Interesting case-thoughts please

[wwcanoer]

Thoughts please! Who knows, maybe I'm mentally making this too difficult-LOL
8 eMax crown and 9 eMax veneer, shade C-1
As you can see from this photo of a diagnostic wax up, these crowns are going to be approximately 3 mm thick, with hopefully at least .5 mm incisal edge on 9 veneer. The temporary on 9, barely raps over the incisal edge. The doctor has already said I can increase incisal length a bit.
Questions:
1) the strategy to deal with incisal edge junction between core and incisal material on 9
2) press and layer?
Anything else I should be thinking of that I haven't? Or is it just a simple case of overreacting a bit over another "interesting" case.

 

[Dentalmike]

I say press and layer. Adjust expectations accordingly, especially for times you know you can't get there from here. Like a really nice incisal edge that's 3mm thick and so on. This is also why I think we all need "difficulty level" built into fees. More difficulty= more time, perhaps additional units or adjustments = higher fee.

 

[rkm rdt]

The 9 should not be a veneer

You need a tissue level crown prep like the 8 to close the embrassures. There will be a lingual food trap otherwise.

Thick incisal edges on veneers also increase the risk of pop off.

 

[2thm8kr]

Press V1 and stain/layer accordingly. It will look ugly to you, but it will be a miracle to the patient.

 

[TheLabGuy]

Geez, did someone forget that dentistry has a whole specialty dedicated to moving teeth to their proper position...where's the ortho? Hope someone got informed consent. I'm tongue and cheek here but c'mon, personally I think the DDS set you up for failure on this one. As 2thm8kr said, do in the Impulse V shade.

 

[2thm8kr]

I agree Lab Guy, but sometimes patients absolutely refuse ortho.
Make temps and see how they live with it before destroying the teeth.

 

[MasterCeramist]

May have been able to get by with no prep or very minimal prep as far as you need to build these out. I really like the distal wing on the central that overlaps the lat. Tough situation interested to see how it turns out please post a photo when you are done.

 

[TheLabGuy]

I agree Lab Guy, but sometimes patients absolutely refuse ortho.
Make temps and see how they live with it before destroying the teeth.

I did say I was being tongue and cheek, and temps is a great suggestion. I guess after a long week of work something like this comes across your desk and it makes you wonder...why? Because in all reality, wwcanoe is going to play hell trying to close those contacts and create them broad enough from incisal to gingiva...and even if she does, still an emergence profile/food trap issue. Tough one

 

[corona]

What about prot-excusions ?? Judging by the incisal edges of the canines , it looks like the centrals were being slowly worn down which make me worry about the veneer popping off or chipping at the inc. edge. I didnt see the opposing so im just guessing by the other teeth on the upper.

Ortho Ortho Ortho for gods sake , then fix cosmetics . Sorry for the patient, even if he didnt consent to ortho , I forsee occlusal issues in the near future and remaking that veneer again.

 

[rkm rdt]

Too late for ortho don't you think?

Woulda shoulda coulda

Lab Guy agrees with the Canadian.....treasonous!

 

[Tayebdental]

The big question, nothing is too late!. Or it dose not matter, you have to do something by ortho first!.
I am really interested to see the centric occlusion with the lower.

 

[Marcusthegladiator CDT]

They're gonna have to be longer than the veneer prep. Otherwise anyone who's shorter than the patient is going to see how thick they are and it's going to look strange.


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[Tayebdental]

This is too severe to be corrected by veneers, the result is too thick of an incisal edge!!.

 

[wilkscm]

I agree with rkm both should be crowns

 

[user name]

Why the hell was the labial of #9 even touched? It should have had the lingual prepped as heavy as possible and then do crowns on both. In your current situation, (which is crap),Id leave the laterals protrusive to the centrals. I realize youre just trying to do your job, but this is horse teeth. The dentist took a crap on this one.

 

[wwcanoer]

Once the case is mounted, I'll post pictures.

Ortho: don't have an answer there

I do know that the patient wore composite provisional veneers for approximately a month before the teeth were prepped. The only request was not to make them quite as evenly facial as the laterals.

Press V1 and stain/layer accordingly..

I've not worked with the "value" ingots yet, why do you suggest using V 1 instead of something else such as the MO, or LT ingots and layering? I'd think with Value ingots, I would have low value problems because of thickness.

Carol

 

[2thm8kr]

I suggested V1 because it is med translucency and an easy conversion to C1 shade/value wise.
If I were going to use an LT I would use LTB1 which is close to V1 in chroma but still an easy conversion to C1. I don't care for the LT (or HT) C shades because in my experience they are too gray and look so in the mouth.
I don't have a lot of experience with MO ingots, but they are more opaque and reflective and would probably require full layering rather than minimal cut back to achieve a value in the range of C1.

My $.02 take it for what it's worth.

 

[wwcanoer]

case mounted

 

[the_prez3]

Any chance the doc would consider prepping the central and just making two crowns? Would definitely be a much better result.

My other idea involves a baseball bat.


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[Marcusthegladiator CDT]

I like how the veneer prep is so sweetly polished.