Restoring a peg lateral

[Decan]

I'm trying to put together a tx plan for a patient who has a peg lateral (#7). She is very self conscious about it and this is the primary reason she came to the school. Currently the tooth is not in occlusion and there is ~2-3 mm space between it and its antagonist. My question: would a composite be the only option? I'm assuming there is not enough tooth structure to retain a veneer (although I've never done one outside of technique lab) but that's just a guess. Ideas?

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[sokrman14]

What about a Porcelain Veneer? If not then a composite veneer, possibly a PFM, but I think the most esthetic is a Porcelain veneer.

 

[cresophene]

I'm trying to put together a tx plan for a patient who has a peg lateral (#7). She is very self conscious about it and this is the primary reason she came to the school. Currently the tooth is not in occlusion and there is ~2-3 mm space between it and its antagonist. My question: would a composite be the only option? I'm assuming there is not enough tooth structure to retain a veneer (although I've never done one outside of technique lab) but that's just a guess. Ideas?

lumineer..no prep veneer 🙂

 

[sokrman14]

lumineer..no prep veneer 🙂

Too bulky, they look like horse teeth. Granted its more conservative, but I would still prefer naturally to bulky.

 

[OceanDMD]

Too bulky, they look like horse teeth. Granted its more conservative, but I would still prefer naturally to bulky.

Actually they work nicely on peg laterals. Minimal prep porcelain conserves the limited tooth structure, bulkness is not as big an issue when you are starting with something small.

 

[sokrman14]

Actually they work nicely on peg laterals. Minimal prep porcelain conserves the limited tooth structure, bulkness is not as big an issue when you are starting with something small.

I actually could believe that with a peg lateral, but a normal sized tooth in normal function I could not.

 

[HupHolland]

I would choose an all ceramic restoration- either a porcelain veneer or full coverage crown, depending on the occlusion. Heck, you might even be able to get away without prepping the tooth with the exception of a gingival finish line. Why don't you wax it up, make a putty matrix and see how much room you have for restorative material?

Hup

 

[Decan]

I don't think we're allowed to do lumineers at the school...and veneers are limited to select cases. Hup, doesn't an all ceramic crown need a 1mm shoulder around the prep (at least this is what we were taught in technique)? Looking at her xrays I may end up in the pulp. Also, can you please explain the purpose of making a putty matrix of the wax up?

 

[OceanDMD]

I actually could believe that with a peg lateral, but a normal sized tooth in normal function I could not.

We are talking about peg laterals, read the OP.


Lumineers is a brand. Most labs have their own "minimal prep porcelain" that you can prep small chamfer/knife edge, and polish the porcelain back once seated. Very straightforward, if there is room on the lingual and the tooth does not sit towards the labial no further reduction needed. Just round off any sharp angles.

 

[HupHolland]

I don't think we're allowed to do lumineers at the school...and veneers are limited to select cases. Hup, doesn't an all ceramic crown need a 1mm shoulder around the prep (at least this is what we were taught in technique)? Looking at her xrays I may end up in the pulp. Also, can you please explain the purpose of making a putty matrix of the wax up?

The 1mm shoulder is indicated for full coverage restorations. As Ocean said, Lumineers is a brand, not a restorative material. Kinda like Zoom! whitening. Just a brand.

Hup

 

[mamelons]

I have peg laterals #7 and #10. I had composite veneers #7-10 for 8 years, and only recently got porcelain veneers. The composite veneers were in need of being re-done due to staining and I decided to get porcelain instead. I had minimal prep veneers done, no interproximal reduction, and very little incisal reduction. Depending on the age of the patient and size of the pulp chambers, porcelain is the best route to go in my opinion for longevity and esthetics.

 

[Mackchops]

I haven't had the pleasure of treating a peg lateral, but do they present with enlarged pulps? I didn't think so? I would go with Hup's suggestion and consider a full-coverage restoration. You need a wax up so you know what your final tooth contours should look like and then make a putty index off of the wax up. You take putty and form it to the buccal contours of your waxed up cast (include a few teeth mesial and distal to #7) then, once it's set you cut back the incisal portion and take the index to the patient's mouth. This way you can see the space between the index and the tooth to get an idea of how much you need to prep. Make sense? Like Hup said, you'll probably only have to create a finish line. Remember, the prep guidelines are the thickness of ceramic required, not how much you need to take away from the tooth. If you already have 2 mm of space between the tooth and putty index you're golden.

I don't know what you use at your school but I've used procera and e.max. Although I haven't delivered it, I've worked with Lava too. For the best esthetics, I'd recommend checking out e.max or lava info -- nice stuff! Especially for a lateral.

 

[Decan]

Awesome info...thanks for the help guys! I'll report back with what my patient and I decide on and maybe even some pictures!

 

[xhamburgersamx]

I'm trying to put together a tx plan for a patient who has a peg lateral (#7). She is very self conscious about it and this is the primary reason she came to the school. Currently the tooth is not in occlusion and there is ~2-3 mm space between it and its antagonist. My question: would a composite be the only option? I'm assuming there is not enough tooth structure to retain a veneer (although I've never done one outside of technique lab) but that's just a guess. Ideas?

if she can't afford an indirect placement, just try doing a composite veneer. You can still achieve great aesthetics with proper blending, and bonding.

 

[lemoncurry]

If it were my patient, I would do composite veneers.

 

[DrJeff]

We are talking about peg laterals, read the OP.


Lumineers is a brand. Most labs have their own "minimal prep porcelain" that you can prep small chamfer/knife edge, and polish the porcelain back once seated. Very straightforward, if there is room on the lingual and the tooth does not sit towards the labial no further reduction needed. Just round off any sharp angles.

Agree 100% If you've got a lab tech whose is remotely good with a minimal/no prep veneer, and you give him/her a good shade to use. Total no brainer for a peg lateral nowadays. The bond strength you get between the enamel and the porcelain is about as good as it gets, and it's far superior in strength/esthetics than direct composite, and far less invasive to the natural tooth structure that a full coverage crown/traditional veneer.

 

[jay47]

Agree 100% If you've got a lab tech whose is remotely good with a minimal/no prep veneer, and you give him/her a good shade to use. Total no brainer for a peg lateral nowadays. The bond strength you get between the enamel and the porcelain is about as good as it gets, and it's far superior in strength/esthetics than direct composite, and far less invasive to the natural tooth structure that a full coverage crown/traditional veneer.

1+. If you can't do a veneer, then go with a chairside veneer (aka- composite veneer) At our school they cost like $60. Cheap and affective for the time being.