When B1 is just too yellow...
I don't get to do a lot of bleach shade cases in my neck of the woods so I am always a little surprised when I actually get the chance. Whew! They are bright and they are white!
Here is a woman who wanted some new crowns due to recurrent decay and she felt they were too yellow. My camera does not do the existing crowns justice. They were a B1!
Her concerns with her previous crowns:
1. #9 was longer than #8.
2. The incisal embrasures between the laterals and centrals were too open.
3. She also didn't like the "black pepper" look between her centrals. #8 and 9 had previous endo.
4. Her crowns were too yellow and she wanted to match her "new crowns" on upper right.
5. Her crowns were all different opacities- #8 & 9 were lava crowns, where as the others were e.max done at different times.
Her plan is replace her lower anteriors next year as well as her upper left crowns.
Here is what I love about my CEREC. This case was pretty easy because all of the hard work was already done for me. I could have done this either Biocopy or Biogeneric Individual. Personally, I chose Biogeneric Individual purely because doing the copy line is an extra step and takes more time. I do however add the Biogcopy folder in the acquisition stage, and scan the existing crowns so that I can use this as a reference point for midline and incisal length. I also have my checklist of things she didn't like and can correct that by ghosting the Biocopy model over my proposals. She did not want a lot of characterization in this case as far as staining, because she wanted Hollywood white. My rule of thumb on this is, the less staining the more contouring. It's how I can get them to pop.
This is a case I chose to do same day. Why? Because seeing one patient vs. 15 is very calming to me personally, and also because when I leave my office, I don't have time to come back and do lab work. The one visit is my scheduled lab time. This is also how I market my practice and I am comfortable with that. My husband does cases like this in two visits because for him sitting with one patient is the exact opposite of calm. He would much rather do this on his own time with no pressure of time. Is there a right way? Yes, of course- It is always the wife's way!!! (just kidding- the right way is whatever you are comfortable with!)
The new crowns are e.max BL 2 MT crowns. I needed a touch of opacity to block out the RCT on #8 and #9.
Looks great Kris! I will say, I almost always do 4 units or less as same day. It is a little stressful for me because inevitably something is getting added in during the time I'm at the office. For many of the same reasons Kris describes, I do these cases in one day. I'm very adept with Biogeneric Individual but I will say I'm doing more and more Biocopy. As Kris described, the challenge is lab work time. Older software versions sometimes had their challenges with an accurate stitch and having biocopy help versus hinder, but the newest software versions are very slick.
With 4 children at home, travel, time, energy, sometimes that can be tough for lab work. I do like to break out the electric waxer, but as time moves forward, I find myself having a lab technician help. Is there a right way...depends on who you talk to and your practice.
Another tip about always imaging a Biocopy folder whether you use it or not is to see tissue levels BEFORE you have packed cord and imaged the preps. I have seen too many cases where the clinician overcontours the contours trying to prevent the dreaded black triangles.
Very nicely done!!!
In my experience, the BL2 and BL3 shades are really nice for bleaching cases or "Hollywood smile" cases. They are light, but with just a bit of warmth to them. In my practice, here in SoCal, people are requesting "White, but not unnatural." These cases can come out looking very light, but beautiful, as you have demonstrated.
On 10/24/2018 at 8:36 am, Jay Stockdale said...
people are requesting "White, but not unnatural." These cases can come out looking very light, but beautiful, as you have demonstrated.
Great work Kris...nice to see well done ceramic smiles.
Funny, here in Phoenix, A2 is considered "white, but not unnatural." That "too white" look is reserved for Scottsdale and Sun City....porcelain for the former, denture teeth for the latter. LOL
Very nice one visit case!
BL2 is as white as we go. We dont let patients go BL1.
Here on Lake Norman, NC, B1 is too yellow all the time. I had to go with BL3 for my Dracula fangs for this weekend.