Restorations Du Jour

droberts

droberts

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Artemis, I use paste glaze. Put it on thin then rubber wheel the surface lightly with a pink rubber wheel.

This slpint has 2 pontics and there isnt enough room for both so I rotated one.
Wrapped the dentin on the incisal edge with a bit of clear then wraped that with reg incisal and some white incisal.

A3/A35 was the shade requested. But I used C4 on the cervical and interproximal.
Margins are all at or above the gum.

ai46.photobucket.com_albums_f116_CDLAB_rvb1.jpg
ai46.photobucket.com_albums_f116_CDLAB_rvb2.jpg
ai46.photobucket.com_albums_f116_CDLAB_rvb3.jpg
ai46.photobucket.com_albums_f116_CDLAB_rvb4.jpg
ai46.photobucket.com_albums_f116_CDLAB_rvb5.jpg
ai46.photobucket.com_albums_f116_CDLAB_rvb6.jpg

This is all I got from the Dr.

ai46.photobucket.com_albums_f116_CDLAB_rvb6_1.jpg
ai46.photobucket.com_albums_f116_CDLAB_rvb7.jpg


Al,

Whats the treatment plan for the posterior?
ai46.photobucket.com_albums_f116_CDLAB_rvb1.jpg ai46.photobucket.com_albums_f116_CDLAB_rvb2.jpg ai46.photobucket.com_albums_f116_CDLAB_rvb3.jpg ai46.photobucket.com_albums_f116_CDLAB_rvb4.jpg ai46.photobucket.com_albums_f116_CDLAB_rvb5.jpg ai46.photobucket.com_albums_f116_CDLAB_rvb6.jpg ai46.photobucket.com_albums_f116_CDLAB_rvb6_1.jpg ai46.photobucket.com_albums_f116_CDLAB_rvb7.jpg
 
Al.

Al.

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Well said John.
Al, could you detail the incisal layering in the upper 6 unit case? I cant seem to get mine to "pop" quite like that.
Its layered normal, body and incisal correct length and width but slightly undercontoured facially. I stained the incisal effects then layered incisal over top.
Same as this one below. Subtlely stained then layered over. And I would emphasize subtle.

ai46.photobucket.com_albums_f116_CDLAB_rvb11.jpg
ai46.photobucket.com_albums_f116_CDLAB_rvb11.jpg
 
Al.

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Danny originaly nothing but now he is having implants placed. I thihk 4 two on each side.
 
droberts

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Danny originaly nothing but now he is having implants placed. I thihk 4 two on each side.

Good idea, you want to protect your beautiful creations:)
 
Al.

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Glad you were able to see value in this technique, it really can save your ass when things are not as we think they should be.

Acrylic is infinitely easier to modify, so try and get it dead on balls accurate before you invest and chuck the metal.

I agree.
I made a matrix of the provisional then filled it with gc pattern resin connection it to the abutments.

This one would have been a disaster if I had gone ahead and cast a frame because it was mounted in protrusive.
I got it back and remounted and had to bring the acrylic back 3mm also had to move the midline over 1mm.

ai46.photobucket.com_albums_f116_CDLAB_rvb8.jpg

It went out yesterday for another try in. Note the 2 anterior abutments are plastic. Straumans gold cast to abutments for them were on back for 2 weeks, so I went with the all plastic.
Also I needed multi abutments for all of them to make them non engaging.
Almost $2,000 for componants and that is with those 2 plastic abutments.
ai46.photobucket.com_albums_f116_CDLAB_rvb8.jpg
 
Al.

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This one is out also for try in.

ai46.photobucket.com_albums_f116_CDLAB_rvb9.jpg

Here it is sectioned and ready for the Dr to screw down and arrange then connect in the mouth, and check the mid line and cant and lip support etc.
I think it is in 8 peices now.

ai46.photobucket.com_albums_f116_CDLAB_rvb10.jpg
ai46.photobucket.com_albums_f116_CDLAB_rvb9.jpg ai46.photobucket.com_albums_f116_CDLAB_rvb10.jpg
 
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paulg100

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great work and good idea with the acrylic jig.
 
Al.

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great work and good idea with the acrylic jig.

Ill cut it back for porc then cast it. So it is also my frame.
I may leave a bit of it in metal on the lingual if he gets the occlusion worked out.

The last case may need to have the two anterior abutnment be cement retained the rest screw retained. I dont think I have enough room for cut back then layer. Its going to be close though. The acess hole is just below the incisal edge in the lngual.
 
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paulg100

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your lucky your clients are prepeared to take an extra appointment to try the jig.

Never ceases to amaze me how many wont and everything goes off the rails. :frusty:

Anything like that now and i cover me butt with written consent and photography. Dosent help much though as it still sours the relationship.
 
droberts

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Not to hi-jack Al's post here. But this may help some out on parts. I have run into a few cases where I needed a non-engaging abutment and VDO was in issue. Shown in the photos are the mesio-abutment from Straumann being modified to eliminate the octa-engagement of the abutment. I also used the lathe to shape these as I needed for the bar case I was going to be welding together. So to save on parts and if the VDO would be an issue, the gold cast- ables could be done in the same manner. This way you have one (1) screw to seat the prosthesis.
IMG_3460.jpg IMG_3462.jpg IMG_3464.jpg
 
marvel

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FREE try-ins and initial adjustment appts...??!

your lucky your clients are prepeared to take an extra appointment to try the jig.

Never ceases to amaze me how many wont and everything goes off the rails. :frusty: ...

Is Dr and/or Dental Lab charging p/t for each tryin and initial til-you-get-it-right adjustment appt?

If yes, try "giving" these "free" and hiding their costs into the big payment sections. For instance, if tryin is at lab, when p/t asks what they owe the lab can answer, "Nothing for today; your doctor has it covered," or, "You owe nothing for today. This appt is part of your Dr/s and us making THE best resto we can for you.

Now mebbe everybody already is doing this but if not take it from this p/t it feels SO tripppy to ask a desk lady "what do I owe for today?" and she checks Dr notes, looks up and smiles and says, "You don't owe anything for today."
 
Alistar

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Hey Al, how do you keep this moving through the lab and keep up on your production work? You must be putting in some long hours.

I'm putting in 8-10+ a day just building porcelain and doing E.max waxing/finishing/stain/glaze. I think I could cut an hour or so off that if I had an extra porcelain oven, because I have 3 different types of porcelain running. E.max, Vita VM9, and Vita VMK Master/Inline and sometimes I even have VM7 as well, and things can get backed up with the long cooling cycles on the zirconia and e.max. I need more time!

Do you have two porcelain ovens? So you can be working on your production pfm work and E.max? Do you have these big cases in a separate work space or time slot?

What is your preferred implant system to work with? And do you prefer to work of predesigned custom abutments, stock, or your own custom ucla's?

Sorry, lots of questions. I understand if you don't get to them all.

Amazing work as usual. That technique John shared with you is awesome. I think I saw that technique used in DLP by Luke Khang as well.
 
TheLabGuy

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Great Stuff Al, but use the non-shrinking tooth colored resin instead of that Durlay/GC pattern red.
 
rkm rdt

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Thanks for sharing your pics Al, the details are inspiring.
 
JohnWilson

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This one is out also for try in.

ai46.photobucket.com_albums_f116_CDLAB_rvb9.jpg


This is going to be a beautiful case.

I will add a couple of tips when using pattern resin

1) GC sets up way faster than Duralay, on the bigger cases I like to have a bit more time.

2)A fast way to make these is to use the matrix that you made of the wax up and then utilize the same technique of a wax injector, just use a syringe that you will fill with the pattern, resin, Keeps things fast and clean,

3)Make sure the Dr uses pattern resin in the mouth to affix the pieces together, unless you plan on sectioning everything back in the lab after he verifies the master model and the smile characterizations. This makes sure you don't have any nasty composite on the frame/waxup that will not burn out clean and more or less muck up all your hard work.

4)If you are planning to cast this in one piece (Good Luck) and you relute the pieces back in the lab post cutback I always recommend to let the unit sit over night screwed down to the model. No matter how dimensionally stable the material is I just feel better letting it sit over night.

Thanks for sharing Al
ai46.photobucket.com_albums_f116_CDLAB_rvb9.jpg
 
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paulg100

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you not got on the piku plast band wagon yet?

check it out, its from Bredent.
 
JohnWilson

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you not got on the piku plast band wagon yet?

check it out, its from Bredent.

No I love this resin for small stuff, we use it exclusively for secondary patterns for VKS attachments on combo cases. Wish they had a bulk purchase as we run through a lot of resin on BIG cases.

We just find its just not appropriate for large units in my opinion. It also sets extremely fast as well, we put the liquid in the fridge to slow down process.

The day they make a followable composite "triad gel viscosity" that burns out perfectly clean, that I can inject through a clear PVS material matrix, my life will get even better. We jumped on the priomtec wagon when it first came out and although it does work great for some things its not suitable for this technique.
 
Al.

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Hey Al, how do you keep this moving through the lab and keep up on your production work? You must be putting in some long hours.

I'm putting in 8-10+ a day just building porcelain and doing E.max waxing/finishing/stain/glaze. I think I could cut an hour or so off that if I had an extra porcelain oven, because I have 3 different types of porcelain running. E.max, Vita VM9, and Vita VMK Master/Inline and sometimes I even have VM7 as well, and things can get backed up with the long cooling cycles on the zirconia and e.max. I need more time!

Do you have two porcelain ovens? So you can be working on your production pfm work and E.max? Do you have these big cases in a separate work space or time slot?

What is your preferred implant system to work with? And do you prefer to work of predesigned custom abutments, stock, or your own custom ucla's?

Sorry, lots of questions. I understand if you don't get to them all.

Amazing work as usual. That technique John shared with you is awesome. I think I saw that technique used in DLP by Luke Khang as well.

If you can have a peice of equipment that saves you an hour a week that adds up to alot of time and production over a year and pays for its self.
I have 2 porc ovens running for pfms and two on a shelf for back ups.

I have 2 pressing furnaces now and that has saved me ALOT of time. I also use them to fire emax in.

Another big time saver is I just bought a second autodevester and set them up to both run at the same time with the same vacumn.

I think the extra pressing and firing furnaces and devesters save me 2 to 3 hours a week. Thats adds up to 1 to 2 days a month of production.

But I work by the week not by the day, that is way more productive for me doing X number of units a week vs doing X units per day. Do everything in groups so I only run my furnaces 2 days a week.
 
Al.

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ai46.photobucket.com_albums_f116_CDLAB_rvb12.jpg
ai46.photobucket.com_albums_f116_CDLAB_rvb13.jpg

First atempted try in. Flunked.
Surface is like sandpaper.
We were torn between closing the space and having the veneer look too wide or leaving a space so I only closed the space partially. That didnt work.
Incisal is off.

ai46.photobucket.com_albums_f116_CDLAB_rvb14.jpg

Came back land I closed the space and after the glaze I rubber wheeled the surface with a pink wheel. It leaves it smooth but not a high shine more matte.

B1 Lt the center (only) of the veneer is at its thinnest .3 at its thickest it is .4.
I stained the cervical with B1 empress stain then layered B1 dentin over with just enough to keep the stain off the surface.
I missed the blue on the M & D I edges.
ai46.photobucket.com_albums_f116_CDLAB_rvb15.jpg
ai46.photobucket.com_albums_f116_CDLAB_rvb12.jpg ai46.photobucket.com_albums_f116_CDLAB_rvb13.jpg ai46.photobucket.com_albums_f116_CDLAB_rvb14.jpg ai46.photobucket.com_albums_f116_CDLAB_rvb15.jpg
 

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