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The previous two chapters have described the recommended protocols for shade matching using a conventional approach (chapter 3) and a technology-based approach (chapter 4); yet each method, when used by itself, affords limited clinical success. Shade determination using only conventional methodologies often results in failure, frustration, and multiple remakes (Figs 5-1 and 5-2). In addi2
Fig 5-5
Clinical photo of the maxillary central incisors after vital tray bleaching. Twelve years prior to the current treatment, the patient had a post-core foundation restoration and a metal-ceramic crown placed on the left central incisor following root canal treatment. The midfacial gingival margin tissue is starting to develop a slight recession defect.
Fig 5-6
SpectroShade (MHT Optic Research, Niederhasli, Switzerland) unit during image capture.
Fig 5-7
SpectroShade comprehensive report for the reference tooth (maxillary right central incisor). Coarse (basic), fine, gingival/body/incisal (GBI), and inferred translucency maps are provided.
Fig 5-8
A basic Vita B1 shade (Vita, Bad Sackingen, Germany) is found for the reference tooth.
Fig 5-9
GBI shade report shows Vita C1 shade in the gingival third and B1 in the body and incisal thirds of the reference tooth.
Fig 5-10
Shade tabs are used to visually confirm the findings of the technology-based shade analysis reports. Here, Vitapan shade C1 (Vita) is referenced based on the gingival shade found by the SpectroShade system. The shade tabs were photographed using twin spot flash from the sides.
Fig 5-11
Vitapan B1 shade tab with twin flash from the sides.
Fig 5-12
Vitapan B1 shade tab with flash from the top.
Fig 5-13
Vitapan B1 shade tab with flash from the bottom. Note change in visual shade comparison when flash orientation is changed (Figs 5-11 to 5-13).
Fig 5-14
Composite photo with extreme shade tabs to assess value change. (left to right) Chromascop bleached shade 010 (Ivoclar-Vivadent, Amherst, NY), Vitapan B1, and Vitapan B4.
Fig 5-15
Photographs of maxillary right central incisor (reference tooth) with lighting from the side (a), the bottom (b), and the top (c), showing nuances in tooth shade and characterization.
Fig 5-16
An 18% reflectance gray card is also used in the dental laboratory by the technician to assess the value differences in shade tabs seen in the reference photographs.
Fig 5-17
Shade tab information is interpreted and converted into the language and nomenclature of the ceramic system used.
Fig 5-18
The language of the ceramic system is transposed onto a printout of a clinical photograph to create a special effects color location and distribution map.
Fig 5-19
Ceramic powders are selected and mixed to a creamy consistency with modeling fluid.
Fig 5-20
A refractory cast with simulated soft tissue is fabricated for buildup of an all-ceramic crown.
Fig 5-21
Secondary dentin is layered at the cervical area, then dentin is layered on top and blended toward the body and incisal areas.
Fig 5-22
An incisal matrix is used in the dentinal ceramic buildup to guide the vertical and horizontal incisal edge positions.
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Fig 5-23
Dentinal ceramic material is layered with incisal enamel and special effects (opal transparent) powders.
Fig 5-24
Crown after completion of first bisque bake.
Fig 5-25
Second ceramic buildup with opal transparent powders (HeraCeram [Heraeus-Kulzer-Jelenko, Armonk, NY]).
Fig 5-26
Crown after second bisque bake with opalescent powders.
Fig 5-27
Final shaping of restoration with a red wax-based pencil. A lead-based pencil should not be used because the lead dust can contaminate and discolor the porcelain.
Fig 5-28
Gold powder is used to visualize the surface texture of the restoration.
Fig 5-29
The restoration is glazed for characterization and polished to give the proper surface luster.
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Fig 5-30
(a) The extreme shade tabs used in the reference photography are compared to the completed restoration against the 18% gray card. (b) Close-up of the extreme shade tabs being compared to the restoration.
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Fig 5-33
ShadeVision virtual try-in. (a) The crown is placed in the restoration holder for scanning. (b) Image of natural right central incisor and scan of crown for left central incisor. (c) Virtual try-in confirms a visual match. (d) Report verifies a base shade of B1. [Au: Cropping for bd OK?]
Fig 5-34
SpectroShade verification using spectrophotometric analysis. Shade B1 is again confirmed.
Fig 5-35
GBI shade distribution map verifies a close match, although there is a slight shade discrepancy at the gingival third (D2 versus C1 [see Fig 5-9]). However, there is a very small E between shades C1 and D2.
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Fig 5-36
The all-ceramic crown is prepared for cementation with composite resin cement (hydrofluoric acid etch, silane air dry, and bonding resin).
Fig 5-37
The restoration is placed.
Fig 5-38
Close-up intraoral view of cemented allceramic crown on the left central incisor.
Fig 5-39
Close-up of smile with crown in place.
Fig 5-40
Full view of smile.
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Fig 5-43
Total E of the natural right central incisor compared to the crown on the left central incisor is 3.80. The value E is 1.87. A E for value of less than 2.0 is highly clinically acceptable.
Fig 5-44
Full-face clinical photo. The patient is pleased with the final esthetic restorative outcome. With this recommended shade-taking protocol, challenging anterior restorations can be matched predictably in one visit.
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Summary
Successful shade taking involves a combination of shade tabs, reference photography, and technology. Details added by the lab technician in the fabrication process can often increase the natural appearance of a shade. Technology-based systems are extremely useful in the verification of a shade match.
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