Value based ingots and shade help

[AL1]

I am redoing a single max central because the mother of the patient didnt like it.
The shade that was picked was 040. I pressed using bleached ingot cant remember which one( I know I should have written it down) The shade was pretty good. I saw a picture of it with the shade tab,it was a very acceptable result.I got it back because moma wanted it more translucent. I trimmed it back and baked some bleached incisal with clear. The dentist was okay with it but momma still wasnt happy. The essence of the bleached shades, being such a high value, is that they are more naturally opaque, at least to my knowledge.
I just got some high value ingots to press a new crown and some bl3 dentin powder which I am going to mix with some clear and maybe some bleach incisal. I am hoping by doing this I can get a whiter shade with more translucency.
Any suggestions?
Oh by the way, the value based ingots are smaller than the regular emax.

 

[paulg100]

ugh the translucency of bleech shades is so damn difficult to match.

Its one thing im hoping to grill Oliver Brix on at IDEA in a couple of weeks.

what i would do is mix the bleech dentine with neutral say 50/50 (do not mix enamel to create translucent dentines as it will change the value, neutral has no pigments in it like the enamel powders do)

Lay this down then enamel on top. You will probably have to play around with different thickness's of dentine and enamel and maybe the % mixture as well to nail it.

Its not easy, maybe Al can add to this or knows the secret popcorn

Its possible the new opalescent ingots will also help with this problem.

 

[Al.]

Tricks for single anteriors ? Its trial and error for me.

One thing I do that increases my odds for single anteriors is on the 2nd try
(and there is almost always 2nd try for me) I make a new crown based on the pics from the first try then I modify the first crown. Give them 2 to choose from.
For me that usually eliminates the need for a 3rd try, but not always.

I have one right now Im working on. We have had 3 try ins and I have made 3 crowns. 3 different ingots and one is very close but still not there yet.

Do you have any pics Al ? We really cant give suggestions with out them.

I know alot of times with bleach shades you have a darker trans tooth with only the surface bleached. It gives it a kind of frosting on the surface.
I had one crown like that that ended up being a translucent D2 with a overlay of OE3 over 3/4 of the crown.

When you check the shade you really need to use the tabs that come with your emax kit.
I found often on these tough shades it is often an incisal tab that matches the best.

 

[Gdentallab]

Tricks for single anteriors ? Its trial and error for me.

One thing I do that increases my odds for single anteriors is on the 2nd try
(and there is almost always 2nd try for me) I make a new crown based on the pics from the first try then I modify the first crown. Give them 2 to choose from.
For me that usually eliminates the need for a 3rd try, but not always.

I have one right now Im working on. We have had 3 try ins and I have made 3 crowns. 3 different ingots and one is very close but still not there yet.

Do you have any pics Al ? We really cant give suggestions with out them.

I know alot of times with bleach shades you have a darker trans tooth with only the surface bleached. It gives it a kind of frosting on the surface.
I had one crown like that that ended up being a translucent D2 with a overlay of OE3 over 3/4 of the crown.

When you check the shade you really need to use the tabs that come with your emax kit.
I found often on these tough shades it is often an incisal tab that matches the best.

I agree with You Al. But don't you think it's time and money consuming when making 3 crowns to choose from?! I don't know if the source of the problem is the ceramic companies that produce unmatched colors ceramics, or the shade of the tooth itself that needs in my opinion a wider choice of shade guide!
Anyway, i find that the Gc lustre kit had helped me in many cases, again i agree that making more than one crown remains the most precise way to catch the desired tooth shade in a unique central cases.

 

[rkm rdt]

"But don't you think it's time and money consuming when making 3 crowns to choose from?! "

Of course it is but if that is what it takes to make it perfect for the patient then so be it.

This is what professionals do.

 

[paulg100]

I quite often make up a couple of sets for single anteriors or say 2 centrals and sometimes i still need to do a third.

Yes it is very time consuming but i charge twice or at least 2 thirds where i can. If it saves the DR having to schedule another appointment because he can pick the best try then it is worth alot to him.

And no its nothing to do with the companies not making the right ceramics.

What are they supposed to do, make 200 different ceramic colors to achieve the correct shade/translucency mixture for a given crown? i don't think so.

If they did would you stock them all or even be able to learn them all? i don't think so

And even then the color dynamics change depending on the amount of space, the underlying tooth color and the core materials used so its impossible to make enough out of the bottle colors.

The only way is to learn the ceramic system you are using intimately and slowly over time you will get better at identifying what to use when. It takes years and this is why it is a bad idea when labs keep swapping their ceramic systems. Find one that works for you and stick with it regardless of what else comes along and at what price.

 

[user name]

I like to add a super-slight blue stain to the incisal before layering to help the translucency. Then it takes less clear porc. to get the effect. I also on occasion have provided two crowns to choose from...service!!

 

[user name]

I like to add a super-slight blue stain to the incisal before layering to help the translucency. Then it takes less clear porc. to get the effect. I also on occasion have provided two crowns to choose from...service!!

 

[paulg100]

"I like to add a super-slight blue stain to the incisal before layering to help the translucency"

yep that is effective.

Another method is to do that and your dentine/enamel first bake.
Then stain a wash of incisal over it (i use a mix of 1 & 2) and fire/fix it before layering the incisal/skin layer. This helps to creat depth also but it dosent look as good as doing it with ceramic.

The emax ceram manual hints at acheving this by using an E15 profundo mix but its really hard to get the thickness and intensity right and to get a thin enough layer sandwhiched between the dentine and enamel builds.

or maybe mix the profundo with the enamel, so many different ways and still all of them are tricky.

Oh and Al1, those bleech shade tabs hardly ever match bleeched teeth, like you say they are to opaque. bleeched teeth are always more translucent, which is logical i guess as the bleech is stripping the pigment out of the enamel/dentine.

 

[AL1]

I did press with the value 1 ingot. It looks like an 040 to my eyes but with slightly more translucency. I also pressed a cut back version in case I need to bake one.