Tetracycline Staining

[Halcion]

So I have a patient who is interested in veneers for tetracycline staining.

The patient has what I would call moderate staining. Would the best course of treatment be 8-10 veneers or crowns? Patient has no restorations on these teeth... very low caries risk. My first inclination was to do veneers due to absence of existing restorations, but now I am wondering if zirconia or emax crowns would be better due to the darkness of the staining. What has been your experience with porcelain veneers and tetracycline staining? Are they too thin in some instances to get a good, esthetic result? Obviously crowns are not as conservative, but is it acceptable to do crowns if the staining is significant? I know if I do veneers on this patient, I need to do inter proximal reduction and carry the prep through the contact area to avoid show-through interproximally, but I am concerned if I would get show through due to the porcelain not being able to block out the discoloration as well as a crown. I can reduce the tooth more, but how much reduction is too much on a veneer before I should just do crowns? Forgive me for all the questions, but I have not taken on a case like this before. I have done veneers 6-11 and 7-10 to replace old composite bonding and for white spots to improve esthetics, but nothing quite as dramatic as tetracycline staining.

Any thoughts? Thanks!

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[HupHolland]

So I have a patient who is interested in veneers for tetracycline staining.

The patient has what I would call moderate staining. Would the best course of treatment be 8-10 veneers or crowns? Patient has no restorations on these teeth... very low caries risk. My first inclination was to do veneers due to absence of existing restorations, but now I am wondering if zirconia or emax crowns would be better due to the darkness of the staining. What has been your experience with porcelain veneers and tetracycline staining? Are they too thin in some instances to get a good, esthetic result? Obviously crowns are not as conservative, but is it acceptable to do crowns if the staining is significant? I know if I do veneers on this patient, I need to do inter proximal reduction and carry the prep through the contact area to avoid show-through interproximally, but I am concerned if I would get show through due to the porcelain not being able to block out the discoloration as well as a crown. I can reduce the tooth more, but how much reduction is too much on a veneer before I should just do crowns? Forgive me for all the questions, but I have not taken on a case like this before. I have done veneers 6-11 and 7-10 to replace old composite bonding and for white spots to improve esthetics, but nothing quite as dramatic as tetracycline staining.

Any thoughts? Thanks!

What's the occlusion like? For me, that is one of the deciding factors of crowns vs. veneers. If the patient has anterior coupling and acceptable guidance, then go for veneers. You can do emax veneers, and prep aggressively so the lab will have room to place an opaque dentin layer beneath a more esthetic translucent porcelain.

Also, I don't understand how a crown is any more likely to block staining than a veneer. You're not specifying PFM vs. all ceramic. Like I said earlier - for a tetracycline case you will need to prep deeper for optimum esthetics.

Good luck!

Hup

 

[efficient]

I'm going to sound crazy and all, but how about bleaching overnight for about 6 months. A lot more conservative and that's what I would do if the patient was my mother. If dissatisfied at that time, then do more agressive tx such as indirect restorations.

 

[Halcion]

I've had experience with bleaching on patients with tetracycline stained teeth, and my experience has been that it does not work very well, especially if a patient has significant staining. Plus, the longer you bleach, the more sensitive your teeth can get. I always present that as an option to see what results the patient gets, but more often than not, they would rather just go for the veneers or crowns.

Thanks for the reply Hup. I have talked to some other dentists, and they have said that Zirconia crowns can block out stain better than a porcelain veneer. I honestly was not sure, because I have not had an experience from which to compare. I will definitely re-evaluate the occlusion.

Thanks!

 

[HupHolland]

I'm going to sound crazy and all, but how about bleaching overnight for about 6 months. A lot more conservative and that's what I would do if the patient was my mother. If dissatisfied at that time, then do more agressive tx such as indirect restorations.

I always offer this option, but let's be honest.. the results are typically mediocre at best. So, the patient has spent 6 months with uber sensitive teeth, buying gobs a bleach with what to show for it?

hup

 

[justsusan]

If occlusion is stable and the patient is not a bruxer, you'd do veneers. That being said, they aren't going to be minimally prepped veneers because you have to give the lab room to block out..about 0.5-0.7 at least.

Zirconia blocks out better than porcelain, yes, but it's not nearly as esthetic...even the PFZs aren't. Also, PFZs have a higher incidence of porcelain fracture.

Take photos and communicate with your lab. Ask them if they will be able to mask the darkness with EMax. And there are opaque cement shades that will help you too. You'll also want to get photos on prep day of the preps with stump shades. Hope this helped.