The ultimate aesthetic challenge in dentistry: a single crown on a maxillary central incisor (Dent Update 2018; 45: 415–424)

I read this article with a sense of dismay, particularly the sequential photos of the crown preparation, and was forced to wonder whether it would pass the ‘daughter test’. (I have a beautiful 26-year old daughter myself!)

Given the initial extensive treatment the tooth has already received, and that in such a young patient, the long-term prognosis for the tooth is already guarded.

If my daughter had such a heavily restored central incisor (and there were no supporting radiographs showing this, but the text mentioned root treatment, apical surgery and a large palatal composite) would I consider turning, what at least appears to be, a whole tooth into a small peg on the basis of an aesthetic problem? Especially as that small peg presumably has a significant hole down the middle of it (where the RCT was done).

I guess I would be looking at trying a lot harder with my bleaching techniques – both inside and outside bleaching, before hastening the destruction of the crown of this vulnerable tooth. Certainly the final crown looks great, but does it improve the longevity of the tooth to iatrogenicly remove most of the remaining coronal tooth structure in the name of aesthetics?