STAYING FOCUSED

Critical Details in Executing Shade Communication

by Joe Weisz, CDT, BonaDent

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I’ve spoken often — both here on Filling in the Gaps and in other venues — about the usefulness of photography when it comes to communicating shade and desired contour. It can step up the quality of your restorative work immensely. The challenge, however, is that proper utilization can be a little more complicated than just pointing your camera at a subject and snapping a picture.

Common mistakes quoteThis is because, unlike what they say, a picture can actually lie. You’ve probably guessed this already after seeing the myriad of settings and filters found on even the most standard of cameras. Opening the aperture up just half a stop more, or moving even the most innocuous-looking dial one step to the left can change the final result wildly.

Color is the way your eye interprets light waves bouncing off of a given surface. The camera is only useful in communicating shade when it gets as close to imitating the human eye as it can. It’s not impossible, but can be tricky. The good news is that the most common problems often lie in the most mundane and low-tech of protocol mistakes. So here are four things to keep in mind when chairside in order to avoid a costly adjustment or remake:

Timing is crucial

Image A copy

Image A

Always take a shade at the beginning of the appointment when teeth are fully hydrated, and before giving any anesthetic. If you wait until after tooth preparation, the enamel will have dehydrated and the value of the tooth you’re trying to match will appear higher in the photo (as it does in Image A above).

Always ask if your patient is bleaching, has bleached in the past two weeks, or is planning to bleach. Teeth need 2-4 weeks to settle into color once bleaching is completed. So if the answer is yes, wait until that process is completed before taking photographs.

Composition, composition, composition.

Image D

Image B

Image C

Image C

Communicating shade doesn’t require a Fine Arts Degree in Photography, but knowing how to properly compose the frame makes all the difference. Always be sure that your patient is standing or sitting face-to-face with you. If not, there may be a discrepancy in the color’s appearance (as in Image B above). Always hold the shade tab incisal edge-to-incisal edge with the tooth you want to match, ensuring that both the shade tab and the target tooth are on the same axial plane. It will be difficult for the technicians in the lab to select a shade if the wrong tooth (namely the one that is being restored) is the one that is being matched (Image C above).

Image B

Image D

Be sure the tooth to match is fully visible. This may seem like a non-issue, but even with retractors, the upper lip on some patients can sag at the midline and cover the centrals (as it does in Image D). It’s much easier to have your patient simply lift their lip out of the way with their fingers.

Also, try to exclude from the frame any colors that contrast heavily with the shade tab, as this can distort its appearance in-camera. If the patient is wearing lip gloss or lipstick, kindly ask them to remove it. (The shade tabs in BonaDent’s Anterior Expert Kit are permanently affixed in pink holders that mimic the soft tissues around teeth, thus eliminating any problems due to contrast enhancement.)

Choose the right camera and set it properly.

Communicate Shade quoteThe best part about having an in-office camera exclusively for communicating shade and contours with your laboratory is that you can set it and forget it. Need help figuring out what camera to buy and what settings to use? You can read our blog on the subject. (Or contact me personally. Many doctors have shipped their cameras directly to me, so that I can do the setting for them, or they’ve requested that I personally order their cameras to ensure they buy the best product for their needs. It’s something I’m more than happy to do. Just reach out to me at fillinginthegaps@bonadent.com.)

Lighting matters.

Image E

Image E

If you plan to use photography to communicate shade using a traditional shade tab, it helps to have the most natural light you can in your office for optimal color perception. We recommend daylight corrected bulbs at 5000 to 5500° Kelvin. If you’re using a system that lets the lab technician make the selection for you — like our Anterior Expert Kit — this won’t be necessary. With both methods, always use a flash to avoid a shadow from the upper lip (Image E). For this, we recommend a twin flash as it’s less likely to wash out the details of the tooth as some other flashes tend to do.

It may take a little additional work on the front end, but, we assure you, the more attention you place on these four essentials, and the more detailed you aim to make your shade photography, the more predictable and life-like your final result will be.

                             

Have questions for Joe about the steps it takes to achieve winning photography for shade and contour communication? Send him an e-mail at fillinginthegaps@bonadent.com.

To learn more, visit our website at www.bonadent.com.

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ENHANCED PRECIZION, ENHANCED SUCCESS

by Heather Voss, CDT, BonaDent

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complex-case-montage

Dental restorations — like the patients that need them — come in all shapes and sizes. Recently our founder Angelo Bonafiglia blogged about what can still be accomplished with traditional dentures, and BonaDent remains a great resource for life-like, esthetic removables. But what about those full-mouth restoration patients who think it over and decide they want something a little more permanent? Well, I’d like to introduce you to our PreciZion Bridge.

statement 1BonaDent’s PreciZion Zirconia Restorations are the perfect solution for a case that requires screw-retained accessibility while also providing superior functionality, durability, and esthetics. Through the use of sophisticated CAD/CAM technology, PreciZion offers the incredible strength of a monolithic zirconia ceramic, along with titanium implant components that eliminate potential for fretting of the hex. We further enhance the life-like esthetics thanks to our proprietary multi shade process that infuses the zirconia with color prior to sintering.

So what do you need to do in office to prescribe a successful PreciZion restoration?

  1. For full arch cases, you will need 12-mm of vertical space for each arch in the posterior to accommodate proper strength connections. This is critical for cantilever cases. We can likely do non-cantilever cases in 8-mm to 10-mm. You will need at least 24-mm for a maxillary and mandibular combination. (Note: To facilitate seating of the 2-CONnect abutment and related bridge work, it is recommended to place 6-mm diameter healing abutments.)
  2. You will also need properly positioned implants. This includes no more than 30 degrees of divergence for any implant with a bridge.
  3. Provide a conventional implant impression using the correct transfer copings as well as an opposing model.
  4. At BonaDent, we have a list of specific compatible implants. The full library can be found here.
  5. If you are providing a wax-up or study guide (which we highly recommend), it must seat on the articulated model, and be removable from that model, similar to a denture set-up. For mandibular cases, a study cast of existing tooth set-up can be utilized.
  6. Finally, provide us with a centric bite registration.

Once your case is received, we will create the design and send a PreciZion verification bridge milled from PMMA material. This verification bridge will be our blueprint — we won’t fabricate a final zirconia restoration without it.

PreciZion-Montage

Image B

Once the verification bridge has been tried in and later approved, we mill the final restoration from solid zirconia. Then, our ceramic artists create naturally beautiful esthetics using our aforementioned proprietary multi shade process prior to sintering. We wrap everything up in the lab by staining and glazing, and adding pink porcelain to replicate gum tissue. (Image B – left to right)

PreciZion-in-mouth-pics

Image C

statement 2c choices

Finally it’s back to you in the office for insertion, and the delivery of a satisfied patient with a new smile to be proud of. (Image C)

Keep in mind, this process isn’t just for full-arch cases. PreciZion screw-retained zirconia can also be utilized for single units, small and large span bridges, and comes with a five-year guarantee against breakage. So if you’re looking to simplify even your most complex cases and deliver your full-mouth restoration patients the ultimate in long-term comfort and satisfaction, consider prescribing BonaDent’s PreciZion Bridge.

                              

Have questions for Heather about how to deliver your patients the best solution with our PreciZion Bridge? Send her an e-mail at fillinginthegaps@bonadent.com.

To learn more, visit our website at www.bonadent.com.

Like us on Facebook: https://www.facebook.com/BonaDent

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