Empress CAD #8,9

[AshleyMarkDMD]

Folks,

I just cemented these Empress Crns. These are my first Empress CAD- we used E4D (we also have CEREC AC). The E4D software is easier to manipulate the crowns at this time....until CEREC 4 software.

Multi CAD A1, Polished w/ Diasheen Diamond Paste, Calibra Resin Cement w/ Light shade

Briefly, there are a couple of finishing touches that we would have liked to complete before placing central incisor crowns, including:

1. Esthetic Crown lengthening - even the gingival architecture of the central incisors w/ canines
2. Root coverage lateral incisors
3. Esthetic posterior restorations

Problems seen @ 400k magnification:
1. Distogingival contour #8 (FDI #11) is more bulbous (overcontoured) than #9 (FDI #21)
2. Distoincisal contour #8 is slightly more rounded than #9

The patient is extremely happy - and - as Dr. K says, "beauty is in the eye of the beholder.."


http://2.bp.blogspot.com/-SWPCJHFSFno/Tp-oUJwMb4I/AAAAAAAAAaY/_fFyM4voNxI/s1600/IMG_2184.JPG

Empress CAD Crown Try-in and Delivery.MP4 - YouTube

[YOUTUBE]http://www.youtube.com/watch?v=pUuFg0GG2iM&feature=player_embedded[/YOUTUBE]

 

[paulg100]

Did you post these on the CEREC Doctors forums? they will all pat you on the back and tell you how great they look

in fairness, there as good as ive seen anyone else produce with these chair side mills, so i guess thats a compliment.

 

[2thm8kr]

Next time do a diagnostic wax up and clone scan it with the E4D.

 

[k2 Ceramic Studio]

Look OK, Could of done with some stain around the neck just to give a bit more balance to the ul 2 3/ur 2 3, think they may be a bit wide in comparison to the 2s, the width may just be due to the short crown length, because of how high the gum is over the 2s and how low it is over the 1s. Did the patient not want to have tissue surgery to balance the gingival height of 321 123, a diagnostic would of been a good idea(try before you buy). It did seem a bit drastic to change the patients bite just to protect the crowns, if the bite was that close then I would of gone for a different material. but like I said for chair side they look good.

 

[user name]

Decent for temporaries.

 

[mrcadcam]

Decent for temporaries.

+1, very mono tone for anteriors.

 

[rkm rdt]

The patient is extremely happy - and - as Dr. K says, "beauty is in the eye of the beholder.."

I'd beholding the Dr accountable!

 

[paulg100]

"It did seem a bit drastic to change the patients bite just to protect the crowns, if the bite was that close then I would of gone for a different material"

Now there is the question of ethics that we hear time and again with these chair side systems.

Adapting the treatment to suit the system.

 

[AshleyMarkDMD]

"It did seem a bit drastic to change the patients bite just to protect the crowns, if the bite was that close then I would of gone for a different material"

Now there is the question of ethics that we hear time and again with these chair side systems.

Adapting the treatment to suit the system.

The provisional comment was...sweet. I laughed, then cried, and now, I'm smiling!

The beauty of adhesive dentistry is that it can be easily removed w/ little trauma. I added composite to the palatal surfaces of the maxillary canines to ensure disclusion of all 4 maxillary incisors during excursive movements. Shearing forces exerted on any material will cause failure overtime. Although it is opined that canine disclusion is preferred, group function will work just as well - depending on the patient. The goal is to prevent fracture of the crowns again - more trauma to the pulp, and then-endo....the slippery slope.

Thanks for the comments,

Kind regards,

Ashley

Functional Occlusion: I. A Review -- Clark and Evans 28 (1): 76 -- Journal of Orthodontics

 

[Tom Moore]

At conversational distance these look just fine. If I was going to be picky at this distance the long axis of #8 looks a little off.

This looks as good as most of the work being put in the mouth made with anything by a lab or dentist so don't let them screw with you.

 

[DMC]

Did you do these in one visit?

Do you think you will ever get 50% of your money back on either of your CAD systems?

 

[marvel]

"beauty is in the eye of the beholder.."

...as Dr. K says, "beauty is in the eye of the beholder.."

I'd beholding the Dr accountable!

Well the mouth still looks kissable but...uh...trying to guess here why p/t wanted her 2 front centrals crowned in the first place...perhaps to mask that weensy chip or discolored filling on apical 8...?

Below are the B & A photos, respectively, taken from the blogspot:
http://2.bp.blogspot.com/-jodHtja7PjI/Tp5ArGidShI/AAAAAAAAAaQ/da_TsHGkG6A/s1600/IMG_1724.JPG

http://2.bp.blogspot.com/-SWPCJHFSFno/Tp-oUJwMb4I/AAAAAAAAAaY/_fFyM4voNxI/s1600/IMG_2184.JPG

Re gin recontouring, I think p/t wise to let it be, at least until she can regenerate recession, most noticeable over the lats. A clean mouth looks not to be a problem, and here are a couple links with some (starter) helpful nutritional hints.
What Vitamins Are Good For The Gums? | LIVESTRONG.COM
Vitamins for Promoting Gum Growth | eHow.com

Show her how to regenerate those gums naturally and she may think you're some kind of deity.

[Edit:] Oh Silly me! The before's above are provisonals; THESE are the original before's--and I do see 8 incisal is starting to show wear.
http://3.bp.blogspot.com/-en39_wkHJ0w/Tp5AcoWm5WI/AAAAAAAAAZ4/Qd3XgDVqF6E/s1600/IMG_0471.jpg

[Edit 2:] Of course p/t has final word on what goes in their mouth, but there are products, which, if as esthetic as these (e.g.) appear in the adverts (I am no Dr),may offer durable, conservative and more natural bonding options than available in the not-so-distant past:
EPIC®-AP Composite
DuraFinish™ & DuraFinish™ ALL-CURE
EPIC®-TMPT Composite

 

[paulg100]

"This looks as good as most of the work being put in the mouth made with anything by a lab or dentist so don't let them screw with you."

?? i think you might have got a bit out of touch with whats being placed out there, the crowns are not even the same width!

Shade dosent match the laterals, surface luster and texture is absolutely awful, black triangle..the list goes on.

this is not what "most" work is like at all, maybe in your market sector, certainly not in mine. none of my competitors are producing work like this, and thats enough labs to keep me on my toes for sure.

 

[Alistar]

At conversational distance these look just fine. If I was going to be picky at this distance the long axis of #8 looks a little off.

This looks as good as most of the work being put in the mouth made with anything by a lab or dentist so don't let them screw with you.

Uterly ignorant statement. You're totaly out of touch grandpa.

Paul said everything else I would have.

 

[user name]

Ditto paul and Alistar. I couldnt sell that..simply for the reason that non of the doctors I work for would accept them. I guess Id have to put a watch out for any Ogres doing lab work???

 

[Tom Moore]

My ego is not that thin and brittle. My busniss is growing and when I'm playing at the computer there still production going on in my behalf. I enjoy snapping some of you on the nose.

I am Grandpa. I have more time in the pay line than most of you have in the chow line in this industry. In fact I was working on adjustable articulators doing full mouth reconstruction before some of you where born.... by a decade. I appears some of you do 6 or 8 units a day techs have tried hard to become legions in your own minds.

The aesthetic of a crown are conditional to the patient not the technician. The symmetry on these crowns is fine and they just do not look out of place in this mouth to the pataint. As for the fit form or fuction that is not doable from a picture. Mark was asking for impute on these crowns and that is what I did and I could care less if you think I deviated from your party line.

 

[user name]

I wasnt trying to crack your ego, gramps. I dont measure success by units produced or money earned. I dont make crowns. I replace teeth..to the best of my ability. I think its great that youre here contributing and that youve had so many years in the industry. As far as 'the esthetics of a crown being determined by the patient and not the tech'..I often tell patients "shhh". Relax and trust me; I do this for a living". I know what makes a successful restoration. If you can tell its a crown, its not good enough. Mine arent all perfect, but my standard isnt 'its good enough'. If I say a turds a turd, and you come along and exclaim that its a shiny turd...and you should know 'cause youve seen more turds than me, well...Ill just have to give you that one.

AshleyMark, Im not saying your work was crappy. Im just making a point to Tom. We're only as good as our last case. Ive never, never seen a milled crown thats worthy of being used in the smile.

 

[Tom Moore]

I wasnt trying to crack your ego, gramps. I dont measure success by units produced or money earned. I dont make crowns. I replace teeth..to the best of my ability. I think its great that youre here contributing and that youve had so many years in the industry. As far as 'the esthetics of a crown being determined by the patient and not the tech'..I often tell patients "shhh". Relax and trust me; I do this for a living". I know what makes a successful restoration. If you can tell its a crown, its not good enough. Mine arent all perfect, but my standard isnt 'its good enough'. If I say a turds a turd, and you come along and exclaim that its a shiny turd...and you should know 'cause youve seen more turds than me, well...Ill just have to give you that one.

AshleyMark, Im not saying your work was crappy. Im just making a point to Tom. We're only as good as our last case. Ive never, never seen a milled crown thats worthy of being used in the smile.

Why bless your heart! To every time thier is a season and you need to understand you have not invented your take on this industry. It is a reflection of where you are in your career. We all have been where you are, or will be.

Success is not just about money. Money however buys choices and those decisions of choice are a direct reflection of how much money you make. I find it much easier to be a great dental tech than someone that can make lots of money. That is why there are more poor techs than rich ones.

Its a shame that if you disagree with some people they take it as license to name call. Whats next a deep sigh and a high pitched WHATEVER!

 

[Bobby Orr ceramics]

I think the true test in a chairside milling situation is...... Is the patient going to pay the same $$ for a chairside milled crown, as a ceramist created crown ? Are they informed about options for their best interest/result? "Mary, would you like a single shaded tooth on the same day? or, would you like a more customized tooth in a week? the cost is about the same? " . If Mary is informed of her options, she'll be happy either way.

I find more and more that no matter how great I think my work/artistry is on the best of days...... patients are dictating how they want their teeth......sometimes they want them to be as bright as the urinal I piss on. That's their vision of choice.

Having said that..... I think the 2 centrals are too dark.... I think even for a monolithic material, a lighter value and lighter chroma ceramic would yield a nicer result. I'll save my critique on contours and texture.

 

[paulg100]

Ill add to my statement that its a fair result given the limitations of the system used.

But i think to claim that its as good as what "most" labs are putting out is doing a discredit to allot of techs who sacrifice a heck of a lot to produce the best they can. And thats nothing to do with Ego.

I think you only have to look at the work that many on here are posting to see thats not that case. Are the members here representative of the industry? id say so.

Maybe its different where you are. I know who my competitors are and what there producing and its nothing like that.

Are patients being warned that they will sacrifice the aesthetic outcome for the sake of time/convenience when using these chair side systems?

Ill just agree to disagree and leave it at that i think