Anteriors...Sometimes it feels like a Love-Hate Relationship
This is a case I did on the 23rd of December.  It was supposed to be a nice easy day just working and documenting this case but as you would expect, I had two emergencies that needed help so that made my day a little more chaotic.  That being said, I share this case because I am hoping to stimulate some discussion.  This isn't my favorite case and in retrospect  I would have chosen a different block.  I choose VITABLOCS TriLuxe Forte and ended up with A2C.  I have my thoughts about what I would have done differently but I'm curious to hear how others may have approached it seeing the before, preps and after.
The patient and his family were really happy with the end result.  However, I talk about as we all know, we grade anteriors on a different scale.  I love doing them and the challenge but it definitely can be humbling and make you lose a little sleep when you critique your photos.
I'm no expert on this so let's see what others say, but wow, great job and great photography. The lateral incisors are begging to lose that labial flare.. perhaps go after those next to make a differenceÂ
Truly awesome job. The only thing that catches my eye is that the gingival zenith on 8 should be slightly higher. It makes 8 look narrower though I'm sure it isn't.
I love empress, but vita was definitely the way to go here. Â It would have been tough to get empress to not look grey with this case. Â I think it came out great.Â
It isn't a joke Thad. I'm not trying to say it isn't good or that I wouldn't have been happy with it when I first got started.
Robert got the part that I'm not happy with. I see grey. It bugs me tremendously because it's all I see at this point in time.
Ross Enfinger talks about how he chooses blocks and the more translucent the block, he tends to go a little brighter in value. Maybe I could have gone a little brighter and used that A1C and stained the case down. I didn't go that route and maybe it would have turned out ok.
But I also see beautiful Empress cases from a lot of the CDocs on here and not sure if I should have went that route....
Carmela, I used Empress stains and glazes. I essentially just used mostly white for the effects that you see and a very slight amount of the A2 Universal stain (similar to the 1 stain for e.max) If I've learned anything from this forum is that we are always trying to get better. How I viewed cases that I thought were wonderful 1 year or 2 years ago is different. My eyes pick up on more subtle details. Photography and looking back at old cases and reevaluation is critical to get us to see what we can't see. After taking Level 4 and now mentoring the class several times, I finally see the stuff the Skramy hates in some of his cases that he shows. At first, I thought "are you kidding me? Who is this guy? I can't ever think about doing that kind of work...". After I got over myself, I realized that I simply couldn't see what he was talking about unless he pointed it out. Now, I am starting to pick up on it. That is really what I'm trying to get at. Maybe the "grey" doesn't stand out that much but it's what I pick up. A loss of value or being too grey are things that stand out fast on a case for me. Value and Translucency are the top two factors for anterior block selection and then Chroma and Hue follow because we can modify those with stains.
Nice case Dan and it's awesome you are looking at things critically. Of all the cases I've done, there are only a handful that I'm extremely happy with. Most look good, but there are always things I would have done different.
When I'm off my phone I will comment more when I can see your case a little clearer
Quite often I'm fairly happy with a case until I take a photo.  So I can see where it helped you to take a tryin pic.  Awesome case!  I would bet that no one would ever suspect that he has crowns on those teeth.
Sorry Dan. Awesome case! I understand your point about always pushing to get better and raise the bar and appreciate it. Ross posted a case recently with several shades and asked which shade would we choose vs. which shade he elected to go with. I don't think anyone that responded chose the shade he went with and when he finished, it looked amazing. I'm having difficulty talking myself into such a value shift as he suggests but have routinely seen some grey in post op photos and should have gone lighter.
Dan- Are you using a ring flash? It makes it slightly difficult to eval with the flash bouncing off.... but really looks great. Is it low value... just a little. The pictures are low resolution so I cannot look super closely in photoshop, but I think you just missed by one shade. I know others like it, but I am not a fan of Forte. Something about it doesn't look quite right to me. I have better luck with just Trilux.
Good Job!
Here is the contrast pic I did... it's just slight, but your eye is correct, it's low value. My guess is that it looks even lower value in person that is why it bugs you a little bit. The flash could be compensating. I'm sure the patient is very very happy!
Mike,
You don't miss much. Yes, it is a ring flash and my camera kind of sucks when it comes down to it. I have a Canon Rebel with a 100mm Macro Lens and a Ring Flash. I just haven't spent the money on a new set up. I will probably get a camera from PhotoMed.net and do the dual flash with the adjustable arms. Sorry about the quality, my megapixels are around 6.3 and since I posted Keynote slides you are limited with the quality. I'll post some more pics without the Keynote slide.
I know you do a fair amount of Vita Mark II, and what went through my head was should I have used that block since it is a little more opaque than Vita Triluxe or Vita TriLuxe Forte? Or maybe I should have simply went with the A1C shade and added some color to tone the value down. I talked to Kris about this and she doesn't like to go up in value and stain down. I know Ross talks about it a lot and I've had success with it, sometimes it just involves more work.
As you would expect, the patient doesn't know what the heck we are all discussing fortunately and is happy. I didn't want this simply to be a thread where I was expecting praise for a job well done. I think it is a good case, but it could have been better. Now that being said....what would have others done differently. Maybe that is simply going with a lighter block A1 versus A2. Or different block all together, e.max MT or Empress Multi...but for many of the clinicians on here I know we all have blocs we gravitate too. Sometimes that is because it is what we are used to or comfortable with and sometimes there are specific reasons for that. I'm hoping that others may share what block they would have chose and why.
Dan
Here's a pic of the upper anteriors isolated and one with the Fade filter in the iPhoto.  The value doesn't look too bad in the altered image, but I definitely feel like the value is a little low.
The case looks much better without the limitations of Keynote. Â I can see that anterior tooth artistry runs in the family. Â
If you want to go with a new camera for anteriors, get something full frame. You can even go back to the Canon 5D markII (circa 2009) and it's an awesome camera. Others to recommend would be the Canon 5D mark III or the Canon 6D. The newer versions (the 5D mark IV and the Canon 5DS) are just too expensive. If you decide to go with full frame though, you cannot use a crop macro lens, you will have to use the more expensive "L" series.
On 1/5/2017 at 2:21 pm, Mike Skramstad (Faculty) said...If you want to go with a new camera for anteriors, get something full frame. You can even go back to the Canon 5D markII (circa 2009) and it's an awesome camera. Others to recommend would be the Canon 5D mark III or the Canon 6D. The newer versions (the 5D mark IV and the Canon 5DS) are just too expensive. If you decide to go with full frame though, you cannot use a crop macro lens, you will have to use the more expensive "L" series.
Thanks Mike...I'll have to go to our local place in Portland, ProPhoto Supply and check out what they have...
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On 1/5/2017 at 2:21 pm, Charles LoGiudice said...The case looks much better without the limitations of Keynote. Â I can see that anterior tooth artistry runs in the family. Â
Thanks Doctor Chuck!  I wouldn't say it runs in the family but we may talk a bit more about dentistry and stare at pictures a little more than the average family....we may even hypothesize and say... "What will Mike say about this case?" :)  All in good fun...There is no doubt that I'm lucky to have someone as talented as Kris to listen to my barrage of questions and the clinicians on CDocs to speed up my learning curve.
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I think too, if you are going to be slightly off, you'll always sleep better with brighter front teeth than slightly grey (lower value). If I am debating in the front at try in between two, I usually pick the lighter one because we all do that - sit at night thinking about that bit of grey...
I think you did an amazing job for sure though, great shape and characterization. No-one will ever think those are crowns or the patient had work done. Which I am sure the patient appreciates!​
On 1/5/2017 at 2:49 pm, Lincoln Parker said...I think too, if you are going to be slightly off, you'll always sleep better with brighter front teeth than slightly grey (lower value). If I am debating in the front at try in between two, I usually pick the lighter one because we all do that - sit at night thinking about that bit of grey...
I think you did an amazing job for sure though, great shape and characterization. No-one will ever think those are crowns or the patient had work done. Which I am sure the patient appreciates!​
Very well done as usual Dan.
I agree with Dr Parker that if we are going to be slightly off, two brighter #8 and 9 are better than darker ones.
For this case, I am wondering would the "different value cement" help a little here.
As for the photography gears,twin flashes with diffusers/soft boxes will definitely make big difference than camera and lens. Lighting is everything for photography.
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Thanks Yao-Lin, so I did use a few different try in pastes that come with the Variolink Esthetic kit. Â When I used the Light try in paste, my assistant and IÂ felt like the restoration looked too opaque. Â I think at the end of the day, I simply choose the wrong block and should have went with a brighter block :)
Thanks for the photography tips....I like your solution for short term since it saves me about $3k or more, and I am slow to make bigger decisions... :)
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Dan
Dan, et al,
Thanks for challenging us. I'm still striving to get there. I see drastic improvement since last year but still need some critiquing. This was #9. Used shade D3 Emax LT and then stained. D2 shade tab seemed too light and LT seems to come out a little brighter. That being said I had to use more white than i thought to brighten it up some. I should've gone D2 and toned down. My camera and flash are terrible so excuse that.
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Thad! That's fantastic! Matching an ugly tooth is really where the artistry lies. Keep posting! Awesome!
By the way, what camera do you have? There may be variations to this based upon preference but I set my camera to Manual mode. Set ISO to 125. F-stop to 29 for intraoral shots and 11 for extra oral shots. That will help getting a better depth of field for your photos.
On 1/18/2017 at 12:38 pm, Daniel Wilson said... Thad! That's fantastic! Matching an ugly tooth is really where the artistry lies. Keep posting! Awesome! By the way, what camera do you have? There may be variations to this based upon preference but I set my camera to Manual mode. Set ISO to 125. F-stop to 29 for intraoral shots and 11 for extra oral shots. That will help getting a better depth of field for your photos.
Thanks Daniel. I have an old Rebel and rig flash that I quit using and last year bought a G16 Powershot from PhotoMed. I went cheap after buying a practice. Looking to upgrade soon and work on my Pixelmater skills. We also just ordered SL-Ai to do more implants. Too many things to learn from you people! I have to find time to actually fix teeth!
