bright white
Generally, I find I'm able to steer patients in the right direction regarding treatment and esthetic decisions, but I also respect their right to determine the course of their treatment. The following case was obviously straightforward with respect to her restorative needs; however, she and I differed on our esthetic vision. After endlessly trying to telk her into a more age-appropriate shade and characterized smile, I eventually relented and gave her the glow-in-the-dark teeth she wanted from the beginning! She now says her expectations were exceeded and she couldn't be happier with what she chose. I'll chalk that up to success despite my personal feelings. Anyway, here is the case with #7-10 in BL3 LT emax and the rest with B1 LT...
Ross,
Very nice.
Is this what they mean by, "The Patient is always Right"?
If they are happy, you are happy. 
as with all your other posts, great work. i too find it hard to push pts into a more 'natural' shade. The smokers/deeply stained teeth crowd always want their smiles to be seen from across town.
Beautiful result! I really like the shape and line angles of the laterals. Just a few questions, what was the reason for the different BL3 7-10 and B1 for the rest? Do you generaly choose a higher value anterior 4? Also, just curious about the lower left. Looks like some restorative in progress?
On 9/10/2015 at 9:05 am, Daniel Butterman said...Beautiful result! I really like the shape and line angles of the laterals. Just a few questions, what was the reason for the different BL3 7-10 and B1 for the rest? Do you generaly choose a higher value anterior 4? Also, just curious about the lower left. Looks like some restorative in progress?
Impressive result Ross. I just wanted to comment on the laterals as well. I would have maybe made them slightly shorter. They are a little flat and long to me... but this is all semantics because we all like to nitpick even our best cases. Wonderful transformation
On 9/10/2015 at 9:05 am, Daniel Butterman said...Beautiful result! I really like the shape and line angles of the laterals. Just a few questions, what was the reason for the different BL3 7-10 and B1 for the rest? Do you generaly choose a higher value anterior 4? Also, just curious about the lower left. Looks like some restorative in progress?
Appreciate the feedback, guys. Daniel, I don't usually mind a little shade transition at the cuspids. Also, these are LT, which in my experience tend to have a lighthouse effect in the posterior (meaning the same shade tends look brighter), so I decided to go lower value as we transitioned back. And yes, she's going to need in implant or two in the lower left. We'll see if she decides to do the lower anteriors to match next.
On 9/10/2015 at 9:09 am, Mike Skramstad (Faculty) said...On 9/10/2015 at 9:05 am, Daniel Butterman said...Beautiful result! I really like the shape and line angles of the laterals. Just a few questions, what was the reason for the different BL3 7-10 and B1 for the rest? Do you generaly choose a higher value anterior 4? Also, just curious about the lower left. Looks like some restorative in progress?
Impressive result Ross. I just wanted to comment on the laterals as well. I would have maybe made them slightly shorter. They are a little flat and long to me... but this is all semantics because we all like to nitpick even our best cases. Wonderful transformation
You're right....also, shortening the laterals would help smooth the transition to the cuspid embrasures. Hindsight!
Great Results! I know some people like the incisal edges even all the way across. That's what's nice about a waxup or even a smile design guide to show them ahead of time.
Ummmm, does she not see her lower teeth?
On 9/10/2015 at 11:35 am, Terry Cowgill said...
Ummmm, does she not see her lower teeth?
She will now !
Very nice result
Tom
Just did one in ImpulseV2. 56 years old, and she didn't want any characterization in color, so I did a little with shape, incisal edges, etc which made them look more natural. Power whitened lower teeth to within one shade of 3-14. They really don't show very much in her smile, but I bet she will have me do 10 lowers just the same.Like you I thought they were to "white" but she loved them. But after discussing the options, looking at photos, etc. I felt comfortable doing her case the way she wanted. Not sure what I would do if she didn't like them!
Ross, Your explainations about the shades was great. I love the case especially th efact that you gave into what she wanted. It's funny, because I usually pick a lighter shade than the patient. As a result the patient winds up being very please with the lighter shade. I agree with the others on the laterals not to beat a dead horse. Its much easier to review later than to see objectively when the case is in progress.
Jeff
Ross, very nice case and happy patient.
Beauty is in the eye of the dysmorphic?
max 4=13 emax BL3 LT
mand 20=29 impulse v2
Ross, great case. Pretty awesome before and after. Jim I got blinded when i scrolled to yours. Thanks. ;)
Ross-
Do you think the facial plane is a little flat? The proportions and shape are great, but there was just something off and I couldn't put my finger on it.
I know you prep the same as I do and use roughy the same technique... So I know you are prepping in 3 planes. Are you using biocopy off a waxup? Maybe wax is too flat.
I think it needs a stronger cervical height of contour (especially laterals) and the incisal 1/3 needs to be contoured more to the lingual...
what do you think??
look at these units... See what I'm talking about...Plus if you are using eMax, this will create some natural edge translucency. These are MT
On 9/10/2015 at 7:36 pm, Mike Skramstad (Faculty) said...Ross-
Do you think the facial plane is a little flat? The proportions and shape are great, but there was just something off and I couldn't put my finger on it.
I know you prep the same as I do and use roughy the same technique... So I know you are prepping in 3 planes. Are you using biocopy off a waxup? Maybe wax is too flat.
I think it needs a stronger cervical height of contour (especially laterals) and the incisal 1/3 needs to be contoured more to the lingual...
what do you think??
look at these units... See what I'm talking about...Plus if you are using eMax, this will create some natural edge translucency. These are MT
Is there any video (non-academy) where we can learn how to texture like this? Can I spend a year or two over your shoulder to get to 10% of that??
Ross...loved your work up, patient education and discussion, decision to please her (she is the one paying for it!), and the great pre-op & post-op photos photos...basically everything! My only comment is that I think "leveling out" the lower anteriors/incisors before you begin design and milling allows for a much better protrusive contact and incisal guidance....Oh, and a nicer looking smile for No Extra Cost to patient!
Any one have thoughts about this aspect?
Great case, thanks for sharing and "challenging" us too!
David
On 9/10/2015 at 8:03 pm, Mike Skramstad (Faculty) said... Btw... Did you get a big uncomfortable hug after?
One of the best things about my job.
Ok that looks better. Maybe slightly flat, but looks better from that view. I think it may be just the length like we talked about earlier transitioning into canines.
On 9/11/2015 at 10:56 am, Mike Skramstad (Faculty) said... Ok that looks better. Maybe slightly flat, but looks better from that view. I think it may be just the length like we talked about earlier transitioning into canines.
I see that they could be tucked in a little more in the incisal third. And I would've loved it had she let me do a step-up on the lateral length. Actually, Mike, at the risk of poking the bear, I thought you were going to kill me on the LT e.max choice. I showed her Impulse and LT cases and she preferred the opaque look, although I did sneak a little stain and glaze translucency in on her.
Great result Ross! Who do you like to use for your waxups? I'm going to assume you waxed this case up. Transferred waxup to the mouth and then bio-copied from there....correct?
On 9/10/2015 at 7:36 pm, Mike Skramstad (Faculty) said...Ross-
Do you think the facial plane is a little flat? The proportions and shape are great, but there was just something off and I couldn't put my finger on it.
I know you prep the same as I do and use roughy the same technique... So I know you are prepping in 3 planes. Are you using biocopy off a waxup? Maybe wax is too flat.
I think it needs a stronger cervical height of contour (especially laterals) and the incisal 1/3 needs to be contoured more to the lingual...
what do you think??
look at these units... See what I'm talking about...Plus if you are using eMax, this will create some natural edge translucency. These are MT
Mike,
You just did the dental version of a peep show.
You can't show that texture and not tell us how you did it. It looks like layered porcelain. Did you use different milling unit burs? There is tertiary anatomy that I bet you hand did. It looks awesome.
By the way, I use Ross as an inspiration to improve every day. His stuff looks awesome. I also love how Mike doesn't hold back on his critique because Ross is that good and he can take it and improve with it.
On 9/11/2015 at 12:05 pm, Aaron Tinkle said...On 9/10/2015 at 7:36 pm, Mike Skramstad (Faculty) said...Ross-
Do you think the facial plane is a little flat? The proportions and shape are great, but there was just something off and I couldn't put my finger on it.
I know you prep the same as I do and use roughy the same technique... So I know you are prepping in 3 planes. Are you using biocopy off a waxup? Maybe wax is too flat.
I think it needs a stronger cervical height of contour (especially laterals) and the incisal 1/3 needs to be contoured more to the lingual...
what do you think??
look at these units... See what I'm talking about...Plus if you are using eMax, this will create some natural edge translucency. These are MT
Mike,
You just did the dental version of a peep show.
You can't show that texture and not tell us how you did it. It looks like layered porcelain. Did you use different milling unit burs? There is tertiary anatomy that I bet you hand did. It looks awesome.
By the way, I use Ross as an inspiration to improve every day. His stuff looks awesome. I also love how Mike doesn't hold back on his critique because Ross is that good and he can take it and improve with it.
Thanks, Aaron. On the upside, I just use my tears from Mike's critiques to run the milling unit....saves me a ton on distilled water!
On 9/11/2015 at 2:36 pm, Ross Enfinger said...On 9/11/2015 at 12:05 pm, Aaron Tinkle said...On 9/10/2015 at 7:36 pm, Mike Skramstad (Faculty) said...Ross-
Do you think the facial plane is a little flat? The proportions and shape are great, but there was just something off and I couldn't put my finger on it.
I know you prep the same as I do and use roughy the same technique... So I know you are prepping in 3 planes. Are you using biocopy off a waxup? Maybe wax is too flat.
I think it needs a stronger cervical height of contour (especially laterals) and the incisal 1/3 needs to be contoured more to the lingual...
what do you think??
look at these units... See what I'm talking about...Plus if you are using eMax, this will create some natural edge translucency. These are MT
Mike,
You just did the dental version of a peep show.
You can't show that texture and not tell us how you did it. It looks like layered porcelain. Did you use different milling unit burs? There is tertiary anatomy that I bet you hand did. It looks awesome.
By the way, I use Ross as an inspiration to improve every day. His stuff looks awesome. I also love how Mike doesn't hold back on his critique because Ross is that good and he can take it and improve with it.
Thanks, Aaron. On the upside, I just use my tears from Mike's critiques to run the milling unit....saves me a ton on distilled water!
OMG this has me rolling! Beautiful case Ross! This is a life changing case.
@ Mike I cannt wait to see this in detail at C30. Kill it on stage for CerecDocs!
Thanks for sharing,
Justin
You guys are funny... LOL
I critique everything that I do as well. There are only one or two cases that i've ever done that i'm completely pleased with. That is how we improve. Everyone is a supportive bunch here on this site and I think that is wonderful. Ross is one of the best clinicians on this site and I analyze his cases like I would analyze my own. Try to find every last thing that I can improve on for the next case. If we do that in a supportive and not negative way, everyone learns.
This is an awesome case that Ross posted. I would not have done it out of LT...LOL (that was for Ross).
As far as the picture some of you alluded to, this as some of you figured out has Bill Marais influence all over it. In fact, this is one of the cases that we did for the Academy Seminar last April. We did a case about 5 times in different ways and presented it. We will do it again in the Fall. If you cannot wait that long, I will show the recipe in Vegas. We have videos going up on this next week as well.
On 9/11/2015 at 6:49 pm, Mike Skramstad (Faculty) said...You guys are funny... LOL
I critique everything that I do as well. There are only one or two cases that i've ever done that i'm completely pleased with. That is how we improve. Everyone is a supportive bunch here on this site and I think that is wonderful. Ross is one of the best clinicians on this site and I analyze his cases like I would analyze my own. Try to find every last thing that I can improve on for the next case. If we do that in a supportive and not negative way, everyone learns.
This is an awesome case that Ross posted. I would not have done it out of LT...LOL (that was for Ross).
As far as the picture some of you alluded to, this as some of you figured out has Bill Marais influence all over it. In fact, this is one of the cases that we did for the Academy Seminar last April. We did a case about 5 times in different ways and presented it. We will do it again in the Fall. If you cannot wait that long, I will show the recipe in Vegas. We have videos going up on this next week as well.
Mike and I like to kid each other quite a bit, but we are both sincere in trying for the best results for our patients. I absolutely appreciate his critiques and there's no doubt that I'm a better dentist because of that feedback. Thanks, Mike!
