Use of porcelain veneers, crowns and an implant to resolve an esthetic problem.

A 51-year-old woman who worked as a company sales representative was concerned about the deteriorating condition of her anterior teeth. On presentation, the appearance of her anterior teeth was less than ideal, and she requested treatment to improve the situation. Her medical history was noncontributory, but intraoral examination revealed excessive diastema between the maxillary central incisors (Fig. 1). The maxillary right central incisor had an incisal edge fracture at the mesial side and appeared mesially tilted. The maxillary right lateral incisor was acting as an abutment for a fixed partial denture (FPD). The retainer on this tooth was out of ideal positioning, and its colour did not match that of the adjacent teeth, perhaps because of opacity of the underlying metallic core (Fig. 2). The maxillary right canine was missing, and the pontic component of the 3-unit FPD that replaced it looked shorter than the lateral incisor and had a flattened incisal edge (Fig. 3). Further examination of the maxillary left anterior side revealed that the 3 anterior teeth were discoloured and the incisal edge of the central incisor was worn down at a slant (Fig. 4). Lingual examination revealed the unsightly appearance of the metallic framework of the 3-unit porcelain-fusedto-metal FPD (Fig. 5). Prior endodontic treatment of the maxillary lateral incisor had been performed through the FPD retainer and the access opening had been sealed with resin composite. Part of the veneering porcelain on the distal aspect of the premolar retainer had fractured, and the remaining anterior teeth had dark extrinsic staining. Use of Porcelain Veneers, Crowns and an Implant to Resolve an Esthetic Problem