Treatment of Tetracycline Discoloured Teeth with Full Ceramic Restorations

by Luc Vandenborght, LTH

Tetracylines were introduced in 1948 and are broad-spectrum antibiotics that may be used in very different cases of infections. Every dental practitioner has seen several cases of tetracycline stained teeth. The effects of Tetracycline antibiotics on teeth are well documented.

There are four categories of tetracycline stained teeth (Feinman et al. 1989):

1. Mild Tetracycline staining: minimal, uniformly distributed, light yellow, light brown or light grey discoloration, restricted to the of the incisal part of the crown.
2. Moderate Tetracycline staining: staining varies more in quantity and location, ranging from deep yellow to brown or grey with no banding. Treatment prognosis is variable, as it depends entirely on the intensity of the staining.
3. Severe Tetracycline staining: dark brown, dark grey, purple or blue staining, with marked banding. Prognosis for an efficient and aesthetic outcome is not good, although teeth may lighten to some degree.
4. Intractable Tetracycline staining: intense pigmentation combining very dark stains with highly pronounced bands. Bleaching is insufficient in such cases.

Case Study of Severe Tetracycline discoloration
A 45-year-old woman consulted us with several colour staining of all the teeth because of Tetracycline antibiotics (Figs. 1-6). The patient had a high Dental IQ because she had already consulted several dentists to find a treatment for her problem. She said that she just came to our office to get some more information. We experience quite often that patients at first say they just want more information. But the fact is that if we have the opportunity to meet with the patients to talk about their problem, our way of treating, show comparable treatments and results patients become very interested in choosing us as their cosmetic practice. We believe it is all about a mindset that is different of a cosmetic dentist compared with a general dentist. Although we have a full time cosmetic and implant practice we encourage general dentists to book undisturbed time for cosmetic appointments and learn how to meet, talk and treat these patients. Cosmetic patients are different than other patients; their dentists should be too.

Fig. 1
Before intra-oral frontal.

Fig. 2
Before intra-oral lateral.

Fig. 3
Before intra-oral lateral.

Fig. 4
Before smile close-up frontal extra-oral.

Fig. 5
Before smile close-up lateral extra-oral.

Fig. 6
Before smile close-up lateral extra-oral.

First Findings
It was obvious that the patient only wanted a solution for her discoloured teeth. At the first visit it was already clear that the patient had many other problems as dental decay and a failed crown on tooth #12. The patient was informed that these problems had to be treated also and that we believed that in her case full coverage crowns and veneers were the best option. Not only could the discoloration of the Tetracycline antibiotics be fully masked with the crowns and veneers, but she could have healthy and beautiful cosmetic teeth. Because of the limited budget it was decided that we would first treat her upper teeth.

Diagnosis and Treatment Planning
At the next visit a thorough diagnosis was done. The resulting treatment plan involved the treatment of several decayed teeth, two root canals, the extraction of two teeth and the treatment of her bite as the MO bite was not the same as her CO bite. Working in CR was very important, as this treatment would involve crowns on nearly all her upper teeth.

General treatments involving treatment of dental decay and root canals were done. Impressions were made and a CR bite was taken. On review of the models in the articulator it was indeed obvious that we needed to make changes in the bite of the patient and we also needed to correct her occlusal plane.

A full mouth diagnostic wax-up was made and was transferred into the mouth using putty moulds and Luxatemp. At the diagnostic wax-up we lengthened the teeth because of poor visibility of her present teeth (Figs. 7-10). As we needed to extract two teeth we decided to work in two stages. The first stage involved the first preps of all concerning teeth and the extraction of teeth #12 and #25.

Fig. 7
Before lip in rest position.

Fig. 8
Wax-up (Smile Design) frontal upper and lower.

Fig. 9
Wax-up (Smile Design) occlusal upper.

Fig. 10
Wax-up (Smile Design) occlusal lower.

Fig. 11
Temps upper.

As we decided to work with bridges instead of implants we did an immediate bone graft of the extraction sockets. This way the volume of the bone and the gums could be best maintained. Then we immediately made our first provisionals and waited for three months.

After three month we refined our preps, took impressions, bites, a stick-bite and KOIS facebow. New temps were made at this time (Fig. 11). The lab made us 12 full-coverage Zirconia with hand layered porcelain crowns and bridges (Figs. 12-21).

Fig. 12
Crowns and bridges on model – frontal.

Fig. 13
Crowns and bridges on model – lateral.

Fig. 14
Crowns and bridges on model – lateral.

Fig. 15
Intra-oral full coverage crowns and bridges three months after placement day.

Fig. 16
Intra-oral full coverage crowns and bridges three months after placement day.

Fig. 17
Intra-oral full coverage crowns and bridges three months after placement day.

Fig. 18
Intra-oral full coverage crowns and bridges three months after placement day.

Fig. 19
Extra-oral full coverage crowns and bridges three months after placement day.

Fig. 20
Extra-oral full coverage crowns and bridges three months after placement day.

Fig. 21
Extra-oral full coverage crowns and bridges three months after placement day.

The treatment resulted in nice looking teeth. Not only was the discoloration of the teeth solved. Also the health and the bite of the patient teeth were treated and restored for a sustainable future. The patient said it was one of the best things that she ever did. Combining oral health with cosmetic dentistry is indeed one of the best things a dentist can do for their patients. OH

Oral Health welcomes this original article.

About the Author
Mr. Luc Vanderborght LTH maintains a Cosmetic and Implant practice in Belgium. He graduated as a general dentist at the Free University of Brussels. He is a Fellow of the International Academy for Dental Facial Esthetics (IADFE) and a Fellow of the International Congress of Oral Implantologists (ICOI). He is an Associate Fellow of the Foundation for Oral Rehabiltation (FOR). He is a member of the American Society for Dental Aesthetics (ASDA) and a participating member of the American Academy of Cosmetic Dentistry (AACD). He is a member of the European Society of Cosmetic Dentistry (ESCD) and a member of the Nederlands Vlaamse Vereniging voor Restaurative Tandheelkunde (NVVRT). He is a Master in Consumer Marketing of the Vlerick Leuven Gent Business School.

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