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Just a fun little case that I finished today. Nothing special, just bread and butter.
Gold Crowns on #3 and 4. #3 had decay underneath and #4 had vertical root fracture.
Extracted #4, let heal 6 months, Implant placement, integrated 3 months, inCoris Abutment (F2) and e.max LT crown. I could have done e.max screw retained... but I did not have the right shade in stock :)
Zirconia Crown #3... polished.
Will give you and idea of what CEREC Zirconia (polished and no infiltration) looks like next to e.max. Not terrible... but why I try and infiltrate lately to lower value more... very opaque
It must be a full moon, because I've recently had three or four cases of young patients falling and causing a fair amount of dental trauma. This beautiful young woman was very happy that we could get her smile back!
There are many threads always going on asking "what block should I use". I will tell you first off, this is almost impossible to answer just by looking at a picture. Ross Enfinger has a really nice thread on this as well.
Just one quick case that will basically give you my theory on anterior teeth cosmetics.
- Always use the most translucent block that will get the job done
- All the natural value, translucency, and opalescence is in the enamel... so if you remove all the enamel, your job is going to be more difficult making the teeth look natural.
- Always as conservative as possible. That is, Veneers always before Crowns if that is appropriate. Veneers are hard, but crowns are much more destructive to the tooth. The more you prep the tooth, the biomechanics change quite a bit and it weakens it dramatically.
- Don't forget composite. After sitting through part of the Spear Composite course last week, I was reminded that we should use composite more in the anterior than most of us do.
Here is a case:
Woman in her 50's came to my office for a consultation on her anterior teeth. She had a pretty nice fracture in #9 and #8 was chipped on the incisal edge. Both teeth had a fair amount of erosion on the facial as well.
We talked about 2 options really: Composite and Veneers. She really had done some research on this already and visited a couple dentist with varying opinions (some to crown the front 6 even) and knew she wanted veneers. I was personally relieved because I didn't want her to choose composite because then I was going to have to execute it :)
After we decided on veneers on 8 and 9 I had to get an idea of what material to use. She has a lot of translucency, so my choice was either e.max HT OR Vita/Vita Trilux... I wasn't sure quite yet. I was concerned about the wear on the teeth, but I also knew that Vita was going to be easier. Either way, I knew if I was going to control translucency and value, I needed to control prep. With her facial erosion, it would be easy to over reduce and increase the material thickness (thus decreasing the value).
So the next thing we do is a quick composite mockup:
From here we can do our proper depth reductions using the Winter Reduction Burs from the Restorative Design Kit and get conservative Veneer preparations:
In the end, I chose Vita Feldspathic veneers on her and protected them with a night guard. You also could have used e.max HT I feel and got a great result as well.
Hopefully this helps and spurs some additional thinking. Also read Ross's thread. I will try and link to it.
I've been using the Verban drill stops with the CG2 for some time and have enjoyed lots of success with it. I recently started using the new version of the drill stop made for the Densah burs and like it a lot better.
The original drill stop fits up against the hub of the handpiece, so the vertical depth is controlled when the handpiece bottoms out on the guide.
The new version of the drill stop sits passively on the Versah drill and can slip up and down until the stop makes contact with a silicone ring that you place on the drill at your desired D2 depth. It also has a lip that engages the guide. This allows more flexibility in setting the D2 value and makes for an easier vertical stop depending on the geometry of the guide.
The D2 is calculated by adding up the length of the implant, the distance from the implant platform to the gingival crest, and the length of the stop. I like to add 1mm on to that length to make sure the stop doesn't prematurely contact the gingiva before the final depth is reached.
In speaking with Dr. Verban, I believe there will be a modification with the silicone stops being made of metal and added to the stop, but the premise will remain the same. This stop allows the ostetomy to be performed for most implant types and situations using a minimum amount of costly instruments.
Patient wanted to do something about his front 4 teeth. Extensive failing restorations and unesthetic. Was very concerned about the teeth looking natural and not fake.
- Same Day Treatment
- Mockup in composite to get overall better shape.
- Keep all 4 anterior teeth slightly asymmetric in order to look more natural. Important to keep triangular shape here and not get them too "boxy"
- Material: Vita Mark 2 shade 2M1
- Bonded with Variolink Veneer +1
Things that are important to keep things natural IMO are:
- overall shape: Keep Height/Width ratios consistent to where there original teeth were if they were " in the ball park"
- Incisal Edge length: Be careful not to lengthen teeth if it's not necessary.
- Asymmetries with both shape and embrasures. You don't want them to be extreme, but slight differences will help.
- Materials: nothing too bright and something that matches the overall value of their existing teeth.
I like cases like this because they are more fun and challenging. Creating bright perfect teeth off a waxup is easy!
So, I've always thought you can't polish a turd, but maybe you can. I've been trying everything in my bag of tricks to make the cerec zirc look good. My go to has been gc paste, but to make these things look good and to have the occlusion not change I'm using jumbo milling offsets in my parameters, or I'm having to adjust the occlusion. I've tried combinations of the gc and emax stains in the speed fire, but the emax stains just don't look great coming out of that oven. I know it's supposed to end the world if we try to put anything off label in the oven, but the sun is still rising. This was my first shot at using a combination of emax stains with vita glaze in a short oven cycle. It's my typical empress technique or my go to for emax that is going to require more than one oven cycle. It's still not perfect, and the fact that I need a second oven cycle for staining is a bit annoying, but I think this one will be a winner when we get some nicer looking zirc options for the speed fire.
Here is the implant plan. A very tight spot and high "pucker" factor. Would you place the implant as planned and if so. If not, how would you change the plan? Or... do you think the space is too tight and would not place the implant at all... She has already been through Ortho...
If you would place the implant, what are some of the considerations you have to be thinking about moving forward about the restoration phase?
No that I have drug my self away from the pool in Dallas (see Skramy's post for reference) here are some cases with the ivocolor that I did last week.
The first case is an extra bridge I had laying around that I use to test glazes on. So it was already sintered and just need esthetic enhancement. This a the same bridge using two different lighting scenarios to show the optics. This is straight out of the oven and allowed to cool. As you can see it is similar to the GC luster paste in that it looks a little grainy.
Here it is after polishing.
Now of course these are out of the mouth so how does it look in the mouth.
Here is a case of two centrals.
The patient had a very dark stump shade on #9
These are MT blocks for the finals. There was an opaquer used on the stump to help block out the color.
Glazing after already sintering is the current recommended method by Ivoclar. What we are actually testing is how does it look and survive with a single firing in the blue state. Let's take a look.
This is a crown my assistant did in a single firing. She did say she went a little crazy playing around with the brown in the grooves
Here is one that I did on an HT block in a single fire. I would have had pics in the mouth but the patient's tissue was bleeding like crazy after clean up.
And here is one fired and put in the mouth.
My take on this material is this. It applies very nice. The colors stay in place and don't tend to get a blotchy. I am still working on the consistency of the glaze(which has to be cut with liquid) and essences ( which come as powders). However the colors are vibrant and gives a nice natural look to the restorations.
When two fires are used you get a little bit of grainy look to it, that could be from my consistency of my mix, but with a little polish you get a nice texture that looks natural. Very similar to luster paste.
When you single fire you get a nice glassy glaze. This is a low fusing ceramic so when by firing it on the higher Emax cycles you are heating the glaze way past its melting point so it becomes very smooth upon cooling.
Also because it is a low fusing porcelain you can use it on any material that we currently glaze. For anterior's you get something very similar to Luster Paste and for posteriors with a single firing you get a glaze that is almost as glassy as the Identco spray glaze. Also since it is low fusing you can use the liquid glaze with the P3 faster fire cycle.
And yes you can use it on the new Zirconium.