Big Red Tooth – Dr Candice Schwartz

Where teeth and health meet

Full mouth rehabilitation – Case report

This patient came to see me and wanted a brighter, whiter smile. When he smiled, he did not like the colour of his teeth, especially the contrast in color between his natural teeth and the crowns. He had no pain. His concern was only esthetic.


The upper and lower anterior natural teeth have intrinsic staining. Intrinsic staining occurs naturally with age. It is unlikely that tooth whitening will make any substantial improvement on the shade of these teeth. There is also a colour discrepancy between the natural teeth and the adjacent dental crowns. The crowns also have a very opaque “dead” look to them in comparison to the natural teeth. The posterior teeth (molars and premolars) have mild to moderate gingival recession. This shows a distinct line where the natural tooth meets the tooth margin. This is very unsightly and also leads to sensitivity. On radiographic examination secondary decay was visible at the margins of some of the existing crowns.

Treatment plan:

Replacement of all existing crowns and crowning of the remaining natural dentition was the only way a uniform colour and brilliant dentition could be achieved. I discussed with the patient that the anterior teeth were “virgin teeth” (never been drilled/filled) and a large proportion of tooth structure would be sacrificed in the crown preparation process. However he was adamant that he wanted a “bright white smile”. For this reason I chose to place Emax(all-ceramic) full coverage crowns on the upper and lower 6 anterior teeth and porcelain fused to metal crowns on the posterior dentition. I choose the porcelain fused to metal crown as it is stronger and I believe the marginal seal between the crown and tooth is superior to all ceramic crowns in the posterior teeth. This reduces the risk of secondary decay and fracture under high occlusal stresses.

The chair time for this type of treatment is very long, for the dentist and the patient. Frequent breaks between drilling are essential and a sense a humour is always a great advantage!

The results are beautiful and the patient is very pleased.On the right side of the mouth there is still staining visible on the last upper and lower molar teeth. I did not place crowns on these teeth as they are not visible at all when the patient talks/smiles and they were completely healthy teeth. A bite plate was made and i recommend it is worn every night. Because almost every tooth in the mouth is crowned, these precious pearls need to be protected and a bite plate will prevent any porcelain fracture during tooth grinding at night. The shade of the teeth is A2. I felt that the shade A1 would be too light for this patient. I always try and persuade my patients to choose the most natural looking shade instead of unrealistic whiter colours.

I am very happy with this result and enjoyed every step of the treatment process. (:


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