1/2 MM pbm...

[dentcre]

I had a upper central pbm #9, non precious
I went to take a look at the shade and it looked liked a bleach C1 ,
lighter than b1 and c1 plus translucent grayish...
"never seen this shade before,,I guess we are supouse to start seeing this after all this bleaching frenzy"

after pouring model the prep is out of the arch compare to number 8, so when I finish making the pbm
I ended up with 1/2 mm thiknes , this is including metal,opaque dentin and enamel.
looked real bad ,I can not get the strange shade to match in so liitle thikness.

its not an endo tooth so reducing on the prep more its not an option at this point. dentist thinks I am a some kind of wizard.

so ....
what do you all suggest I try, considering I have only 5 tenth of a milimiter to work with.
popcorn

 

[TheLabGuy]

a lithium disilicate........it will give you the translucency you're looking for.

 

[Al.]

a lithium disilicate........it will give you the translucency you're looking for.

I agree all ceramic is what you need, but for pfm you need to match the opaque to the shade you want. A c1 or b1 opaque is going to look terrible. I have an intense incisal opaque modifier that works well for these situations. Try a base coat of D2 opaque then violet opaque on top of that. For pfm you have to have it thicker or mabey they need ortho to bring the tooth in.

 

[Al.]

I had a upper central pbm #9, non precious
I went to take a look at the shade and it looked liked a bleach C1 ,
lighter than b1 and c1 plus translucent grayish...
"never seen this shade before,,I guess we are supouse to start seeing this after all this bleaching frenzy"

Do you have bleached shade guides? Do you have incisal shade guides?
Alot of difficult shades are incisal shades. If your porc dosent have incisal shade guides make your own. Fire tabs of all your incisal porc, not just 57-60 but your opalesent incisals your white incisal porc and your violet and blue incisal porc and I bet you can match most difficult shades. Number them and write it on paper.
Also you can match alot of shades with your vita shade guide if you cover up all the tab except the incisal 1/3 to 1/4. I seen alot of teeth that are the shade of the inciasl 1/4 of the d2 or b1 shade tab.

 

[dentcre]

thanks,,
interesting about violet opaque, and the disilicate

I suggested ortho to save the root cannal , so right now is..., more reduction or no crown,, situation is frustrating ,,no help from the dentist , no help from the patient to take the time to come to the lab.
I dont need the hassle. I want to do it because is kind of a challenge for me and it will help me in the future but cant force them to do it.
..
...

 

[Al.]

thanks,,
interesting about violet opaque, and the disilicate

I suggested ortho to save the root cannal , so right now is..., more reduction or no crown,, situation is frustrating ,,no help from the dentist , no help from the patient to take the time to come to the lab.
I dont need the hassle. I want to do it because is kind of a challenge for me and it will help me in the future but cant force them to do it.
..
...

You can make it look good with only .5 on the facial with an all ceramic crn if the prep is not discolored. but for pfm you really need 1 mm if it is a trans looking tooth. If it is a bleeched shaded tooth it is pretty easy to mask out the metal.
.2 metal, .2 opaque, .6 porc. Do you have a pre op model, I bet the original is out there, just make it 1mm thick and tell the doc that is all that can be done in PFM.
Do you have to outsource your all ceramic? If so you are really hamstrung in what you can do estheticly.

 

[dentcre]

You can make it look good with only .5 on the facial with an all ceramic crn if the prep is not discolored. but for pfm you really need 1 mm if it is a trans looking tooth. If it is a bleeched shaded tooth it is pretty easy to mask out the metal.
.2 metal, .2 opaque, .6 porc. Do you have a pre op model, I bet the original is out there, just make it 1mm thick and tell the doc that is all that can be done in PFM.
Do you have to outsource your all ceramic? If so you are really hamstrung in what you can do estheticly.

I fabricate inceram in the lab ,im making an inceram right now ,
also
making a 88% gold coping and cut a window right in the facial middle where there is no space . ,,there is very little space in the lingual also thats why I was thinking of this gold option , maybe the inceram will brake ,.
aestethics will dictate wish one stay in the mouth

anyways I will try to take pics . in the mouth, once I deliver, good thing im getting payed for both plus custom staining..

ps..no pre prep model,,patient was refered from an out of town doctor that couldnt make her happy .

 

[Al.]

I fabricate inceram in the lab ,im making an inceram right now ,
also
making a 88% gold coping and cut a window right in the facial middle where there is no space . ,,there is very little space in the lingual also thats why I was thinking of this gold option , maybe the inceram will brake ,.
aestethics will dictate wish one stay in the mouth

anyways I will try to take pics . in the mouth, once I deliver, good thing im getting payed for both plus custom staining..

ps..no pre prep model,,patient was refered from an out of town doctor that couldnt make her happy .

Thats intresting, I know a guy who said he cut out a window in a pfm like that. What do you do, lube the die and opaque it or use porc sholder material or refractory or foil?

Thats funny your making 2 crns, Ive done that a few times in the past on really diffuclt patients as insurance that one of them would be right. I ate my labor and scrapped the metal, but it was worth it to have a very happy Dr. and patient.

I would love to see pics of the crn with the cut out, if it works out for you.
Good Luck,Al

 

[dentcre]

yeah the 2 crowns will save me a lot of time, and since I cant decide between the 2 , im just making both. plus patient is from out of town.

on the window deal,, i soak the die in water before, it wont stick, if you separate before the porcelain is very dry ,. no opaque just regular dentine porcelain,,this is because the prep has a nice color, though I might give it a pass with colorlogic masking porcelain
,I think this doctor has a kit on colored cements that he uses for veneers.

now im debating on what shade to use on the inceram.
c1 coping or d2 ,b1