A day that didn't go as planned- Case 1
I had the incredible opportunity to speak at DS World this year and was asked to post the cases I presented. All three of the cases I will post were done on a random day in my office. The same random day. It was a day that didn't go nearly as planned but at the end of the day my patients were happy and my team was profitable. It was a win-win. Here are some tips and tricks I've learned over the years from others willing to share their cases before me...
What's the first thing I think when I see a case like this? This patient needs comprehensive care. He needs ortho in an ideal world but declines the option. The dark tooth on #9 had never bothered him until now due to a wedding in the near future. Tooth #9 has had previous endo. When I see a bite like this my first instinct is to use BioCopy because I don't want to mess with nature. I also lean towards e.max. It is strong and forgiving and easy to stain and glaze.
The burs I actually use isn't really that important but here are a few tips on preps. For efficiency sake, use a pattern and stick to it. The best advice I got was doing axial walls first, then reduction, and then smoothing off any sharp corners. I try to use no more than three or four burs and always in a specific order. I see so many doctors get caught up in the small details and determined to use as many burs as possible going back and forth between them. This is not efficient. Have a system. Don't bounce around.
I also use a lot of opaquers when I work on anteriors. This allows me to use more translucent blocks by blocking out the color underneath. My personal choice is Cosmedent's opaquers. In this case I chose A2 so that the substructure would match that of #8. These opaquers have a consistency like flowable composite and that is how to treat it. Etch, bond, add the opaquer and then image.
This is a perfect case for the articulator function. I will be honest, I wasn't using this much in the past until I went down to Scottsdale to mentor and I think Sam was telling me how much it has improved and can really help out with post op sensitivity. I decided to see if this was true so we started tracking it in my office. We decreased our post op visits by 43%. Crazy! Of course there could be other factors but we don't believe we changed anything else other than starting to use the articulator function to remove interferences.
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to watch the full version of this video plus hundreds more. Subscribe TodayIt's pretty obvious that #9 would cause an interference. It's longer than #8 after all... but this was my first mistake in this case. I assumed that of course he would want his teeth even! You know what they say about assuming...
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to watch the full version of this video plus hundreds more. Subscribe TodayMy other quick design tip is to close the gingival diastema (or the dreaded black triangle that looks like pepper) from the lingual using the Shape > 2D Circular tool.
Here is the immediate seat. It looks a little low in value which is normal when the tissue hasn't healed all the way. My assistant did a great job staining the tooth trying to mimic the coloring on his other teeth. He was happy and left the practice only to come back about an hour later. The problem wasn't that he didn't like the shade, it was that he couldn't "bite the skin of his lips". He was pretty distraught about this. I gave every explanation of why his teeth should be even and that he would get used to this, but to no avail. He wasn't leaving until this was fixed. Out came the consent form because I wanted to be clear...
So I cut off the freshly bonded crown and remade it. My assistant was helping out with another patient so I got to play with the staining on this one... I also was able to use the same block to mill out the second crown so that was a bonus.
I really love using white as a distraction. Matter of fact in James Klim's lecture he calls this the "Art of Distraction." It just means that you get to be a little creative in your staining. Don't use super straight lines with your stain. That is what makes it look fake. Have fun with it. Light touch, feather like in design. I used e.max stains for this e.max A2 MT crown. More tips on staining and glazing in following cases... Stay tuned!
Nice job Kris. I'll have to start asking patients if they want to bite the skin off their lip before I change their incisal edges. :-)
Glad you were able to post one of the cases from your great presentation at DS World.... you always hit a "real world" home run!
It was a great story, a great result... I remember thinking at the time that your "consent form" should have had the line about his soon to be bride could not complain about that length for their wedding photo... heard a lot of complaints over the years, but "can't bite my lip" was a new one....
Mark
Awesome case and great story. It's amazing what patients will have an issue with. Both crowns look amazing.
Nice stain job. I noticed the midline was different in the two photos. Did you have the patient slide left and right while incisals were touching . I m sure it would not have solved the problem but very curious how much the relationship changed when posturing left and right.
Saw your presentation of this case at the break out session at SiroWorld. Awesome work. Super great conference, wasn't it? So nice to finally meet you too. Blessed to part of this great community.
Thank you all for the wonderful comments. I truly wouldn't be the dentist I am today without this community right here. I am forever grateful of all I have learned and continue to learn from everyone on the boards.
