The Power of a Feldspathic Porcelain Block-Vita Triluxe
There was a thread last week when Sam kept asking why not Feldspathic Porcelain for a Veneer or an anterior crown. For me personally, a lot of my decisions for block was a matter of very my comfort was, and not being familiar with the properties of other blocks. After going to Level 4 a few years ago, it was the first time I really saw Sam and Mike's affinity for VITA blocks. As we can all attest to, Mike's case make us want to cry sometimes because they are so good and makes me wonder what type of "hack shop" I run :)
Everyday I get better and better with understanding block selection for certain cases, but as I use VITA Mark II or VITA Triluxe more, I really like the esthetic properities of the materials and obviously being able to see color straight out of the mill is a huge benefit too.
Here are a few cases that I have done to showcase the power of the block. Obviously, VITA isn't the strongest material we have so if strength is a major concern for a cause, I would revert back to blocks like Celtra Duo or eMax.
Case #1:
This patient hated the spaces at the gingival 1/3rd of her lower anteriors. She is post ortho and I inherited the case after the ortho was already finished. We discussed the challenges of closing the spaces completely, and I wanted to prep them as conservative as possible but essentially they are crown preps because I had to prep interproximally to the lingual aspect so far to help with the space closure gingivally, and was only able to preserve the lingual cingulum of the lower teeth. Funny how pics show all your flaws, but I swear I rounded all the preps with a 3M finishing disc and they still look to sharp in a lot of areas. Fortunately, the restorations all milled and seated beautifully. This was a case I did same day. I have 1 mill unit and used Biojaw to help with the design of the crowns, and the patient was in the chair for about 4 hours.
Preop:
Prep:
Day of Pics: 
1 month Post op:
Ironically I didn't stain and glaze the case. I tried the crowns in and polished them slightly but when I tried them in, she was so happy that she didn't want me to do a thing. So I polished them completely and bonded them using a total etch technique with Variolink Esthetic Neutral. The blocks were VITA Triluxe 1M2. I still am pretty amazed that we have materials that can come out of the mill, be polished and bonded and look like this.
Case #2:
Patient needed veneers on #8 and 9. Again I used VITA Triluxe (A1C) and bonded used total etch technique with Variolink Esthetic Neutral. This was one of my first cases with using GC Lustre Paste. I hate the texture. Part of the learning curve of using Lustre Paste. It really is apparent in the photos but the patient loved them so much that she didn't want me to touch them. One of these days I will find an excuse to polish this veneers more :)
Pre op:
Prep: 
Day of pic: 
1 week post op: Sorry about the articulating paper mark...ugh
Case #3:
This was a really frustrating case. Patient hated her crown because of the dark grey margins and asked if I could improve it. I tried and failed with emax LT. Ended up sending her home and milled out a few different blocks and the one that looked the best was VITA Mark II A1. I did bond this with a Variolink Esthetic Light. This was stained and glazed with Lustre Paste. The whole reason I chose to even mill the crown in Mark II was because I was reading about a veneer case that Mike had done where he was able to conservatively prep for a veneer and block out a reasonably dark prep. So I thought, what the heck, I'll try it. Not perfect but the patient was pretty happy.
Preop:
Color of core after PFM removed:
eMax tryin:
Post op:
Beautiful work, Dan! You're a great dentist and always willing to help. Thank you for all you do!
Daniel,
Thank you so much fo r sharing. They are great! I am honking of adding luster paste to my stock but I am not sure here are so many. Only using Ivoclar empress and max so far. I do want to branch out but.....
Carrie
Great cases!!!!
Did she show her lower anteriors a lot when she talked or smiled? Or was she just obsessing about them?
Grady....it was one of those things that as a middle aged woman who spent a lot of money on her face, then ortho, time to finish the job in her eyes. So no...she didn't show them much
If case #1 was still in braces, what would you ask the orthodontist to do before you do restorative?
Great cases Daniel! I have heard more about Triluxe here than Empress multi. Any particular reason?
On 11/1/2016 at 7:19 pm, Daniel Wilson said... Grady....it was one of those things that as a middle aged woman who spent a lot of money on her face, then ortho, time to finish the job in her eyes. So no...she didn't show them much
She'll show them now.... I can visualize her pulling her lip out to make people look.... Yep, Dr Wilson did this....
Nice work Dan!
Mark
@Chris: as far as ortho goes and if the patient was in the midst of treatment, I think the conversation with the orthodontist would have been about the possibility of slenderizing the lower anteriors to minimize the black triangles, but looking at the pics and the corresponding loss of papillas, I think it would have been tough to do much. Regardless, I always like to have this conversation in advance with the orthodontist and patient and set the expectations for what our challenges are and what may be necessary to get an ideal esthetic outcome. I feel like this is a no-brainer, but I still have a few adult ortho patients that have transfered to me and have some gingival recession and corresponding loss of their papillas and I know there will be black triangles after ortho, but I still get questions from the patient about when will the orthodontist close their spaces....
@Thad: Thanks for the compliment...just like my previous stated comfort level with emax initially, I simply don't have a lot of experience with Empress Multi. I don't have anything against the material and I look forward to using it more. I know Yao-Lin Tang posts a number of beautiful cases with Empress Multi...so does Skrammy but you knew that already :)
@Dhaval: Thanks, I know you do a lot of VITA, and I enjoy seeing your cases on Facebook and in the CEREC Doctors magazine! When you do your VITA cases, how do you like to stain and glaze... VITA stain and glaze kit, Lustre paste, Empress stains? My biggest beef with Lustre Paste is that it is quite technique sensitive and if I'm not careful, it can come out grainy...
@Mark...thanks my friend...you are too kind
They look great! My only thought with ortho is to even the gingival levels because I thought slenderizing the teeth would not create the result she was looking for. Treating to the gingival margins might have minimized prep on the laterals. Still, I think you pursued the best possible option and came out with a great result.
BTW, I can only see those gingival level variations because your photography is so good.
Fantastic work. While you might not love the texture of #8/9, I think they look great. Bet they look even better at conversation distance.
Got it Chris! Usually the gingiva levels are on my radar always but in this case they weren't a chief complaint and wasn't terribly asymmetric.
But I definitely agree with you about using ortho as a tool for that. I have seen some amazing things to increase vertical height of bone, papillae formation, even gingival contours, etc with ortho so yes, I agree that you definitely need to have a great open dialogue with your orthodontist about what you want to achieve.
Thanks Steve! And yes, you're right, the subtleties that our cameras pick up that we beat ourselves up about typically aren't seen by patients or in conversation. Every time this patient sees me, the first words out are praises about her new teeth.
But I will argue that all of us sharing and paying attention to the details that no one else sees helps us more than we know.
As a follow up to my previous comment about texture on Case #2...what this forum has taught me is to see the details of anterior teeth in a way that I never saw before. Whether it was lack of experience, thinking things were "good enough", or just not critically evaluating my own cases with photography, the details matter. If you don't see them then you can't reproduce it when you do your next case. None of us are perfect and every case can be a little better.
Here is another classic example of what I didn't see until the photo was taken. I probably wouldn't have picked up on this 2 years ago. This was an implant case that I had done on #9 with CEREC. eMax abutment block with tibase and eMax MT B1 crown: 
See how the flash picks up on the depression on the mesial line angle. Does the patient see it..."no"...but I'll pay attention to it a lot more now
Do you prefer TriLuxe or TriLuxe Forte, or Vita real life? I have a difficult # 8 on a 20 yo and I would like to try the vita TriLuxe, but not sure which one to order.
I'm sure we may get some different responses but I prefer VITA Triluxe. I've never used VITA Real Life and I just like Triluxe more than Triluxe Forte. I look at it from the perspective of having the right "base" to start with from a value and translucency perspective. I can add chroma and characterization with stains.
These are all wonderful results Dan. Vita is a definitely a very under-utilized block. There's nothing that compares to the beauty of feldspathic porcelain in the anterior as you've demonstrated. I love Triluxe Forte for the anteriors. This is why we shouldn't just consider a single block for all applications. Great job man!
Dan and I tend to talk a lot about teeth after work.. so one day he comes home with this poster of these gorgeous teeth he has restored! Not only were they beautiful but he had a poster!! AND he didn't tell me until after he got the poster!!!!
So being the slightly competitive person that I am...
Vita has this cool website at www.myvitacase.com where you can submit your cases. Cerec is very under represented and the doctors here on cerecdoctors.com do amazing work every day. I've had a lot of fun with some Vita cases lately (even if it was at first purely to get my own poster). I'm challenging anyone wanting to do more anteriors- take photos, try these blocks and submit your cases. What's the worst that can happen?
Kris has the presentation stance nailed. You need some work Dan. It reminds me of The Price is Right. 
On 11/15/2016 at 6:08 am, Tom Monahan said...Kris has the presentation stance nailed. You need some work Dan. It reminds me of The Price is Right.
I know I can't pull of The Price is Right or Vanna White stance as good as Kris...but maybe I should have worn this outfit to "highlight" my poster a bit more! 
On 11/15/2016 at 4:15 pm, Daniel Wilson said...On 11/15/2016 at 6:08 am, Tom Monahan said...Kris has the presentation stance nailed. You need some work Dan. It reminds me of The Price is Right.
I know I can't pull of The Price is Right or Vanna White stance as good as Kris...but maybe I should have worn this outfit to "highlight" my poster a bit more!
Love the shoes!!!
I have had my CEREC for two years now and have only used emax. I really like your cases and the material! I have a few questions:
1.) What is the bonding procedure for Vita in regards to preparing the ceramic for bonding
2.) what is the strength of the material (for example emax is around 400 mp)
3.) the dark stump case - is this material more opaque then emax?
4.) can I use the emax stain and glaze? What cycle do you fire it under? Does the firing make it stronger?
