CEREC Doctors

Eight is Enough


I recently did these 8 veneers in one long visit for a very nice college-aged patient. The first "before" picture was the initial presentation. Years ago, we first did esthetic/clinical crown lengthening and then composite veneers until she hit 20 years old. The second "before" picture is after crown lengthening. I finally completed the case last week by converting the composite veneers to thin e.max veneers.


Very nice!  I need to learn how to work with impulse blocks.  Do they use different shades for the stains than Vita Classic colored e.Max?

 

Joe


Very nice case Ross.  Always give us something to strive for.. 


Beautiful contours and overall result.


On 8/13/2015 at 10:26 am, Joe Ramellini said...

Very nice!  I need to learn how to work with impulse blocks.  Do they use different shades for the stains than Vita Classic colored e.Max?

 

Joe

You can use the same e.max stains and glaze. I find that these pick up enough warmth at the gingival that, as long as they're relatively thin, you don't need to characterize much. Same thing on the incisal third...they're translucent enough that they look vital. I just usually add a little bit of incisal edge halo effect and some craze lines. 


Nice case as always! You are on a roll my friend!

Do you have any pictures of the prep? How thin are the veneers? What cement did you use? Did she have ortho extrusion of#6?


On 8/13/2015 at 8:19 pm, Rodrigo De Marco said...

Nice case as always! You are on a roll my friend!

Do you have any pictures of the prep? How thin are the veneers? What cement did you use? Did she have ortho extrusion of#6?

Thanks, Rodrigo. I prepped with Brasseler's .3/.5/.7mm tri-planar depth cutter. After smoothing, these were around .4mm thick at the gingival margin. I bonded with Optibond and NX3 transparent. No ortho, just perio surgery. 


Looks really nice, buddy!


Very nice Ross

i still struggle to create thin eMax even though this is my preferred material. 

How do you get it so thin? - bio copy, setting your parameter thickness very low, then bulking margins and hand polishing back?

Thanks. 


On 8/14/2015 at 7:31 am, Ken Heath said...

Very nice Ross

i still struggle to create thin eMax even though this is my preferred material. 

How do you get it so thin? - bio copy, setting your parameter thickness very low, then bulking margins and hand polishing back?

Thanks. 

Ken, I feel your pain. My strategy for larger multiple same-day anteriors is Biocopy in segments, a fresh 12 step bur (not 12S), dial up my margin thickness to 100-120, and over bulk the design of necessary then hand-polish back. 

To me, the key to these thin cases is to start at the end point with outcome-based tooth preparation. That means I have some type of intraoral approved mock-up that establishes the final desired external outline form. I Biocopy that intraoral prototype and then prep through it using the depth-cutting burs. The point is that you can control your eventual ceramic thickness so that you have an even appearance across the smile, even though the ceramic is very thin and relatively translucent. This allows you to use the underlying tooth to influence the overall look, instead of fighting against having different thicknesses and dentin shades. Of course, that's a double-edged sword, which is why thin-prep isn't ideal for a majority of cases. 


Ross 

Thank you for posting this beautiful. I am doing 4 veneers next week. My first since level 4. I an thinking of using triluxe. I have the impulse blocks but we decided on A2. Her teeth are on the dark side wanted to lighten them a bit. I have empress multi also. Any suggestions. I'm on vacation so no pictures. 

Carrie

 


On 8/14/2015 at 9:21 am, Carrie Polster said...

Ross 

Thank you for posting this beautiful. I am doing 4 veneers next week. My first since level 4. I an thinking of using triluxe. I have the impulse blocks but we decided on A2. Her teeth are on the dark side wanted to lighten them a bit. I have empress multi also. Any suggestions. I'm on vacation so no pictures. 

Carrie

 

Carrie, it's hard to say without clinical photos, but I would have no reservations with taking Impulse V1 to an A2 with some minimal stain and glaze and/or by going thin and allowing some chroma from the underlying tooth to show through.

You said the shade is A2, but what part of the tooth is A2? Body, cervical, incisal edge? Pick your block based on the highest value you see in the tooth you are matching instead of the overall "shade". Milling an A2 usually won't give you an A2 result (it's going to be darker), so pick based on value and stain to match. I think Mike is working on a cookbook formula, but in the meantime it takes some experience from trial and error. If you post some pics of the case, I'm sure you'll get a number of suggestions. 


Ross,

thank you for the advice. I love your preps! I don't have a camera like Mike's, I usually use an intraoral or my phone. I'll try on the Cerec machine. Her teeth are darker than an A2. But I wanted to lighten them up a bit. Body shade. I'll have to see the stump shade after prepping. My first Cerec veneers. After level 4 I am looking forward to adding my own touch to them rather than trusting the lab tech. 

Carrie

 


On 8/14/2015 at 9:11 am, Ross Enfinger said...
On 8/14/2015 at 7:31 am, Ken Heath said...

Very nice Ross

i still struggle to create thin eMax even though this is my preferred material. 

How do you get it so thin? - bio copy, setting your parameter thickness very low, then bulking margins and hand polishing back?

Thanks. 

Ken, I feel your pain. My strategy for larger multiple same-day anteriors is Biocopy in segments, a fresh 12 step bur (not 12S), dial up my margin thickness to 100-120, and over bulk the design of necessary then hand-polish back. 

To me, the key to these thin cases is to start at the end point with outcome-based tooth preparation. That means I have some type of intraoral approved mock-up that establishes the final desired external outline form. I Biocopy that intraoral prototype and then prep through it using the depth-cutting burs. The point is that you can control your eventual ceramic thickness so that you have an even appearance across the smile, even though the ceramic is very thin and relatively translucent. This allows you to use the underlying tooth to influence the overall look, instead of fighting against having different thicknesses and dentin shades. Of course, that's a double-edged sword, which is why thin-prep isn't ideal for a majority of cases. 

Thanks Ross - I think your point here about consistent thickness is spot on. I've used the intraday-oral prototypes which I've then bio copied very successfully ... But probably NOT got the consistent thickness, so that's what I need to nail more.  Sometimes being too conservative / thin with the prep makes your "lab" life much harder - but then again, we are all trying to preserve tooth, and have to get that balance.   I need to work on the Preps. Cheers mate.   Ken