Today's Lateral incisor
My favorite thing to do is match a single tooth into a difficult situation. Here is one today that I did.
Tooth #7 had RCT, metal post, and composite buildup that fractured off.
I built the tooth up using the existing metal post and remaining tooth structure and made a full coverage crown.
Vita Trilux 3M2 (the easy shade 3M1). I don't have that shade in trilux, so I had to increase the chroma with Lustre Pastes. Used a combination of L-A, L-N, L-2, L-3, and L-5 Lustre Pastes in 2 fires to get this final result. Bonded with Variolink Veneer (old formulation) (-1).
This will be my topic at CEREC 30 breakout Saturday morning and I videotaped the contouring and LustrePastes technique on this case.
Great case Mike. Looks amazing. Do you have any concern with longevity of the crown because of almost no ferrule?
On 7/21/2015 at 2:56 pm, Nassim Missaghian said...Great case Mike. Looks amazing. Do you have any concern with longevity of the crown because of no ferrule?
Of course... there is always a risk, but there is 1-2mm mesial and distal, at least 2mm on the facial and 4+mm on the lingual (ferrule)... plus, he has more of an end to end bite and doesn't hit it at all in excursives. Not placing a ton tension on this tooth.
Invisible dentistry! That restoration just disappears. The shape and contour of this tooth is impeccable of course... but the Lustre Paste with 2 fires just sent it over the top!
As Always Ridiculously Awesome Mike.
Thanks for sharing,
JG
Beautiful job Mike. I hope it works out for the patient. My experience has been that almost all the herodontics cases I have tried fail some time. It may take 2 years, or 3 years, or even 5 years, but eventually it happens. I make no 5 year guarantees on these things.
On 7/21/2015 at 4:37 pm, Charles LoGiudice said...Beautiful job Mike. I hope it works out for the patient. My experience has been that almost all the herodontics cases I have tried fail some time. It may take 2 years, or 3 years, or even 5 years, but eventually it happens. I make no 5 year guarantees on these things.
I really don't consider this "herodontics" to be honest. You always have to think about how a restoration could fail when designing it. Most of the time tension is the failure mode of of laterals restored like this. The occlusion here I feel is ideal for success. If this were my mouth, I would likely extrude the root a couple mm first (Gregory Mark has showed some great cases doing this) and then restore. I would not place an implant unless that was the last resort. Time will tell.
On 7/21/2015 at 4:16 pm, Tom Monahan said... Great case Mike. Impressive. Did u stain in the mouth or from photos?
I did intend to do this in 2 fires 
The first fire I did based on the photograph. It needed a bit more, so I did in fact place the restoration in the mouth and did the final characterization. I teased off 1/2 with and explorer and then grabbed the margin and the incisal edge with a cotton pliers and placed back on the pin to fire for the second time.
On 7/21/2015 at 5:44 pm, Darin O'Bryan (Faculty) said...Beautiful texture and characterization. Do you have a full front 6 shot of the teeth?
I do Darin, but it's still in RAW and I have not processed it yet. Will try tomorrow.
I do agree to some extent with some previous posts about the possibility of post failure. All to often I've seen this happen as well. Post fractured or debonds. But hey it's a beautiful result none the less. Hopefully it will workout for some time.
That looks exactly like some of the work I do but the slides are in reverse order? I had convinced myself just yesterday to skip CEREC 30 but now I'm thinking I really need to go.
Very impressive esthetics and if you guys are sweating that thing failing then I'll never post any of the teeth I attempt to salvage.
Nice job sir!
Mike,
Awesome result like always and thank you for sharing.
You make me fee so inadequate. What is the differnce between emax stains/glaze and lustre paste?
On 7/22/2015 at 10:19 pm, Dhaval Patel said...Mike,
Awesome result like always and thank you for sharing.
You make me fee so inadequate. What is the differnce between emax stains/glaze and lustre paste?
Don't be silly Dhaval... you can do this quality of restoration. I've seen it!!!
The advantage of Lustre Pastes is that they are non metallic based and actual porcelain. There is no "intensifying" effect so what you see is what you get when you apply them.
Mike I'm still waiting on the full front 6 teeth photo. I know you had a kid blah blah blah. I want to see how that tooth looks compared to the other side. The cervical is darker (more grayish) than the adjacent teeth. I'm wondering if that was by design to match the contra lateral side or to break up the similarity of the canine and central. In other words keep the over all color scheme but not match the adjacent teeth exactly.
I'll get right on that Darin...lol
It's darker because I added to much in that area and overdid it a touch. It looks perfect in the mouth though. These are extremely difficult type of teeth to match as you know. I will grab some more photos after healing as well.
I wasn't knocking it. Those little imperfections are what make them blend in. Perfect imperfection as I like to call it
Don't pick on the poor sleep deprived guy.
I withheld criticism of Mike's first pictures. I agree with Darin, the photo of the tooth looks too dark cervically. The dark root appears to be transmitted up into the crown. My first instinct was that you needed an opaquer or thicker ceramic (compromising on matching the eroded cervical look of the other teeth) in that cervical area to mask the darkness of the root.
My second instinct was to be wary of all who have a man-crush on Mike and don't go saying anything. Please don't hunt me down, I really admire Mike's work. Far superior to what I produce most of the time. If my crowns look as good as his I consider I've been a but luckier than normal that day.
Its interesting Mike feels it looks great in the mouth. I think what's happening is with the flash intensity the light penetrates deeper into the teeth and reflects back off of natural teeth nicely, but these endo teeth just transmit or absorb that same light. Hence they look darker under flash, but normal light levels they look fine.
Its easy to dismiss it as just macro flash photography, but (and not saying I know the answer) maybe this phenomenon does have some relevance in day to day family photos flash photography. I suspect probably not, but I'm not sure.
On 7/25/2015 at 5:13 pm, Damian Chung said...Don't pick on the poor sleep deprived guy.
I withheld criticism of Mike's first pictures. I agree with Darin, the photo of the tooth looks too dark cervically. The dark root appears to be transmitted up into the crown. My first instinct was that you needed an opaquer or thicker ceramic (compromising on matching the eroded cervical look of the other teeth) in that cervical area to mask the darkness of the root.
My second instinct was to be wary of all who have a man-crush on Mike and don't go saying anything. Please don't hunt me down, I really admire Mike's work. Far superior to what I produce most of the time. If my crowns look as good as his I consider I've been a but luckier than normal that day.
Its interesting Mike feels it looks great in the mouth. I think what's happening is with the flash intensity the light penetrates deeper into the teeth and reflects back off of natural teeth nicely, but these endo teeth just transmit or absorb that same light. Hence they look darker under flash, but normal light levels they look fine.
Its easy to dismiss it as just macro flash photography, but (and not saying I know the answer) maybe this phenomenon does have some relevance in day to day family photos flash photography. I suspect probably not, but I'm not sure.
Criticism of this case is welcome and actually correct. I knew it from the moment I posted it. Thanks for posting your thoughts. I can tell you exactly what went wrong and why it is not a big deal. Your first instinct was actually not correct. Vita Feldspathic is not translucent very much at all and this root was not dark. This is a very difficult tooth to match and even though the shade was 3M1, there was a lot of reduction on the tooth. This inherently will lower the value of ANY porcelain. I milled the 3m2 block because that is the closest block we have and through experience, I knew that would even be too light and would need more chroma. The initial S/G crown was in fact too light. This is the reason that I had to fire a second time. The truth of the matter is that I overdid it a little bit. The L-A lustrepaste (base shading porcelain) is a little too dark for the normal A shade. It's more like an A3.5 to A4. What I should have done is a 50:50 mixture of L-A and L-B. This will get you closer to an A1,A2, or A3 shade.
The reason it doesn't matter much is in the mouth, it looks ok. I was tempted to polish it off a little bit, but I felt that would not be necessary (nor did the patient). It's interesting you mentioned the photography. Most on this site shoot anterior teeth with a "ring" flash and overexpose the photography. In theory you should never do that for proper color and texture photography. At the minimum, you should use side twin lights. To make them really good, you should use dual point brackets and pocket bouncers to soften the light at an angle, which what was done here (I attached a photo of the setup I use). However, it's rather difficult to shoot 1:1 photography with the pocket bouncers and get underexposed, dark images. It's a work in progress for me...
Either way, good points and i'm definitely not perfect. You and Darin nailed the overall flaw of this case.
On 7/25/2015 at 5:13 pm, Damian Chung said...Don't pick on the poor sleep deprived guy.
I withheld criticism of Mike's first pictures. I agree with Darin, the photo of the tooth looks too dark cervically. The dark root appears to be transmitted up into the crown. My first instinct was that you needed an opaquer or thicker ceramic (compromising on matching the eroded cervical look of the other teeth) in that cervical area to mask the darkness of the root.
My second instinct was to be wary of all who have a man-crush on Mike and don't go saying anything. Please don't hunt me down, I really admire Mike's work. Far superior to what I produce most of the time. If my crowns look as good as his I consider I've been a but luckier than normal that day.
Its interesting Mike feels it looks great in the mouth. I think what's happening is with the flash intensity the light penetrates deeper into the teeth and reflects back off of natural teeth nicely, but these endo teeth just transmit or absorb that same light. Hence they look darker under flash, but normal light levels they look fine.
Its easy to dismiss it as just macro flash photography, but (and not saying I know the answer) maybe this phenomenon does have some relevance in day to day family photos flash photography. I suspect probably not, but I'm not sure.
Hmmmmm
Sorry Damian, I'm just bored on a Sunday evening.
