Doc I don’t really smile....
Patient presented wanting his smile fixed. Concerned with the laterals and #5. After 5 years of seeing him finally allowed me to do 7 first. Once he saw it signed up to do 5 and 10 in 2 weeks. When we finished this week he said now he can stop smiling on just one side.
Beautiful! I love making what's there more beautiful.... love the 10 unit cases for pop, don't get me wrong. But this is a great improvement and better assessability for the patient to help them look better, and YOU figuring out how to execute it. Nice! 
Mark
Great blending of the "old" with the new. Well done. That's real life dentistry there and a gorgeous example of it. Congrats.
Wow beautiful result. I’m trying to learn more about available materials. When do decide to use vita triluxe vs emax vs. other options? Thanks!
Thanks everyone.
David, it really comes down to what you get comfortable with. I think you could get a great result with several different materials. However, my thought process goes in this manner:
For anteriors:
1. Warm looking tooth or bright tooth. Also can include age of patient (older the tooth less brightness they have). If I’m going warm I will stay in the VITA realm. If it is bright I’m leaning towards Empress. Only way I’ll do EMax in the anterior is if I’m worried about strength or if I’m doing multiple teeth in which I’ll use MT and if I’m matching an existing PFM I’ll use LT. I tend to shy away from HT in the anterior as I feel it greys out.
2. Shade gradient. Some teeth have it and some are very monochromatic. For warm teeth If the gradient is there I use Triluxe for VITA if not Mark2. If it is bright teeth with gradient Empress Multi if not Empress CAD.
For posterior:
I’m mainly staying in the EMax family and stick with HT or LT. If I have a premolar and feel comfortable not needing strength I’ll use Empress CAD or multi using the decision formula I stated above.
Hope this helps
Tom
Thanks Tom, that is very helpful. Can you describe how you stained/glazed these restorations in order to get such a nice match? How many different applications of different colors were used?
Just to give you an idea. This was straight out of mill and then contoured. We take this photo so they can evaluate how much they need to change the cervical. Even though it’s a triluxe the natural teeth had more of an intense gradient they had to match.
also shows you that you can match and save most cases because value was correctly matched
Nice....fun case, huh. So great when pt's want to have something done and they're pleased with your work. Good job!!
JJ
Nice case. How are you scheduling your time on these anterior cases? Staining can sometimes prove time consuming...
Again, very nice result.
Brad,
It really depends on each case. If we are in hygiene or new patient exam and have decided we want to do an anterior case, I'll have my assistant come and take a quick look. They are getting an idea for block selection and how many times they think they'll may have to fire it. Normally I'd say for 1 anterior we will schedule between 2-3 hours. Always ask patient if they are ok with that amount of time, very few will say no.
Now, what benefits us as CEREC users is we can accomplish multiple procedures in one visit. So with this case in particular, patient wanted to go ahead and do #5. Our time did not change that much since you have the option to just polish and bond #5. So we start with prep of 10, get that milling. My assistant takes over from there and we manage the time by either another assistant helping me out while the first is contouring, staining and glazing, or while 10 is milling, I'm prepping 5. Just maximizing the time of that appointment is where to me the actual length of the appointment doesn't mean so much.
Always ask the patient if they want to do more, you never know.
Tom
