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:
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.
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.
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.