Sameer Puri D.D.S. I was cleaning out my hard drive and was going through some old cases. While these cases brought back some memories from my days at my practice in Los Angeles where I practiced for close to 14 years prior to moving to Scottsdale, this one case is especially memorable.
It is memorable not because the ceramist at the time did a great job with the ceramics, which he did. It is not memorable because the tissue response to the ceramics was great, which it was. It is not because we were able to mask tetracycline stained teeth effectively, which we did. This case is memorable to me because of the big screw up that occurred and its entirely my fault. When doing anterior esthetics, one of the biggest mistakes clinicians make is not having the proper angulation of teeth. Other than Japan where flared laterals are become a fashion trend, the inclination of the laterals needs to be more mesial. In other words, when you draw a line through the long axis of the teeth, all the lines should point towards the patients belly button. The inclination should be slight in the centrals, and more severe as you go towards the laterals, canines and premolars. Now in the case below, you can see my classic screw up- the laterals are pointed to the distal, especially #7. I would love to blame the ceramist who did this case but the fact of the matter is that if I don't prepare the tooth enough, there isn't enough room to give me a mesial inclination. This is further compounded by the fact if you already have teeth that are malaligned. In these cases, you need to prepare the teeth even more to give yourself adequate room. This is no different whether you use a CEREC to fabricate your final restoration or a ceramist. Bottom line is give yourself enough room so that the ceramics have enough space to be angulated in the proper direction. All teeth should have a mesial inclination which will give your porcelain esthetics a much better end result.
