One of those cases that meant a lot...
This is just one of those cases that meant a lot to me. This women walked in my practice looking for a third or fourth consult for her front teeth. She was celebrating 1 year of being cancer free after undergoing pretty severe chemo and radiation with low survival rates. She beat the odds but her teeth suffered. She had something to smile about now and wanted her teeth to reflect that. She hated her smile and I was so grateful that she chose me because I wanted to be a part of her story.
Major damage from erosion was done to teeth #7-10. The canines also show buccal erosion and pitting on the cusp tips. She has obvious tetracycline staining as well and in her smile we decided to work from #5-12 knowing that she could always add in #4 and #13 at a later date if she wanted.
When I am looking at the shape of her teeth, I see that the laterals are a bit wide, I want to lengthen #8 and 9 due to the amount of wear and erosion (meaning I have to pay attention to occlusion here) but I really like the overall shape of her teeth.
I set this up in the computer as Biogeneric Individual, but then manually add a BioCopy Upper folder so that I know where her midline, incisal length papillae are.
This is a case I delivered in one appointment and a tip that I have definitely learned over the years is to trust biology. I have a huge fear of black triangles and I know I am not alone. Patients hate the look of having pepper stuck in their teeth and are always asking if we can fix it. It's not an easy task with a tiny bit of composite for natural teeth, and then with crowns, I just used to make these long, broad contacts to avoid it at all costs. The problem with those long, broad contacts is that they just don't look quite right. Now it's this constant struggle in my mind of making sure there is no black triangle and trusting biology to fill in the triangle.
Here is an example of that-
Immediate seat
1 week post op and praying to the papillae gods
3 week post op
This was such a fun case for my entire team getting to know this woman who has more courage and strength than I could fathom. She affected every one of my team members in a positive manner and now can't stop smiling. She scheduled to do her lower anteriors in a month and I can't wait. She was an amazing reminder of why I love what I do.
Great case Kris and wonderful to see you gave room to allow papilla to fill in. I think it’s too common to see people want to close those spaces. Having that biocopy folder is a huge help for knowing where your landmarks are. Awesome case!!
Kris,
You got such a nice result with those crowns given the underlying stumpf shade. LT or MT E.max? Anything special in bonding them in in regard to cement type/shade?
Thank you!
These are an e.max A1 MT, bonded with Variolink Esthetic, shade light.
I will pick MT over LT any chance I can. Honestly with the existing tetracyline staining if I wanted a more natural look I would have gone with HT but she wanted a bit of pop and knowing we were doing the bottom teeth at a later date I chose MT. As far as cement, I will typically use light or warm for a little depth.
Hope that helps!
VERY nice Kris... great result and presentation... "papilla gods"?.. funny! If they existed, I think we'd all be giving homage...
Mark
Inspiring Kris! You mentioned one appointment. So I'm guessing no wax-up since you chose Bio Individual. How long did the design take? How about milling and crystallizing? How many mills and ovens do you have? Trying to figure out how this can be done in one appointment. Thanks so much for your input and expertise. Beautiful case!
Carmela
On 9/4/2019 at 11:14 am, Carmela LaFalce said...Inspiring Kris! You mentioned one appointment. So I'm guessing no wax-up since you chose Bio Individual. How long did the design take? How about milling and crystallizing? How many mills and ovens do you have? Trying to figure out how this can be done in one appointment. Thanks so much for your input and expertise. Beautiful case!
Carmela
Thanks Carmela!
I didn't use a wax-up on this case. I absolutely did when I first started doing these cases, but now I do enough of them consistently that I am pretty comfortable with what I can and cannot do. The design time with the Primescan has cut of a significant amount time which is amazing. I maybe spend 10-15 min on my design but I do spend a lot of time contouring. I need my design close but I don't get super OCD because I know I will be contouring by hand. I always try to get the centrals milled first, and then the laterals and then canines, etc. I spend more time on the more anterior crowns with characterization and contouring.
I have two mills and just have to watch the schedule with my associate so she doesn't have to make her patients wait on me. I also have 2 Ivoclar ovens and a Speedfire. Total time for this case was a little over 5 hours for 8 crowns. This was not the case when I started though. My team will totally attest to that! I have had 13 years of practice with my CEREC cases and just keep improving my work flow and systems. Every case I do I try to learn something from and how to improve for next time. Hopefully by sharing cases and tips I can shave of a lot of those years for others ;)
