patient question about front teeth Emax

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amoeba

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I am a patient requesting comment as I am meeting with my dentist and his lab tech next week:

My front teeth (#8,9) crowns, after 3 tries by the lab, came out slightly yellower and grayer than the surrounding teeth. D2 was the requested shade, which was the best match to #10. #8 has a root canal. The stumps are different colors. Prior to the shade selection by the dentist, I did tray whitening for two weeks prior, followed by about a week of no whitening. Here is the history since then:

attempt 1: crowns come in slightly grayer than shade chip but match each other. I could barely tell difference from the adjacent teeth (#7 and 10). Dentist sent back to lab with chip to match front teeth to it.

attempt 2: crowns come back, #8 very gray, #9 seemed better. Dentist sent back to lab with instruction to match crowns to each other.

attempt 3: crowns come back, both slightly yellow - with gray underneath. I mention to dentist before they get cemented in. They get cemented in. The overall color, compared to the other teeth - I would say is slightly green. The shade of the two front teeth is slightly darker than the surrounding teeth.

The shade/color difference is not extreme, however the crowns are darker/yellower than the adjacent top teeth, as well as the bottom teeth.
A second opinion described it as about a half a shade. It is visible at distances close up, less than 2 feet. It is more noticeable in natural and incandescent light, compared to flourescent light.

Upon returning to dentist to discuss this problem, the dentist considers the shade/color not bad, and if he was to redo - he recommends replacing only the grayer of the two crowns (#8) and match it to #9. My lay opinion is to disagree; I think that making two front teeth at the same time would be easier than matching a cemented crown that has been to a lab three times already. I also see the color and shade to be off on both crowns, although #8 is somewhat worse. I think the front teeth should look at least as white, if not slightly whiter, than the surrounding teeth, not more dark/colored.

I see there are a few other posts on front teeth with emax coming out a little gray. I don't know what material was used (HT or LT); all I can say is that the teeth, on the first attempt, looked somewhat translucent, they don't anymore - it seems some sort of lighter coating was applied.

In any case, the dentist is bringing in the dental lab person to look at this at my next appointment, next week, and I would appreciate any comments.
 
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Sounds like they were pressed and stained , but need to be layered. Redo BOTH!
 
amadent

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sorry - CANT GIVE YOU A COMMENT OR OPINION WITHOUT SEEING PHOTOS OF THE CASE PRE AND POST OPP
color is impossible to discuss with photo documantation
 
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charles007

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If your crowns are emax, HT emax is not used on dark preps....... We have a chart that shows which ingots or blocks, to use depending on the stump shade. Generally speaking ! HT are not used on full crowns because they can turn out grey.....HT's were made for veneers ! but can be used on full crowns.

The D2 shade that was used, D2 is a grey shade! and will look very gray if you have a A range shade .

The hardest restorations to make! is a single anterior. Yes you are right, remake both, or it may be a repeat of many remakes again.

Taking a shade is best done out side in sun light, but not on a cloudy day. The lab tech will most likely do a much better job, we work with colors everyday.

You are right again, your 2 centrals are lighter, not darker than the other teeth, and your lower anteriors can be the lightest shades of all.

If you prep is darK, LT's would not be used and other ingots would be used.

I could give you more info but I don't want you to misunderstand any information I give you. This forum is for techs and its so easy for the public to read these post and totally misunderstand the meaning of what we are talking about.
As technicians, we work with Dentist, not the public, and make crowns for dentist with a written prescriptions, just as a Pharmacist does with drug prescriptions.
Will be glad to answer simple questions. But without any pictures as written above, we can't give you very good answers.

One last thing, if using emax, bonding the crowns in will make the crowns stronger, rather than regular cement.
Good Luck
 
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odchamp

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I agree with Charles, and find your knowledge of our trade as impressive, are you sure your not connected in some way?;)
 
Al.

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Charles I found that for anteriors often for D2 if I use a layered D2 LT it comes out too grey.
B2 works good for D2. I dont know why but B2 LT for anteriors is very easy to turn in to a D2
 
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charles007

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Charles I found that for anteriors often for D2 if I use a layered D2 LT it comes out too grey.
B2 works good for D2. I dont know why but B2 LT for anteriors is very easy to turn in to a D2

Good to Know about using B2's with emax

Al, you make more emax crowns in one month than I do in 6 months, I bet the grey issue with D2's is the extra translucency.The D2 shade is the easiest shade that will grey out in my opinion........I bet I've remade dozens of anteriors pfms that the doctor gave me a D2 shade when the correct shade was an A or B2... I've also seen the same when using a B1, this shade can look grey with the high value it has....... ALL the more reason to rely on Value by using the 3D shade or picking a shade......As much as I hate to take a shade with the 3D shade guide, it works.........
Charles
 
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amoeba

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well, I have a camera, computer, and digital pictures that show what I am talking about, but can't for the life of me figure out how to post them (if any instructions for a complete novice on how to post a picture, say so and I will give it a try). Otherwise - I'll let you know what the dentist/tech say tomorrow after appt.
 
TheLabGuy

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well, I have a camera, computer, and digital pictures that show what I am talking about, but can't for the life of me figure out how to post them (if any instructions for a complete novice on how to post a picture, say so and I will give it a try). Otherwise - I'll let you know what the dentist/tech say tomorrow after appt.

email them to me and I'll post them for you [email protected]
 
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amoeba

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Met w/ tech/dentist:

There was discussion and use of shade guides. Sounds like the target shade remains D2 or a maybe little lighter to match/blend surrounding teeth (various colors). Tech originally used LT D2, proposes remake both crowns with LT B1 and adjust somehow, and also doing something involving color of cement or bonding material (I believe in regards to mask stump color).

I recall discussion between dentist/tech involving whether existing crowns cemented or bonded and if color used, and dentist mentioned compound used but I dunno what it was - I think it is cement. I recall discussion about B2 and B1, and tech thinking B2 had too much chroma.

Will this work? concerns (re: comments by Al recc'd starting with something different, B2 for D2; by Charles -greying being a problem with B1)?
 
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