Another problem shade

[NicelyMKV]

Hi everyone,
Well , after 3 attempts I still can not make this patient happy. She is in her late 50 early sixties and has severely over bleached her teeth. I attached some photos to see what you all thought. I am restoring 8 and 9. The crowns in the photo are D2 LT layered with D2 and TI-3 per Doctors initial shade prescription. I was able to see her and get photos after the temporary seating of the first crown attempt. I keep seeing an in between BL-2/BL-3 with a translucent grey low value etc. I built the last two attempts using BL-3 LT with TI-3(failed) then tried staining a BL-3 LT sub with A complex grey and layering with TI-3(failed). I obviously need to go back to school but until that time I was hoping you guys could give me some assistance. The prep shades are #8,C2 gin, C3 mid and C4 incisal. #9 is A4 gin, B4 mid and C4 incisal. I was thinking of going with a translucent ingot but I only have about 5 to 6 tenths of facial room. I go any more thick and the patient complains. With these preps it is just not looking good, huh? She wanted her centrals left long as well. Thanks for your help.

 

[designasmile]

Ingot Selection

Have you looked at trying something like Impulse V1

Link to video by Gerald Ubassy showing Impulse V1 vs MO1

Gérald Ubassy's Videos | Facebook

 

[TheLabGuy]

I'd probably do BL2 with TS3 layered and they may still be too dark and BL1 with TS3 layered will work better. You know the layering, it's the ingot selection that is the issue in my opinion. V2 might be a choice as well too.

 

[charles007]

I would try the 3D guide with a stain kit ... stain the tabs if you don't have translucent enamels shade tabs, then fire a few sample porcelain tabs to match, and use a zir frame......
I'm no expert at choosing ingot selection, duh the reasoning for using zirconia.

 

[disturbed]

I would: thin HO coping , BL3 dentin, Thick TS-2/W 1/3 OE-1 mix, maybe a thin bowtie of OE 3-4 for the middle of the tooth. couple spots of white stain to match some of that hypo.

 

[Flipperlady]

My eye keeps going to #7 mesial incisal edge where the doc must have accidentally hit that with a bur while adjusting something. If that were a denture tooth i'd have to replace it.....

 

[NicelyMKV]

I would: thin HO coping , BL3 dentin, Thick TS-2/W 1/3 OE-1 mix, maybe a thin bowtie of OE 3-4 for the middle of the tooth. couple spots of white stain to match some of that hypo.

The problem is I only have about 5 to 6 tenths of room on the facial

Thanks for all the help. I feel like there is just not a way for me to duplicate the effects due to lack of room. Seems like a bleach shade with a really thick overlay of really low value trans.

 

[rkm rdt]

What about the refractory technique using your enamel shades?

 

[Al.]

The problem is I only have about 5 to 6 tenths of room on the facial

Thanks for all the help. I feel like there is just not a way for me to duplicate the effects due to lack of room. Seems like a bleach shade with a really thick overlay of really low value trans.

I think it is the opposite. On alot of bleached patients I see a dark trans tooth that has only been bleached on the surface.

What did the BL3 look like to high value?

If it was my case I would have pressed in B1 LT. I would think it would look grey since B1 greys so easy. Then I would layer it with some BL3 in places Tran 1 or 2 and quite a bit of OE4.
All the white frosting on the surface looks like OE4.

 

[Alistar]

Have you looked at trying something like Impulse V1

Link to video by Gerald Ubassy showing Impulse V1 vs MO1

Gérald Ubassy's Videos | Facebook

Very insightful video.

You can see the prep under there, so I don't know if an LT is going to work unless the patient is willing to go thicker.

A MO-0 or HO-0 coping lightly stained with the D luster paste shader cut with 1/3 pink insical L-7 shader to get the underlying pinkish/grey at the gingival(I'm seeing some grey/brown - red/brown). Dentine shade of B1/BL3. Then layer similar to what Al and Disturbed said.

 

[rkm rdt]

"I was thinking of going with a translucent ingot but I only have about 5 to 6 tenths of facial room. "

I don't see how there is much room to layer OE 3 or OE4 over a pressed core with .5-.6 room.

You guys aren't suggesting our good friend exceeds the minimal thickness guidelines are you?:nono:

 

[Alistar]

"I was thinking of going with a translucent ingot but I only have about 5 to 6 tenths of facial room. "

I don't see how there is much room to layer OE 3 or OE4 over a pressed core with .5-.6 room.

You guys aren't suggesting our good friend exceeds the minimal thickness guidelines are you?:nono:

You can press to .3/.4 and layer on that shell. It was in the new Ivoclar Reflect newsletter. In the case where it was done the tech initially did refractory technique veneers, but it didn't go. He then press the shell and layered on that, and had success.

I will add, in that case he was not trying to cover a discolored prep, but I think you could press a MO or HO shell and layer on that instead of doing refractory. Only problem is you need to be VERY careful when working with a stained core/shell and not hitting it during you contouring. Ask me how I know this sometime. *sigh*

 

[Al.]

The minimal thickness area is only 50% to 60% of the crown and the crowns look flat in the center compared to the laterials. I bet you could fudge to .8 to
1mm over the prep if the shade is right. There is alot of room for layering on the M,D and incisal.
I would bet .6 B1 Lt directly over the prep, then .2 layered or .4 BL3/2 directly over the prep then .4 layered over that would have it in the ball park.

You can taper the M and D and roll the incisal edge to blend in and mabey get away with .8 to 1mm over the tip of the prep ?

With that underlying C3 I bet bleed through on the right thickness of Bl or Bl3 would give you the correct value.

Rather than make 2 new crowns,
If he is a local Dr couldnt you press 2 copings one in B1 one in BL3 LT. Sit chairside and thin the copings till you start getting the underlying color to show through to see how that effects the shade keeping everything wet.
I just think C3 bleeding through the white might get close.

 

[Al.]

You can press to .3/.4 and layer on that shell. It was in the new Ivoclar Reflect newsletter. In the case where it was done the tech initially did refractory technique veneers, but it didn't go. He then press the shell and layered on that, and had success.

I will add, in that case he was not trying to cover a discolored prep, but I think you could press a MO or HO shell and layer on that instead of doing refractory. Only problem is you need to be VERY careful when working with a stained core/shell and not hitting it during you contouring. Ask me how I know this sometime. *sigh*

Thats exactly what I would do, dont mask the underlying color but let it bleed through. You just need the correct ingot and thickness.
The higher value it is like BL2 the the thinner you take it directly over the prep. Like Bl2 mabey .3 to .4 or Bl3 .5 or B1 .7 etc.

Do the lingual full contour treat it just like a pfm with a metal lingual.

 

[user name]

I dont envy your challenge. Record it well. Im thinking youll be doing more work on that mouth. Nobody has suggested that this may be simplified with an opal ingot??

 

[Alistar]

I dont envy your challenge. Record it well. Im thinking youll be doing more work on that mouth. Nobody has suggested that this may be simplified with an opal ingot??

I think an Opal ingot could work, but they are more translucent than a LT, so he would get more stump show-through. If there wasn't that to consider it could be a good choice, and could be toned down with complex gray and TI1.

I've pressed an Opal2 for an OM1 shade, and it worked well. Very Opal/bluish ingot with a high value. I would say it's similar to the OE3/OE2 enamel.

popcorn

 

[NicelyMKV]

Taking it all in. I will definitely photo document my attempts. Thank you ALL for your help. I will give it another go tomorrow after I decide which direction to go. I have dentine colored paint so I may stripe the preps and do some experimenting with different ingots.

 

[NicelyMKV]

I think it is the opposite.

What did the BL3 look like to high value?

Yes. They would not even try it in. I was hoping they would have due to the prep shades underneath but....

 

[labmanmike]

I agree with Al...

 

[user name]

Opal.