Dr. Arthur R. Volker DDS, MSEd, FAGD, FACD, DWCMID shares an amazing e.max press crowns and veneers cosmetic dentistry case where he is masking a dark tooth while achieving harmony followed with a 3-Year recall. This case is outstanding and you can see this case and a many more on the Dentaltown Message Boards on the Cosmetic Dentistry forum at dentaltown/MessageBoard/thread.aspx?s=2&f=101&t=240702&v=1. Introduction: A case where e.max Press was used to restore the anterior. An ingot (MO1) was selected that would be opaque enough to mask the discolored tooth on #8, while also allowing for a less aggressive preparations to the other teeth. Additionally, using a glass ceramic allowed for a predictable bonding protocol. I had posted this case on another thread, but am adding more detail and a three year recall photo. The pt presented with a failing PFM on #8 that also had too much incisal display at rest. #s 7, 9 and 10 had fractured or failing composites. Darkened gingiva over #8. Uneven gingival zeniths as well. Final preparations. Discolored tooth and cast post on #8. The other teeth were either prepared for veneers / 3/4 crowns, depending on caries excavation. Always like to send a bunch of photos to the lab. This is one of my favorites (learned it somewhere on DT, I think from either Jason Smithson, John Nosti or Lane Ochi). I align three shade tabs in the same plane as the preps, with the likely shade in the center. This helps negate the need to color calibrate monitors between doc and lab. I send color and grayscale photos. Now I will add polarized pics as well. Restorations from the lab (not Oral Design). Because an adhesive protocol can be used with lithium disilicate restorations, we were able to perform a less invasive preparation and preserve the cingulums of #s 7, 9 and 10. Placement of bonding agent on the tooth surface of # 8. #7, 9 and 10 had been placed via an adhesive protocol with a DUAL cure resin cement. Universal priming agent (Monobond Plus from Ivoclar) placed only on the metal post. #8 then also cemented with a dual-cure resin cement. Immediate post-op. The restorations were made with an MO ingot, cut back and layered, and then stained and glazed. I do not ask for external stain anymore (will show why). The gingiva over #8 is still dark, and I am OK with that as I have no inclination to even attempt to remove a perfectly functional cast post. Ten day post-op demonstrating a uniform value and appearance. Additionally, there is no show-through of the dark stump of #8. There were a good number of periodontal and esthetic compromises in this case (uneven gingiva, long contacts, proprtionality). However, this demonstrates the uniformity that can be obtained with proper ingot selection. Three year recall pic. Pt not great with hygiene. Though I am ok with this case, you can see why I will not ask for an external stain anymore. It now looks patchy. Had this happen a few times. Rick Knect suggests asking for an intrinsic stain, then layered porcelain if possible. Its what I ask for now. Conclusion: While translucency was somewhat sacrificed, using a more opaque ingot allowed for 3 major advantages: 1. Ability to block out dark stump. 2. Visual uniformity among the restorations. 3. Less aggressive preparations. What I would have done differently (three years later): 1. NO EXTERNAL SURFACE STAINS. Never....ever again...ug (thank you Rick) 2. Asked for more incisal cutback and layering. 3. Perio graft or CL or maybe ortho.... (Could have been more aggressive in pushing perio / ortho.) Regards, Artie #ArthurRVolkerDDS #CosmeticDentistry #emaxPressCrowns #emax #Dental #Dentist #Dentistry #DentalContinuingEducation #DentalLearning #DentaltownCE #DentalOnlineContinuingEducation #DentalLearning #DentalLearningOnline #DentaltownOnlineCourses #DentalStudyClub #DentalSocietyMeeting #DentalSeminars
Posted on: Tue, 06 Jan 2015 23:17:21 +0000
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