MASTER TECHNIQUE

6 | AUGUST 2005
Beyond White and Bright
Cosmetic
Restorations
Redefined
by Brad Jones
with the case, teeth to be restored, type of
restoration desired, preparation shade, detailed
shade-mapping, type of light source used to take
the shade, shape desired, crown lengths (centrals,
laterals, canines), the amount and color of incisal
translucency, surface texture, and any other
relevant miscellaneous information (Figs 5-6).
The items that must be included with the case are:
one or more master impressions, impression of
opposing arch, preoperative models, diagnostic
wax-up, bite records, transfer jig, model or
impression of the approved provisionals, and a
matrix for determining the buccal-lingual position
of centrals. Equally important are photographs of
the preoperative smile (standard 12 AACD shots),
Key Words:
Cosmetic
Dentistry,
Brighten the
Smile, Pulse
Pressed Ceramic,
High Value
CASE OBJECTIVES
There were three main objectives to this case.
The first was to straighten teeth #6-11. The second
was to brighten the patients smile, and the third
was to widen the buccal corridors (Fig 1-4).
NECESSARY TOOLS
It is essential for technicians to have all the
information necessary to complete the case. This
begins with a diagnostic wax-up, which will be
evaluated from the photographs of the patients
smile in the form of a provisional. In addition, it is
extremely useful to receive a complete laboratory
aesthetic prescription that includes the goals of
the final case, a checklist of the items included
Cosmetic dentistry is a fast growing segment of dental restorations. Meeting
the demands of this special segment of the market is a challenge many
dentists and technicians are rising to meet. However, these restorations
continue to be redefined as something other than strictly white. In the
following case presentation, Brad Jones describes the materials and
techniques unique to these restorations.
AUGUST 2005 | 7
MASTER TECHNIQUE
Fig. 1. Full Face Pre-op Smile. Fig. 2. Retracted Pre-op.
Fig. 3. Natural Smile Pre-op.
Fig. 5. Detailed Aesthetic Prescription (front). Fig. 6. Detailed Aesthetic Prescription (back).
Fig. 4. Retracted Pre-op.
MASTER TECHNIQUE
8 | AUGUST 2005
eyebrow-to-chin photos of stick-bite, and
eyebrow-to-chin photos of the natural smile with
approved provisionals (taken a couple of days
after prep appointment).
Lastly, high quality model fabrication insures an
accurate result (Zeiser Dentalgerate GmbH;
Meteor Design, Twin Falls, ID).
WAXING AND PRESSING
A silicone putty matrix was formed over the model
of provisional (after a few improvements were
made) and quickly placed in a pressure chamber
at 60 psi for better adaptation. This matrix was
then used as a mold to inject wax over the
lubricated dies. This injection process accurately
reproduces the patients provisional including any
minor changes made to the provisional model to
perfect the case.
MATERIAL SELLECTIONS
In nature we find centrals predominantly higher
in value, laterals lower in value, and canines more
chromatic and less translucent. For example, if a
Fig. 7. Horizontal Plane Guide Reference Photo. Fig. 8. Prep Shade Photo.
Fig. 9. Wax-up Photo. Fig. 10. Pressed Units Fitted to the Dies.
High quality
model
fabrication
insures an
accurate result
AUGUST 2005 | 9
MASTER TECHNIQUE
doctor prescribes a Chromascop 040 shade, it is
best to use this shade for the laterals and bicuspids
only. Generally, central incisors are one shade
lighter (030) and canines one shade darker (like
110 or Vita B1.) In selecting a ceramic material,
look first at the color of the preps. This patient
had perfectly light colored tooth preparations to
work with (stump shade #9).
Commonly, preps are naturally orange-pink in the
cervical, khaki in the gingival interproximals, and
sometimes slightly translucent at the incisal tip. It is
of great importance to utilize the patients own prep
shade to influence the final restoration whenever
possible. This allows the cervical of the restoration
to integrate seamlessly into the gingival tissue.
In this case, a new pressable ceramic called Pulse
was used (Microstar/Jensen Industries; North
Haven, CT). This material has all the strength of
the Authentic (Microstar/Jensen Industries)
pressable, and has the unique ability to blend in
the oral environment. These ingots have an
enamel-dentin look to them.
Fig. 11. Pre-op Model Occlusal View. Fig. 12. Pressings on Dies Occlusal View.
Fig. 13. Minimal .3 mm Vertical Reduction. Fig. 14. .5 mm Incisal Facial Bevel.
In selecting
a ceramic
material, look
first at the color
of the preps
MASTER TECHNIQUE
10 | AUGUST 2005
The bleached Chromascop shades 010 040 are
typically too high in value to render a natural
appearance (I had all my doctors bury their 010
and 020 shade tabs in their back yards). A greater
percentage of patients will want these shades if
they are presented by the dentist. A more natural
appearance is attained by using (slightly more
translucent) 030 for the centrals and a more
translucent version of 040 for the laterals and
premolars. The target shade for the canines is A1
cervical and B1 body. The canine should be
denser in appearance (less translucent).
To achieve these Chromoscop shades, the
following Pulse ingots were selected: BOO+ (high
value 020 in color) ingot for the centrals, BO
(matches the B1 shade tab in chroma and value)
for the laterals and pre-molars and A1 (more
chromatic) for the canines. This subtle color and
value shift between ingots emulates similar shifts
found in natural dentition and puts us well on our
way to replicating the natural smile even before
ceramic layering begins (Figs 9-11).
Fig. 15. Soften Sharp Cuts. Fig. 16. Cut-back in Matrix.
Fig. 17. Grey-blue Stain in Grooves, Orange Pink Between Lobe Detail. Fig. 18. Powder Effects.
After divesting
and fitting
each unit we
are ready to do
the enamel
cutback
AUGUST 2005 | 11
MASTER TECHNIQUE
CUTBACK
After divesting and fitting each unit we are ready to
do the enamel cutback. This starts by reducing the
incisal 0.3 mm in length (Fig. 12). The perimeter of
the area reduced is marked with a red pencil. Then
a line is drawn 0.5 mm in from the facial edge
using an extra-fine pencil (Fig 13). The incisal edge
is then beveled halfway down the facial using a
contouring stone (Brasseler USA, Savannah, GA).
A straight groove is cut into the mesial incisal edge
and then a curved groove is cut into the distal
incisal using a knife-edge contour stone (Brasseler
USA) (Fig 14). These grooves or troughs, will hold
both grey-blue stain and porcelain(Trough
technique, Wayne Payne, San Clemente, CA). A
fresh double-sided diamond disk is then used to
cut in the internal lobe formations (Brasseler USA).
A pointed flame diamond bur (Brasseler USA) is
then used to soften the mechanical looking cuts.
Lastly, the cutback is checked in the matrix before
staining (Figs 15-16).
Fig. 19. Powder Effects After Firing. Fig. 20. Opal Filled to Full Contour.
Fig. 21. Bisque Bake. Fig. 22. Pre-glaze, Texture and Polish.
A double-sided
diamond disk is
then used to
cut in the
internal lobe
formations
MASTER TECHNIQUE
12 | AUGUST 2005
STAINING AND EFFECTS POWERS
Using a low fusing stain, the gingival interproximals
are colored. The outermost mesio-incisal and disto-
incisal edges receive a blue-grey stain. A hairline
brush is used to apply an orange-pink highlight to a
sliver detail that is cut in between the mesial and
middle lobe with a diamond disk (Fig 17).
Because the stain used was a paste, it is possible to
place the effect powders in the same bake. The
Pulse Effect Powder is placed over the core lobe
detail using mostly Pearl 1 (white dentin) with a
thin segment of Enamel 3 over the middle lobe.
Then, the same Pearl 1 powder is used to create a
high-value filter band through the middle incisal
of the tooth, which is brushed out in both
directions, incisally and cervically (Fig 18).
When baking Pulse in the porcelain furnace you
must be working with an oven that is well
calibrated. The fusing temperature of the Pulse
powders is 810 degrees Celsius. After staining and
building up the effect powders the restoration was
fired under full vacuum at a rate of climb of 60
degrees a minute with a one minute high
temperature hold without vacuum (Fig 19).
Because the
stain used was
a paste, it is
possible to
place the effect
powders in the
same bake
Fig. 23. Glazed and Polished. Fig. 24. Post-op of Natural Smile.
Fig. 25. Lateral View Post-op. Fig. 26. Retracted Post-op.
quality alloy defined
jensens aztec
Hi gh Nobl e Porcel ai n Al l oy 99. 9% Gol d, l ess t han 1% I ndi um
Aztec is the ultimate choice for increased
aesthetics and patient biocompatibility.
Compatible with most popular ceramic
systems, Aztecs light oxide and rich
yellow color offer the perfect castable
solution when high-nobility and enhanced
vitality is desired.
R
e
s
t
o
r
a
t
i
o
n

f
a
b
r
i
c
a
t
e
d

w
i
t
h

J
e
n
s
e
n

s

A
z
t
e
c

a
l
l
o
y
C
o
u
r
t
e
s
y

o
f

M
i
c
h
a
e
l

G
o
r
s
h
e
,

C
D
T
.
Beautiful 24k Gold Color
Vitality Enhancing Light Oxide
Increased Patient Biocompatibility
Exceptional Finishing and Handling
AZTEC OFFERS:
Jensens AztecQuality Alloy Defined
To order, call 800.243.2000 today.
New
Ad?????
MASTER TECHNIQUE
14 | AUGUST 2005
OPAL POWDERS FILLED TO CONTOUR
After evaluating the effects, including the high
value filter band, fill in the mesio-incisial and
disto-incisal edge grooves and build them to full
contour using a mixture of grey-blue and grey
transpa powders. Opal 2 powder was used between
the lobes. The Opal 2 is a low value powder and
contrasts well with the effects (Fig 20).
After firing the build-up with the same firing
cycle, the bisque bake is evaluated (Fig 21).
GENERAL INFORMATION
This cutback and layering technique described is
the basis for almost every cosmetic case performed
in the laboratory, although the internal dentin lobe
formations, staining and powder effects will vary to
achieve different results. The pearl high-value filter
band controls the value of the restoration.
FINAL GLAZE
The shapes and contours should be performed
paying close attention to the reflective and
deflective zones. Once basic shape is established,
the surface texture and lobe formations are
added. After the surface has been rubber wheeled
(Brasseler USA), the perikymata are cut in with a
tapered diamond bur (Brasseler USA). Finally, a
thin consistent layer of the Pulse Fluorescent
Glaze Paste is applied to the restorations and then
they are air-fired at 750 degrees Celsius with a one-
minute high temperature hold. To make the surface
reflection appear natural, first knock down the high
sheen of the restoration with a knife-edge rubber
wheel. Lastly, use a large felt wheel and diamond
paste to bring up the luster on the heights of the
lobes (Fig 23).
CONCLUSION
As with all ceramics, a thorough understanding of
the optical properties of the ceramics used is
essential for a good result. Using the Pulse ingots
and layering materials, the objectives of the
clinician and the patient where satisfied as this
case appeared more natural and life-like in the
mouth (Fig 24-26).
In Recognition: I would like to give recognition to
Jeffrey Burns DDS for his fine clinical work in this
case presentation.
Biography of BRAD JONES
Brad Jones is one of sixteen accredited technicians with the AACD. He
recently became an accreditation examiner and was just elected to the AACD
Board of Directors. Brad is fellowshipped in the International Academy of
Dental-Facial Esthetics. He lectures nationally and internationally on
advanced ceramic techniques. Brad co-founded and co-directs Total Team
Advantage, a hands-on live patient seminar where clinicians and technicians
gain experience and confidence in high-level aesthetic smile designs. Brad
owns and operates a boutique laboratory, Professional Dental Arts, in Boise,
located in the heart of the Idaho mountains. Professional Dental Artss
exclusive services range from simple smile design cases to complex full
mouth reconstructions. This gives Brad the opportunity to excel in creating
some of the most beautiful smiles in the world.
Brad@secondonlytonature.com www.secondonlytonature.com
This cutback
and layering
technique
described is the
basis for almost
every cosmetic
case performed
in the
laboratory
Fig. 27. Before. Fig. 28. After.