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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.
This topic came up about a month ago and a text from Darin O'bryan finally got me motivated to open this stuff up and give it a test drive... I am very impressed. It works nice.
I don't want to compare it to LustrePastes quite yet... but initial impressions were extremely positive and I'm going to work with this a lot more (probably exclusively) to form a better opinion. I did a 14 unit case with e.max MT with it today. I seat it tomorrow and will take some photographs. I also am going to test the fluorescence of it because the shading and essense pastes supposedly have particles in it. I really like the dentin shading. Really easy to apply.
Looks like we have another winner :) Darin can post his comments as well.
I inherited this case and I know the patient was frustrated with the lack of communication, and this lead to him switching to me. I was a little worried that he wasn't going to be a good patient by some of his initial comments but I made it clear with pictures, waxups and just general discussion of what we could achieve. He was interested in CEREC and so paranoid about these looking big and bulky like his prior bridge, that he wanted to see my proposals before I milled them...
Tough case nonetheless. He was a bit brighter than B1 so I went with a BL2 MT block...geez...they are bright!
Tried it in and it didn't look too bad but definitely needed to be toned down. So I used L-A and L-3. The A stain to give a little more gingival color and the L-3 to lower the value of the crowns. As many discuss, there is a bit of a learning curve for Lustre Paste, but I do love it. The abutment block is a MO2 block...used an S-block for Biomet 3.4 implant
It's just amazing what we get to do everyday and the technology we can do it with. The excitement level from patients to my team just keeps getting better and better. I wanted to post these 2 cases because the "dreaded single central" are the most challenging cases to me. And somehow we have had 2 this week.
People always ask, "what material I should use for this case....". And as all of us know it varies. So just wanted to show 2 different materials that you can use on a day to day basis. I will have to say that I could not do this type of anterior without a very passionate team member. My assistant is very talented with staining a glazing and is an invaluable asset to my cosmetic work.
Case 1: 61 year old male that had a 30 year old PFM that I have been asking at every hygiene check if he wanted to replace. Every year, no not this year, not bothering me. Well this year was the year. He decided to replace it. Used biojaw to get good starting point and then refined post mill. Was very happy just from the initial try in with no stain or glaze. This case was Vita Triluxe, 1 fire.
Case 2: 66 year old female with #8 having RCT a while ago and had 2 large composite fillings on the lingual. Decision was made for full coverage since they were leaking and a redo filling was not a great option. Discussed doing some ortho or involving more teeth, but patient decided on just 1. So had lengthy discussion of copying existing size and shape. Biocopy was used on this case. Vita Mark 2 with 2 fires (1 stain and 1 glaze). Value may be a little low, but will see in a few weeks after teeth rehydrate.
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