No Prep Refractory Veneers

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I've got this case in the lab and the Dr is asking for no prep veneers on 8 & 9. The original treatment plan called for minimal prep on 8 & 9 and possibly press veneers. The Dr decided to go with no prep incase the pt wasn't happy with the results. The goal is to match shade of 9 with 8 and the rest of the teeth. No. 9 is BL4, discolored from past trauma. 8 and every thing else is BL3. Pt has bleached multiple times in the past but hasn't in the last year.

I have a little leeway with regard to bulky ness since 8 and 9 are set back in the arch.
I'm thinking refractory veneers. Using BL3 first bake and TI1 and OE3 second bake on 8 to maintain shade. On 9 BL2 first bake and a thin layer of inc and oe3 on second bake. This is only for shade correction, shape will be maintained.

Any better ideas, tips or techniques? Any suggestions would be appreciated, thanks. I told the Dr I don't like the whole "no prep veneer" thing but that I'd give it a shot.
Brad

Pic from occ view on stone model
6dfa84dd.jpg


Pic of pt
adf3b61f.jpg
 
amadent

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judging from photo, i think you are on the right track
due to the fact that they are set back in the arch you should have room for the color change between 8,9
still might use prep colored die spacer to make sure you mask the darker off the 2
are you closing the interproximal space?
 
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are you closing the interproximal space?

No, the veneers will be like contact lenses on the labial of 8 & 9.

I keep trying to convince myself I need to use a whiter porc on 9 but then I think it would be better to let the Dr fine tune the shade chair side at cementation.
 
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paulg100

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dont like the whole no prep thing, or dont know how to do the whole no prep thing?

Im not knocking you, im on the same learning curve as minimally invasive dentistry is the big thing now.

theres nothing wrong with no preps, its possible to get superb results with the right cases or right short term ortho pre-positioning and the right lab techniques.

one q though, why refractory for this and not emax?

heres a case im currently working on which is very similar to yours:

Very Minimal/no Preps. Centrals are already prominent even before veneers and one is quite heavily discoloured. in other words, a bit of a nightmare :)

img1917xd.jpg


.1 emax shells:

aimg6.imageshack.us_img6_3294_img0008wf.jpg

1st bake shade try-in

aimg560.imageshack.us_img560_4677_mg1030w.jpg

As you can see the amount of masking ive been able to get with .1 shell and .2 of layering is pretty mad. Ended up way to much in fact.

The advantage here is i have a stump shade to work off, rather than a white refractory die or silver foil. Both of these techniques i find it virtually impossible to have any control over colour without a proper stump to work to.

These are both LT B1 shells btw to reach a B1 final shade. Theres no point in using an ingot thats way higher in value with super thin veneers, as you will go through to the ingot at the margins and end up with a potential bright halo around the veneer. This has been my stumbling block with doing these things in emax up until now.

Cant give you much more details at the minute as this technique is a work in progress but dont think you need to go refractory to get intrinsic masking with very thin veneers.

It can be done with emax too. It takes a lot more time and care than doing regular Emax so you need to charge extra for these things.

looking at your case and the fact that the centrals are set back, you have stacks of room here to mask with emax.
aimg6.imageshack.us_img6_3294_img0008wf.jpg aimg560.imageshack.us_img560_4677_mg1030w.jpg
 
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Thanks guys for your insight on this case. Paul, very nice work I may wax and press some emax this weekend to compare with the refractory veneers. The whole not liking the no prep thing is just me, I guess I needed a kick in the pants to get over it. I know more patients are willing to get in the chair for no prep restorations and this Dr is one of our biggest emax accounts.
I was thinking refractory because it would give me more control in specific areas, such as masking darker areas and using mor trans porcelain in the lighter areas while keeping the veneers as thin a possible. The pt didn't want her centerals brought into alignment and didn't want the inc edge any thicker than necessary. Good point on the Use of the stumpf, refractory is definitely a guessing game to some extent.
I would not have thought to use a LT ingot in this case, probably would have used O2 and struggled with the brightness.

.1mm thickness on emax, you're the man!
 
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"I was thinking refractory because it would give me more control in specific areas, such as masking darker areas and using mor trans porcelain in the lighter areas while keeping the veneers as thin a possible."

yep thats what ive done here. the preconditioning layer that you would normally fire onto the refractory die is just a .1 emax shell instead.

obviously im in the process of redoing the 8 (11) with less masking before i layer both with enamel.

i pressed several shells from one B1 ingot so i had back ups.
 
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Clear Precision Dental

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i pressed several shells from one B1 ingot so i had back ups.

A very good idea. You are on the right track.

Pinhas Adar, MDT, CDT told me (a long time ago) that for these type of cases, he would make several veneers (or crowns) with slight variations and let the doc choose the best pairing. There was a charge of course.
 
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I highly recommend going the emax route. We do a lot of masking with emax; it's really trial and error depending on your thickness but the stump dies make it easy. The LTs will definitely mask it out, but you might even get away with the value ingots, which will give you a little more translucency, since you probably aren't going to have much room for porcelain on these.
 
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"but the stump dies make it easy"

mm not sure id go that far, but they help a heck of alot compared to working off a white refractory or grey foil.

I have no idea how guys doing refractory or foil are getting predictable final shades with that. Some kind of jedi mind trick .

Id love to make it out to Magne's new training facility in LA and take his refractory course but ill have to get saving for that.
 
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Here's a case I did a few weeks back. I tried emax first but couldn't even get close to the shade. In this instance a clear or neutral ingot would have been nice. There was no more than .3mm reduction on #9 and all the color I needed was right there in the prep. Any ingot I used would have muted that color and I would of had to recreate it in .1-.2mm or space. My second go around I did refractory and used trans neutral, TI3, clear, a streak of OE3 here and there, and a little trans brown-gray in the incisal.
I've got nothing against emax, I'd much rather use it any day over refractory. I've got a lot more to learn about using emax, I'm sure some of the pros could have knocked this out of the park first try doing press and layer. I think in some cases refractory is a simpler road than press.

This isn't the best pic, I have a better camera and lens since this was taken.
78cafff5.jpg
 
Tom Moore

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For me pressing is the way to go. Lots of things to do to this after pressing and while your burning an ingot anyway make two of each. Maybe one pair so thin you can do a very light build on them.
 

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