There are two options when facing heavily discoloured teeth: improve the substrate’s colour through bleaching or mask it with the restoration. If the first option isn’t possible, preparation design and material selection are essential for effectively concealing a heavily stained tooth and achieving an attractive smile.
Restoration translucency and aesthetics
While more translucent restoratives are often considered more aesthetic, a severely discoloured tooth requires sufficient opacity to mask the discolouration. Choose a framework with higher opacity, such as Initial Zirconia Disk HT or Initial LiSi Press MO. Micro-layering with Initial IQ ONE SQIN will add depth and translucency. If in doubt between two shades, choose the one that is highest in value.
Remain minimally invasive
In case of a discoloured prep, it might be tempting to remove more tissue on behalf of the veneering ceramic. However, with micro-layering, one can already obtain nice results within a layer that is less than 0.6mm. Tissue preservation should always prevail.
A single discoloured prep poses a challenge to match the shade and keep a lively translucency.
Clinical images: Single anterior crown of Initial LiSi Press (MO0 ingot) on a heavily discoloured prep. Courtesy of MDT Stefan Roozen
Cementation options
When a preparation is significantly discoloured, opting for an opaque cement can be preferable. Yet, if the framework itself has a higher opacity, the specific colour of the underlying cement becomes less critical. Depending on other case variables, one could choose for a glass ionomer based cement such as FujiCEM Evolve or for a resin cement such as G-CEM ONE (White Opaque or AO3), depending on the target shade.
Discoloured teeth pose a common challenge for dentists, whether affecting one tooth or several. Identifying the cause is crucial for proper management. Severe discolouration often requires masking.
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