Veneer prep before. Although creating exquisite temporaries is difficult and often frustrating, it remains a vital part in communicating with both patient and lab. Most patients who are having their anterior teeth treated have the end result of a white smile in mind, but some patients can be different. There will be times when a patient doesn't necessarily want bright white teeth and will want you to create a natural looking result with both irregular contour and arrangement, as well as natural shade and characterization.

For these patients, it is critical to be sure of what they are trying to achieve so it can be clearly communicated to the lab. It is very frustrating and costly to get a set of anterior restorations back from the lab, try them in, and have the patient tell you that they don't look anything like what they wanted.

The patient you see in this picture insisted that he didn't want straight white teeth as an end result of his restoration. In fact, he hesitated on letting me treat his anterior teeth because he feared the restorations would look too nice and alter his look too much. The challenge is to identify what he really wants in arrangement, shade, and characterization so it can be effectively communicated to the laboratory.

His existing incisors were a virtual shade guide, each being a different color, the one he liked best was a Vita classic A3.5, much darker than what most patients want. This was not a problem at all; customizing colors can be done easily by staining the temporaries. My favorite technique uses a light cured resin (Palaseal, from Kulzer), and I mix powdered porcelain stains from any porcelain company in the Palaseal to create the shade stain I desire.

Given the experiences I've had with these types of patients, I always try to make the temporaries a couple of shades lighter than what they originally asked for to negate the risk of them looking too dark. If you make them the darker shade and they don't like them, it is a remake; however, if you make them too light for the patient it is a few minutes of staining to darken them. In addition, it allows the patient to see what lighter teeth would look like and sometimes they like them. I made his temporaries a Vita Classic A1 for this reason. After putting the A1s in his mouth, he hated them and wanted the teeth darker.

Veneer prep after. To rectify the situation, I then used my Palaseal and porcelain stain to give the patient the result he wanted. Typically any blue porcelain stain for the incisal edge along with any orange porcelain stain for the cervical and body of the teeth will yield the results you are aiming for.

After mixing, I applied the stain to the temporaries. Within minutes we were able to achieve the color he wanted, photographed the temporaries with the closest shade guides, in this case A 3.5 and sent the photos and models off to the lab.

The final picture shows the end result that he was extremely happy with.

 

Frank Spear, D.D.S., M.S.D., is co-founder of Spear Education and a member of Spear Resident Faculty.


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