Fabricating an indirect restoration for a single maxillary central incisor is the most challenging and frustrating treatment the dental team can provide for a patient – yet it is also possibly the most rewarding. Understanding the patient's expectations before treatment is critical to the success of the case. If the expectation is to match the adjacent central incisor as perfectly as possible, it may take several attempts to achieve the desired outcome – this requires additional clinical and technical time and materials.Setting appropriate fees before treatment is imperative from a business perspective. If you charge additional fees during the course of treatment, you may create the perception that mistakes were made by the dentist or technician. If you do not set the fees high enough and have to absorb additional chairside or laboratory costs, doing these types of restorations can be a losing proposition for the dentist.
If your patient has high esthetic expectations regarding the accuracy of the match between the restoration and their adjacent natural tooth, I suggest discussing these critical points before beginning treatment, to set reasonable expectations of the process and potential outcome:
- A single central incisor is the most difficult of all indirect restorations to produce from an esthetic perspective.
- Several restoration remakes or modifications may be required to achieve the best match, even for a master technician. This means multiple appointments with the dentist are to be expected.
- We are trying to match natural tooth structure with non-tooth materials (dental ceramic).
- If the goal is to preserve as much natural tooth structure as possible, there is going to be limited space for the restorative material to compensate for any influence of the remaining underlying tooth.
- If there are problems such as discoloration of the underlying tooth structure, masking materials must be used – followed by layers of ceramic to build back the effects needed to most closely simulate natural dentition. This is a difficult process, often requiring multiple attempts before a satisfactory result can be produced.
- Teeth change in appearance from the dehydration that occurs during dental procedures. This makes evaluation and communication of color, brightness and translucency very challenging.
- The fees charged for the services are higher because of the additional clinical and technical time and expertise needed to accomplish this very difficult task. In the end, this is generally less expensive than doing multiple teeth.
These points are simplistic when compared to the innumerable complexities that comprise the fabrication of restorations that mimic natural dentition. However, establishing the expectation that multiple attempts may be needed to produce a crown or veneer that is deemed perfect, will mitigate the frustration that can be inherent in this process.