Emax Cant. Bridge

[Al.]

This is contraindicated but the patient has an open anterior bite, and the Dr requested it so I fill out the script. I dont think it will break.

Pre-Op




Restoration




It went on the first try.

A couple things I would correct.

1 After glaze I added a bead of low fusing porc under the pontic. I didnt think it was snug enough. You can see it. I should have have used reg porc for the add on not add-on material.

2 I missed the clear band or halo under the incisal edge.

3 I should have added a layer of clear porc over the facial to give more depth and trans. The incisal looks too white.

4 Loose the brown craze lines, replace them with white to match the patients.

 

[TheLabGuy]

I spoke with Ivoclar Saturday about this.......they don't recommend it at all. Even with an anterior open bite don't be surprised if it comes back, that tongue is a powerful force......thank goodness

 

[Al.]

Yeah he knows, but its a risk he was willing to take.
He does maryland bridges with one wing also. Theyve been in the mouth for 2 years now.

 

[Al.]

That bead of add-on porc under the pontic matches the plaque on his other teeth.

Ill just say it was custom make to look like plaque.

 

[desertfox384]

That bead of add-on porc under the pontic matches the plaque on his other teeth.

Ill just say it was custom make to look like plaque.

Hahah, good point - Nice match otherwise - What shade ingot did you end up using?

 

[PGguy]

I spoke with Ivoclar Saturday about this.......they don't recommend it at all. Even with an anterior open bite don't be surprised if it comes back, that tongue is a powerful force......thank goodness

I snapped one...huge overjet case, ridiculous size tongue trap connector too

 

[Al.]

Hahah, good point - Nice match otherwise - What shade ingot did you end up using?

Its a fair match,I would love to get it back to make changes.

What is very intresting is this Dr is super picky about shades.
We works on all his patients under a microscope and he has a camera hooked up to it.
He emails me pics of everything for the shade matches posteriors included.
I get the shades before the case.

I am finding that our normal crowns we build every day with the contours and shades and anatomy up close they dont match natural teeth.From normal talking distance they may look ok.

Before working with him I had rarely seen my posterior work in the mouth and never up close.

What I did is send him the stump shade guide, the LT shade guide, the incisal shade guide and the Impulse shade guide from the Emax system.

That makes it soooooo mush easier to match shades.

There is no way in hell I could even have gotten this close to the shade in one try with regular shade tabs. This guy is several hundred miles from me.

In other pics without the flash the A4 LT tab matched so I pressed in that and the Trans Brown Grey tab matched also so I used that for incisal.
The problem came when I thought it may be too dark so I added some lighter incisal like a little 58, 59 and it contrasted with the other and looked white.

I should have kept that on the incisal edge only and added clear under it for the halo effect.

But live and learn.

Sending him those shade guides at $80 a peice paid for themselves with this case, in time saved not having to change the shade.

 

[charles007]

Really nice work Al.....those guides made the difference,,,,,,,,,, would be interesting to know what kind of shades he would have given you without those guides........

Just curious if you do this a lot on your bread and butter work without a upgrade in price..........or only on your premium work........

Charles

 

[charles007]

Al,
There are a few ivoclar chromascop shades that match the 3D shade guide better than the classical.....Did you also buy that shade guide for your docs?
Do you buy those chromascop ingots on you 3d shades? I'm getting a lot on 3d shades and its a pain compared to a classical shades......(incisal 1/3 cutback cases)

 

[Al.]

Really nice work Al.....those guides made the difference,,,,,,,,,, would be interesting to know what kind of shades he would have given you without those guides........

Just curious if you do this a lot on your bread and butter work without a upgrade in price..........or only on your premium work........

Charles

Hi Charles, sorry I havnt responded thurs and fri are my super busy days.

Im starting to get more work from Drs that will pay more, but for the guys that dont, I do their work as fast as I can but I always take a few cases from the low paying drs and spend the extra time and pratice on their stuff even though Im not getting paid for it.

It takes twice as long to do really nice work so if I charge double Im not really making any more money.

When you know a dr is going to look at your crowns under a microscope I have make margins perfect or as close as I can.
They expect more than a 2 body build up and all the crowns have to be drop ins and look like real teeth not crowns. Also they sometimes check the metal frame work support in their xrays.

Its not easy to find Drs willing to pay more for crowns, most want them fast and cheap.

Im feeling old I want to do less work for a bit higher price to cut back on the volume.

 

[JeffT]

Hi al, beautiful work mate. I like the lighter incisal on the mes bucc of the 4. I think it matches in nice overall, especially with that light filling on the mes incisal of the 21. natural look i reckon.

thanks jeff

 

[JohnWilson]

Its not easy to find Drs willing to pay more for crowns, most want them fast and cheap.

Im feeling old I want to do less work for a bit higher price to cut back on the volume.

Hi5 Al!

Now your thinking!!!

Still want you to come out to do a course for me and my techs. EMAX is our biggest growing product now and we would love to have you show us some secrets.

Bring your wife too, there is a gym right up the road to keep her busy

Have a great weekend!

 

[Al.]

Thanks for the invite John.

Here's some work from last week.

 

[Travis]

:adore::adore::adore::adore::adore::adore::adore:

 

[JeffT]

Hi Al, did you use creme for the incisal effects on the Ants? Do you stain and pre-fire before glaze or with the glaze.? Awsome job, and love those molars.

ps. how much material thickness have you got at the deepest areas of your carving/building Al?. I can never seem to build depth like that in my molars without creating thin areas.
Inspirational work Al.
Jeff

 

[Al.]

ps. how much material thickness have you got at the deepest areas of your carving/building Al?. I can never seem to build depth like that in my molars without creating thin areas.
Inspirational work Al.
Jeff

Jeff for me to get maximum depth on posteriors part of it is using a thin underlying brown or orange in the central fossa right on top of the opaque.
In my build I think of the cusps as being more individual.

After my build I take my instrument (pointed needle like) and poke it to the opaque in the pits and seperate my cusps from up there. Then carve some secondary.
I clean it up with a sharp tipped brush pushing it closer together, but not filling in the grooves if you want maximun depth.
Fire and the cusps will pull apart.
For your 2nd bake evaluate the occlusal color and partialy fill in the primary grooves with a small amount intense brown or orange or less intense depending on the shade.
Next finish building the cusps in the pit areas with small amounts of incisal porc (whiteish if you want) pushing it over the primary grooves and the intense colored porc. Push the cusps till they touch each other but dont let the porc melt together.
Fire.
The crowns I posted dont have much occlusal stain, my pics tend to pick up the stain more than what is really there.
I use a very sharp pointed instrument to apply occlusal stain.

I really cant cut anatomy. It really needs to be built.
Also I dont think of groves but seperate individual cusps coming close together forming the groves and for secondary anatomy I dont think of groves but lobes.
I use a white porc to build the lobes or you wont even see the secondary, same with the cusp tips.
Build ups like that take me from 7 units per hour to 4 per hour.

Did I make it clear as mud?