Refining anatomy:

[Empire C&B]

In full press/monolithic restorations. What have you found that works well?

 

[charles007]

With emax, I stopped using AccuFilm 1 that I grew up on and started using Bausch Progress 100. and checking for good disclusion.
Fine diamonds work well at slow speeds for touchups.

 

[user name]

A more accurate wax-up.

 

[JohnWilson]

A more accurate wax-up.

Bingo

In a perfect world where everything we get from our clients is spot on this will always be the best means. However for example

We have a FMR case in the lab right now all EMAX ant layered post mono mounted up via Fakebow and quadrant bites. Sounds like my guy did his homework and everything will be a drop in

WRONG!

So we have to remount from a slight side shift, at least plane of occlusion is perfect and ant symmetry is spot on its just that the post units are contacting on incline planes rather than the central fossa like we waxed it.

So what to do?? Big diamond lots of water and go for reworking the morphology>? Rewax and repress and charge for another unit? Cut it all back and layer in the anatomy?

Lots of ways to do and none of them is what we want to do but its fine diamonds and water to the rescue. Dr wants to retain mono benefit so layering is out and he doesn't want to pay full boat so no repress and I sure as hell am not reworking a FMR for free so its 50% and lets pray for no micro fractures. We purchased a bunch of different shaped diamonds to rework this case my guys are not happy about making this look pretty this way.

We are using this as a learning experience and documenting the time associated with the rework vs the time it would take to rewax and press the case.

 

[dmonwaxa]

Bingo

In a perfect world where everything we get from our clients is spot on this will always be the best means. However for example

We have a FMR case in the lab right now all EMAX ant layered post mono mounted up via Fakebow and quadrant bites. Sounds like my guy did his homework and everything will be a drop in

WRONG!

So we have to remount from a slight side shift, at least plane of occlusion is perfect and ant symmetry is spot on its just that the post units are contacting on incline planes rather than the central fossa like we waxed it.

So what to do?? Big diamond lots of water and go for reworking the morphology>? Rewax and repress and charge for another unit? Cut it all back and layer in the anatomy?

Lots of ways to do and none of them is what we want to do but its fine diamonds and water to the rescue. Dr wants to retain mono benefit so layering is out and he doesn't want to pay full boat so no repress and I sure as hell am not reworking a FMR for free so its 50% and lets pray for no micro fractures. We purchased a bunch of different shaped diamonds to rework this case my guys are not happy about making this look pretty this way.

We are using this as a learning experience and documenting the time associated with the rework vs the time it would take to rewax and press the case.

John, what are the savings doing it like this, and do you anticipate a compromised occlusion? Or are we talking minor adjustments?

 

[JohnWilson]

Troy its minor but changing the anatomy of this material is very difficult so this makes it more difficult.

When I mentioned slight side shift its enough that many clients would try and do it after cementation in the mouth. I don't want my guys touching a big case like this if possible and the amount of time that went into nailing the bite is astounding.

We fabed 2 sets of temporaries and the patient has been in these for almost 3 months. What I believe happened is when the Dr had the patient return for final clean up pf the preps and final impressions for the case the temps may have not had the crisp centric stop that we needed to establish the bite. When the Dr took temps off half of the arch for the bite then replace and continue to do the same on the other half there was obviously a little slide when the patient bit together.

Anyhow the anatomy was waxed with an aged cusp appropriate for this patient so it wasn't a deep cusp fosa relationship. Simple spot grinding via a new mounting and carving in new secondary anatomy will suffice. If the material wasn't so hard it would be a 2 hour job plus the reglaze.

I certainly do not think I am compromising except for the potential unknown micro fracture that can propagate later into a catastrophic failure but that can happen with almost any material.

 

[charles007]

John, not being able to see how much grinding is needed and # of units to repair... I would be very tempted to rewax and take the loss to prevent any breakage in the future... I just don't trust doing much grinding on emax... Now you see no checks, then you do... I'm thinking in terms of pfm porcelain now ... talking about checking.

 

[dmonwaxa]

Troy its minor but changing the anatomy of this material is very difficult so this makes it more difficult.

When I mentioned slight side shift its enough that many clients would try and do it after cementation in the mouth. I don't want my guys touching a big case like this if possible and the amount of time that went into nailing the bite is astounding.

We fabed 2 sets of temporaries and the patient has been in these for almost 3 months. What I believe happened is when the Dr had the patient return for final clean up pf the preps and final impressions for the case the temps may have not had the crisp centric stop that we needed to establish the bite. When the Dr took temps off half of the arch for the bite then replace and continue to do the same on the other half there was obviously a little slide when the patient bit together.

Anyhow the anatomy was waxed with an aged cusp appropriate for this patient so it wasn't a deep cusp fosa relationship. Simple spot grinding via a new mounting and carving in new secondary anatomy will suffice. If the material wasn't so hard it would be a 2 hour job plus the reglaze.

I certainly do not think I am compromising except for the potential unknown micro fracture that can propagate later into a catastrophic failure but that can happen with almost any material.

John, knowing how tough and time consuming LD is to adjust was my reasoning with the questions. I realize taking an imp after the patient is anesthetized can be tricky, and even the best sometimes miss the bite. My thoughts are especially in large cases like this is to use wedge bites. One in the anterior and one each bilaterally in the posterior to preserve centric and vdo. Its a little extra work clinically, but can save K's later due to reappts, remakes etc, excluding the extra lab time involved to make it work.. I'm sure you'll do a bang up job regardless.

 

[JohnWilson]

its all 16 post units

No way we will rewax this case it just will take time to modify and define the anatomy. Dr has been informed as to cost associated and has chosen this course of action. I run a business and when its something minor I have that worked into my fees. When its something as advanced as this there is no way I can stay profitable and give away a redo here. My client understands and is grateful for the option to rework this at a substantial savings..

Now if something fractures here in the lab as we modify it then its on me to make it right so that’s why the topic on this thread is such good timing. That is why there is a charge to grind it in not because its nickel and dimeing the client but because of the risk involved with the task.

Its just like the old days when a client would send in a STOCK ceramic abutment to be modified. He has expensed that abutment I charge for my labor to modify it, I also take the risk if it fractures. No free lunches.

 

[dmonwaxa]

Great points John.

Regarding the original question. Diagen from Bredent, Sin-Cer, DVA; and fine diamonds work well for minor adjustments IMHO.

 

[Empire C&B]

Yeah, I'm on board with the accurate waxing, I just need to do some refining/touch up before finish.

Thanks all

 

[charles007]

Yeah, I'm on board with the accurate waxing, I just need to do some refining/touch up before finish.

Thanks all

Mike, I meant to say, try Bausch Progress 100 with your wax. Wax-ups always seem to be high in occlusion after casting and pressing. Must use a thicker articulating paper.
Bausch sent me a lot of free sample The Progress 100 is still my favorite for occlusion. Arti-fol works great with contacts.

 

[dmonwaxa]

Mike, I meant to say, try Bausch Progress 100 with your wax. Wax-ups always seem to be high in occlusion after casting and pressing. Must use a thicker articulating paper.
Bausch sent me a lot of free sample The Progress 100 is still my favorite for occlusion. Arti-fol works great with contacts.

Charles you're absolutely correct with regards to being high after pressing. Some expansion is to be expected making contacts a little heavy both occlusally and proximally.

 

[user name]

My waxups are checked with black silk typing ribbon. When the occlusion just clears so NO ink transfers, the press will be perfect!

 

[Empire C&B]

Thanks guys, great tips as always! :tea: