Single Central Incisors: Setting Dentist and Patient Expectations

We all know that restoring and matching an indirect single central incisor — as opposed to multiple teeth — can be challenging and frustrating, but potentially rewarding for the dental team and patient.

Dentists must understand the patient's expectations, while the dental technician and laboratory must understand the dentist’s cost and chair time expectations, and both must be willing to charge the proper fees to achieve optimal outcomes. Both patient and dentist must recognize that matching the adjacent central incisor as perfectly as possible will generally take several attempts to achieve the desired outcome, requiring additional clinical and technical time, material and costs.

Setting the appropriate fees before treatment is imperative from a business perspective. It is important to set the fees appropriately for this procedure to avoid additional charges during treatment and unnecessary losses both in the practice and laboratory.

[RESTORATIVE WORKSHOPS: Learn from Dr. Winter and other longtime Spear educators in upcoming “Restorative Design” and “Anterior Restorative Dentistry” workshops in Scottsdale, Arizona.]

If your patient has high esthetic expectations regarding the accuracy of the match between the restoration and their adjacent natural tooth, it is important to review several critical points before beginning treatment, so reasonable expectations of the process and potential outcome are set.

Points to review include:

1. A single central incisor is the most difficult of all indirect restorations to produce from an esthetic perspective. A near-perfect match the first time is highly unlikely.
2. The skills of a master technician will be needed, and several modifications may be required to achieve the best match. This means dentists should expect to schedule multiple try-in appointments with the patient.
3. If the treatment goal is to preserve as much natural tooth structure as possible, there is limited space for the restorative material to compensate for any influence of the prepped underlying tooth. It is therefore critical to schedule a try-in appointment to check the esthetic match to the adjacent tooth.
4. Dehydration that occurs during the dental procedures changes the appearance of the tooth, making the evaluation and communication of color, brightness and translucency very challenging
5. If there is any discoloration of the underlying tooth structure, masking materials must be used followed by multiple layers of ceramic to most closely simulate natural dentition translucency. This is a very difficult technical process, often requiring multiple try-in attempts before a satisfactory result can be produced.
6. The fees charged by the laboratory will be higher because of the additional time and skill level this restoration takes, and fees charged by the dentist should be higher because of the additional chair time. In the end, it may be less expensive to do multiple teeth or consider a direct restorative approach.

If the patient understands the amount of time and effort this process takes, the dentist is able to charge enough to cover the higher laboratory fees and chair time. Then both patient and dentist understand there will likely be multiple attempts made by the technician to produce a crown or veneer that is deemed the best match, so the inherent frustration that is likely during this process should be mitigated.

Robert Winter, D.D.S., is a member of Spear Resident Faculty.