Praying you can help me!

[cabingrl]

Thanks in advance to all who can help me. I am a 31 year old dental hygienist with congenitally missing laterals. (7 and 10). Had an ugly yellow pair of maryland bridges since college and recently underwent removing them and had them remade here at the office where I work. I have whitened and my teeth are quite bright. They do have a "warm" undertone, and they always match the A1 temp shade perfectly, but the A1 porcelain shade appears too yellow. We opted for a B1 shade and the first time they came back from the lab they were visibly gray. Even on the model. Sent them back and asked for them to be whiter and fuller at the gingival margin to hide embrasure spaces. They came back again looking a little gray to me, but since I work here at the office I felt bad asking to have them sent out again so I ok'd the shade since it did look very close under the light of the dental chair. Fast forward to that evening. I get home and look in my bathroom mirror. They are VERY gray in that light AND natural lighting! I didn't even want to say anything to my boss/dentist, but a few days ago one of the wings already popped off. I ended up telling her I am unhappy with the shade and she is having me go to the lab tomorrow for a custom shade match. They will probably both beed to be totally remade. How can I ask for them to not look so grey inside? And how can I request that they look fuller at the gumline? They look very narrow and "set back" from the centrals and canines. Thanks to all for any advice!!!

 

[Bobby Orr ceramics]

cabingrl..... give me a call today. 604-916-8708 . James

 

[rkm rdt]

Are the wings metal?

 

[cabingrl]

They are not. They look very close to my natural teeth in bright lights. But the "inside" of the pontic looks grey...almost like the teeth are bruised or shadowed. Very nervous about tomorrow and hoping that the person I meet with understands what I am saying and will work with me. It's practically my front teeth and I work with teeth for a living!

 

[user name]

Marylands at best are a crap solution. They need to be made of a beryllium-nickle for starters. As far as shape...youre a little locked in by your other teeth and closing embrasures might not be possible. Your shade needs to be determined by an artist. you cant just guess and get it right. You tried B1 and complain that theyre gray...thats a grayish shade. Im not trying to sound snotty, but you cant get a good steak at a fast food joint. There are right ways and wrong ways to do a job. So far youve been making the wrong choices. I hope you give Bobby a call.

 

[rkm rdt]

They are not. They look very close to my natural teeth in bright lights. But the "inside" of the pontic looks grey...almost like the teeth are bruised or shadowed. Very nervous about tomorrow and hoping that the person I meet with understands what I am saying and will work with me. It's practically my front teeth and I work with teeth for a living!

So what is the bridge made of? You should know if it is zirconia or Emax.

 

[cabingrl]

Thanks for your input and you do not sound snotty! You all sound like you know your trade inside and out. I opt for maryland bridges because when they tried to do posts for implants they had to abort because my bone was so thin and would not support the post. The embrasure spaces on the current "gray" ones are pretty much closed and I am satisfied with that, but the marginal 1/3 of the tooth seems thin, making it appear "sunken back". Believe it or not I don't know as much about dental restorations as you might think, we hygienists tend to be more into perio than restorative! But I THINK my bridges are E-max, almost positive that's the name I heard being thrown around. I'm also confused why my other marylands stayed on for 15+ years and these popped a wing loose in less that 2 weeks! They used Rely-x (sp?) to cement them in. As far as color...you are absolutely right when you say we should not guess at the color which is why I am going to the lab tomorrow. I don't know why the B1 is coming back dark. The lumen shade guide we hold up here in the office looks nice and white and my bridges look like they have pencil lead on the inside. You said give "Bobby" a call...is that the person who signed as James in British Columbia? I am going to try to call him in a few minutes.

 

[2thm8kr]

Thanks for your input and you do not sound snotty! You all sound like you know your trade inside and out. I opt for maryland bridges because when they tried to do posts for implants they had to abort because my bone was so thin and would not support the post. The embrasure spaces on the current "gray" ones are pretty much closed and I am satisfied with that, but the marginal 1/3 of the tooth seems thin, making it appear "sunken back". Believe it or not I don't know as much about dental restorations as you might think, we hygienists tend to be more into perio than restorative! But I THINK my bridges are E-max, almost positive that's the name I heard being thrown around. I'm also confused why my other marylands stayed on for 15+ years and these popped a wing loose in less that 2 weeks! They used Rely-x (sp?) to cement them in. As far as color...you are absolutely right when you say we should not guess at the color which is why I am going to the lab tomorrow. I don't know why the B1 is coming back dark. The lumen shade guide we hold up here in the office looks nice and white and my bridges look like they have pencil lead on the inside. You said give "Bobby" a call...is that the person who signed as James in British Columbia? I am going to try to call him in a few minutes.

Why not bone augmentation for implants? You could the eliminate Maryland bridges all together.
How about a diagnostic wax up to make sure the form and function are what you need?

 

[cabingrl]

Oh..I see now...Bobby Orr ceramics...gotcha

 

[cabingrl]

I would rather not go through bone grafting just yet, I think in the future it would probably be nice but I just really like my maryland bridges. They've served me well in the past. I absolutely love the shape/thickness/color of the A1 temps. Wish I could just copy those!

 

[SlowWater]

Don't give up and don't get satisfied until you are satisfied.

I made some and the pacients are very happy with them. But they cost the Dental tech a lot of time and patience. So go to the lab and find a Tech for your problem. You are in this buissines. So I can't see a problem.

Here was also no bone.







Pictures already posted, but I will post it again for you.

Regards, jan

 

[TheLabGuy]

Bone graph... As for the porcelain, contour and shade, go to them and do some try-ins to make sure it's right. There is a ton of stuff we ceramists can do to get the color right, but seeing the patient in person is the communication key here. Good luck.

 

[cabingrl]

Wow. Why can't you all just work right here in St. Louis so I can get some of those perfect non-grey teeth! I did get to speak to James just now and am so grateful for his knowledge and insight. I feel better prepared to communicate effictively with the tech tommorow. I had no clue a BL shade could be used for the framework, I think that would almost completely solve the color problem! Can't express my gratitude enough for all the input from all of you. The fact that you take time out of your day to help a stranger is so touching. You really are artists! I'll let everyone on here know how tomorrow goes.

 

[cabingrl]

Just called the lab and my appointment is Friday at 10:30, so I'll keep everyone posted. They sounded very understanding and willing to work with me on the phone. I was picturing some mad scientist guy under a single bulb in some closet laughing with this evil cackle as he made my blue teeth. But they sound pretty normal, not at all what I was afraid of. Thanks again to everyone.

 

[rkm rdt]

Just called the lab and my appointment is Friday at 10:30, so I'll keep everyone posted. They sounded very understanding and willing to work with me on the phone. I was picturing some mad scientist guy under a single bulb in some closet laughing with this evil cackle as he made my blue teeth. But they sound pretty normal, not at all what I was afraid of. Thanks again to everyone.

What are they teaching you in Hygene School?

 

[martintay]

Any chance of a photo to help evaluate the pencil lead look ?

 

[2thm8kr]

Just called the lab and my appointment is Friday at 10:30, so I'll keep everyone posted. They sounded very understanding and willing to work with me on the phone. I was picturing some mad scientist guy under a single bulb in some closet laughing with this evil cackle as he made my blue teeth. But they sound pretty normal, not at all what I was afraid of. Thanks again to everyone.

That's just how we lure you in MHUAHAHAHA!

 

[martintay]

Out of interest, what do you guys think about e-max marylands ? Seems like a lot of load for thin wings ! But i haven`t done any !

 

[paulg100]

"Why not bone augmentation for implants?"

"Its highly unlikely" you will need bone augmentation, you "should" have stacks of bone as there were never any teeth there to start with. If you take the nice plump papilla in the image below as an example, it gives a good idea of how much crestal bone there is in a typical CM lateral case.

Just finished restoring my girlfirends CM laterals on 2 implants. This are some check shots of the emax MO crowns on metal abutments.The implants are already in there, just not exposed and this was after 16 months of fixed ortho. Case is all finished now, just have to get final shots which ill post at some point.



and look.... nice strong body opacity and no greying so theres a few tricks going on to do this with MO emax with the space available, but thats where finding a good ceramist comes in

Funny thing, i have CM laterals as well,its more common than you'd think. Although restored mine with 2 3 unit bridges years back. They look awful and need replacing badly, I have a nice diastimer opened up now between the 2 centrals which is what always happens eventually when you do 2 separate 3 units bridges from central to canine. ill HAVE to get around to re-doing em at some point soon.

tbh, if you asked the lab to match the opacity and trans of a stock shade tab and there not coming back right, then basically the ceramist your using dosent have the skills and understanding.. simple as that. I mean he has the exact tooth (the tab) there to copy, it dosent get any easier than that.

Martin: forget about using emax for marylands, no way there would be enough connector strength unless the abutment teeth were prepped to allow enough depth for the wings. just use zr and a ceramic slurry under the wings, works fine.

 

[rkm rdt]

Out of interest, what do you guys think about e-max marylands ? Seems like a lot of load for thin wings ! But i haven`t done any !

The first mistake is to prep the linguals as if they were to receive metal wings.
You need to redesign the prep to incorporate the cingulum and axial walls which will create connectors that transition into the lingual.

If you are replacing a pfm maryland then a pfz is a better option because of the existing preparation.