Aesthetic rehabilitation of cervical wear (abfraction) and diastema with E.max all-ceramic crowns

Our male patient, aged 76, reported to our clinic with the following complaints:

  • He was immensely disturbed by the compromised aesthetic condition of his teeth.
  • He was ill at ease to smile because of the looks of his teeth.
  • He was looking to eliminate the cervical wear on his teeth and the gaps between them.
  • He sought to restore his self-confidence by the aesthetic rehabilitation of his teeth.
  • He wanted to smile again without embarrassment.
  • He desired to have a nice and natural smile with no overly white teeth but ones that matched his age.



The fabrication of E.max all-ceramic crowns (10 workdays)

At the first consultation a panoramic radiograph was taken and the condition of the teeth and the periodontium examined.

Panoramic radiograph of the initial condition

The first examination revealed that the lower left wisdom tooth (no. 38) was due for extraction and the adjacent bridge was in need of re-fabrication since it developed carious tissues underneath. A treatment plan was drawn up and handed over to the patient with a quote included. Since aesthetics was a top priority with the patient we advised E.max all-ceramic crowns for his upper and lower front teeth, but a metal-ceramic bridge restoration for rear molars.
Following the filing and preparation of the teeth, precision impressions were taken thereof to be forwarded to the dental technician together with the photographs and the patient’s every single request. A gnathological treatment was conducted involving bite registration and a face bow transfer by means of an Artex face bow.
Professional tartar removal and polishing were carried out to find a matching colour for the all-ceramic crowns to achieve a perfect smile. Tooth number 38 was removed. The fabrication, trial fitting and luting of all-ceramic crowns is a meticulous, high-precision and time-intensive procedure. Our patient was perfectly satisfied with his new teeth and is comfortable to smile again, which has boosted his self-confidence.

What we should know about all-ceramic crowns:

  • They are perfectly suited for overcoming aesthetic shortcomings of the front teeth such as crowded teeth, misshapen teeth, gaps between teeth (diastema), discolorations, broken incisal edges, and developmental disorders of the enamel incorrigible by teeth whitening.
  • They can alter the size, position, colour and shape, of front teeth.
  • They are not applicable with teeth reinforced with metal post and cores since the greyish, blackish shade shows through beneath all-ceramic crowns.
  • E.max crowns contain no metal (metal-free crown, tooth restoration) and thus comply with the highest aesthetic demands.
  • Less tooth material and enamel needs to be filed down as compared to conventional metal-ceramic crowns.
  • The size and colour of all-ceramic crowns can be perfectly adjusted to our natural teeth.
  • Being thin, they do not disturb the tongue and the lips and getting used to them poses no issues.
  • When fabricating all-ceramic crowns a few other considerations must also be taken into account. All-ceramic crowns should be forgone in case of patients with severe bruxism (tooth clenching or grinding).



It is often thought that no professional tartar removal is required with tooth restorations (crowns and bridges), but this is a misbelief. Tartar may also deposit on tooth restorations such as beneath bridges, and in the interest of the longevity of the tooth restorations professional cleaning by a dental hygienist every once or twice a year is indispensable.

Metal-ceramic bridge designed for the lower left teeth on the master cast


The metal post and core cast into the rear pillar (prepared root canal of the abutment tooth) of the lower left metal-ceramic bridge and the shoulder preparation as laid out on the master cast


The metal post and core cast into the rear pillar (prepared root canal of the abutment tooth) of the lower left metal-ceramic bridge

The plaster model of the rear pillar (prepared root canal of the abutment tooth) of the lower left metal-ceramic bridge for which the cast metal post and core was designed.

The rear pillar (prepared root canal of the abutment tooth) of the lower left metal-ceramic bridge in the mouth for which the metal post and core was designed – pictured before the post and core was installed

The lower left metal-ceramic bridge cemented in place

Photographs of the lower and upper E.max all-ceramic crowns on the master cast

Follow-up panoramic radiograph of the metal-ceramic and all-ceramic crowns designed for natural teeth





The new smile

Keywords: E.max all-ceramic crown, E.max, IVOCLAR, metal-free crown, metal-ceramic crown, gnathological treatment, Artex face bow, aesthetic rehabilitation , closure of gaps between teeth, diastema, cervical wear, abfraction, cast metal post and core, bridge replacement, pontic replacement, bruxism