Guided tooth preparation for a pediatric zirconia crown

Background and Overview: Unesthetic primary incisors can produce negative self-perceptions in preschool-aged children. In recent years, because of increased esthetic demands, prefabricated zirconia crowns have become increasingly popular. However, zirconia crowns cannot be crimped, and the clinician must prepare the teeth to fit the zirconia crowns. Therefore, extended preparation and fitting times are necessary, especially for inexperienced practitioners. A 1- to 2-millimeter subgingival feather margin also is required. Gingival hemorrhage after subgingival preparation compromises the retention of zirconia crowns. Case Description: In this clinical report, the author presents a step-by-step description of the clinical and laboratory procedures for restoring a discolored traumatized incisor with a zirconia crown. The author used a polyvinyl siloxane occlusal registration material as an impression material and made 2 identical casts. The author fabricated 3 reduction guides after prospective tooth preparation on the casts. The author rapidly prepared the discolored incisor with the reduction guides and ultrasonic burs. A zirconia crown provided an optimal esthetic result and gingival health. Conclusions and Practical Implications: Because the reduction guides provided a visibility intraorally, fast tooth reduction, less trial placement, and passive adaptation of the crown were successful. Because the ultrasonic burs prevented gingival injuries, hemorrhage control was not necessary. The presented technique reduced the patient's discomfort and total chair time. Therefore, this alternative technique is helpful for inexperienced practitioners.