GAP Australasian-Dentist-May June 2019

Category 50 AustrAlAsiAn Dentist t he One Visit Crown (OVC 3 ) appears to be an increasingly popular and viable option to restore posterior teeth, such as those that are heavily broken down, heavily restored, exhibit cracked tooth syndrome (Cts), as well as restoration of endodontically treated teeth. However, one aspect that has been seldom discussed until now is use of the One Visit Crown where a high aesthetic is required. the following case study of a notably discoloured maxillary first premolar highlights the ability to achieve a highly aesthetic result with placement of a One Visit Crown using a direct technique, which traditionally can appear challenging. One Visit Crown (OVC 3 ) Clinical Case Study – Discoloured Maxillary Premolar Figures 1 & 2 show a notably discoloured upper right first premolar tooth with an extensive amalgam filling on the disto- occlusal aspect. the patient presented enquiring about options to cosmetically enhance this particular tooth, as she considered the appearance to now be socially unacceptable. After clinical and radiological examination, the tooth tested vital with no indication of pulpal necrosis or peri-apical pathology. A visible crack line was also noted on the mesial marginal ridge (Figure 3). Four treatment options were discussed with the patient: no treatment (not recommended), a large composite overlay restoration, a traditional ceramic crown, or a One Visit Crown. the One Visit Crown was chosen for financial reasons. the One Visit Crown can present a highly appealing treatment alternative to a traditional crown, as it can usually be completed by the clinician in a single visit, on average taking the clinician less than an hour and at a lesser fee. in this particular case, a dark discoloured tooth creates a more challenging clinical scenario and therefore is potentially more difficult to achieve a good aesthetic result. this was conveyed to the patient prior, who understood the potential limitations of the treatment outcome. the contents of the OVC 3 refill case are shown in Figure 4. each OVC 3 refill case contains everything required in order to complete the One Visit Crown, along with the clinician’s standard chairside materials and equipment. the black case of each refill contains an orange replica that helps determine sufficient occlusal reduction from tooth preparation (its size and shape mirrors the cured top layer of the OVC 3 ), as well as McDonald Matrix Bands that are specific to the size of the OVC 3 . the crown is in the lid under a light protected cover. Also included is a measuring selector Key, two green OVC Wedges that are great for build ups such as in the case of deep marginal elevation (DMe), and two orange stretch Wedges that can be flossed between the teeth and help create separation similar to sectional matrix ring systems. One Visit Crowns are available in 5 sizes for each tooth; pre molar and molar and are available in different shades. the tooth was isolated with rubber dam (Figure 5), and a selector Key was used to determine the correct size of OVC 3 , which in this case was a size small for the upper premolar (Figure 6). in this particular case, shade A3 was used. When significant tooth structure remains, rather than a traditional crown preparation with circumferential reduction of the tooth, the OVC 3 procedure recommends minimal reduction in order to prepare the tooth for an adhesive onlay type restoration. Use of the One Visit Crown (OVC 3 ) to achieve an aesthetic result Sam Koh By Dr Sam Koh Figure 4 Figure 5 Figure 6 Figure 1 Figure 2 Figure 3 lInICal