Kricket Doker There are five major factors that go into perfecting the final outcome of your anterior restorations: design, anatomy, line angles, texture and, of course, shade. As an expert dental technician, I know if even one of these are off, you will instantly notice something isn’t quite right.
While creating a seamless blend can be tough, here are my five secrets that will have you creating realistic anterior restorations without having to send them to the lab.
1. Perfect the Design: Aim for an Identical Twin
Design is crucial and can make or break your case. Every embrasure needs to match perfectly, as even the slightest discrepancy is easy to spot. The width and overall dimensions of the ceramic must align with the contralateral tooth, even if the actual measurements don’t match exactly. This is where the use of line angles will trick the eye, making it appear as though the tooth is the same size.
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As attendees in my “Lab-Quality Chairside Restorations: Mastering Stain and Glaze for Dentists and Their Teams” hands-on workshop learn, anatomy of the restoration needs to mirror the surrounding teeth. Check this by drying the surrounding teeth & scrubbing them with articulating paper. This helps to define the facial anatomy and depressions, allowing replication on the ceramic. After identifying the anatomy on the adjacent tooth, scrub the articulating paper on the ceramic and mimic the indicated depressions.
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to watch the full version of this video plus hundreds more. Subscribe Today3. Manipulate Line Angles for Flawless Symmetry
When symmetry isn’t perfect, you can make the restoration appear symmetrical by adjusting where the light hits through manipulation of the line angles. This is a powerful technique to ensure the restoration has the appearance of symmetry.
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Texture is incredibly important and can elevate or diminish the overall outcome of the restoration. Natural teeth don’t usually have a super shiny, glassy finish, but have more of a matte surface.
If you create a beautiful design and anatomy within the design but then apply a thick glaze, you risk losing all the fine detail you worked so hard to achieve. Sometimes a glaze with a honey-like consistency, which gives a highly glazed finish, is what the case needs, especially when matching other ceramics.
Other times, you need to mimic the natural texture of a tooth. This can be done by simply applying a thinner glaze and control the application amount to highlight the anatomy and blend the restoration more naturally. If after firing you find the glaze is too heavy, brush over it lightly with a Meisinger polisher to soften the finish while still preserving the underlying colors.
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to watch the full version of this video plus hundreds more. Subscribe Today5. Shade Match to the Highest Value
Finally we come to shade, which is arguably the most important aspect.
Even if your line angles or design are slightly off, people may not notice, but if the shade is wrong, it will stand out. The key to shade matching is finding the highest value in the tooth you are matching.
For example, a patient may primarily be an A3.5 but near the incisal edge, the value could be A1. If you mill the A3.5 shade, the restoration will never match. You cannot increase value like you can decrease value. In this case, I would mill an A1 and use colors to lower the value where needed.
For shade customization, look at the patient’s before photo and intraorally to make sure nothing is missing. After treatment, dehydration from prolonged mouth opening and suction can cause the value of the teeth to increase, so make the shade appear lighter in this situation.
Over time, this process becomes easier and more predictable- it’s really an art. An art that you can master with the proper training and practice. Analyze the colors and replicate what you see, and always remember, you can always refire.
