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The list of adjectives synonyms of superb are numerous… Aesthetic, Excel, Natural, Premier, Reliable, Superior, Unique etc... . These are not just adjectives, however, but dental laboratory names from our in-house license manager software that helps us keep track of both existing and prospective customers. Many of the others in this industry are family names—names such as Dantonio, Glidewell, Killian, Rogers, Root---reflecting years of hard work to establish strong reputations for the very same superb characteristics.
It is always interesting to plan and finish a dentist’s case. They are the most discerning of patients of course, but are also extremely appreciative of our efforts, because they know the amount of work that goes into the final result.
Ahealthy 68-year-old woman presented to the “Faculty Practice Clinic” of Herman Ostrow School of Dentistry at the University of Southern California for treatment. The patient presented with an old complete denture with severe occlusal wear. The patient mentioned that “she did not want to wear the dentures anymore and that she wanted something fixed”.
The utilization of laminate veneer in anterior dentition is the most documented approach in literature for procedures such as extensive smile changing. Among the advantages of this restorative strategy is the possibility of achieving a perfect harmony between soft and hard dental tissue. This harmony is possible thanks to the physical properties of the ceramic, which remains stable for a long term. However, to obtain a perfect balance besides soft tissue health and function the clinical success is dependent of a major factor: the bonding procedures.
Thirty years as a removable dental lab owner and technician has taught me many invaluable lessons, not the least of which is the necessity to constantly re-evaluate the products and fabrication techniques that my laboratory uses to produce the removable appliances delivered to my clients. For a small laboratory serving a select clientele of dental offices, my primary objective is to provide my clients with finished appliances of exceptional quality that best replicate natural dentition and provide greatest functionality for each particular patient. In this quest to enhance and customize dentures, I have looked at many aspects of fabrication including: articulator designs, acrylic choices, processing techniques, and methods for naturalizing denture bases. For my laboratory, however, one of the single most significant enhancements to product appearance and functionality has come in the area of posterior and anterior tooth selection.
The first overpressing procedures performed by my lab date back to 1999. The material used at the time did not always respond to expectations. Today, thanks to research and innovative materials, excellent results can be obtained. Overpressing is the ideal solution to optimize work processes. The simplicity by which a natural aspect can be obtained is determined by a high level of pellet translucency (Fig. 1) and stains (Fig. 2) grinded thinly with reduced oxide levels; thereby, conveying a brightness to the element similar to natural teeth. Surely overpressing procedures were conceived for extensive bridges.
Perfectly matching a single central anterior tooth is nearly impossible. Mimicking natural teeth completely, while always very difficult, becomes even more of a challenge when a patient easily dehydrates. Patients who have an abundance of saliva are easy to match during a custom shading appointment because the teeth are wet and do not dry quickly. This means that the technician has time to analyze the layering of the dentition enamel and translucency because everything works all together at the same time. However, if a patient quickly dehydrates, the color is lost easily and it’s difficult to figure out exactly what we are seeing. The only way to accurately accomplish this is to re-hydrate the patient and even then the time limit will run out quickly – a 1 to 2 minute maximum after the patient opens his/her mouth.
As a dental technician for over two decades, a large amount of my time and energy has been concentrated on the sometimes difficult shade matching process. With a large variety of ages in my patient base, I have been asked to work with many types of colors and characteristics over the years. Numerous times, even with the best of intentions on my part, the final restoration has not matched and has needed adjustment or repair. Through this experience, I have learned valuable lessons about a variety of dentin and translucency colors.1, 2
Every technician has their own concept about color matching. By relating some of my own experiences in this commentary, I hope to help others in the industry so that my mistakes are not repeated.3, 4
The loss of the interdental papillae is a grave consequence of periodontal disease. Surgical reconstruction is still not feasible. There are several approaches to reducing or masking the black triangles which occur as a consequence of the missing papillae. Conventional restorations are an option if the teeth additionally show increased mobility. If this is not the case, that is, if the periodontal tissue is healthy, it is crucial to find a biomimetic solution, meaning that the restoration should take esthetic, biomechanical and biological factors into account.
The development of dental composites offers tools to reproduce the optical properties of dental tissues in great detail. We have several systems that are composed of dentine masses, which reproduce the yellow-orange shade of natural teeth at different levels of saturation and with similar opacity to natural dentine, enamel and translucent bodies, and also with varying degrees of translucency which permit similar results to dental tissue upon passing light through them.
The cases shared in this article are the result of the collaboration between European technical artistry and a contemporary movement towards conservative dentistry in Southern California. Willi Geller inspired the development of the “additional veneer concept”.
His insight into the optical properties of dental porcelain material was translated into a demonstration of a novel ultra-conservative technique for porcelainbonded restorations. Cases 1 and 2 represent theresult of the treatment of patients during a hands-on course by Willi Geller.
The patient in our case study is a woman in her 50’s. Her husband is a dentist and as an employee in his office, her smile is an important part of his practice - for obvious reasons. She presented with a slight misalignment of the maxillary anteriors and her teeth color lacked brightness. The consensus was that the appearance of her teeth could have been better.1 However, as they considered whether to change the teeth in question, # 7-10, they were concerned about the fact that they had been previously untouched. They really could not decide whether it was necessary to proceed with any preparation - knowing the teeth were healthy in structure, and just cosmetically challenged.