e.max Translucency and Photography
Today I did a pretty simple case on a single central incisor on #8. Well... the tooth was pretty toasted, but she had a ton of lingual tooth structure and I was able to get adequate ferrule and do a post/core and new crown.
When looking at shade and material we had a decision to make. About 5 years ago, I restored 4=6 bridge with e.max HT (LT block not available yet) and #7 with an e.max MO core + e.max HT (to match the bridge) crown. I felt it looked ok at the time...
Fast forward to today and my assistant wanted to use e.max HT to restore #8 because that is what we used on 4,5,6,7... however, I wanted to use LT.
When I took the preop picture, you can see you don't see a ton of difference in the value...
However... I knew that it was a little low value in the mouth and I wanted to choose e.max LT to match.
When you take the correct photography with side flashes, contraster, and light bouncer... you can see the very low value on #7...
Photography really makes a difference to see the true value... really should not use a ring flash when trying to match teeth :)
Mike,
I can see the issue because of your excellent photography but I submit that it is not noticeable to the naked eye at conversational distance and nobody cares about this but you. However, if you can sell it to the patient, God Bless You. The people I see would laugh me out of the operatory.
On 1/9/2017 at 12:52 pm, Mike Skramstad (Faculty) said...Today I did a pretty simple case on a single central incisor on #8. Well... the tooth was pretty toasted, but she had a ton of lingual tooth structure and I was able to get adequate ferrule and do a post/core and new crown.
When looking at shade and material we had a decision to make. About 5 years ago, I restored 4=6 bridge with e.max HT (LT block not available yet) and #7 with an e.max MO core + e.max HT (to match the bridge) crown. I felt it looked ok at the time...
Fast forward to today and my assistant wanted to use e.max HT to restore #8 because that is what we used on 4,5,6,7... however, I wanted to use LT.
When I took the preop picture, you can see you don't see a ton of difference in the value...
However... I knew that it was a little low value in the mouth and I wanted to choose e.max LT to match.
When you take the correct photography with side flashes, contraster, and light bouncer... you can see the very low value on #7...
Photography really makes a difference to see the true value... really should not use a ring flash when trying to match teeth :)
Mike, Don't worry, I'll recover from the blow to the gut...I got the hint :)
On a more clinical note, nice work and great topic! I love HT for the right case but I completely agree that HT in this case would have had a major drop in value. As you know the prep design and color of the prep will have a tremendous effect on the final outcome of the restoration. I find this extremely difficult to use HT on these severely broken down teeth because they will tend to be over-prepped simply because of the amount of breakdown and the thicker the porcelain with HT, the larger the drop in value.
I have a case showing this very thing with some crowns on #4,5, but I may wait a few weeks when you forget about my ring flash :)
You think i missed that Dan! Especially with my love affair with soflex disk! Taken care of ;)
I think the ring flash with the polar eyes does a nice job in showing value and chroma. I believe Mike recommended it way back.
#8 & #9 A1 teliocad as implant temps
With polar eyes attached
Great work!
Polar eyes does an awesome job cross polarizing light to mitigate specular reflection and give a high contrast, hyper saturated image loosing the fine details. I tend to use photoshop a lot for this
y not use mt if u had the shade to split the difference between ht and lt values differential
On 1/10/2017 at 7:00 am, Brian Saltzman said... y not use mt if u had the shade to split the difference between ht and lt values differentialToo bright for this case.
On 1/10/2017 at 7:14 am, Mike Skramstad (Faculty) said...On 1/10/2017 at 7:00 am, Brian Saltzman said... y not use mt if u had the shade to split the difference between ht and lt values differentialToo bright for this case.
Mike, I know we have talked about this briefly but can you elaborate on this? I think the remark about MT being "too bright" here can get misinterpreted. I think if we follow the remarks discussed here, Brian's logic is what many of us would have concluded.
very nicely done. One of the things I do is I restore the incisals of the lowers also. I simply use a matched composite and it does a lot to enhance the restoration of the tooth and i really enhances esthetics. I have been doing this for years and it makes a big difference in the quality of the dentition. It is a great value for the patient and the doctor. No injection needed.
On another note. I have a question about staining or discoloration of emax cad over time. I have a case that I have done emax cad crowns and bridges-all in LT A1 over a period of years and the colors and shades of these different restorations do not match up. Does the shade of the emax change over time? Does stain and discoloration occur with emax cad?
Does glazing have any effect on this one way or the other?
Dan and I have discovered that if I focus on the boards rather than his driving on the way to the mountain then it helps our marriage... so I'm just catching up on this one. Dan asked me to check the thread so I'm nagging now :)
Mike- MT is brighter than LT?? Did we read that right??
On 1/10/2017 at 9:41 am, Daniel Wilson said...On 1/10/2017 at 7:14 am, Mike Skramstad (Faculty) said...On 1/10/2017 at 7:00 am, Brian Saltzman said... y not use mt if u had the shade to split the difference between ht and lt values differentialToo bright for this case.
Mike, I know we have talked about this briefly but can you elaborate on this? I think the remark about MT being "too bright" here can get misinterpreted. I think if we follow the remarks discussed here, Brian's logic is what many of us would have concluded.
The MT block is brighter than the HT block of course, but more translucent than the LT block. In this case we were matching duller and more opaque crowns... a perfect (and IMO only) reason to use LT in the Anterior. So the comment too bright may be the wrong word, but it's too translucent. And my experience with the material is that this value shift upward also can have the tendency to increase the brightness in the restoration by one shade. E.max MT is my go to when I have to restore all the teeth including functional aspects to it. It has more Vitality and Life to it than the LT blocks. It's generally not my first choice when matching existing restorations. It certainly can work and I could make it work, but it is dependant on what you are trying to match and the overall value, lustre, etc... of that tooth.
I know I'm setting myself up but I have boxes of MT blocks but I milled a few and found too bright. I haven't used them for that reason. I think they are brighter than the shade they are suppose to be maybe the between shades. I try empress for anterior crowns. In this case, since others in emac would have used same material of course.
Carrie
On 1/13/2017 at 9:58 pm, Kristine Aadland said... Dan and I have discovered that if I focus on the boards rather than his driving on the way to the mountain then it helps our marriage... so I'm just catching up on this one. Dan asked me to check the thread so I'm nagging now :) Mike- MT is brighter than LT?? Did we read that right??
Kris,
My wife does it too. Funny, when we were dating not a word was said about my driving. I've decided that it's what wives do. I have decided to keep quiet and treat it as road noise. When she is driving, I focus on the boards.
