15 Everyone’s Excited for the Clinical Try In!

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After the firing, the moment of truth has arrived: the first clinical try in! The air is full of tension as Dr. Jens Gebrande takes the temporary restorations to put them on the stumps for the very first time. If you listen closely, you’ll hear the drum roll. The first glimpse into the mirror: It’s all going into the right direction! A few minor corrections will be done in accordance with the patient:

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The translucency in the transition area from incisal edge to bulge area will be reduced a bit.

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The contact surfaces will be extended towards the gingiva to close up on the black triangle.

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The teeth are supposed to look a bit narrower morphologically.

 

 

14 Second Dentine Firing

The second dentine firing allows for the precise finalization of the effects of morphology and colors. Renato designs the neck area more chromatic with a one-to-one mixture of BASE DENTINE A3 and light orange EFFECT CHROMA 5. He adds a balanced mix of BASE DENTINE A2 and NEUTRAL for the structure of the bulge area.
He also uses NEUTRAL for the incisal area to reduce the translucency with the slightly opaque ceramic. He applies a light blocker palatinally of whitish INTERNO 01 for the same reason and covers it with chromatic EFFECT CHROMA 2 (sand-beige).

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13 Everything Prepared for the First Dentine Firing

Having controlled the occlusion, layering can now be finalized. The crowns are carefully taken from the model and fixed with a pair of tweezers from the lumen side. Here we go!
Just as in the preceding ceramic layering steps, he carefully fills and smoothens the approximal areas one after the other.
Renato has a final tip for Youngbae Kim and Ryo Funaki from the US and Bashar Omar and Vanessa Bauer from Germany: “I haven’t applied too much. Make sure you leave enough space for the second dentine firing! This way you will be free to decide later if you need more chroma or translucency.
He positions the two crowns on the firing pin and puts everything into the furnace.

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He chooses a firing program and the furnace drives the restorations up into the firing chamber, step for step.

Youngbae Kim

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Ryo Funaki

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12 Implemented Play of Light and Color

“The mamelons are not so remarkable. This is why I’ll only apply a slight layering there”, explains Renato the layering with BASE DENTINE A2 and NEUTRAL in a one-to-one ratio. He then adds TRANSPA DENTINE in the cervical and palatal area. “I’m closing the gap between the incisal and the cervical area with pink-translucent EFFECT ENAMEL 3 to intensify the reddish color of the basic shade A2.” Renato uses skilled brush movements while he finally covers the whole tooth with WINDOW. And this is due to a certain reason: “When I finally add WINDOW, I can see everything behind this last layer after the firing. When the shade appears too intensive, I just do a correction firing with NEUTRAL. This ceramic material is milky and not quite so translucent.” He establishes the halo effect: “With a focused layer of TRANSPA DENTINE A2, mixed with a brush tip of sandy INTERNO 02 at the palatal incisal edge, the light will be broken and reflected later on.”

11 Controlled Translucency

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Renato Carretti takes a deep look at his actual result, mentally comparing it with the patient situation. He then hands the model to the participants. They take photos with their smart phones and examine it closely from all sides. Then they pass it back to Renato. In the cervical and neck area, the same layering protocol is performed as before, followed by a decreasing chromaticity with a balanced mixture of BASE DENTINE A2 and TRANSPA DENTINE A2 towards incisal. In the incisal area, a one-to-one mixture of bluish-translucent EFFECT ENAMEL 9 and greyish-translucent EFFECT ENAMEL 11 is layered. He add whitish-translucent EFFECT ENAMEL 1 directly beneath the incisal edge.

10 A Hint of INTERNO

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“I use INTERNO for every crown! The internal stains are very intensive. So I use only a little bit”, Renato describes the next step. With gentle vertical brush strokes, he is carefully applying INTERNO 2 (sand) directly on the dentine body. In a next step, he is systematically adding EFFECT CHROMA 3 (light yellow) and BASE DENTINE A3 in a one-to-one mixture in the cervical area to intensify its chroma. BASE DENTINE A3 is layered in the neck area, followed by BASE DENTINE A2 towards the incisal area. A balanced mixture of BASE DENTINE A2 and NEUTRAL is established there to fade out the chromaticity. After that, INTERNO 1 (white) and INTERNO 2 (sand) are applied very gently vertically from the incisal area.

09 The Interdental Space

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The palatal and cervical areas are layered in a first step. His trick to close the proximal in the cervical area: “I always close the interdental space from the palatal! That makes it appeal much nicer.” This is followed by BASE DENTINE A3 in the neck area. Afterwards, the dentine core is created in the determined basic shade. “In the incisal area, I layer dentine a little bit over the EFFECT LINER to mask it sufficiently”, explains Renato.

08 With a Steady Hand

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Then he takes the brush in a resolute manner, dips it into the small water bowl and wipes redundant liquid off on a tissue. He is now layering the chromatic cervical area with a one-to-one ratio of EFFECT CHROMA 3 (light yellow) and BASE DENTINE A3.

07 Let the Layering Begin!

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Slowly, the furnace is opening and the restorations move downwards step by step. The patient takes place next to Renato so he has control over the layering procedure at any time. He positions both frameworks carefully on the model and takes a deep breath.