Single Centrals- Happy with them until...
Happens all the time. You complete a single-central and feel you've done a great job. Then, as many others on here do, you photograph your stellar work only to find that your "A" is more like a C+. Statements such as, "The patient was thrilled..." can be found all throughout this site. And while that's important, we (I feel I can speak for many here) know it's not the only factor...nor is it the most important. Here are 2 such cases where 'the patient was thrilled' but my efforts were less than ideal. Hopefully you'll see something that can help you in your next case and avoid these pitfalls.
CASE 1:
Gentleman fractures #9, implant placed. The surgery isn't the point of this post, so we'll skip to the restorative portion.
Healing abutment. I've set myself up for success. Now I just have to not F it up.
Notice how 'bulbous' the restoration is? Way too round. I didn't take my time and contour in the mouth before delivering. Incisal edge has no characterization and the distal incisal edge is too short.
Again, he's happy with it but with minor corrections, this case could have turned out much better.
CASE 2:
PFM #8. Pt not happy with appearance.
What I found as soon as I removed the crown. Prepare tooth, blockout with Cosmedent Pink Opaque.
Shade, texture are ok but the distal line angle/incisal edge are too short. Also, I could have closed the incisal embrasure a bit more btwn #8/9. I also missed the incisal translucency present on #9; could have been corrected with some blue on the lingual of the restoration.
Overall, small items...but items that were missed/are lacking nonetheless. Thanks to those who post cases from which I have learned a lot...my hope is that I can do the same for someone else. And if you haven't, make your way to AZ or NC for hands-on courses...you will cover this in depth.
Enjoy the Holiday weekend!!!
I wish my good cases looked as good as your “bad” cases!
Which blocks did you use on these cases?
#teamrednecktaco
Steven
Just another suggestion for case 1. My personal preference, for the sake of symmetry, I would have widened the crown allowing it to overlap the adjacent lateral. Nonetheless GREAT work!
Westin. For us dentists it would be easier to take a little off the mesial of #8 prior to scanning to broaden the midline and get better symmetry. Thanks for sharing Steve.
Toughest case of all: replace ONE incisor, especially the central. Like yourself I put my cases under the literal microscope and try to learn from every case. Taking photos is very helpful - probably the best option to critique one's case is to take photos before permanent bonding. Once the case is cemented it's hard to change obviously. I make it a rule in my office for years that, with difficult cases, we have a "try-in", not a "cementation" appointment with our patient. And the try-in is scheduled in a second appointment obviously and for 60+min. We can finish most of our cases then and there, but the patient's expectations are lower and tweaking and improving the restoration is not being looked as cover-up. I have no problem at all doing two or more appointments. Cerec for me is an awesome tool - but not just for same day crowns - but to satisfy my "hidden inner lab guy" 
You should be very proud of yourself posting cases and critique then as well. It's a great learning experience. Btw I've learned a lot from Spear and also AACD in regards to these challenges.
Keep up your good work!! I wish everybody the guts to be so honest with their work! Kudos!!
Did I mention - I do like case 2 very much.
Juergen
Great tips Steve! Photography is all too humbling but if you take the time to re-evaluate you do, it only makes you better.
Case #1- If you look at #10, tooth is very rectangular, similar to your #9. I think the best thing would be to re-contour distal of #8 anyway to give it a more rectangular shape. I think this would be a good post op option to still improve overall esthetics.
I didn’t b/c, for me, I prefer to use positioning and morphology tools. But I see your point.
I think both cases can be improved to your liking with minor in mouth adjustments of both centrals.
I have learned so much on this site from doing just this... posting and evaluating. It's amazing what you begin to see when you really start to look or are taught what to look for. CEREC is also very humbling when you have to own your work. I love this post. Thank you for sharing this!
I do have a curious question though... #teamrednecktaco?
Steven thank you for sharing your cases! I hope your patients realize the amount of thought that's going into their care!
For the last case, I had one very similar last month. What tools would you use to lengthen the distal edge and close the embrasure mesial embrasure? When doing this is there an easy way to round/square those mesial/distal corner of the incisal edge?
By the way: These restorations are definitely not 100% in esthetics, but the first one is about 65% and the second one around 75% I would say.
I often finish with less than that.
It is good to be objective and realistic enough to always understand that, I think. Patient satisfaction should be not be overrated in the evaluation criteria. Of course.
Indeed: nothing makes my feet fall asleep faster than reading regularly how great and magnificent and perfect and easy etc. everything is.
Sorry, that +1 was for Jeremy's comment right after Steve's post that I wish my good results were as good as your bad results.
On 8/31/2018 at 9:38 pm, Jason Boeskin said...Steven thank you for sharing your cases! I hope your patients realize the amount of thought that's going into their care!
For the last case, I had one very similar last month. What tools would you use to lengthen the distal edge and close the embrasure mesial embrasure? When doing this is there an easy way to round/square those mesial/distal corner of the incisal edge?
Anatomical
I would do this post milling in the mouth
On 8/31/2018 at 9:19 pm, Kristine Aadland said...I have learned so much on this site from doing just this... posting and evaluating. It's amazing what you begin to see when you really start to look or are taught what to look for. CEREC is also very humbling when you have to own your work. I love this post. Thank you for sharing this!
I do have a curious question though... #teamrednecktaco?
The first rule of #TeamRedneckTaco...
On 8/30/2018 at 3:23 pm, Weston Hatcher, CDT said... Steven Just another suggestion for case 1. My personal preference, for the sake of symmetry, I would have widened the crown allowing it to overlap the adjacent lateral. Nonetheless GREAT work!
I understand from your lab point of view. You receive a case and can fix it perfectly. Or do you tell the dentist after you fix # 9 like as in the first photograph and tell the dentist to contour the distal of #8?
2 good point of views.
Ray
