How Would You Restore This Tooth???

[Al.]

Im just wondering with all the different crown systems out how would you make a crown for this patient?

We have different Zirconia systems, different press systems, castable high yellow gold, captec and composites.

A slew of different layering systems.

Im just courious what everyone would use for a substructure and how you would layer it?

What colors would you use and where would you put them?

Tooth #7 and prep shade ND3.

 

[Brian]

Al to be honest with you....... I think they should extract and have a transitional (flipper) made using one of the new open faced gold teeth that glow in the dark from Starlight..

I have been dying to use one; well I'd really like to do a whole 1x6 of the dollar sign..

 

[JohnWilson]

Hi Al,

I saw you posted this on DentalTown and did EMAX. We are not quite as adept at exploiting this system yet but if I was to get this case with these photos I would do a jacket foil PJC of course the prep shade would dictate exactly what we used.

Did your unit get delivered?

BTW the pictures and the work looked amazing.

 

[Al.]

Hi Al,

I saw you posted this on DentalTown and did EMAX. We are not quite as adept at exploiting this system yet but if I was to get this case with these photos I would do a jacket foil PJC of course the prep shade would dictate exactly what we used.

Did your unit get delivered?

BTW the pictures and the work looked amazing.

Hi John, Yeah it went in but I didnt stay for the final seat.

I wouldnt know where to begin with a PJC. Its a ND3 stump shade.

Would you use opaque or an opacious dentin for your core?

I would really have to put some thought into it if I did a pfm or captec or a zirconia crown I never even thought about a pjc.

This was acually a very easy crown to make in Emax I am just courious how other guys would make it with other systems or how emax guys would do it.

Everybody has their favorite that works best for them.

Another thing there is no shade tab that matched this.

 

[kcdt]

I have been dying to use one; well I'd really like to do a whole 1x6 of the dollar sign..

I wanna see the picture when you do.

 

[Al.]

Typical answer for a removable tech, "Extract it".

Brian are you still playing around with Emax or are you strictly removable.

 

[Pronto]

Milled Mark II layered.

 

[Al.]

Milled Mark II layered.

What is Mark II?

 

[Pronto]

Vita porcelain blocks that are milled with the Cerec miller. They are about the same strength as Empress. We mill them, cut back and layer them. We've had some nice results.

 

[Al.]

Vita porcelain blocks that are milled with the Cerec miller. They are about the same strength as Empress. We mill them, cut back and layer them. We've had some nice results.

Do they come in all the vita shades or 3D shades or are there a half dozen shades and you layer for color?

Or are they plain blocks and you add color to them like they do with lava.

Do they have different levels of opacity to help mask if you need?

Why wouldnt you use LD blocks for the extra strength?

Thanks, Al

 

[Pronto]

They come in the 3D "M" shades and Vita Classic. We layer and stain for other shades but the "M" shade cover pretty much anything we need. Although for years they have been used in the posterior and anterior by Cerec drs we recommend them for anteriors since they are not as strong as YZ. They now come in low trans for use over implants or dark stumps. We are now recommending Emax CAD for posteriors or YZ if they want to cement. The Emax can be cemented but it won't have the stength it would if bonded.

 

[Al.]

Ok, I took the shade using the tabs that came with emax ceram.
Every bottle has a shade tab for it.
First I use the pressing ingot shade tabs. If I have to put alot of internal stuff inside the crown I go with MO ingots. They are also a much safer bet not to grey out in the mouth.
I always err on the light side. Patients will accept a crown a bit on the light side but if it is a bit grey its a redo.

Then I use the body tabs to pick out the different body shades. Then I use the incisal tabs to pick the incisal shades and value and the essence tabs for different character.

I dont bother mapping it out on paper, I use the pics for that. I just put the different tabs in a baggie and write down later what I picked after they are disinfected and before I put them back.

If I can find a tab from the vita or 3d guide that is close I make note of it.

Then I study the pics and make a plan in my mind. From the design of the coping, the different layers of porc, texture or facial anatomy to final polish.

This is what I came up with for this case.

What do you think so far. Will it match? With a translucent all ceramic you never know till it goes in. Captec or pfm what you see is what you get but you have that opaque layer that gives you fits in the mouth.

 

[Al.]

Well dang, over 100 views and nobody is intrested in how other labs get the results they do.

Ive been documenting different teeth and prep shades and the combination of emax cores and layering materials to get predictable results.

Nobody seems intrested anymore so, I'll keep it with the Drs that pay my bills.

Here are the finals for this case.

Al Hodges




And one I did for fun.

 

[sixonice]

That upper lateral turned out absolutely gorgeous! It absolutely disappeared - you must have had a VERY happy patient and dentist. I really like the lingual view on the model. It gives a great perspective on the translucency you needed to acheive in the incisal third of the restoration. Did you use ceram clear or transpa neutral for that effect? Or the Al "custom" blend!?
Your practice case is also awesome! Very European....I see this same work from the best techs in Germany, Switzerland, Italy, etc. Was that case done with e.max? Full countour, fully layered or reduced layering?

 

[Al.]

Six pack of Corona,

That lateral was very easy.

I pressed it in MOO. I took the facial to .5-.6.

I wet the coping with glaze liquid and stained the gin 1/4 with A2 shade, then I dusted the entire coping with BL4 Deep Dentin and fired.

Then I built it with 50/50 B1 and BL3, because I was out of BL4.

I did my cut back irregular with some fingers, and I put OE1 on the M and D and filled in the fingers with it, then finished the buildup with Inc 1.
I like OE1 it is very clear but dosnt lower the value as quick as clear and it dosent leave that sharp line of demarcation.

Then I made 4 vertical cuts to the core and fired.
The cuts need to be straight not angled to the distal or lingual and it is best if they follow the axis because it can look odd if the tooth is angling toward the patients bellybutton but the cracks are going another direction.

Then I put stain on one side of each wall of the cut and fired at a low temp with out vacumn to set the stain.
I tried vanilla/crackliner as it is called and it dosnt show through well, white on the other hand is too intense so next time I will mix white and crack liner 50/50 and see what happens.

Next with a sharp tipped brush and loupes I put some clear in the cuts and pushed it to the side, you dont want to fill the whole thing with clear it might look like a Zebra. Then I filled then it the reat of the way with Inc 2 and fired.

And done. Almost.

She has highly polished enamel that shows up well in the pics, so after the glaze I highlighted several areas with a rubber wheel and buffed it with diamond polish. Under the maco lens every misplaced scratch is magnified along with surface stain. Ever brush stroke of external stain that is not blended in shows very badly in pics.

 

[sixonice]

Mom o' man! Couldn't have ASKED for a better explanation. Your doing work that only a very, very small percentage of folks are doing out there. The time, knowledge, hands skills and workmanship in your restorative is top-notch. Then sharing your secrets, tips, tricks and ideas with all of us is appreciated. I hope you are compensated very well by your dentists and they realize in turn what your doing for them (they are probably spoiled and come to expect this type of perfection I would imagine).
Thanks again, and I for one, appreciate the pictures and posts.

 

[labdude]

Well Al,
Check out the # of lurkers here everyday. Most are probably looking at your stuff.
Myself, I appreciate what you do and the quality that you display. I'm not able to comment on it with any expertise as I just fiddle with wires all day. Still, I have learned A LOT from your posts and pictures. Very enjoyable to quietly lurk and watch you work.
Don't ever think it goes unappreciated Al, plenty of folks here now, and in the future will gain a lot of knowledge from your posts.
I'm just not going to send you flowers every dang day.
Know this Al, for every one that praises your work, there are 100 others here that feel the same, without saying a word. Wish they would post,but, like at most sites, more lurkers than posters.
Mike.

 

[JohnWilson]

Al you are getting so good with this material I may have to fly you out here and ask you to give a nice course for my techs.

Very impressive, I would send some photos to Ivoclar and if you have any ability to speak in front of an audience I am sure you could get a nice side gig with travel benefits if you choose to.

Or you could quit your local clients unless they wanted to pay 350+ a unit and service only clients that understand the value of such a build up and the time/experimentation it takes to make the unit come out like this one.

OK I am done complementing you as your head is getting too big for your country ass

Have a great week!!!

 

[labdude]

Actually...with this here post...I believe your at 145 views.
On edit: country ass!!!

 

[charles007]

Al, very impressive work. Couldn't keep my eyes off the incisal edges on those lowers anteriors....... When are you going to start selling emax posters?

You need to call Pat S. at Ivoclar, and let him see you cases !!