Restorations Du Jour

[SlowWater]

Thanks Al. and other members but I was still hopping for a few more words

As a dental tech I am always having problems after I give away my work. It's so difficult to restore teeths, because you are changing so much on the patients look by removing or adding just a fracture of a milimeters.

So this is also why I like to work in a way so I can see the patient and communicate with him. I can't post pictures of a full face case for their privacy, but I can make let say nice teeth on the model, but sometimes it turns out, they just don't fit in pacients mouth.

I came up with this case done aprox. 2 months ago and completly forgot it. I have just looked at the first photo and didn't know were to put it.
Have I done something ? is there something to be done? is it just a case for analyze? It looks like there is nothing to be done! Why do I have this picture in my camera? ....

It just looked great to my eyes. But then I have found this one photo of the situation and I had some doubts. Are the teeth matching perfect or not, is the value ok, is the position natural.
But when I was finishing the work, I know/ I think it looked good, otherwise I would have corrected it ! Definetly, but what if I have not been able to see it at that time? So here we are - time will tell.

So this is why I can only say, we learn from our mistakes and that's why I have searched for some more answers about posting pictures and making lifelike teeths just through the eyes of the camera and not being you behind the viewfinder.

I think it's easier to replace one tooth, then all, because by replacing one, you are just copying it and not changing the rest of the enviroment and we all now the nice copy paste function

especially after we take the final picture - there is absolute no forgiving

And here are the thousand words ... me behing the viewfinder

 

[bonded]

Hi Slowwater , Very nice.
But looks too shiny, If you use mechanical polishing ( mat polish ) will blend with the rest of teeth.

 

[martintay]

Nice,what material is it ?

 

[martintay]

Is it zirconia ? I like it !

 

[rkm rdt]

It's my first Lava Ultimate

 

[D-CCTO]

Very Nice! Looks awesome!

 

[Affinity]

Dont know much about the lava ultimate, its a composite right? do they have correction materials for it? or stains?

 

[rkm rdt]

Thankyou Kastle Mills , I can't wait to fabricate a hybrid implant crown with LU.The possiblities are endless.

 

[rkm rdt]

Dont know much about the lava ultimate, its a composite right? do they have correction materials for it? or stains?

Absolutly, 3M Espie Sinfony is perfect for modification. I cut back both buccal cusps and added E1 to the mb cusp and E 5 to the db cusp.

It's hard to not get exicted about this material.

 

[NicelyMKV]

Absolutly, 3M Espie Sinfony is perfect for modification. I cut back both buccal cusps and added E1 to the mb cusp and E 5 to the db cusp.

It's hard to not get exicted about this material.

How does it compare to Emax?

 

[rkm rdt]

How does it compare to Emax?

Emax doesn't offer a 10 year warranty.
Less abrasive to the opposing dentition
probably a better material for single implants
repairable chairside.

 

[mokome]

To Slow Water(#781) These are beautiful work, only the reason that I may know these are crowns because incisal edges are not naturally sharp. Don't ask me how can you do it because I don't know how neither, Al might be able to tell us how we can achieve it without spending too much effort. Also I saw someone was talking about surface is too shiny but I believe that you did polished it, I believe if you are looking for more perfect, you have to put more tiny bumpy surface texture and less polish. Maybe needs little more contrast in different values in incisal 1/3 which maybe deeper and shallow cut back in the body build up when you make mamelon shape. But again if I could make something like this I can charge 5x more fee to my dentist. You can teach courses. By the way what is the material that you used? Thanks.

 

[bonded]

Mokome , " put more tiny bumpy surface texture and less polish "
You are very correct !!
I think you knows very well lol

 

[GAP]

How does it compare to Emax?

You also need 2mm of occl reduction. I have hard time getting 1.5mm for e.max.

It looks nicer than I expected but I think its application in clinical situations is limited due to the reduc needed.

 

[SlowWater]

Hi Mokome, Bonded and others,

Nice remarks and I can see them good - thanks But I also need to write down that the high polish is made on purpose, because we had some minor problems with gingiva (see picture again).
So it is better to be polished good - it was a decision made in the docs office before cementation and I have repolished the crowns.
I can take away this high gloss anytime. The picture is taken right after cementation, so you can see the lower teeth are much whiter then in the situacion picture, because they were exposed to the air during cement.

But anyway I know it is not perfect and still there is always the next time to hold on and make it even better but the pacient smiles again and this is also good to see.

I would also like to say that I am working for years with pacients directly, so they have given me a new dimension in building the teeth for them. The natural look came much closer then building through a wish paper from the docs office with a nummber on it, like A3.
This is also why I like Al.s thinking with those monolitic crows entering the market and flooding it with crows that don't look natural or lifelike crowns that we can produce and stay still in business - so no worries there.

So this is a point in my life, were new doctors are asking me to make some crowns for them, and I have to decide were to do it or not (And I mean making the crowns through pictures and post office). I also know that the results will not be in this range that I am posting. So even less good.
Doctors also have never such a wish for the teeth (form, color, look etc.) than the pacient has.
The opposite - Pacients are willing to spend hours and hours with you, just to get a better set of natural looking teeth made directly for them - and I have just a few exclusions in years of work.

But at the other end of the story - this can be also a very stressfull situacion. And you are also taking a lot of responsibility. You are some kind of a 'wishmaker'

This is a case, were I needed to replace all but the 4 lower teeth.
The pacient wanted the lower to match their neighbours and the upper to slightly match the lower, but look whiter, bigger and not to white, because they must be bigger and the should not look to solid or full again, because they need to be bigger and longer.
It is hard for me to explain in the foreign language, but you can look at the pictures for yourself.




In the mean time they have also teached me, not to mess to much in the incisal area and I know it looks good on the pictures, but If you give them the options, they don't buy it etc.....






Instead of staining the cervical area, it is better to clean the natural teeth area and use less stain on the produced crowns




So this is why I was asking for some advice about posting and sending. I am not saying I am buying it.
Anyway this is also my last post about this, because I don't want to bother you with my decision problems

Mokome - #781 is layered e-max, but not e-max porc.

 

[Al.]

Wow SlowWater your work is so nice ! Dont ask me for advice I should be asking you !

I agree most cases esp females want white straight at least here in the US.

Sounds like you are struggling about taking on work from out of your area.

3 years ago I did all local work. Now I have only 1 local Dr. Most all my communication is with photography and email now.
One thing you may need to do is go visit the Drs that want to mail work to you and teach them how to take the pics you need.
For me now I can match teeth much better now through photography than by what I used to do by eye.

To match the crowns to the patient long distance it is best to start with a patient and Dr approved wax up.
The Dr or you will make the temps from the wax up. The patient and Dr will approve the esthetics and function of the temps. The occlusion, incisal edge position, length, shape, square round triangle etc, buccal corridors, all from the temps. Then they take the impression of the temps in the mouth for you to use as a guide.
IMO you dont need to see the patient.

This case I just finished yesterday. It is for a dental assistant 1000 miles from me. She is very picky about what she wants.
I made a wax up, he preped, and put her in temps and sent me a impression of the temps along with a impression of the preps.
She wanted straight incisal edges. Square and full teeth with the distals softer. No cervical color, minimal to no incisal character. Shade B1.

I pressed them .4 HT BL2 and layered B1 and Incisal 1 over it.
I sent the Dr 12 pics of the glazed case on the solid model for her to approve before I mailed it. She approved and I sent them off this morning.
Here are 5 of the pics I sent for her approval. The others were different angles and exposures so she could get a really close look.

IMO (In My Opinion) you can communicate as well or better with the Dr and Patient with out ever leaving the lab.

 

[Al.]

Implant PFM

Wow Martin, that looks so real some Dr may try to extract it!

 

[Markyboy]

Has the solid model been modified? The cervical margins look high. I hope the patient approved that.

 

[Al.]

Cervical margins look high. I hope the patient approved that.

I assume its just the tissue is retracted and they will come down or probably already are.I closed all the spaces except a couple tiny ones.

If some of them do end up supra-gingival I really thinned the margins and I used HT which is clear when thin, so my bet is they will go. LT though for supa gin margins is too noticeable in the anterior esp for picky women.

 

[bonded]

double post sorry !!