option. In the past, replacing teeth with implants was a long, drawn out procedure and costly too. However, with the advances in modern dentistry and techniques, the treatment can be delivered quickly, with minimum fuss and is affordable. Our case involves replacing a missing molar with an Astra Tech dental implant and placing an Empress E-max crown on the adjacent tooth. Please view the before and after photos to see what can be achieved:
 

Dental crowns are required to protect heavily damaged teeth, teeth will large fillings or teeth that have had root canal treatment. They are essential to maintain the function of the tooth and they will act as a natural replacement for the damaged tooth. Not all crowns are the same! Significant skill and care is required to firstly prepare the tooth for the crown and then fabricate the crown. If these are done well and the crown is well looked after, there is no reason why dental crowns cannot last for many years. They should be considered an investment.

The following case demonstrates the level of expertise we have in dental crowns: