Keeping restorations Natural
Patient wanted to do something about his front 4 teeth. Extensive failing restorations and unesthetic. Was very concerned about the teeth looking natural and not fake.
Plan:
- Same Day Treatment
- Mockup in composite to get overall better shape.
- Keep all 4 anterior teeth slightly asymmetric in order to look more natural. Important to keep triangular shape here and not get them too "boxy"
- Material: Vita Mark 2 shade 2M1
- Bonded with Variolink Veneer +1
Things that are important to keep things natural IMO are:
- overall shape: Keep Height/Width ratios consistent to where there original teeth were if they were " in the ball park"
- Incisal Edge length: Be careful not to lengthen teeth if it's not necessary.
- Asymmetries with both shape and embrasures. You don't want them to be extreme, but slight differences will help.
- Materials: nothing too bright and something that matches the overall value of their existing teeth.
I like cases like this because they are more fun and challenging. Creating bright perfect teeth off a waxup is easy!
Thanks for the tips. You're right - these are much harder to do, but more common than full work up with wax-ups.
On 5/31/2016 at 10:02 am, Sam Carroll said...Very nice Mike! What glaze pastes do you use with Mark II?
In General, Empress Universal. It's pretty low fusing and works fine.
I also will mess around lately with Lustre Pastes and Ivocolor. Those are the 3 systems that I use.
On 5/31/2016 at 11:18 am, Dennis Dobrin said...Any chance you took a picture of the stains before you fired? They look so dang natural!
Sorry I did not. I can tell you that I use a lot of white. I will try and get a contrasted photo posted to show a little more of this.
On 5/31/2016 at 12:41 pm, Farhad Boltchi (Faculty) said...Is the first picture the pre-op or the post-op? It really looks natural to me.
Farhad
Ha Ha :)
On 5/31/2016 at 12:02 pm, Carrie Polster said...Mike,
Beautiful! Do you have a picture of the preps?
Carrie
I don't actually. I forgot to as I was in a rush to get the case done on time :)
Fantastic result Mike! I really like the imperfect shape and how it seems to blend in with the natural teeth.
Thanks for sharing,
JG
In the contrasted photo is the incisal translucency stained? It looks very heavy in that picture , but in the non contrasted it looks perfect. Trying to figure out if it's the material or the stain that did it.
On 5/31/2016 at 1:46 pm, Dennis Dobrin said... In the contrasted photo is the incisal translucency stained? It looks very heavy in that picture , but in the non contrasted it looks perfect. Trying to figure out if it's the material or the stain that did it.
It's very very lightly stained....almost not even detectable. The contrast picture looks like a lot because in the 3rd plane of the central, I thin it out a bit. I use white to get an opalescent halo effect.
Gorgeous case Mike. Every time I see your posts like this it makes me want to give the Vita blocks a try. It looks really natural.
Great case Mike! Love the subtle asymmetries you created! With the composite mockup...how long did the case take you?
With the composite mockup probably 3.5 hours. I said 3 hours earlier, but I did the composite mockup at a quick appt prior after he agreed to go through with treatment. It just took 30 min. Was very quick.
Any tips to doing a 30 min composite mock up? Or was this case easier? What were your steps?
I am assuming no wax up at the initial exam appt before the mock up?
On 5/31/2016 at 8:11 pm, Jeffrey Gregson said... Any tips to doing a 30 min composite mock up? Or was this case easier? What were your steps? I am assuming no wax up at the initial exam appt before the mock up?
The best tip I can give you is using warm composite and composite wetting agent (Ultradent). If you keep the composite wet you can mold it very very quickly. I just do it one tooth at a time.. place a large blob of composite on the tooth and shape it with instrument. Have to use the wetting agent. I mostly just bond all the teeth together. After I get them initially shaped, then I will use soflex disks to fine tune the shape.
Love wetting resin. Absolutely easier to sculpt. It comes in handy for patients who want resin rather to close diastemas. We have a great colleague and friend her by the name of Corky Wilhite. Some probably know him. He teaches transitional bonding. You can find him on YouTube. He teaches opening bites with resin for patients who can't afford crowns. He is amazing with resin. He shows some great techniques which I use to this day.
For these cases, are you adding a separate fee for the mock up? Or is it a total package deal? I would charge for the mock up especially since I don't do it for every case.
On 5/31/2016 at 10:12 pm, Jeffrey Gregson said... Love wetting resin. Absolutely easier to sculpt. It comes in handy for patients who want resin rather to close diastemas. We have a great colleague and friend her by the name of Corky Wilhite. Some probably know him. He teaches transitional bonding. You can find him on YouTube. He teaches opening bites with resin for patients who can't afford crowns. He is amazing with resin. He shows some great techniques which I use to this day. For these cases, are you adding a separate fee for the mock up? Or is it a total package deal? I would charge for the mock up especially since I don't do it for every case.
corky is a great guy. got to spend a few days with him at a 3M event 2 summers ago. Really enjoyed him and his work is amazing
