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.

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

Follow us on Twitter: https://twitter.com/Bonadent

PEACE OF MIND IN A PURPLE BOX

by Joe Weisz, CDT, BonaDent

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Anterior-expert-Kit-copy

Image A

I’ve discussed in previous blogs the struggles you go through when taking a shade, but we all know that’s neither the beginning nor the end of your stress when it comes to doing Anterior Restorations. A number of troubling thoughts can enter your mind at any moment (likely from challenges you may have previously experienced), such as:

  • What if I get the final restoration back but the occlusal plane is canted or the midline is off?
  • What if the final restoration doesn’t replicate the provisional contours my patient is madly in love with?

Nothing makes your heart pound more than the idea of having to send a case back and forth to the lab for multiple adjustments, or — worse yet — a remake. Well, you can put those worries behind you. I’ve been working closely with our Anterior Specialists at BonaDent to develop an easy-to-use kit for dentists of all ages and experience levels. We call it the Anterior Expert Kit (AEK), and in it we provide dentists with the highly specific tools necessary for handling the challenges associated with Anterior cases, large or small.

Three fundamentals to tackle when it comes to restoring Anterior cases are:

  • Treatment Planning and Lab Communication
  • Shade Selection
  • Preparation and Proper Reduction

Let’s take them one at a time:

cois-analyzer

Image B

occlusal-plane-pic-copy

Image C

1.) Treatment Planning & Lab Communication

Taking the time to think through the case with your laboratory before proceeding is critical. Knowing what can and can’t be achieved plays a crucial role in case design and material selection. For assistance with treatment planning, we’ve included the Kois Dento-Facial Analyzer, an essential instrument that will guarantee that all the models — from the diagnostics to the provisional to the model work the final restorations are fabricated on — are properly mounted. This ensures that the restoration’s incisal edges, occlusal table, and midline are all properly oriented to the patient’s facial midline (Images B & C). The Dento-Facial Analyzer also improves upon the traditional “stick bite” as it can be mounted to an articulator, producing consistently predictable results. And the best part is that the removable, disposable index tray with the bite registration is all you send to the lab. The Analyzer itself always stays at your office, ready for the next time you need it.

From this mounting plate we can begin the diagnostic wax-up. I discussed the importance of diagnostics in an earlier blog, but will take a moment to reiterate how this very critical step will ensure that the case blueprint is properly designed and executed before moving on to the prototype or provisional stage. We’ll use this diagnostic to produce reduction guides as well as the prototype provisional that the patient will wear to try out their new smile.

AE-Tabs-Perfect-Example.002-e1386109652140

Image D

2.) Shade Selection

When it comes to shade, our motto is “Stop taking shades and start taking photos.” Believe it or not, when using the AEK, we’ve asked you to stop selecting shades altogether. We’re more interested in your photography. Before prepping the teeth, simply photograph our 8 shade tabs (included in the kit) edge-to-edge with the tooth you want us to match – it’s really that simple! (Image D) (See our recommended camera system and settings here.) Once completed, our Anterior Specialists will accurately determine the correct value, hue, and chroma for the restoration(s) being created.

3.) Preparation & Proper Reduction

For your convenience, we’ve included a custom designed selection of burs for adequate reduction when preparing both full coverage and veneer cases. In addition, you’ll find three-dimensional models of ideal preparations for your reference.

filling_in_impression

Image E

calipers

Image F

To ensure that you achieve proper reduction, the AEK includes a highly accurate dial caliper. As mentioned previously, at the diagnostic phase we’ll provide you with a matrix of the approved diagnostic. When making your temporaries, simply inject your provisional material into this matrix and seat your preps (Image E). Remove the temps and take a measurement of their thickness using the dial calipers (Image F). Ideally, the thickness should be about 1.2mm at the incisal third. This guarantees that our ceramists have enough room to build those same contours into the final restoration. If you’ve ever heard a patient say, “I liked the shape of the temps better,” or “These look/feel bulky” after receiving the ceramic restorations, the caliper thickness check at the temporary appointment will eliminate these concerns in the future. If, after checking temp thickness, you find it is too thin to replicate in ceramic material (feldspathic, lithium disilicate, etc.), you have the opportunity to make final prep adjustments while your patient is prone and available.

Packaging It All Up

Despite the usefulness of each of these tools separately, the greatest benefit of the AEK may be that it’s all in one place. All the materials stay in the box, ready to use when they’re needed. And the kit itself functions as an impressive presentational tool for you to your patients. Nothing says “Expert” quite like displaying the Anterior Expert Kit in your operatory and confidently getting to work with all the features provided.

Leave your worries about canted midlines, missed shades, or the need for remakes behind you. With the AEK, you have all the tools necessary for delivering great results the first time, every time.

Become an Anterior Expert today!

                             

Have questions for Joe about how our kit can turn you into an Anterior Expert? Send him 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

Follow us on Twitter: https://twitter.com/Bonadent