Shade Communication - Part 2: PhotographyNot that long ago dentists simply wrote the shade on the prescription and asked that the restoration match it exactly or they gave a written description of how to change it. Never mind that the same tab is likely a little different on each version or that verbally describing color is ridiculous at best. Imagine instructions like, “add more translucency” and pretend that we all have the same measurement of more, a little more, or a lot more.
Most top ceramists generally agree on what is important in photography, while lamenting that they don’t receive it often enough. Most of you are familiar with our head ceramist Gary Nunokawa through his work at the Kois Center and other educational venues. I want to use this opportunity to give you insight on what an accomplished ceramist wants in photography and what Gary sees in the different photographs. Dene LeBeau Photography, Color and What Matters by Gary Nunokawa
0 Comments
The Lighter Shades of DentistryA collection of some of my favorite dental humor Hygiene Pedo Food Trap Pedo Cosmetics Restorative Ortho Collections The End - Dene LeBeau
Zirconia vs. Metal - Ceramics: Dollars & SenseAt $1700 per ounce, precious metal has become one big downer for fixed dentistry. We are now half-heartedly giving zirconia a second look, but we still suffer PTSD from old memories of failed cases. Remember back when it came in one stone white material that killed esthetics and the layering porcelain chipped away from itself. Poor design, loose fits and open margins didn’t matter so much because the porcelain was likely to shear off anyway! Dark dental days indeed and our leaders were right to sound the clarion call to cease and desist!
I am talking about Reinforced Porcelain System (RPS), a little known nearly bulletproof system for metal ceramics. We used it for over 20 years because it was just too logical to ignore, so take a look at the link. When zirconia came on line, we lost our design niche because we were completely dependent on the milling centers. Our special design went MIA. Also, early zirconia layering porcelains were predisposed to chipping and under fired porcelain made things worse. Zirconia Design By now you sense that I believe in design first, so fast forward to lab owned scanners. For the record, we use the 3Shape CAD Design for our digital workflow and then outsource the case to high tech mills. Make no mistake about it, real design and doing it digitally is a real skill set.Technicians and milling centers are not created equal, so education needs to be involved. A more recent study that labs and dentist should read is Modified Veneered Zirconia vs. Metal Ceramic. This study lends credence to the importance of design in zirconia vs. metal ceramics and can help us understand design fundamentals. When designing zirconia, my lab uses a strategy we call monolithic layering combined with RPS strategy.
Going Forward Today most dentists quietly deliver fixed zirconia work while awaiting some magical endorsement of perfect. We didn’t let “perfect” get in the way of “really good” in metal ceramics, but it is no longer a viable option due to extreme metal cost. Financially and esthetically, we need to use zirconia today and it should be all about design! Doctors or Lab feedback welcome!
- Dene LeBeau Seating Custom Abutments: JKADHow many times have I heard it said that we must allow the soft tissue to “be contoured” around some crown shape in order to end up with an esthetic implant restoration? Periodontal and biological principals dictate that we can generate natural appearing restorations from impression to delivery without the use of tissue forming provisional restorations. While this is not always possible, the development of anatomic simulating abutments like JKAD is an artistic solution to transform the contour from the diameter of the implant prosthetic platform to that of a natural clinical cej on which we cement a crown. An issue that many labs mention and doctors decry is that the “natural abutment” will not fit into the tissue upon removal of the healing cap. How can we make restorations that properly emerge from the implant top and support papilla to mimic the adjacent teeth without resorting to ridge-lapped mushroom cloud crowns, which collect food? When the diameter of the healing cap is used to form the emergence profile of the crown, the crown often takes the shape of a mushroom and creates a poor environment for hygiene One easy solution is to utilize larger flaring secondary healing caps, which create most of the space required. If more tissue “stretch” is needed then a simple incision to the mesial and distal col accompanied by gentle elevation with a Molt or similar periosteal elevator will allow easy seating. A second key is that a fresh wound will institute healing so that the tissue itself will form to the ideal contour of the abutment rather than having the crown/abutment forming to random tissue configuration. NO sutures are required. This follows the same concept that pontic site development does for ovate pontics. Another example is the subgingival emergence of the bulges on titanium bite posts. When the tissue is thick or tall, the apical or second bulge on the bite post can be submerged below the tissue making it difficult to fit back onto a solid gypsum cast without creating a soft tissue model. The lab can overcome this obstacle by adjusting the stone and creating the ideal abutment contour. They need not worry whether it will passively fit inside the soft tissue contours at delivery. For those that feel we still must create a tissue forming provisional, I ask; who does a better job? The dentist who arbitrarily creates a temporary crown on a stick abutment, or the lab who can measure and create an engineered anatomic abutment? For the same reason bone sounding with a probe allows us to know where to put a crown margin, JKAD allows us to create esthetic implant crowns. If the abutment doesn’t fit into the tissue then pick up a scalpel and cut away!
– Mark W. Wilhelm DMD, MSD |
Dental Street Blog
Categories
All
Archives
November 2022
|