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

Part 5 - Porcelain selection and why it is so important.

Instructors:

Tom Trinkner, DDS

Tom Trinkner, DDS

Thomas F. Trinkner, DDS, teaches as an associate at the L.D. Pankey Institute and is a clinical instructor for the General Residency Program at Palmetto Richland Memorial Hospital in Columbia. He lectures both nationally and internationally in the field of Aesthetics and Complex Restorative Dentistry.

Matt Roberts, CDT

Matt Roberts, CDT

Matt Roberts is one of the most recognized Dental Ceramists in the United States. His goals are to elevate the quality of restorative treatment received by patients by creating an interactive working relationship between dentists, ceramists, and specialists.

In this section of the dental continuing education course, Matt Roberts discusses porcelain selection and why it is so important.

O.K I am looking at Judy's, I am going to look at Judy's lower anterior teeth with the shade tab held up to them in picture 0031, it looks like her lower anteriors have areal white dense incisal edge compared to the shade tab. I have the same shade tab here that is held in her mouth and it also looks like the value of the teeth maybe actually slightly higher and with a tiny bit more chroma than the shade tab. So let's come over to the Lava system porcelains and let me pull my microscope down here so that we can show this on the screen, but there is 020 and let's just look and see what we have available for dentins. We've got the bleach shades here of W1's through W3. W3 Looks about the closest to that, it is a tiny bit brighter and remember the 020 looks slightly grey in the mouth, and if we get around here to B1 then B1 looks way darker than the 020 shade does so I think for a dentin to work from either the W3 or the w2 because we may get a little bit of show through from the underlying color of the tooth so W2 would brighten it up a little bit. Now, to me the Lava dentins look pretty dense. They are a real European high density dentin and we are in a fairly conservative prepped restoration so we may want to make those a little bit more translucent by adding some clear porcelain to them. Ithink I am going to add maybe 25 to 30 percent clear porcelain in with the bleached dentin other than in the discolored colored areas to give it a little bit more depth a little bit more vitality, because we are making fairly thin restorations and we don't have the option of huge enamel overlaying and we do need the dentin to brighten the teeth up a little bit. So let's look at that and then with that, I've looked through all of the really nice shade tabs that we have here from Lava, and we can pick out our Mammelon effects of the fluorescent incisal effects maybe some FL1 with a little bit of FL3 thrown in for color. I certainly won't use the FL3 straight on a case that is this bright of a bleach shade, and then we have our really cool opalescent enamels here and notice how everything looks kinda blue and that is because there is a light in my microscope hitting it and when you front light and Opalescent material it is very, very blue, and if I took these same materials and I held them up to an overhead light and looked at them like this and I know you can't see this on camera but they turn kinda of a sunset orange so we are getting true opalescent in these. And Ithink for kind of a blue white I like the N1 there then for my higher value whites I am going to use N3 and N4 butt hose are going to be fairly high percentage of the enamel that I use. I will use a little bit of the E1 which is just a neutral shade enamel out of the Lava kit and I will also use the E5 which is a very white enamel and we can look at those colors here. And kind of compare them. E1 is just standard light shade enamel that you use filler in theincisal edge. E5 is a very bony white enamel and when we get that over here against the N4 we see that they area bout equivalent but the E5 is not opalescent, it does not turn blue in front. If we take the intense front light off and just take a look of it out there we see that they are just about identical in appearance. But opalescent porcelains you have to understand how they work. And the brighter the light gets the more blue we are going to get so E3 we will be really cautious with and we will only use it in the areas we want a blue white. N1 does not turn as blue and that could be a real nice translucent that will still work well with that very bright incisal color that our patient has. So with that I will go ahead and lay my pallette out and we will start building the case. So this will take just a moment of grabbing scoops of porcelain and arranging them out here, so we will start taking scoops of our dentin porcelain, and again as I said this is a very bright porcelain so let's go maybe 20 percent clear with this. I'll grab my clear porcelain here and just make this a little bit more translucent so we will use 4 scoops of the dentin porcelain and 1 scoop of clear to make a translucent dentin and then I will grab a tool to stir that up. Matt Roberts will continue to lay out the porcelains keeping track of what goes where. What I want to do now is take my refractory dies and soak them with water so I will just dip them into my water dish inthe background and they will come out dripping wet and we will just let that soak in for a minute. One of the nice things about refractory technique is that you can create a translucent effect at the margin that lets the underlying tooth slowly show through so there is gingival recession you don't have a real white restoration that ends in real hard line. You make a contact lens effect where the end of it is invisible. And you use that or you do that by using translucent porcelain right at the margin and in this case I am going to us a CL1 which is cervical or CI1 excuse me which cervical incisal number 1. It does not have a lot of color to it there is just a little bit of color in there. I am also going to be taking a couple of still photos of this at this stage. So what we will start doing here is working with the cervical incisals around the margins and do justa very, very minimal layer of porcelain there. We will start off with that and what I want to do is thin this out, I don't want to create a big band of color or a big window to show through I just want to create some color gradient where my dentin porcelains effect will be lessened by a little bit of translucent porcelain right at the margin itself. I am putting a very thin layer of this on and I will come over the top of that an it will blend in with the dentin, do the same thing to the rest of the teeth. O.K so that was the cervical incisal. I am going to give a little bit of color gradient to the case by using a little bit of A1 over here on the cuspid, I am not going to use a lot just a little, in the gingival half and up into theinterproximal. And then on the centrals I want those to be the most dominant teeth so I will stick with my bleached dentin. This is going to shrink a lot so I will put alittle bit more volume of this than I really want for my final positioning of the dentin, I know I am going get alot of vertical dimension loss on it, fill in that interproximal. Try not to make everybody to motion sick by moving around here but unfortunately some of it you just have to. For convenience sake, I am just building with the model off the articulator but in a moment we will go back to the articulator and we will check the positions of our dentin lobes and our build ups and we will see how we are relative to our incisal edge position, that's what we are trying to head for. We will also use the stick bite to make sure our mid line is not canting as this case continues to develop. Remember everything is going to shrink drastically. What will be nice is we are going to be using the same type of porcelain on both the anterior veneers and the posterior Lava crowns. We're using Lava layering porcelain here as a refractory porcelain we'll be using it over the zirconia core in a little while so we have one porcelain system handling different applications in the arch.