Porcelain crown opinion

[SLA]

This young female patient is unhappy with her six new front porcelain crowns. In her opinion the four central teeth are too flat, squarish and short which makes her look older. Could I get your professional opinion about the look of the crowns and what should be done to make the teeth look better. Please advise and thank you so much for any help.

 

[charles007]

Patient is correct.....
Bring in the line angles alot ! and round up. Facial surface is way to flat which makes the centrals look even more wide.
Laterals are a sad story, they are wider at the incisal edges from mesial to distal than the middle 1/3.
Shade looks grey, but may not be accurate with the pics. Centrals and laterals need to be lighter.
Cuspids are lighter than the centrals..... reverse for sure.
Lengthen the centrals if possible with shorter laterals to give a younger look.
I think they have the China Syndrome curse... just kidding !!
What material did you use, and shade ?,..... hope not a C shade.

Charles

 

[Mark Jackson]

Too masculine. Round them off and make the centrals a little longer. Possibly narrow the laterals a tad. She has nice lips though

 

[SLA]

THANK YOU very much for your time and advice! The patient asked for the whitest color on the market (bleach shade) but the dentist felt in her judgment that the most natural color would be shade B0. The crowns were made for her twice due to the patient not thinking the teeth were white enough nor were they long enough. The second crowns came in shade 00 (double zero) and the dentist said this is the whitest color possible to get, although the patient's old crowns used to be whiter. The dentist also said the crowns were made 2mm longer which is doubtful since if the ones she had made beforehand were 2mm shorter, they would have looked like baby teeth!

 

[Bobby Orr ceramics]

WOW!!! lots of mistakes here clinically and technically.....

Clinically:

*brutal tissue management.....margins? open? resin clean-up?
*patient got a canine to canine smile when her esthetic zone is clearly molar to molar.....buccal corridor consideration missed by Dr...... case could be limited cause of $$$

Technically:

*centrals too short ..... function may be limiting this but that's how they appear.....length:width ratio clearly violated.
*laterals too wide for centrals
*canines too bulky
*line angles of incisors too straight...... no natural relationship developed from central to canine.
*surface texture is brutal..... light reflections make centrals appear short and laterals appear long.
*Ceramic appears low in value and monochromatic.....any dark preps shining thru??

Sorry for pulling out the blow torch criticism on this case......

I agree with the patient's unhappiness

James

ps. check out this link, hopefully it helps you with this case

Award Winning from Ocean Ceramics

 

[user name]

Agreed with all the above. I initially had typed out the first post, and decided to delete it. This is an excellent example of the value of doing a diagnostic wax up and getting the teams approval.

 

[charles007]

Agreed with all the above. I initially had typed out the first post, and decided to delete it. This is an excellent example of the value of doing a diagnostic wax up and getting the teams approval.

You know this is not really a difficult case....on the other hand, wouldn't touch without a diagnostic wax up and educating the patient a little about shades-"bleached", and what's unnatural -fake looking crowns that can be seen from miles away..
This patient has been through the mill and back, and you must tread lightly to please her...........

 

[dmonwaxa]

Too masculine. Round them off and make the centrals a little longer. Possibly narrow the laterals a tad. She has nice lips though

Probably had em done up special for the glamour shot.

Lots of truth in what has been said so far, and those so pure white till they're blue shades are like Charles said can be seen a mile away. And just imagine she wants em whiter, shes nuts.....period. I've been to this rodeo before. The things some folks do in the name of vanity and it looks so fake. Just like fake boobs, it just draws the wrong kind of attention. Plus sh'e way too young to be getting that kind of agressive dentistry, whats next implants? Because at that rate or replacement she'll have nothing but stumps. Techniaclly, Since the material was not given, the only solution I know is to use use Cercon illumine zr porcelain they come in 8 shades of white; from off white to blue A pure white Zr core and illumine I8 she'll be 4 shades brighter and happy. It also looks like things are breaking down posteriorly and thats a detriment to future of the anterior teeth, which may also have influeced its length. Too many young women want the mouth full of teeth with no natural incisal embrasures and curvature very masculine showing no negative space look and when they get them end up dissappointed,,, really?,,,,go figure. Way too many things going on, unatural shade,,,shape,,,contours,,,dimensions ...ratios to name a few. How much vertical space does she have? Looks like she has a significant overbite, buccal cusp of premolar broken off and #14 looks somewhat super erupted.

 

[ed 3]

Female anatomy is missing here,not rounded, too muscular. Laterals should bee a beat smaller than centrals. Also I see black triangles on gum aria. Every tooth like a Chiclet

 

[doug]

HIPPA violation in Slide #7, James
Beautiful results on the case.

 

[Bobby Orr ceramics]

aaaaahhhh !! thanks Doug...... missed that !! I'll call my web guy .

 

[JohnWilson]

Not wanting to thread jack it, but James that case turned out great utilizing old school materials.

Whenever I see work like that I always wonder why there is rarely ever a retracted view in centric relation.

Nice photography as well.

 

[Bobby Orr ceramics]

Thanks John, I rarely photograph teeth in centric cause it's more difficult to see a cosmetic set up with embrasure development and enamel build up. The dentist worked out all functional considerations and I only posted the photos that pertained to Design and ceramic development for THAT patient.

I love pressed ceramics, but my only knock on any pressed ceramic is...... "When a dentist preps away a minimum of 5-6 shade variations of tooth structure, why do we replace it with 1 core shade with surface colours"? . I know it's a general statement that will probably spark some criticism, but call me Old School @ 42. , James

 

[TheLabGuy]

Hey James, #8 looks gray buddy, especially at the cervical. Nice PJC though

 

[Bobby Orr ceramics]

Good eye Rob!!!....... dark prep I was strugglin with..... only dark prep in the smile of course..... was dinged a minor fault for that but the case still passed AACD accredition.

 

[senthildtech]

hi scl

crown looks good but small mistakes like our friends said if you make latral missial edges little round it will look more natural and over female teeths are rounded thats it then i know when your donig second time we are little bit upset dont be worry when ever your doing think thats first time evrything will get solved

thanks