011 – Severely Carious Upper Front Teeth That Affect Smiling and Self Confidence

A set of well align teeth not only give you a beautiful smile, but also make your appearance pleasant to other people. It is an impact to the appearance if someone lost the front teeth, it leads to loss of self confidence and might have changes in attitude, or worst, become anti-social. Below is a case report of similar condition.


A 17 year-old female, presented with severe dental caries involving 4 upper incisors. Although she did not feel any pain from the involved teeth but it badly affected her self confidence. She neither smiles nor talks to others because of the unpleasing appearance. After several discussion on the treatment option, we decided to save the upper 4 teeth by root canal treatment and follow by reconstruction with porcelain fused to metal crown.

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This was the condition of upper incisors when she was first presented. Periapical radiograph (xray image) showed that the roots of the teeth were still in good condition and free from any lesion.

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The caries was removed under local anesthesia, because the pulpal tissue still vital.

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The teeth temporarily restored withresin composite, only up to half of the crown height to avoid from chewing force.

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The teeth were isolated with rubberdam, then root canal treatment wascarried out to remove the pulpal tissue. The root canals were sealed with root canal filler (gutta perca).

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A space was prepared inside thecanal, followed by cementation ofpost. Core built up with resin composite.

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A procedure known as CrownLengthening was performed. Thepurpose of surgery was to increase the length of the tooth structure for the crown construction.

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The gum was stitched at lower level,the gingival margin now are 2-3mmlower than its original position.

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The stitches were removed after 2weeks. The gum healed at thedesired position to provide sufficient ferrule support for the following crowns.

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The crown preparation for all upperincisors. Impression taken withsilicon base material and sent to dental laboratory for fabrication of crowns.

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Provisional crown fabricated onchair-side and cemented withtemporary cement. Patient improved tremendously on her self-confidence.

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The Porcelain Fused to Metal crownswere permanently cemented withresin cement. She can now smile and socialize with friends confidently.