A clinical case by our Community member Dr. Victor Clavijo
This article and its content are published under the Author’s responsibility as an expression of the Author’s own ideas and practice. Styleitaliano denies any responsibility about the visual and written content of this work.
Since color matching was considered a subjective process, accurate shade choice was frequently the utmost challenging step in order to recreate the natural appearance of teeth. Furthermore, accurate determination of tooth color was imperative for the final outcome of dental restorations.
Dental laboratory technicians are challenged to achieve a color match when working only from a prescription based on a shade guide. A dental shade guide may increase the reliability of visual comparisons of tooth restoration efficacy. While there was no process considered as the gold standard, various methods to measure color in dental world exist, including visual and instrumental.
Patients are generally displeased with the color of their restorations. In an attempt to solve this problem and improve the shade of these restorations, different devices have been evolved and reported to stabilize the color in dentistry field. Hence, it is a practitioner’s responsibility to provide restorations which can adequately mimic the surrounding natural dentition. This could be possible by a new digital color measurement device (Optishade, Smile Line, Switzerland) in conjunction with Matisse 2.0 software.
With this solution, Optishade was able to measure the shade of the preparation or the natural tooth and Matisse 2.0 provided an Anaxdent (new outline mix). Afterwards, the mixture was obtained and poured into the impression material and within 5 to 10 minutes, a reliable reproduction of the mouth will be achieved. In addition, Matisse 2.0 reduces the dilemma in selecting the framework, ceramic powders, and enamels. With the Matisse customized recipes, the dental laboratory will be capable to succeed an incredible outcome and leave both dentist and patient mesmerized.
Further, a perfect smile and aesthetic demands by means of healthy teeth are now recommended. Thus, the aim of this article is to showcase the importance of using the Optishade colorimeter with Matisse 2.0 software on the predictability of shade matching. In addition, this case is an attempt to improve the confident smile of the patients.
Fig.1
A 68-year-old male visited our dental office and asked us to improve his smile. The main complaint was a splinted resin temporary crown over the edentulous area of 1.1, the restoration was about to fall. An initial situation with cheek retractors was taken before the replacement of the restoration.
Fig.2
After removing the old temporary, the teeth were prepared. The choice of a fixed bridge was done because the teeth had multiple restorations and the edentulous area was far from ideal for implant.
Fig.3
Occlusal view of prepared teeth for a ceramic bridge.
The first cord was placed in order to retract half of the sulcus. This cord makes a vertical retraction.
It is important to mention that if the chosen cord does not retract half of the sulcus, then a thicker one should be selected.
Fig.4
A second cord with astringent and epinephrine (Siltrax plus, Pascal, USA) was placed in order to ensure a horizontal retraction and to make a room for the impression material.
Fig.5
A (PMMA TELIO CAD) temporary material was used. This resin is stronger than other materials, and can ensure high resistance, aesthetic stability, and excellent margin fit. Color was taken in a second control appointment, with the temporaries in place, in order to have the teeth as clean and faithful as possible to the normal situation.
Fig.6
Color was taken with Optishade Styleitaliano, and sent to the laboratory in matter of seconds.
Fig.7
Color was dark (L* 64.5), quite red (b* 4.6) and strongly yellow (b*22.4) and when comparing to the database the closest match was an A4. Technician tends not to look at the color scale, but at the L*a*b* coordinates in order to reproduce the perfect ceramic match with the help of Matisse Software.
Fig.8
Digital impression of the teeth.
Fig.9
Same picture was taken from the screen but in a black and white mode.
Fig.10
Details from the Matisse Software screen. The Matisse, software calculated for this case the framework, dentin mix for the different areas and skin enamel.
Fig.11
Ceramic Zirconia bridge was fabricated by MDT Willi Clavijo, with Kata Zirconia structure (Noritake, Japan) and layered with E.Max Ceram (Ivoclar, Lichtenstein) using the indications of Matisse software.
Fig.12
Detail of the texture.
Fig.13
Internal view of the Zirconia ceramic bridge and hyper-gloss Zirconia pontic.
Fig.14
Insertion of the ceramic bridge in the tooth preparation (Try-in procedure).
Fig.15
Cleaning and disinfection of the prepared teeth from any remnants or debris.
Fig.16
A universal cleaning paste containing sodium hydroxide (Ivoclean, Ivoclar, Liechtenstein) was used for cleaning the restoration surfaces that might have been contaminated during the try-in.
Fig.17
Afterwards, a layer of silane (Monobond N, Ivoclar, Liechtenstein) agent was applied to internal surface with a microbrush and left for 1 minute for solvent evaporation according to the manufacturer’s recommendations.
Fig.18
The excess of the dual cure cement (Multilink Speed, Ivoclar, Liechtenstein) was removed after cementation.
Fig.19
Final aspect of the restoration. Technician never saw the patient, and the restoration was a virtual excellent match (Under 1.6 DE94) with the first try-in. The dentist and the patient were very happy with the final aspect.
Fig.20
Color comparison of the Natural teeth vs the prosthetic work. Further restorative work will be done to the patient.
Conclusions
The complex decision process for anterior esthetic restorations can be clarified and simplified by a magic procedure.
There is increasing evidence that in many situations, it is possible to bond highly esthetic materials to tooth structure recovering a significant portion of its original physical properties with minimal preparation. However, the choice of the most appropriate for anterior teeth in terms of color match was considered difficult and challenging.
Numerous guidelines can orient the clinician to simplify the daily clinical anterior practice:
• Starting from the preparation and fabrication of a good temporary restorations. The Bis-acryl (WAS PMMA MILLED) resin materials are aesthetic, fast and easy solution to fabricate provisional restorations in the dental office.
• Good cementation relies on properly programmed design and operative phases, in order to achieve the best therapeutic outcome. It is important to emphasize that cementation should not be used to compensate for errors made during the previous phases, such as inadequate tooth preparation or faulty restoration.
• The use of a new digital color measurement device (Optishade, Smile Line, Switzerland) led to less color differences and less incorrect shade matching than obtained by the conventional methods with color shade tabs.
• Matisse eliminates the dilemma in choosing the framework, ceramic powders, and enamels. With the Matisse customized recipes, the dental technician will be able to choose the correct framework and thickness, in addition, the tooth will be layered according to the histo-anatomy of the dentin and enamel.
• With the combination of Matisse 2.0 and Optishade colorimeter, a predictable outcome will be obtained making the clinician, the patient, and the lab technician so satisfied. Thus, it is nowadays considered a magic solution.
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