Daniel Wilson 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
