Case Bomb. Kindly advise.

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What went wrong? Third attempt. DW and actual case. Redo on teeth 3-10. Original DW is 2-14. Dentist insists in keep in 2, 11-14 from previous cementation that had height imbalance between Q1 and Q2. Patient wants the approved DW and is unhappy with case. Is a full redo needed or partial redo on 3-10? Patient not happy with profiles and teeth shape.
 

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Flipperlady

Flipperlady

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If the case is for a woman I would not use such masculine teeth. #8 needs to come down and out a bit (the left photo on side by side) and # 10 push up a smidge. The right photo on the side by side #6 and 11 are tipped in a bit much. The middle photo side view the anteriors seem a bit short, again #8. The far right picture the bicuspids seem a bit long. If the pt is older, they may say they want the really white teeth but they look odd on an older person, I would try a bit darker shde.
 
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This is a B1 shade. 40 year old young looking male. Trying to wrap my head around why the DW is significantly different from the case provided by the ceramist.

Is this much of a deviation unacceptable?

Thank you.
 
Doris A

Doris A

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On the DW that the pt approved, the necks of 7&10 are longer, especially 7, 6 is tucked in more and the long axis is different between 8&9. If that's what the pt wants, then yes it's a remake.
 
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Full redo on 2-14 or only partial on 3-10?

I feel like getting as close to the DW might require full arch redo?
 
npdynamite

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To start DW can deviate from final results for a number of reasons. One is that it ignored realistic expectations of how much can be prepped etc. Also the doctor can do a crappy job on the prep (not enough reduction, margins not low enough). Lastly depending on workflow if say they wax up was done entirely by hand but the finals are zirconia if your digital technician doesn't do a good job creating the frameworks or full contour restorations that will be another difficulty.

A last note is that when the pink tissue gets added it generally causes the DW to fuller around the gingiva than you could ever realistically achieve.

For these reasons I like to prep my DW in a similar fashion to how a doctor preps and then design the case digitally and mill in wax so that I can start from the same design when the case comes back
 
npdynamite

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Another note, while you might be able to change some contours to help achieve the DW, you would likely need to lengthen the preps of the laterals and canine and include 11 to really get close
 
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The problem with these cases is just like someone said above.
You can wax it to whatever you want but if you didn't provide a prep guide and they did not follow it.
You will be very limited to what is realistically possible.

Take this with a grain of salt because I'm pretty sure every tech would make adjustments on any case they see.
I sometimes want to change things after I see them cemented.

I just think a bit of recontouring and opening the embrasures will help.
make the bicuspid cusps not so pointy and flatten the cuspid out and bring in the mesial so it's not so prominent.

But you wont be able to do much with the #7 because of the placement of the margin.
It's going to look short and kind of out of place no matter what. Doc Needs to drop the margin if you want to copy the DW

Whoever designed the DW didn't really follow a proper prep.

Like I said just my opinion without seeing the preps.
I'm always hesitant to critique because I know how limited you can sometimes be by the preparations.
 
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The problem with these cases is just like someone said above.
You can wax it to whatever you want but if you didn't provide a prep guide and they did not follow it.
You will be very limited to what is realistically possible.

Take this with a grain of salt because I'm pretty sure every tech would make adjustments on any case they see.
I sometimes want to change things after I see them cemented.

I just think a bit of recontouring and opening the embrasures will help.
make the bicuspid cusps not so pointy and flatten the cuspid out and bring in the mesial so it's not so prominent.

But you wont be able to do much with the #7 because of the placement of the margin.
It's going to look short and kind of out of place no matter what. Doc Needs to drop the margin if you want to copy the DW

Whoever designed the DW didn't really follow a proper prep.

Like I said just my opinion without seeing the preps.
I'm always hesitant to critique because I know how limited you can sometimes be by the preparations.
Thank you.
 
Contraluz

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To start, DW can deviate from final results for a number of reasons.
You can wax it to whatever you want but if you didn't provide a prep guide and they did not follow it.
You will be very limited to what is realistically possible.
This!
Full redo on 2-14 or only partial on 3-10?

I feel like getting as close to the DW might require full arch redo?
I don't think a full redo is required. Re-contouring and adding here and there some volume. But as mentioned a couple times above, that #7 needs crown lengthening.
 
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