Here are nine simple, yet very powerful, strategies that will dramatically increase the success rate of any shade-sensitive case, whether it involves bleached shades or not:
One- Annotate everything you do very carefully, including: the opaques and opaque modifiers used; the recipe for the opaceous and body dentins; the enamels selected; a schematic of the buildup; and any additional information that will help you--or your colleagues--recreate the shade accurately without relying on memory.
Two- Bake a sample crown as a test for the patient or for yourself. This, together with its detailed recipe, is invaluable for future cases. Remember that every single anterior crown is merely a sample until it is definitively cemented!
Three- Carefully check the shade of the opaque before continuing with the buildup. The thinner the crown, the more important this layer becomes.
Four- Bake a tab of modified opaceous and body dentins before the buildup to ensure that they will be adequate. Keep them for future reference.
Five- For complex shades with many color variations and characterizations, use a "live-stain" layering sequence as follows: -Build the crown in a slightly lighter shade than needed. -Build to exact contour plus a little extra length and bake. -Adjust the shade with stains and fire. -Complete with enamel powders to compensate for the shrinkage of the first bake, then shape and glaze.
Six- For bright opaque shades, try using a white opal enamel.
Seven- For translucent light teeth, use brighter dentins, since the more translucent enamels you need to use will lower the value.
Eight- For bright translucent shades, the cutback of the dentin is very critical due to the marked contrast of the enamel and body porcelains: carry a thin lingual wall of opaceous dentin almost to the incisal edge to control the light transmission in this area.
Nine- Experiment, be creative and, again, keep detailed notes. This habit alone will improve your artistic skills immensely, reduce stress and save valuable time!
© 2015 LMT Communications, Inc. · Articles may not be reprinted without the permission of LMT
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