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6 unit Anterior Bridge Remake

Discussion in 'Case Presentations' started by Al., Aug 31, 2009.

  1. Al.

    Al. Well-Known Member

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    Ok I just got this case in the mail.

    It is a bridge from a Dr that is just starting to send me work.

    This bridge is from another lab. He tried the bridge in and took a half dozen pics. He sent me the bridge and their model work and the original imp.

    He requested I call him which I will do tomorrow and he wants me to strip their porc off and redo it using their frame work.

    The frame looks ok to use I should be ok there.

    I dont know the name of the lab or how much he paid yet, but I wont post the labs name anyway.

    Shade and trans or lack of it are another story, it needs alot of contour changes.

    It needs way more lip support added, the height of contours need to come way out, the line angles and the long axis need to be changed, the D of the lats need to be brought over towards the cuspids it needs more incisal seperation etc. etc.

    I actually see this alot, people dont realize how much the ridges have shrunk back and way undercontour the gin pontics.
    In all fairness to the other lab sometimes you cant tell untill you see it in the mouth.


    ai46.photobucket.com_albums_f116_CDLAB_6u1.jpg

    Ok I printed out this pic and I rough sketched out the changes I intend to make. Then I snapped a pic of my sketch and uploaded it.

    Im going to send these to pics to the Dr.

    What do you think? They may be a bit large but I think he will get the idea.
    But I am not quite sure because looking at the profile pics I think she may need it made this large.

    ai46.photobucket.com_albums_f116_CDLAB_6u2.jpg
    ai46.photobucket.com_albums_f116_CDLAB_6u1.jpg ai46.photobucket.com_albums_f116_CDLAB_6u2.jpg
  2. CatamountRob
    Amused

    CatamountRob Banned Member Donator

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    How will you re-oxidize the metal after stripping the porcelain if you don't know what the alloy is, or do you know what it is? Rob
  3. SSDS

    SSDS Member

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    Hi Al,
    this sort of problem usually occurs when Dr takes imp, opposing model and his instructions to the lab are "please make 6 unit bridge shade A1 with little A2 neck" and that is it. Without diagnostics or some sort of study models the lab sometimes goes in one direction without knowing patients details, lip support necessary shape etc. I would be interested to see your result, which I have no doubt will be nice judging by some of your other postings, or if you encounter any problems.
    Jim
  4. sixonice

    sixonice New Member

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    Al:
    I like your sketch and ideas for re-doing the case. She defineltely needed more gingival third contour and width (the original bridge looked to tapered) but like you mentioned, the lab probably did their best with what they had. Without a study model or any good input from the dentist (even a pre-op picture would have helped some) your doing the case on blind faith and instinct. Now, with YOUR revisions and changes, you put yourself in the driver seat and the dentist has to approve YOUR ideas!
  5. charles007

    charles007 Well-Known Member

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    Al, not that I can give you any ideas with all your talent, just my $.02 worth.

    Make a couple sil-tech putty matrixs to have a reference of the bridge, on the incisal edges also.
    Make the centrals a little wider as you said.. Hope the patient didn't wear this bridge, she may not like a wider look, but I think the centrals need it.
    Tilt the neck of the laterals to the distal as you said, they are contoured away from the midline.
    Cuspids are bulky, round back so that you don't see the the surface of the facial from mesial to the distal. This mistake is seen soo often in cases like this.
    Throw in a few incisal embrasures just for the fun of it.
    Add a slight dentin color on the incisal edges of the centrals, maybe !
    Needs a more translucent shade on the centrals, value is a little high, especially the middle facial surface.
    Laterals, have a very slight color change. I like a half shade darker than centrals at the neck, some techs like the reverse. Shorten the incisal length of the laterals if you want a younger look to the bridge...
    Cuspids, make shade a little darker than laterals, more chroma so that its more natural looking, instead of the same shade for all 6 anteriors.
    Open up the incisal embrasures alot on the cuspids, they are closed on this bridge.
    Don't know the prep style, would use some deep dentin especially on the cuspids, opaque is showing thru so much on 6,11. Probably little reductions when preping.
    I would be careful with the gin 1/3 shade on the centrals, patient may not want that darker color as seen on this bridge and the lowers. This patient may want to restore the lower anteriors next.
    Hope the cte matches your porcelain, and you have good metal support ..

    I like your drawing, just not so square on the incisal edges, more rounded. More width at the neck in your drawing also look better than the bridge.

    Now tell me Al, what did I forget, or you disagree with ?
  6. Al.

    Al. Well-Known Member

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    Thanks guys for the suggestions!

    Alot I wont know untill I start building porc.
    The sketch and pics are a great way to communicate with out of state Drs.
    I promise if you email your Drs pics of your progress, they eat it up and they tell their friends. They love that kind of communication and it is much quicker (for me) then driving to their office and waiting to talk to them and show them a case. I just sent them an email with pics attached and wait for their appproval. I like to document my intresting cases with pics anyway.

    I have better communication with Drs out of state through pics and email than I do with my local Drs.


    One thing I know that really screws us up on ant bridges is the laterals.
    Our cuts on the model work, take away too much tissue and often we make our laterals too far mesially and at the wrong angle.
    Now I go back on my pontics and cut in retention and add on with acrylic to fill in the space, unless I build on the solid model.

    But alot of times the frame is waxed wrong because of the space then we follow the frame.

    Here are some more pics.

    The opaque really shows through in the thin areas and the lab put stain on it to cover it up.

    That can be taken care of sooooo easy. If you do a A2 shade do NOT opaque the margins and interprox in A2, use an A3 or and A35 and then apply a shade darker at the gin and interproximal. I have a cervical porc I put there.

    I have seen it in the mouth and it will eliminate that terrible highvalue in those areas.
    Also I put opaque "intensive incisal" on the tips and it makes a big difference with the incisal 1/3.

    Here are some more shots.

    How do you like those lower ants? I bet some stiff imp materials could extract them.

    ai46.photobucket.com_albums_f116_CDLAB_6u3.jpg
    ai46.photobucket.com_albums_f116_CDLAB_6u4.jpg
    ai46.photobucket.com_albums_f116_CDLAB_6u5.jpg
    ai46.photobucket.com_albums_f116_CDLAB_6u6.jpg
    ai46.photobucket.com_albums_f116_CDLAB_6u3.jpg ai46.photobucket.com_albums_f116_CDLAB_6u4.jpg ai46.photobucket.com_albums_f116_CDLAB_6u5.jpg ai46.photobucket.com_albums_f116_CDLAB_6u6.jpg
    Last edited: Sep 1, 2009
  7. Al.

    Al. Well-Known Member

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    Holy Crap I didnt think of that. That would be a disaster.
  8. Al.

    Al. Well-Known Member

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    I think the only way to be predictable with ant bridges in the pontic areas (height of contours etc) is with a wax up and temps made from them and then the doc needs to adj and add on till they get them how they want, then take imp of the temps.

    But that dosent happen too often, at least for me.
  9. Al.

    Al. Well-Known Member

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    You know what is intresting, I did not receive a pre-op model, but the other lab must have had one.

    They have the incisal edge length marked on the opposing and the midline.
    So they must have hand art the models and drawn it on the opposing.

    BUT they are 2 mm short of their own incisal edge lines!
  10. Al.

    Al. Well-Known Member

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    I dont know I didt think that far. I quess I will get the docs sec to call and ask what metal they used.
  11. charles007

    charles007 Well-Known Member

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    Al, find out the what alloy you have, measure every sq mm for thin spots, then refinish the surface. Oxidize as recommended, change cooling rate to make up for the cte IF its close enough to use. I always refuse to use some elses frame, but you do what you have to do sometimes. Saves time if its ok, and the dr thinks he's saving buckets of money.
  12. charles007

    charles007 Well-Known Member

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    On the last picture, contours are to bad looking straight on.. Opaque showing, laterals are going the wrong way, need more incisal embrasures, with bulky cuspids.. Correct the length if doc wants to match the length marks on the lower model? Really need pre-op model.
    This should be an easy fix .
    Last edited: Sep 1, 2009
  13. CatamountRob
    Amused

    CatamountRob Banned Member Donator

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    Al,
    I would be terrified to do it with d.sign porcelain, unless I knew exactly what the metal was, it seems to be to very alloy sensitive. Hopefully in-line is more forgiving. Its things like this that make me miss Will Ceram porcelain, it seemed you could put that on anything with no problems. Rob
  14. Al.

    Al. Well-Known Member

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    Thats the tough thing with pfms, they can look great in the lab under our lights but take them out side or put them under the flash or that bright operatory light their opaque.

    I try to put a layer of incisal porc over all the body porc, that tones down the opaque alot.
    Also the body porc for pfms seems much more opaque than the body porc for all ceramic systems, I think to give it more masking ability?

    So I always feather the incisal, 3/4 of the way down.

    There is an orange and a yellow cervical translucent that works to give translucency on the G 1/3 without losing chroma. Ive been using that some lately.
    Last edited: Sep 2, 2009
  15. Al.

    Al. Well-Known Member

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    Ivoclar claims that inline has a wide cte range and can be used with more different metals than other porc.
    I dont know if that is true or marketing hype.

    I miss Will Ceram too. I used it till they discontinued it or replaced it with inline. I switched by force. But it was tough on long span high gold content bridges because of the higher firing temp.
  16. CatamountRob
    Amused

    CatamountRob Banned Member Donator

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    There is another company out there selling Will Ceram porc., I'm guessing that Ivoclar must have sold them the rights. I don't know if it's the same as the old Will ceram or not though. You can find it you do a web search. Rob
  17. Al.

    Al. Well-Known Member

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    Your right. Here is their site they opened in 05 it says.

    Id be afraid to try them. Start using a product from a new company and get used to it and they go out of business.

    If I was going to switch I would try Noritake. I heard good things about them.

    Mabey Id try Vita?

    Provident Dental Products | Welcome
  18. wwcanoer

    wwcanoer Member

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    Is there a way to eliminate the "black triangles" between 6 & 7, 7 & 8? Ruins her smile IMO. Ging porcelain?

    carol
  19. Al.

    Al. Well-Known Member

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    Hi Carol, I wont know untill I start building but I am pretty sure that just by making the pontics larger and moving them towards the distal a bit all the spaces will fill in.

    I try to use gin porc sparingly.
  20. wwcanoer

    wwcanoer Member

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    I have a whole lot of Williams/Ivoclar Will-Ceram porcelain collecting dust, boss says I can sell it if anyone is interested. I'll try to get a complete inventory list together

    Carol
    Last edited: Sep 4, 2009

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