coping with a difficult central
There have been some really nice posts recently about block choices and prep design. Here's a dark, endo-treated central where Impulse/MT and LT were not enough to block out the stump, so I milled an MO O coping and bonded an Impulse V2 crown over top.
Ross, very nice. Looks great! What did you use to cement the coping to the tooth and the crown to the coping?
Nice result for sure. Out of curiosity did you try LT, Impulse or MT without the coping? That tiny stump doesn't look all that scary. Just being a pain....
Can you share for the masses how you were able to design and mill the coping?
@David - I bonded the coping to the tooth with MultiLink Hybrid cement for even more opacity (see why below) and then the crown to the coping with Variolink Esthetic neutral.
@Andrew - Thanks, I spent all day coming up with a punny title.
@Bob - I really don't know why this one was so tough, to be honest. Looking at the photos it doesn't look that bad, but this tooth nearly kicked my butt. First I tried Impulse/MT V2 without a coping and it was extremely gray due to the ceramic thickness plus the dark stump. That really didn't surprise me too much and I had already started milling an LT BL3 while the V2 was in the oven. What really shocked me was that even the LT BL3 was too low value. Even if it had worked, it would've needed a lot of stain and glaze tricks to fake the level of translucency in the adjacent teeth. Here's the photo, which doesn't show as much gray as it did in person...
Needless to say, I wasn't thrilled with having to do a split case with a coping. I imported it into InLab and split it, but couldn't design the coping so that shoulder was thick enough to mill without chipping yet thin enough not to be noticeably supra-gingival. So I went old-school and milled the coping then imaged in the mouth to mill the crown as a second case. You just can't charge enough for this stuff!!
On 10/21/2015 at 6:06 pm, Bob Conte said...Lots of work for sure, but a perfect result. Money doesn't matter.
Thanks, Bob. And I totally agree about the money. It's the patient who matters...and occasionally being so pig-headed that you refuse to let a tooth beat you.
Excellent result ! Thanks for sharing , I like the staining on the coping !!! How was your margin design ? Did you end up on the coping or tooth? Thanks
Awesome. You missed the value slightly. +3 variolink would have nailed it or maybe the V3.
Either way, great job. Those cases suck.
On 10/21/2015 at 7:09 pm, Mike Skramstad (Faculty) said... Awesome. You missed the value slightly. +3 variolink would have nailed it or maybe the V3. Either way, great job. Those cases suck.
I know, dude...it killed me. It's not noticeable in person but the flash "exposed" my mistake. But I did learn a good tip: flip down the orange filter on your loupes and you'll be able to see value discrepancies easier.
i'm sure the patient will not notice... this is just me putting my super picky eyes to a wonderful case. Good job.
Amazing job of handling a tough tooth! That's a wonderful trick to use a coping first. Awesome dentistry Ross!
Thanks for sharing the case,
Justin
Great case! Thanks for sharing! I just had one on #11 where the stump was a lot darker and even after subopaquing I couldn't get the result I wanted to I sent it to a lab. This is definitely something I would consider next time!
Hi great case Dr . So did you HF etch the coping intraorally and silanate intraorally or use the new combined ivoclar etch and silane intraorally prior to using the variolink esthetic to bond the crown over the coping ? Or did you join the coping and the crown extra orally and then cement them to the prep ?
Cheers
cam
Wow! Great result. This is the answer to my daughters central. No matter what I put on it the gingival third greyed. Christmas break project!
On 11/30/2015 at 1:30 pm, Ernie Johnson said...All I can say is "WOW!"
Amazing results and a great answer to a difficult question.
Thanks Ernie, but shouldn't you be on your honeymoon right now?! Congrats again, buddy!
As for the case, here are the follow-up photos. I think I got closer to the right value than I initially thought.
