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Building the Bridge from Dentist to Ceramist: Why Communication Matters Part II

Part 2 - Matt Roberts begins the internal effects on the anterior.

Tom Trinkner, DDS
Matt Roberts, CDT
Lab technician Matt Roberts begins the internal effects on tha anterior restorations.

I'm actually going to put a little bit of color, a little bit of high value band in here as well, use a little brighter enamel. In natural teeth a lot of times you'll see a little color band that kind of comes across at this level of the tooth. It's just a little bit brighter, not as much on the canine; we'll keep that a little bit more subtle. I'll probably use the N4 enamel for this, the real bright blue white enamel and come across with a should give little bead of that. Tease that across there. That should give us a nice effect. Just avoiding, trying to avoid getting everything looking like it's all one color with no variability, that makes things look pretty fake. Although-good contour can over come a lot of lacking in layering. In other words the provisional restoration looks pretty darn good in the patient's mouth and those are just one color of Luxatemp. They just happen to be in arrangement and shape that was very pleasing, that's 90% of your aesthetics. Ceramist would love to ooh and ahh but how many powders we're using in our build up and all these internal affects that we're doing. And to be honest probably about two thirds of those we're doing for nobody other than ourselves, nobody will even know it. So you never want to loose site of maintaining control of contour and arrangement and position because that's much more important than aesthetics than what I'm doing here at the layering. O.K I'm going to check my stick bite one more time, I'm not going back into my matrix because I don't want to mess up my incisal edge. I've measured it and I know I'm really close there and I'm actually a little longer than the matrix right now. I just want to make sure I'm perpendicular to the stick and yes I am, that looks good. The tip of my cuspid is a little bit lingualized,I'm going to pull that out just a little bit. Build # 11 out to the facial just a tiny bit more before I get anymore layering on it. O.K I'm going to start to be translucent porcelain over this next. And once I put translucent porcelain on then it would be hard to build it out to the facial without getting it very, very grey and translucent looking so we use a little bit more bleach dentin up here and just build that middle lobe out a little bit more so it follows the bicuspid behind it. I'll throw just a little bit of translucent in and around it;it's one of the blue whites and a little high value. Now we're going to use the FL's which are highly fluorescent porcelains. We have FL 1 and 3 out here on the palette. Since this is a bleach shade we're going to use a lot more of 1 then we are of 3. And you can see the 3 would be kind of a honey color fleck in the incisal edge. 4 looks kind of nice for an incisal color too. I see that quite frequently. 2 looks a little too yellow to me but a blend between 3 and 4 would be a very pretty color, in not as bleached of a tooth. In a bleach tooth FL 1 and I'll mix a little bit FL 3 in with the FL 1 just for one or two little flex in the middle of the tooth to make me happy. Not going to make the patient happy, it's just going to make me happy. O.K now this is the mix, the tooth will have a little bit more of gold look to it, just a hint of that out in the middle there. Come back in there and kind of intersperse the brighter version of it in and around that. And then when I have all of those in there you can see the boundaries of them are fairly distinct especially that one right there. I'll take my brush and wet it and splay it on the sponge where it has a real ragged tip like this and I'll come in, I'll drag that up through there trying to feather away that volume of material. And then if we want to check that and see what we've got going on. I'll grab my still camera and I'll shoot a back light shot when I have only #8 with mammalon effects in and #9 doesn't have them in. I can see from the photograph that I haven't feathered that mesisal lobe and one of the distal lobe mesials Rather than also needs a little feathering. I can show this. Rather than finding this out after we fire it now we can go back here and jump in and I'll grab the end of my brush and split that a little bit and drag it and there's one right here that's was too hot too. I'll do that. Then we'll goon to the other teeth. Besides being a pretty photograph,it's also a very useful photograph. I use digital cameras a ton to evaluate what I am doing. It looks different when you look through a camera lens; it looks different when you put it on the screen. It's not a kind experience to your ego. If I'm sitting wondering what's wrong with the case, I can't quite figure out why I don't like, usually if I pick up the camera and snap a couple of shots at it, throw it upon a plasma screen, I'll see 20 things that need to be changed. Surprisingly there's a lot of discussion with a lot of different people. Tom and I will talk on the phone on a regular basis. He'll call up on a case like this and say O.K we're missing teeth in the #5 position, we have a missing tooth in the # 12 position, 13 position. We have one dark tooth. What should we use for restorative material; we're going to open the bite a little on this patient also. That's a very valid conversation, but it becomes an e-mail back and forth and visualization game too, that requires your undivided attention. After 20 more minutes in the furnace, Matt is now ready to add some color depth. It looks like our internal affects are It looks like our internal affects are doing O.K. You can see I did a little tiny bit of grinding there my mammalon effect was a little bit too hot so I just took a little burr and I used it like an eraser to feather that a little bit. Every where else I'm liking what I'm seeing. We're in pretty good shape here. We're going ahead and re-wet the dies. What we're going to do now is add some depth to these restorations. Remember we had kind of dark dentin underneath so I used a bright dentin like porcelain that cut with a little bit translucency and thank goodness we did because it's still pretty bony. And now we're going to put a thick layer of enamel like porcelain over the top of it and we'll pick one of the opalescent enamels to fill out the full contour. All our affects are already in place so now we just need to get the most important thing which is the shape done. So let's dip our dies into some water. Let that soak in for a moment or two. Add a little bit more there and let's look at what we want to filter here and want we want to accomplish. I'm kind of liking those,the natural enamel series, the N series. Let's look at that a little bit and see what we think might make a nice look over the top of this. We have kind of a bony white going already so we don't need N4 we have enough white already we don't need to bring the value up. Maybe an N1 or N2 might be nice. We also could look at our translucent materials, our E's. The simplest would be a clear or a E1 which also might be nice. The E's vs the N's. We're going-to look at them out here where they aren't being heavily front lit just to see the difference in appearance. E1 is little higher value than the N1. It still looks that way there too. I'm going to try to using predominately N1 on this maybe a little bit of N2 if I feel I got an area where N1 is going to gray out too much. N2 is a lot higher case are value than N1. The results I'm seeing with the Lava case are very, very nice and going to look good clinically, I think so. It's exciting material to work with aesthetics are great and the powdered building technique it's something we've done for years on PFM, it's very familiar throughout the laboratory industry. In asking me a question does probably like that your dealing with a guy that does probably 80% press ceramic restorations so it's a little bit like pulling me out of my favorite Ferrari and asking me to drive a Mercedes, it's also a very, very nice vehicle but a completely different vehicle. And incidentally I don't own either a Ferrari or Mercedes. Yeah, that's kind of a nice look. I really like that blue white ice color. That came out really cool. Remember we put that inter-proximally in two or three places. It just has that right kind of blue whitish color. I may actually use a tiny bit more of that like on the mesial of this tooth, a little bit in here on the spotter too. So we need just a little bit of ice, I'll put that on first. My object on my last bake here, and hopefully it's my last bake, I'll still probably have to do a correction bake after this, but the object here is to use as few powders as possible. Because now we're worry about what's most important to esthetics which shape. Previously we have been doing all our layering in coloring I've wanted to get all that out of the way and in the right positions before I started worrying about shape. Now we can be fully focused on axial inclination, on contour, on incisal position, on length to width ratio, on balance of reflective to deflective zones, all of the things that are really important to aesthetics. So with that in mind, let's grab some N1 and just start working on the contour, we gotta close up the space between the two. I don't want that to go too translucent in there so I may use a little tiny bit of dentin back in the back of that. Let's stop and reach for just a little bit of dentin down there and that gingival third we don't want to create something that looks like a black triangle. Let's do that, close up the space up way back in there and then we use translucent in front of that. We just want to blocked a little bit of light in those areas.