Emax Veneer help

[NicelyMKV]

Having some issues with one particular account. I keep getting thin veneer cases but discolored preps. I attempted a 5 tenths thick LT lightly layered with Incisals but as you can see the grey showed through. I was not aware of this discoloration by the way. Was told preps were light. I was thinking of going with an HO ingot but how in the world would you guys go about it without having an extremely bright restoration or having to over contour to get the shade right.







Thanks,
Jason

 

[paulg100]

Forget about using a HO ingot for a veneer, it is like chalk.

MO can be use for a veneer OK but you need .5-6mm for the frame still otherwise its masking ability will quickly diminish. Also need a bit more room than LT for the layering ceramic to mask the MO frame.

The thing with masking dark preps with pressed veneers is you cant work miracles!

Either the doc needs to do something like a walking bleach technique (only about 50% success) before the veneers, or you need SPACE!

Cant have your cake and eat it with pressed veneers, IE minimal prep and dark stumps don't go together.

You have more options with feldspathics in this regards.

 

[subrisi]

I just had to do the same thing. I used HO, made a thin (o.5) coping and painted a thin wash of the purple stain to fake some translucency, then layered porcelain. It worked well. Just don't paint too much it would lower the value too much. If you see the purple on the surface, it is too much.

 

[NicelyMKV]

Thanks guys. That is what I was thinking about subrisi. I thought about thin HO with violet stain to lower the value, but like paulg100 said, this stuff is just so difficult to make it look good. Especially 8 & 9. This Doctor told me last week to just use HO on all his so he would not have to worry and I explained how bad of an idea that was. 1mm reduction, sure, but he gives me 5 to 7/10s on most cases and I do not want to fight with HO all day.

Paulg100, I got into this about fourteen years ago and by the time I got into ceramics they were all ready pressing OPC so I never got any experience with the feldspathic methods. I did a foil technique using synspar years ago to match a 3D shade but I was very inefficient with it. The lab I started at was using refractory models with ceramic pins but unfortunately it was before my time in ceramics. Seems like I could take and literally opaque the foil and layer over it?

 

[amadent]

Seems like I could take and literally opaque the foil and layer over it?

You dont want to do that, because if opaqe is not thick enough you run risk of etching right thru opaque also im not sure how well opaque takes an etch. you need to use OD and know what color / colors is going to give the result you need to block out that specific underlying color

Greg Amendola MDT

from past experience IMO you will not get rid of that with a venner feldspathic or emax
the gingival does not look to bad in photo you sent

 

[user name]

Alot of people complain about using HO ingots. You can opaque a metal frame and do real nice PFMs...a HO ingot is leaps ahead of that. I like to use an old Finesse porcelain opaque guide to help dial in the color before I layer.

 

[paulg100]

"from past experience IMO you will not get rid of that with a venner feldspathic or emax
the gingival does not look to bad in photo you sent "

take a look at this book and see how and what you can mask with feldspathic (the tech work is michel magne)

Quintessence Publishing porcelain&fromfile=searchlist

Trust me, you can do alot more with feldspathic than you can ever do with pressed when it comes to masking and colour control. That to me is the big thing feldspathic has over pressed.

"I just had to do the same thing. I used HO, made a thin (o.5) coping and painted a thin wash of the purple stain to fake some translucency, then layered porcelain. It worked well. Just don't paint too much it would lower the value too much. If you see the purple on the surface, it is too much."

Would be great to see an intra oral shot of how it looked , not saying it cant be done and sure your work is great but id be very impressed if this looked vital in the mouth.

"Alot of people complain about using HO ingots. You can opaque a metal frame and do real nice PFMs...a HO ingot is leaps ahead of that. I like to use an old Finesse porcelain opaque guide to help dial in the color before I layer."

When was the lst time you made a minimal prep metal veneer? If you completely block ALL light with metal or the HO's virtually do, then you need sufficient porcelain space to impart vitality again (OK you can try to fake it with a complex grey mix but even that has its limits),so if the space is minimal then how do you do this?

"I just had to do the same thing. I used HO, made a thin (o.5) coping and painted a thin wash of the purple stain to fake some translucency, then layered porcelain"

purple stain is a light reflector, not an absorber. Use a complex grey to absorb the light. Again would be great to see what this looked light in the mouth with purple stain underneath, a reflective core with a reflective stain. Im guessing it looked as dead as hell but i may be wrong..

 

[GAP]

Is the Dr using opaque cement? I know a tech that made herself an e.max LT cr over her metal abutment. No metal showed through, the Dr used opaque cement.

Why not tell him to buy it, or buy it yourself and give it to him as a sample

 

[user name]

"Alot of people complain about using HO ingots. You can opaque a metal frame and do real nice PFMs...a HO ingot is leaps ahead of that. I like to use an old Finesse porcelain opaque guide to help dial in the color before I layer."

When was the lst time you made a minimal prep metal veneer? If you completely block ALL light with metal or the HO's virtually do, then you need sufficient porcelain space to impart vitality again (OK you can try to fake it with a complex grey mix but even that has its limits),so if the space is minimal then how do you do this?

Nothing in the photos suggest 'minimal' on the prep. These look like very adequete reductions, and if they are veneers then theres only the cingulum left.

 

[amadent]

Paul thanks for the info on the book, but no disrespect meant you are talking about one of the most talented ceramist in the entire world. We all strive to produce better work and to truely own what we do. This begin said a " michel magne" most of us will never come close. while dentins are dentins and enamels are enamels, it is the understanding and precise handeling is the difference from what most of can obtain and what the true masters can create
.9mm is the rule of thumb for extreme shade changes and even with that it is not an easy task it becomes even more difficult when that color is grey

Greg Amendola MDT

 

[toothdesigner]

all of this is why i quit offereing veneers from my lab redos and cracked veneers after glazing etc. this is using empress aesthetic .best results were with platinum foil and reg. porc.shade changes are out of the ?>great luck

 

[paulg100]

Greg do you have that book, the techniques are not that difficult. I'm not saying were all gonna be michel magne's, but the techniques are fully achievable buy competent ceramists in my opinion.

The problems with pressed ceramic is its all or nothing. If i want to mask an area of tooth which is dark, then a HO blocks everything not just the area in question. you then have to battle with the rest of the HO ingot to impart
vitality/translucency again.

Ive posted some of this case before but it gives a good idea of colour blocking with emax veneers:

Emax crown on 11(8) and veneer 21(9)





This was a MO0 shell and layered. Took two trys, the first i had 1mm reduction and couldn't mask it, the veneer was greying, the 2nd was prepped at bit more so ended up with 1.5mm. The shell was about .8-1mm. (did have a image of the 1st try, ill post if i can find it). Even in these images the veneer is greying ever so slightly.

If you have less than 1mm and a prep like this, then from my experience you aint gonna block it with MO, LT or HT. Maybe with HO, but is it possible to make the tooth look vital?

I just cant imagine how i could have got vitality in a HO frame, but if someone is doing it then please share.

"This begin said a " michel magne" most of us will never come close"

Personally i think were all capable of comming close, just depends on the amount of time and effort we want to dedicate. 1) he is very talented, 2) he has no doubt sunk a TON of hours in to developing his skills. We may not all have 1 but we can all do 2 which will get us close.

" you need to use OD and know what color / colors is going to give the result you need to block out that specific underlying color"

Have you tried playing around with mamelon/OD mixes / power dentines greg, this will make better colour blockers.

All in all MKV i think your client needs to ba a bit more realistic. If you have this kind of discolouring and minimal labial space, then maybe a minimal crown prep on zirconia would be the best option. I find Zirconia sits between HO and MO (depending on what brand you use) and is alot easier to manage than a HO ingot but has better masking ability than MO.

Or.. you start learning feldspathics. I hope to dedicate some time to this meself as it really is a great tool for these types of cases.

Dang i just noticed a pit in that veneer in the last image! ah well ,back to the drawing board

 

[amadent]

Great Job_ Paul

Greg Amendola MDT

 

[NicelyMKV]

GAP, this Doctor is a big cutter and just wants to grab one bonding material and BOOM, move on to the next operatory. I know, no excuse and dont expect miracles but you know. I did email him about needing to bleach or block out the prep with bonded composite but you know. This photo would have been helpful before I did the case as well

user name, I am 5/10s thick on the immediate facial but as the dark area wraps around to the interproximals there is definitely more room. Another thing I am concerned about is the shoulder margin area appears a little low in value as well. As you can see I am far from any kind of fantastic ceramist but I think with the right material choice even us regular guys can at least block out undesirable situations. That is what I was posting here for. See if anyone had any magic an average tech could borrow

 

[NicelyMKV]

paul100, so the veneer is a feldspathic method and the other is Emax? I must say the veneer looks more alive to me. Beautiful work!

 

[NicelyMKV]

Paulg100, one other thing. I am looking at the book on the webpage and wondering about fabrication time for these types of techniques. Is it something that involves a lot of expense to get into but is also time consuming? I remember they were using refractory models with ceramic pins when I got my start. We would duplicate the model after the dies were trimmed and go from there. They seemed to struggle with it a lot but I really dont know about their skill level etc. One tech told me he preferred the foil method but said he always had trouble sealing his margins and would sometimes break the finished restoration trying to remove the foil. Just curious.

Thanks for everyones comments and help.

Jason

 

[paulg100]

oops double post

 

[paulg100]

Nope the crown and veneer are both MO0 emax. fully layered.

Refractory veneers are not really complicated. You can make the models up with pins or just make up the dies. Dupe em to make refractory replicas and make a hard tissue cast model. Sounds like a lot of work but once youve got it sussed its not that bad.

Used foil for years and i wouldnt go back to it by choice, as like you say, its not easy to get good fits. Certainly you can blow the fits out the water with pressed and i would say refractory sits some where in between.

As your Dr Dennis Wells said at a lecture i sat some time back
"find a tech thats proficient in all three methods, not just one"
and i have to agree. They all have their uses depending on the situation.

Foil-no prep veneers
refractory -advanced masking and colour control
pressed - strength & fit

thats my opinion anyway, from experiance and study.

All my work is pressed at the moment, but gonna start playing with refractories again soon.

If you want more info on the technique magne uses for making his refractory models, it is explained in detail in here:

Quintessence Publishing

 

[NicelyMKV]

Here is what I have acheived so far. I am 6 to 7 tenths thick using an HO-0 ingot at a little over 3 tenths thick.


Doc wants smooth slick facial so.... I am going to try and get by his office tomorrow to take pics regardless of outcome. I did a lot of staining on the core and it seems to have worked out.





Value does not appear to high. What do you think?

Jason

 

[Alistar]

Looks good to me, but I'm viewing on my mobile phone.