Custom Anterior Shade Cases

[Ken Knapp]

Recently, I have had a few custom anterior cases back and forth with dentist over shade.
Dentist sends pictures and RX shade for FCZ. I follow RX, case is sent back for shade change form B1 to C1 and add porcelain for incisal translucency as an example.
Cutting back an existing B1 framework to make a C1 with porcelain of course doesn't work. I have to make a new framework in C1 with cut back and add porcelain.

Photos are taken with phone and shade varies with photo angle.
It's driving me nuts and of course the dentist asks have you changed your material, It must be a lab problem!

Do you work with only pictures on challenging custom shade cases or need to see the patient?

 

[zero_zero]

For challenging cases the pt. has to come in for shade taking... if is something super difficult, then there's a second appointment for custom staining...

 

[Car 54]

If I don't like what I see in the photos they send, I ask to take the shade.

 

[Ken Knapp]

For challenging cases the pt. has to come in for shade taking... if is something super difficult, then there's a second appointment for custom staining...

Photo of case 4-6 bridge, RX B1 with FCZ. I used Cube X material. Bridge shade matches B1 but doesnt match patient. New photo with C1 shade tab and patient/dentist wants to mimic incisal edge translucency.
Have to remake framework and add porcelain at NO Charge.

 

[2thm8kr]

That shade isn't C1 either. Just because you get photos doesn't guarantee you will match the shade perfectly. Matching natural materials with man made is quite challenging. Set your fees accordingly. Sometimes you hit the shade the first time, other times it takes 3 or more attempts.
You need to devise a policy and protocol for custom shades.

 

[Dentalmike]

That shade isn't C1 either. Just because you get photos doesn't guarantee you will match the shade perfectly. Matching natural materials with man made is quite challenging. Set your fees accordingly. Sometimes you hit the shade the first time, other times it takes 3 or more attempts.
You need to devise a policy and protocol for custom shades.

This

 

[rkm rdt]

I see every patient for anterior cases unless they don't care.
Every anterior crown is layered and I charge for the shade and photos.
Pt books in for the shade and returns for the verification prior to the appointment.

My system works for me and my Drs are very happy with the results.
I never work from someone else's pics.

 

[CatamountRob]

Photo of case 4-6 bridge, RX B1 with FCZ. I used Cube X material. Bridge shade matches B1 but doesnt match patient. New photo with C1 shade tab and patient/dentist wants to mimic incisal edge translucency.
Have to remake framework and add porcelain at NO Charge.

If I was asked to make a FCZ anterior case and it turned out later that it needed to be layered, there would be an additional charge. You don't have to do anything, you choose to get walked on or not.

 

[RileyS]

I'd definitely charge if the Rx is being changed but either half price or if the job is simple and quick like a staining a flat fee of $40. 2th charges per hr for labor.
He asked for one thing and got it, now he's asking for another which takes the same effort and material cost as the first. That's asking a lot.
For zirc, are you shading darker than rx? I send all mine back 1-1.5 shades darker and clients report they are either great or a bit too bright still.

 

[Ken Knapp]

That shade isn't C1 either. Just because you get photos doesn't guarantee you will match the shade perfectly. Matching natural materials with man made is quite challenging. Set your fees accordingly. Sometimes you hit the shade the first time, other times it takes 3 or more attempts.
You need to devise a policy and protocol for custom shades.

Your'e correct not C1 either. Great ideas, thanks.

 

[JohnWilson]

Custom shade, custom charge

If they pick a straight shade this is the cheapest path, any shade changes are charged FULL BOAT. When it leaves my lab it hits the guide, PERIOD what happens in the mouth is not controlled by me.

If they send to the lab for me to take the shade this is the most expensive restorative path. I eat ALL shade redo at no charge this is what commands the price. If you make it double your crown fee it still does not cover the real world **** you have to do to match single central's we do 2.75x of normal pricing

If they send a photo, good or bad my policy is to ATTEMPT to get it close with no guarantee. If its a washed out picture I refuse to do the case until I get better shade photos. A camera phone is better than nothing but will not be good to map a shade in most shots. We charge 1.75x of normal pricing

The other reason I charge so much is in the case of local clients since the bulk of my work comes from out of state when I do get local work it's only the tough cases as the bread and butter goes elsewhere in most circumstances. I set policy and stick to it and they either value it or they don't. Makes my life easier either way.

 

[Contraluz]

other times it takes 3 or more attempts

Individual central incisors? Been there, done that and tired of them...


A lot of great points mentioned, already! Here is my take on it:

Photo of case 4-6 bridge

That picture, you have there, is pretty useless. The teeth you have to match are covered by the lips, the shade tab, besides of being off (from what we can see on this pic),isn't on the same plane as the teeth you have to match. Although, I love my phone for picture taking and I use it pretty much every day to communicate with my clients, it is of no use for shade evaluation! There are a few threads, on this forum, addressing the right protocol on picture taking for shade evaluation.

 

[Ken Knapp]

Custom shade, custom charge

If they pick a straight shade this is the cheapest path, any shade changes are charged FULL BOAT. When it leaves my lab it hits the guide, PERIOD what happens in the mouth is not controlled by me.

If they send to the lab for me to take the shade this is the most expensive restorative path. I eat ALL shade redo at no charge this is what commands the price. If you make it double your crown fee it still does not cover the real world **** you have to do to match single central's we do 2.75x of normal pricing

If they send a photo, good or bad my policy is to ATTEMPT to get it close with no guarantee. If its a washed out picture I refuse to do the case until I get better shade photos. A camera phone is better than nothing but will not be good to map a shade in most shots. We charge 1.75x of normal pricing

The other reason I charge so much is in the case of local clients since the bulk of my work comes from out of state when I do get local work it's only the tough cases as the bread and butter goes elsewhere in most circumstances. I set policy and stick to it and they either value it or they don't. Makes my life easier either way.

Great information, love it.
Thanks,

Ken

 

[rkm rdt]

If I was asked to make a FCZ anterior case and it turned out later that it needed to be layered, there would be an additional charge. You don't have to do anything, you choose to get walked on or not.

Sometimes my back wants the same thing.

 

[rkm rdt]

I don't plan to make changes to anything I send out.
I'd rather say no at the start.

 

[rkm rdt]

We all approach solutions differently.it always
Boils down to the communication we have with our Drs.

 

[rkm rdt]

Have you noticed that your best clients are the ones that ask you what you need to do your best?

Have you noticed that when you weed the garden,the plants produce more?

 

[JMN]

Have you noticed that your best clients are the ones that ask you what you need to do your best?

Have you noticed that when you weed the garden,the plants produce more?

Like, Winner, agree, informative, useful.

Dude, that's a great one!

 

[rkm rdt]

Like, Winner, agree, informative, useful.

Dude, that's a great one!

''Tis the season for garden analogies.

 

[rgkbmk]

Good photos and the use of shadewave has worked for me. I don't guarantee anything custom shade in FCZ though.