My first post! And my version of one of the hardest things we do in dentistry- matching the color of one single unit anterior crown to the existing dentition.

A few reasons I wanted to share this case, because I think we all go through it:

1) I learned a bunch because it really didn't go smooth. Thankfully, the patient was a pleasure to work with.

2) The Restorative Design Workshop, thanks to Bob Winter and Gary DeWood, reminded me why Spear is so valuable.

3) Just when I thought I communicated well with a lab because I sent photos, I learned there can always be more information shared between dentist and lab tech.

This is a case I just completed. A replacement crown for #10 using Emax. I started the case in early December and have just delivered mid-February, with multiple attempted deliveries in between. Thankfully, I attended the Restorative Design Workshop in January while the patient was in her provisional so I could bring home the pearls and wisdom gained in the workshop and apply to the case. It's still not perfect, but thanks to the workshop we got pretty close and wasted less time/appointments getting there. Speaking just for myself, in the past I have delivered these single unit crown cases when the esthetics come out pretty good and the patient is pleased, but I know it could be better. I may not be sure how or why it could be better, but I know it could be better. Attending Restorative Design really helped make a lot of connections about materials, equipment, photography, lab communication, and prep design and how all these factors effect case result.

Here goes:

Patient wants #10 replaced because she is unhappy with esthetics and "wants it to match other teeth better". Of course, I'm thinking I know I can get it looking better than this. Easy enough, but it's a different story to get it looking like a tooth!!

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Next photo is after removing the old crown. Not much tooth left, especially in the facial-lingual dimension.

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Notice the patient is missing #7. I failed to give my lab tech any guidance on shape, size or dimension for #10 and he sure can't mirror image #7! I did provide the above pre op photos in addition to one with shade tab. Also, #8 & #9 have some pretty distinct characteristic and are different color than #11.

Next photo of first delivery attempt-

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The patient and I both did not like the shorter length and it looked too dark. This photo went to the lab along with the crown. Back on with the provisional which is next photo-

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Next photo is second delivery attempt-

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Better length, but still too dark and maybe a bit overdone on the staining. Back on with the provisional and sent this photo to the lab asking to make it lighter and then stain in the characteristics. Patient also says "I like my temporary better". Clearly, the provisional is nothing fancy, just a basic Structure temp made from pre-op alginate.

Now I head off to Scottsdale and attend the Restorative Design Workshop with Bob Winter and Gary DeWood. Bob is talking color, hue, Emax ingots, opacities and translucencies. Sure enough he shows an example of a too translucent crown that looks dark, exactly like my first delivery attempt photo. A great example when your colors and stain may be correct, but when using the wrong type of porcelains, things can still look too dark. I immediately thought of my patient saying she liked her temporary better (which has no enamel) and realized the source of my problem- I wasn't thinking of how my prep design would effect the resulting dimensions of my final restoration. When I removed the original crown there was hardly any tooth structure left from the first time it was prepped 20 some years ago. This means my new crown thickness was going to be much greater than usual, especially on the facial aspect.

Returning back home, I was now able to better discuss the case with the lab tech and describe what I saw in the tooth prep with it's relation to it's future restoration. We had the crown stripped down to the core, then re-layered with more thickness of dentin porcelain and then the usual amount of enamel translucency. The next photo is our final result, after some chairside staining. Still not perfect, but the patient was thrilled and very appreciative of our team being determined to "get it right".

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The Restorative Design Workshop gave me a greater appreciation for the amount of information I can use to communicate with my lab. It also gave me a great understanding of the value of 0.2mm. To be completely honest, I didn't think I needed Restorative Design because I already "knew how to prepare teeth." Boy was I wrong!! I still may not be able to see the difference in 0.2mm as I prep a tooth, but I sure do have a greater respect of what 0.2mm can do for the case in the lab! I've also enjoyed sharing more details with my lab tech on materials choices and have even thanked him for all those times he's made my dentistry look good when I didn't give him much to work with!!