For best shade matching results, take the patient’s shade first, before you prep or impress. Once teeth dehydrate, it can take 6 hours or longer to rehydrate causing teeth to appear several shades lighter.
This photo is evidence of why dental implants should not be placed in a patient before they have stopped growing. One of our dentists recently sent this case to our laboratory. This female patient (age 21) had an implant placed in the anterior of the maxilla when she was 15 years old. As the rest of her mouth matured, the implant and restoration remained in the same position. Now at the age of 21, she is very unhappy because the tooth is too short compared to her natural dentition. Even though the abutment and crown can be redone, the implant, bone and soft tissue contours cannot be corrected without removing the implant, letting it heal, osteodistraction and starting the case over.
In most cases females are generally finished growing between the ages of 16-18 and males between 18-21 years of age. It is important that dentists and surgeons do not place implants in any patient until their body is fully matured.
A diagnostic wax-up is a mock example of the technician’s understanding of his/her treatment plan. It is provided to replicate the outcome before the patient is in the chair.
To get the most accurate diagnostic wax-up, the technician needs a full description of what is expected; items can include the following:
- Is the goal to match existing teeth, mirror opposite side or correct teeth esthetically?
- Will the case be veneers or crowns?
- If the centrals are is involved, the technician needs to know the expected length of the centrals.
- Shapes vary and any type of description of expected shape would be helpful. (ex: square, square oval, oval as found in “The Smile Styles; The Smile Guide”, or wants teeth to appear more feminine)
- Many times Doctors will add a note that asks the technician to call for instructions. The advantage of descriptive written instructions is to expedite the completion of the diagnostic wax-up. Further, without descriptive written instructions, the technician may feel his information is complete and creates the diagnostic wax-up with the information given. Full descriptive disclosure of the expected outcome will prevent frustration on the part of both the Doctor and technician.
– Steve Bates, CDT, Specialty Ceramist
We’re not just talking about first impressions with patients here. Impressions are the ‘holy grail’ of medical device and restorative work, because it’s the foundation of anything we create. And not all impressions are created equal. Taking a physical impression can be a challenge, whether you’re aiming to capture clear margins or dealing with a patient that has a bad gag re-flux. In our lab we’ve seen it all. You may be a veteran with impression taking or gone digital with scanning in office, but the techniques behind capturing a clear impression maintains the most crucial part of what we do.
So what do we look for in our impressions? Here’s a short list of our A+ impression takers.
- Clear margins on prepped teeth for crowns, veneers and bridges
- No excess impression material bearing into impression posts for implant cases
- Avoiding warped or pulled impression material, caused by removing the impression before set
- Digital scans with clear margins and manually marked margins if the scan is not clearly picking up
- Pour your own models? Avoiding pesky bubbles on cuspids, to ensure vertical clearance is met
Need impression help? If you’re unsure your impression is accurate, make a note on your RX. As we’re quality checking in our model room, we’ll also reach out if something needs adjustment. As always, we’re here to help and serve as a reference for you!
As you know, things can get hectic at the office. You often feel overwhelmed and feel as if there are not enough hours in the day to get everything you need accomplished. New Image Dental Laboratory wants to help! Below are the top 7 tips to managing your time at the office:
1. Start your day the right way: Start each work day with a clear plan of where you are headed both task-wise and time-wise. You don’t want to be that employee buried under 100 post-it notes all over your desk. One suggestion is to make a to-do list for the next day before you leave the office at night.
2. Learn to manage your time effectively: Always feeling rushed and never quite “catching up” is a very unhealthy and stressful state to allow yourself to get into. Don’t respond to every task that pops up. Know which task are important and focus your energy on those things.
3. Get organized: Ditch the desk clutter. Organize your workspace so that it maximizes your efficiency. Don’t forget to organize your computer and e-mail files too!
4. Managing e-mails and a constantly ringing phone: Don’t check e-mails as soon as they arrive in your inbox. Set a particular time of day to read and send e-mails (10 minutes every hour). Turn off your incoming e-mail alerts so you are not constantly distracted. You should also set aside time for phone correspondence. One helpful tip is when you make calls, make several in one block of time.
5. Avoid time wasters: Interruptions are usually either work-realated or social. Ask yourself this question whenever you are interrupted: “what is more important” – the interruption or what you are doing? Attend to whichever is more important.
6. Share the load: Delegate some tasks to others if possible.
7. Take time out: No matter how busy your work day is, take time out for a coffee break, a “real” lunch break , or watch a funny YouTube video.
Now that we have shared several tips on saving time, try implementing one at a time. It will save you time, help you get organized, and reduce stress inside and out of the office!
Mandibular Procera Implant Bridge (PIB) with an Upper Denture
View step-by-step how we helped the doctor give this patient back her smile! The patient presented as fully edentulous. After wearing dentures for a number of years, she had issues with her ill-fitting lower denture and desired a fixed alternative. Upon delivery of a Procera lower implant bridge with a new upper denture, the patient was thrilled, proclaiming “I now feel like I have my natural teeth back”.
Pictured above: “Before” picture of patient’s existing dentures
Pictured above: At this point the surgeon has placed the implants and allowed them to heal. On top of the implants are the impression posts. The two in the back are old implants (silver) and the four in the front are new implants (gold).
Pictured above: The final impression including impression posts which stay with the impression.
Pictured above: The verification jig on the model is used to verify the accuracy of the model as compared to intraorally.
Pictured above: Zirconia framework on the model
Pictured above: Zirconia framework try-in
Pictured above: Occlusal view of Zirconia framework try-in
Pictured above: X-ray of the framework in the mouth which is used to confirm the prosthesis is fully seated.
Pictured above: The final prosthetic on the model. The technician applied porcelain to the framework with pink gingival porcelain for aesthetics.
Pictured above: Occlusal view of the final prosthetic on the model
Pictured above: The final denture and Procera implant bridge delivered
Pictured above: Occlusal view of the delivered Procera implant bridge
Pictured above: Patient’s new upper denture opposing the PIB
Pictured above: Happy patient
Count on New Image to be a resource for your next implant case!
Hand-Layered & Pressed
Esthetic porcelain veneers can be used in a variety of situations. Take a look at this unique case New Image Dental Laboratory fabricated in partnership with Dr. Kenneth Murphy of Atlanta. The case is fully documented below.
This complex restorative case combined Empress Esthetic veneers and IPS e.max crowns. The centrals were a challenging combination of a Zirconia abutment and e.max crown for #8 along with an e.max crown on #9. The implant crown is very slightly out of occlusion for functional purposes. Empress Esthetic veneers on teeth # 5, 6, 7, 10 , 11, and 12 completed the total maxillary transformation.
Presurgical/Diagnostic: The patient presented with a history of childhood trauma for teeth #8 and 9. Tooth #9 had a previous crown restoration. Tooth #8 failed due to external resorption.
Treatment Objectives: The patient was interested in correcting his midline discrepancy and improving anterior esthetics.
Treatment Plan: Dr. Murphy advised the patient of the need to extract tooth #8 and replace with an implant/crown. He also suggested orthodontic treatment with which the patient complied. A provisional was placed on tooth #9 during the orthodontic treatment.
Esthetic Planning: New Image Dental Laboratory fabricated a diagnostic wax-up to finalize desired esthetics. The patient reviewed and accepted the wax-up.
Surgical: The oral surgeon placed a Nobel Active 4.3mm at tooth #8.
Challenge: The patient had some difficulty with his provisionals as he was not very careful with his chewing and a few had to be replaced.
Outcome: The patient was very happy with his new smile. He said he will have to relearn how to smile. From the looks of the photos, mission accomplished! The Process Through New Image Dental Laboratory:
Diagnostic wax up:
Soft tissue model with implant analog:
Custom zirconia abutment:
Zirconia abutment on soft tissue model (Note the ideal shoulder preparations):
Finished e.max crowns #8, 9 and Empress Esthetic veneers
on # 5, 6, 7, 10, 11, 12:
*Photos used with express written permission of patient in compliance with all HIPAA laws.