Mike Skramstad There are many threads always going on asking "what block should I use". I will tell you first off, this is almost impossible to answer just by looking at a picture. Ross Enfinger has a really nice thread on this as well.
Just one quick case that will basically give you my theory on anterior teeth cosmetics.
In short:
- Always use the most translucent block that will get the job done
- All the natural value, translucency, and opalescence is in the enamel... so if you remove all the enamel, your job is going to be more difficult making the teeth look natural.
- Always as conservative as possible. That is, Veneers always before Crowns if that is appropriate. Veneers are hard, but crowns are much more destructive to the tooth. The more you prep the tooth, the biomechanics change quite a bit and it weakens it dramatically.
- Don't forget composite. After sitting through part of the Spear Composite course last week, I was reminded that we should use composite more in the anterior than most of us do.
Here is a case:
Woman in her 50's came to my office for a consultation on her anterior teeth. She had a pretty nice fracture in #9 and #8 was chipped on the incisal edge. Both teeth had a fair amount of erosion on the facial as well.
We talked about 2 options really: Composite and Veneers. She really had done some research on this already and visited a couple dentist with varying opinions (some to crown the front 6 even) and knew she wanted veneers. I was personally relieved because I didn't want her to choose composite because then I was going to have to execute it :)
After we decided on veneers on 8 and 9 I had to get an idea of what material to use. She has a lot of translucency, so my choice was either e.max HT OR Vita/Vita Trilux... I wasn't sure quite yet. I was concerned about the wear on the teeth, but I also knew that Vita was going to be easier. Either way, I knew if I was going to control translucency and value, I needed to control prep. With her facial erosion, it would be easy to over reduce and increase the material thickness (thus decreasing the value).
So the next thing we do is a quick composite mockup:
From here we can do our proper depth reductions using the Winter Reduction Burs from the Restorative Design Kit and get conservative Veneer preparations:
In the end, I chose Vita Feldspathic veneers on her and protected them with a night guard. You also could have used e.max HT I feel and got a great result as well.
Hopefully this helps and spurs some additional thinking. Also read Ross's thread. I will try and link to it.
