It is no secret that any dental restoration driven by cosmetics, whether it be a single unit or a full arch, requires extra time and attention for both the dentist and the dental lab.
Here at Whatcom Dental Lab, we have had the privilege of working on thousands of cosmetic dental restorations. Over the years we have found some key factors that aid in ensuring a successful restoration and happy patients.
We want your preps and seats to go smoothly and efficiently because we know your time is valuable. By providing the lab with additional information, and taking some extra time to give the lab a solid foundation to build from, we are confident that you will experience better, more beautiful results.
Laying the foundation:
Case planning is a beneficial process for all parties involved. You as the dentist are able to take out the guesswork of the patient’s expectations and help them feel more confident about the process. The lab is much more likely to produce the results the patients are looking for on the first try.
Here are the tools and steps that you and the lab can utilize to help ensure success:
A Pre-Op impression.
Giving the lab a look at what the patient is starting with gives us a foundation to begin shaping the cosmetic changes. Knowing what the patient likes, and dislikes about their current smile is the best way to determine the style that the diagnostic work will reflect.
The digital diagnostic wax up.
Whatcom Dental Lab has moved exclusively to digital diagnostics. We have found them to be more efficient and precise and have decreased turnaround time. Digital diagnostics are milled from wax to give you and the patient realistic expectations of the outcome of the case.
With having a hands on look at what their smile could be, minor adjustments can be made ahead of time. You as the dentist can work with the lab to troubleshoot before the case is fabricated, rather than needing to remake and reseat a case.
Consider using an additive wax up.
An additive wax up is the same design of the diagnostic wax up, but is meshed with the pre-op model in order to be tried in the patient’s mouth. This can be done before the prep appointment at a separate consultation meeting, or if necessary at the beginning of the prep appointment.
This gives the patient a cheap way to try on the new look of the teeth, and help them determine their end goals. Additionally it serves as a reduction guide for the prep appointment.
Many doctors find that having patients who are on the fence about committing to a cosmetic restoration are more likely to go through when they get a chance to “test drive” their new smile.
Utilize the option for a lab made PMMA eggshell provisional.
Many patients feel less confident in their temporary crowns. Having a higher end temporary, in the form of a PMMA eggshell provisional, provides greater aesthetics for the patient. With the lab handling the temporaries, the dentist and staff are saved time by eliminating the need to make them chair-side.
Staining options allow for more character to be added to the restoration, creating a lifelike look in the mouth. This material is also strong yet lightweight. These factors are especially important if there will be a longer than normal timeframe between the prep and seat appointments.
During the prep appointment:
Best results come when dentists prep subgingival on both the buckle and interproximal margins. This creates a more natural emerence profile and helps us eliminate dark interproximal triangles.
We have seen a trend of dentists moving away from packing cord in lue of other techniques or products. Unfortunately we have yet to see those alternatives produce results as successful as cord.
A properly packed cord is necessary to accurately locate the margins and ensure that our restorations fit seamlessly without relying on cement to fill any missed gaps.
Sufficient reduction is needed.
In order for our crowns and bridges to fit properly, we need a minimum of 0.5mm of reduction. Less than that results in bulky contours on the facial and not enough room for a well fitting occlusion. More reduction than the minimum is of course preferred.
Record the stump shade.
As you know a dark stump shade will affect the crown’s shade once seated. Knowing the stump shade, regardless if it looks dark or not, is still helpful in ensuring the most accurate shade match. We have seen greater success in our shade matches with this information in hand.
Note if the patient is bleaching.
Many patients have confusion or misinformation surrounding the effects of bleach on crowns, or the proper timing on when to start the process. It is important for the patient to know that beginning to, or continuing to bleach their teeth after they have had their crown(s) prepped will likely result in a less accurate shade causing the crown to stick out from the others.
Take a post-temporary impression & pictures.
Ideally this should not be necessary given we will have the pre-op impression, or files from the diagnostic design. However, we have found that many factors will cause small changes in the temporary that the lab is unable to account for. Some of these factors include, adjustments to the temporaries after they are placed, too much cement, or even small distortions in the in-office made temporaries.
Taking another impression, and pictures, once the temporaries have been placed is an easy way to take out any unknown factors that will affect the fit of the final restorations.
Encourage a custom shade consultation at the lab.
Having your patient do a custom shade appointment here at the lab with Nate is the best way to ensure the restoration will fit seamlessly in the patient’s mouth. Not only will the custom shade be assessed and recorded, but Nate can consult with the patients about what other changes might be important to them.
We have found that often patients are either seeking to revitalize their old smile or create a brand new one.
Asking questions to help determine what is working or not working with the temporaries, and exploring their goals for the end result gives our technicians important details about the case they are sculpting. We have also found that this consultation helps put patients at ease with the process and feel more confident about undergoing the time and cost associated with cosmetic restorations.
It is important to note that if your client declines a custom shade consultation, it is necessary to take pictures in the mouth to capture and record the surrounding tooth shades and the details within the anatomy.
The final product:
The cases are manufactured.
We encourage our clients to reach out to us via call, text or email if they have any questions or ideas regarding the restoration. You are also welcome to come to the lab to discuss case planning or changes in person.
We want your patients to smile proud with their new restorations. If you or your patient is unhappy with the final look, we will work with you to remedy the issue at hand until everyone is thrilled with the end result.