IPS e.max HT-Using the "Grey" crown to your advantage
Inventory. It's a love hate for me. I love to try out new materials and have lots of material choices and have all the shades under the sun.
But as a business owner who is trying to run a successful, profitable practice and set the tone for our doctors, I need to be smart.
When I first started using CEREC, I saw post after post from doctors warning us against using IPS e.max HT. If you do, you will get the dreaded "grey" crown. As many of you have seen, I do a lot of HT in the anterior, for crownlays, and if I'm trying to match a patient with a C-shade. In my eyes, C shades are just a lower value of A shades. Sometimes we just say the tooth is "grey" but on the flip side, we can use this to our advantage. If I see a lower value, C-tones or "greyness" in a tooth, my thought isn't to pick a C-shade, it is simply to use IPS e.max HT.
Here's my rationale. It keeps my inventory simple. As I already stated above, I have a lot of uses for the HT block. One of the other qualities of an HT block is that the value can be dramatically affected by the color of your cement. For a case like this, I can use this to my advantage by understanding the nature of qualities of my block on hand. People have argued that I should just pick a C2 or C3 LT block and that is just easier. I look at it from the other end of the spectrum in that using the HT block kind of bails me out if I don't choose the exact right shade. Let's look at this case.
I put the A3.5 shade tab up just to show the lower value of the teeth compared to the tab
This is a case that I see C-shades and automatically think about HT. I told my assistant that we would be doing A3 HT and that she would be doing the rest. I'm really been trying to train up my team members and not do all my stain and glazing.
Below are the Pre-Op, Try-In and Delivered Crown. All we had was A2 HT left, so this made my assistants job a little more challenging with staining down this crown to get it to match. I told her to use a little of the e.max "1" stain for the gingival 1/2, some of the I-2 stain for the cusp tips to drop the value down a little more and to add some white to create some craze lines. Overall, she did a good job with the staining. At Try-In, the value was too bright for my tastes though I wasn't trying to match the "darker" canine, I still wanted to lower the value down more. If I had done the C2 or C3 LT block, the different color resin cements wouldn't make too much of a difference. In fact, the thicker your porcelain, the less of a difference the colored cements make. As you can see from the photos, the occlusal of the tooth is relatively unaffected from the Warm + cement.
There isn't anything too incredibly special about this case, but wanted to share some things I've learned about IPS e.max HT and how I use it. I hope this can help others not be intimidated by the block and utilize it when appropriate.
Dan
Great job man. I did the same thing yesterday on a 93 year old lady. Learned this from you and my ceramist.
This is a great tip and works really well, especially for older patients. Great documentation!
Looks great! Someone really smart must have taught you those characterization techniques 
I love HT blocks when I am trying to get in the C range. I don't actually stock C shade e.max crowns but default to using the HT instead.
Thanks Kris! You do get a lot of credit since you and Cheri helped get my team trained more on contouring and staining and glazing at the CEREC assistant study club.
It was really fun to see my assistant’s confidence grow. Actually hard for me to let go of these things because I enjoy doing them. Tom Monahan made fun of me for the lack of occlusal characterization in this case. Most of that is for us as dentists but I still let her know that it’s nice to add it in just to make our restorations stand apart a little more.
This isn’t a perfect case but just wanted to share a simple trick with block selection and how HT blocks gives you some freedom of the shade is a little off and how it can keep you from needing to stock C shades as well.
Very well done and thank you for sharing the tip.
Have you ever tried lustre paste L-8 effect olive??
I think in this case, it would have added a very natural chroma to the cervical third.
Thanks for sharing, really enjoyed reading through this.
I was in Scottsdale level 4 this past weekend and had a broken #8 walk through the door today. Tooth had a DL composite in addition to MFLI fracture. Decided to do a crown. EMax HT was the only block I had in inventory that seemed like a reasonable choice. Decided to use it, despite what I’ve heard about the gray crowns that happen with it. Was cool to read through this case just having finished the crown immediately before.
I built up #8 with composite then used biocopy to get final crown. Curious to hear everyone’s thoughts and how you would have approached this case. Patient was happy and so was I with results.
If I could have used any block, I probably would have used empress multi, but the HT block gave a good result IMO. 
Pictures don’t show it very well, but #9 is quite lingual to 8.
Incisal embrasure looks funky because of that.
@Harry...I do have the Lustre Paste kit and have that particular shade. I tend to use the Empress Stain and Glaze Kit more because it is more user friendly in my hands. I have a C shade stain that is olive in tone that gets the same effect too.
@Kyle. Nice work!! Personally when I have a compromised tooth position case like this, I will do a Class IV composite and just let the patient know that this is a long term temporary and that if they would like to fix the esthetics more permanently, we can look at some porcelain restorations for both centrals (assuming that things are so out of whack that ortho wouldn’t be best). Regardless, Nice work...sounds like you were lucky and had a good crew helping you at Level 4!
