Restorations Du Jour

[Al.]

Ok Im going to repost my production build.
The thread My 5 Powder Production Build is 3 yrs old and 2 computers ago and all the pics are gone. I have had so many people send me emails asking for them. It may take me a while because there are 37 pics for a single crown build.

I dont do nearly as many PFMs today, emax has taken a bite out of that but I know there are still millions of them prescribed every year.

Even if you dont do many single posteriors they still apply with implants and bridges and the principles apply to layered Zir and Emax and even anteriors.

 

[Al.]

I learned this building technique from Kenneth Guthrie. I couldnt productively use his exact technique so I made changes to suit me.

He used a #8 brush for the entire build, That took me too long so I use a spatula, a small pointed carver, and a brush.

12 minutes is the max time I want to spend on a posterior build. After that Im loosing money.
Im happy with an average of sub 10 min builds. Bi's are faster, large odd shaped molars longer, so it averages out.
If a Dr is paying more per unit I spend more time with detail in the build. Some Drs send pics for posterior shades and want them matched. But there is only so much you can do with a molar.

Ive been doing it this way for over 25 years since I first took Ken's courses.
I have no idea where he is now but if your out there Ken, thank you so much I have made alot of money from the techniques you shared.



This prep is a bit short on room. I had to reduce a spot on the opposing lingual cusp. The lingual is also underpreped which seems typical.

Shade A2
I opaqued the occlusal Intensive Incisal so it wouldnt look opaque in the thin areas.
If it was part of a splint and in the esthetic zone I would have opaqued the margin in the D range. D2 or 3. The rest A2.




I use a wet tray. Powers are always mixed and wet I just add when they get low.
I mix Ivoclars two building liquids(P & L) 50/50. One was to gummy the other didnt stay wet long enough. Gives me the best of both worlds.

Cervical Dentin. I use the Cervical Dentin D2/3 for most everything because that is all Ivoclar has with Inline. It would be nice if they had more.
I dont use the Oclussal Dentin Orange or Brown as much because it is not very forgiving. It is very strong and must be used sparingly or I will be grinding it out.
I can get sloppy with the CD D2/3 and it still blends in.

I like to pick up enough with my spatula to make one swipe across the occlusal and be done with it. It takes a couple at the cervical and I feather it upwards. This should only take seconds.

 

[Al.]

Now Dentin A2.
First on the occlusal. Again I try pick up the entire amount I think I need.
That is why I use a spatula rather than a brush. I couldnt pick up enough porc with a brush and it needed to be wetter. With a spatua I can pick up more without as much moisture to have to blot out.

Again I wipe it across the top.



Next one cusp at a time. I try to pick up enough material for the entire cusp and body and shape it on either side with the spatula.




Lingual




Ok the dentin build is done. This can be done really fast. Judge how much you need to pick up and make sure it isnt over done so you dont need any major cut back for incisal.



Now I check my occlusion.
Very Important !!!! I work my models hard. I dont want to have to grind much after firing. Tap Tap and it will be too high.
If I need I rewet the porc so I dont break it or disturb it.



Now I scrape out the center where the occlusion is. Usually one swipe of the spatula. I replace the removed area with OE4 or a white incisal.
I do not want translucency here or I will have a opaque occlusal.



Recheck the occlusion. Note how it spreads the white incisal.

 

[Al.]

Now Incisal 1.
Same thing. Use the spatula and pick up enough to try do one cusp and body at a time.




A bit on the lingual. The space is limited there.



Thats it with the spatula. Very fast. Not too pretty at this point but fast and accurate. Im not doing this for the camera but this is production.

 

[Al.]

Now I use a brush to finish the incisal.
Then check the occ again firmly going through all the motions.



Now I add OE4 on for shrinkage and occlusion. Marginal ridges, cusp tips some inclines I know will shrink. I let everything I dont want to grind shrink out of occlusion.



Now I take my pointed carver and add some chicken scratch.
Often times in spots I hit the coping.



I use a smaller brush, the blue one from Renferts Genius brushes, and clean it up a bit. Fairly quickly



Now from here I can take it off and add contacts let the anatomy tear and fill it in with the darker cervical porc or I can get a bit more Artsy Fartsy. It depends on how much the Dr is paying.



BEWARE !!!!!

At this point you can really burn up time. Trying to make perfect little groves and lobes and often you can mess it up. You can spend 5 + mnutes on the occlusal if your not careful.
Often Less is better. Patient says I get food stuck in that new crown or It feels rough compared to my other teeth etc.

I remove the crown add contacts often with OE1, then I take a worn #8 brush flaten it fan like and finalize the contours of the crown and add on here and there.

I do usually condense it a little because I may have disturbed the porc carving in the chicken scratch and I want it to all settle back in and some of the groves or lobes to come together so I have less tearing.




Time to fire it and see how it comes out.

 

[NicelyMKV]

You can't leave me hanging like this Al!!! Why?!?!?!

 

[TheLabGuy]

Quick Question Al....if you were to pick a shade for those non-inline users. What would you say OE4 and OE1 are closest too in the shade guide. I imagine like mixing B1 with some neutral or something like that?????

 

[doug]

Al, Ken moved to Alabama. Don't know where but I'm sure he's leaving his mark. BTW, thanks for the lessons.

 

[Al.]

Quick Question Al....if you were to pick a shade for those non-inline users. What would you say OE4 and OE1 are closest too in the shade guide. I imagine like mixing B1 with some neutral or something like that?????

OE4 would be probably closer to a bleach dentin with incisal mixed in.

Before the companys had a white incisal or snowcapping porc I used to take white body modifier and incisal and I think clear, mabey some blue incisal mod, I dont remember what the mix was but I would measure it all out into a large empty porc bottle then rubber band it to a plaster vibrater and turn it on and let it vibrate for an hour or two. I would turn it over every 15 minites.

Im not one to mix a bunch of different powders together with different formulas.
Just dont make enough money to do that.

I dont kow what OE1 is. Its a clear that dosent grey like Clear or neutral. I think it has some white and blue in it? Kind of opal?

I use the OE1 for contacts. Dont know why probably because it is mixed znd there and a habit. Dont know if it makes a difference.

 

[Al.]

Al, Ken moved to Alabama. Don't know where but I'm sure he's leaving his mark. BTW, thanks for the lessons.

Thanks. I wonder if he is still in the dental field?

 

[Al.]

Ok its fired and contacts adjusted.

Ready to adjust the occ.

This is not fixed up for the camera its a case that has to go out mon. Just stopped to take the pic. No babying it for a good pic.

Everywhere you see the white is where I added on for shrinkage and occ.
The white brings out the cusps, without it the reg incisal is translucent and it is hard to see the anotamy and that tends to cause us to cut alot of grooves to try to make the occ anatomy stand out.
Its the same principle with anteriors. A body and incisal only anterior tends to look blah often fake so to compensate we try to fancy it up by putting alot of facial anatomy and texture in. In anteroir teeth often they are smooth and the texture and anatomy if there is any is on a macro level. My anterior teeth are as smooth as glass. No texture.

Now if you put a little color or different trans in the same anterior crown it looks good as is and you dont feel the need to put alot of often unnatural anatomy in it.





I dont add alot on the inclines of the buccal cusps. I want them to shrink out. I want them opened NOT locked in on the opposing or they will have to be adjusted by the Dr. I want to see into the centric occ from the buccal.

Ive done a couple of FCZ crowns. They had some really beautiful anatomy but had the occ locked in and I had to do alot of adjusting to open it up.
Because of some of the designs I can see some FCZ crowns destroying the opposing. Not necessarily because of the material but a combnation of the material and the occlusion.
Some of these programs could use some imput from Russ's occlusal compass.



The occlusion is adjusted.
I use a #6 round carbide and a worn green stone for the flat areas.



Ready for 2nd bake. Needed it on the buccal and to fill in the occ.

Usually use incisal for most of the body addons. For the tears in the anatomy I use the cervical dentin but that is a good time to use the Oclussal Dentin Brown or Orange. It it intense and a bit opaque and will mask out where the opaque is exposed and looks like stain but blends in better. Makes the need to stain much less.
On the occ its almost always the OE4/white incisal unless it is overdone then I use reg incisal.
Like I said they are always premixed and in their places on my tray so it is automatic to pick them up, no thinking about it or premixing.

I added on or refined a couple of lobes with the add on which really was totaly unnecessary. I could have just added to the areas that are torn. But sometimes an area is too much out of occ so I add to fill in the space but in the form of a lobe.



Ok its basicly finished ready to be shaped a bit. I dont smooth out the grainyness on the occ because it will smooth out during the glaze.

I go over the body with a green stone to get rid of the grainy surface then smooth it with a bush silent really quickly.
I use the bush silent on emax margins. Dosent chip for me as long as it turns true.

You can already see the contrasts in colors and how they make the cusps stand out and give the illusion of depth.

Building to contour really pays off with anteriors. Getting the shapes down before you fire really does save time. For layered veneers it is necessary because adjusting contacts and contouring little potato chip peices of porc with stones and a handpeice is very frustrating.

 

[thewhitelab]

Thank you for taking precious time to do this Al

 

[desertfox384]

Al thanks for this.. Im making my notes. I have already starting using your technique for the past year and have started getting pretty good with it. Havent brought myself to using a spatula but after seeing this set of pics I see how time saving it will be. What wet tray are you using? if its anything like mine then I cant imagine how you keep all your powders on it.. I may need to look into a larger size.

 

[rkm rdt]

The biggest complaint I hear from patients is about" the black line at the gums".

No matter how beautiful the crown looks,the metal show through at the margin defeats the purpose.
I know that a butt margin takes an extra bake but there are ways of saving that time in other steps.
I know we are talking about production bakes here but that doesn't mean we have to cut corners for time.

In fact I don't think it will take any more time to include a porcelain butt margin into your technique.I think you get a better margin with buccal porcelain and a lingual metal band.

If I am unable to provide a porcelain butt margin then I would advise the dr towards a metal band or better yet a pfz,but a porcelain to metal margin is my last choice.

I would be happy to share what I have learned in my journey if you are interested.

 

[wilkscm]

l love all your efforts and learn huge amounts from u all
best Chris

 

[NicelyMKV]

Al, that was awesome! Thanks! I think I am wasting A LOT of time trying to build more accurately as far as occlusal anatomy is concerned. I also need to get some OE-4. That really contrasts nicely with the incisal at the occlusal table. I stopped by the lab last night and set five crowns aside for Monday to try out your method. So you do the same type of build up for anteriors? I have a six unit maxillary and mandibular anterior opposing bridge case for tuesday. I am going to try and implement some of what u have taught me. Thanks again!

 

[NicelyMKV]

Quick Question Al....if you were to pick a shade for those non-inline users. What would you say OE4 and OE1 are closest too in the shade guide. I imagine like mixing B1 with some neutral or something like that?????

The author of the book I am reading now uses 50% A1 or A2 with 50% enamel light for an ivory enamel coating. Not sure if that helps anyone.

 

[Al.]

Desertfox I use renferts tropicana tray. Probably going on 6 yrs with that tray.

OK got it glazed. Knocked off the roughnes mainly but did a little contouring.

Not a museum peice but a nice crown built fast with min grinding.







On the solids I only seat single posteriors 90 to 95% of the way down.
Dont want them to come back for contact add ons. You can see its not quite fully seated.

 

[Al.]

Al, that was awesome! Thanks! I think I am wasting A LOT of time trying to build more accurately as far as occlusal anatomy is concerned. I also need to get some OE-4. That really contrasts nicely with the incisal at the occlusal table. I stopped by the lab last night and set five crowns aside for Monday to try out your method. So you do the same type of build up for anteriors? I have a six unit maxillary and mandibular anterior opposing bridge case for tuesday. I am going to try and implement some of what u have taught me. Thanks again!

Jason for your lower anteriors use your incisal to emphisize your line angles for your tooth form. I used OE3 on the add on in the pic below. This one is a little exaggerated because its on a rotated prep and has some gum loss and spaces.
Also keep your incisal edges sharp and the linqual edge higher. That is how lower anteriors ware.





Also use your OE3 to keep your anteriors from graying and to get a marbling or opal effect. Just a little added here or there can have a dramatic effect. A horozontal band or a line angle.
You can see it on these.

 

[Hal2a]

Al,
Hitoshi Aoshima's book is mostly a presentation of his work although it has a couple of pages that outlines his techique. He starts with a basic build, dentine and incisal,fires, then internal stain, fires low so no glazed surface, then a clear overlay. It reminded me of your build on anteriors.
Thanks for your time posting your 5 powder production build. I find using Vita Master that I have way too much shrinkage. My build with posterors almost always involves correction porcelain with the glaze cycle. I will try inline porcelain when i get back to work this week. It's a tough situation because I have sold my accounts on the 3D shade guide.
Happy New Year !!!