DR. DENNIS HARTLIEB
Blocking out the metal post with pink opaque
Blocking out the metal post with pink opaque
I believe that we are fortunate to have such wonderfully esthetic dental materials at our fingertips these days – from composite to lithium disilicate to zirconia, tooth colored restorative materials have universal acceptance in the dental marketplace. As the demand for natural looking dentistry has increased, our manufacturers have answered this call.
While we have these great esthetic materials available today, not so long ago we were routinely restoring anterior teeth with metal post and cores, and porcelain-fused-to-metal crowns.
While we have these great esthetic materials available today, not so long ago we were routinely restoring anterior teeth with metal post and cores, and porcelain-fused-to-metal crowns.
Certainly master ceramists and highly skilled dentists could, and still can, create relatively esthetic results with metal based materials. Esthetic success for the average clinician and dental laboratory technician are however, limited. Dentistry, professionals and patients alike, became immune and complacent to this cosmetic compromise until recently. It used to be ok for crowns to look artificial and not resemble natural teeth. But now the stakes are higher.
Our patients’ demands are increasingly heightened due to many influences, including media, marketing, and social media.
Given our patients’ demands, we are often pressed into finding ways to create esthetic restorations in highly challenging areas. One case in point, and the one that we will review today, is when we have an existing metal post-and-core on an anterior tooth that needs crown replacement – which is especially valuable on a patient with high esthetic demands.
Ideally the metal post and core is removed and replaced with a tooth colored post and core material, either direct or indirect. There are circumstances, however, where it may be difficult or impossible to safely remove the existing post and core without damaging the root structure.
Ideally the metal post and core is removed and replaced with a tooth colored post and core material, either direct or indirect. There are circumstances, however, where it may be difficult or impossible to safely remove the existing post and core without damaging the root structure.
In these situations, where the metal post and core cannot be removed, the dentist has a couple of options.
1- The first option is to leave the metal post and core as it is and use a highly opaque crown material to block out the shine thru of the post/core.
The two crown material options commonly considered today are either using metal (with an opaquer over the surface), or a dense, highly opaque zirconia based restoration. In my experience, the dental technicians that I routinely work with no longer use metal based restorations for esthetic situations due to the inherent challenges in the laboratory technique.
For highly esthetic cases, my technicians will typically utilize zirconia based restorations where blockout is required. As great of a material that zirconia is, we often find the final restorations is not ideal. The crowns can turn out low in value, or just not bright enough.
There remains a ‘shine-thru’ effect even though the ceramist is using an opaquing zirconia material for the basis of the crown. In an effort to completely block out the dark post and core, the restoration is overly opaque, again not ideally esthetic in the final result. In either case the shade can be corrected, but the final esthetic result is limited due to the inappropriate value, or brightness of the restoration. It is because of this shine-thru, and the challenges for the ceramist, that I prefer to block out the metal at the tooth preparation.
For highly esthetic cases, my technicians will typically utilize zirconia based restorations where blockout is required. As great of a material that zirconia is, we often find the final restorations is not ideal. The crowns can turn out low in value, or just not bright enough.
There remains a ‘shine-thru’ effect even though the ceramist is using an opaquing zirconia material for the basis of the crown. In an effort to completely block out the dark post and core, the restoration is overly opaque, again not ideally esthetic in the final result. In either case the shade can be corrected, but the final esthetic result is limited due to the inappropriate value, or brightness of the restoration. It is because of this shine-thru, and the challenges for the ceramist, that I prefer to block out the metal at the tooth preparation.
2- The second option is to block out the metal at the tooth preparation.
In the case that I am sharing with you today, the existing failing crowns on teeth #8 and #9 were removed exposing two very dark tooth abutments. I felt it was too risky to remove the existing cast post and core on the right central incisor, as the post was quite large with thin remaining root structure walls.
Our treatment plan was to restore the central incisors with all-ceramic crowns and use prototype bonding to enhance the esthetics of the other teeth in the esthetic zone. You’ll note in this case that Fran has a very ‘gummy’ smile. I was able to create a more pleasing smile by performing a ‘gum lift’. Read my blog post on predictable esthetic crown lengthening to learn more.
Our treatment plan was to restore the central incisors with all-ceramic crowns and use prototype bonding to enhance the esthetics of the other teeth in the esthetic zone. You’ll note in this case that Fran has a very ‘gummy’ smile. I was able to create a more pleasing smile by performing a ‘gum lift’. Read my blog post on predictable esthetic crown lengthening to learn more.
I believe my ceramist is able to create the most natural esthetics with lithium disilicate (eMax, Lisi), rather than with zirconia, so I absolutely needed to block out the metal post and dark tooth structure.
With the crowns removed, the dark post and core of #8 and the dark tooth of #9 are realized. The post and core on #8 was stable and intact, and outside the esthetic nature of the metal post, the post and core was quite serviceable. Again, due to the diameter of the post, I opted to leave the post and core in place and block out the metal prior to impressions for the final crowns.
The technique that I use for blocking out metal is a little different than when I block out a natural tooth (read my ‘Masking the Dark Tooth with Direct Resin’ blog). When I am blocking out metal, especially grey metal, I need to block out the darkness entirely. Pink Opaque (Cosmedent) is used as the first layer in masking the metal because of how the pink neutralizes the dark grey of the metal.
The reason that pink neutralizes the grey is based on the Munsell color system, but quite frankly, it’s a little above my head. I just know that it works. If you’ve used white opaque in the past to block out metal, then you probably had the same experience that I did; if I used a little, then the white turned grey but if I used a lot, the block out was too white and opaque, and impossible for me to block out in the final restoration.
The reason that pink neutralizes the grey is based on the Munsell color system, but quite frankly, it’s a little above my head. I just know that it works. If you’ve used white opaque in the past to block out metal, then you probably had the same experience that I did; if I used a little, then the white turned grey but if I used a lot, the block out was too white and opaque, and impossible for me to block out in the final restoration.
Let me walk you through the step-by-step technique.
After removing the PFM crowns, I slightly overprep on the facial to give me a little more restorative space. If there is enamel, I’ll use phosphoric acid as the first step in the adhesion technique. More often than not though, I’ll be entirely in dentin in these cases so I can use a self-etch adhesive, like Clearfil SE from Kurrary. Here is the first part of the technique:
1. Microetch (sand blast) with 25-50 micron aluminum oxide
2. Rinse and dry
3. Use self-etch primer on all tooth structure, 20 seconds, air dry
4. Place a metal primer on the metal post and core and air dry
5. Place the ‘bond’ (2nd bottle of Clearfil SE) over the primed tooth structure and post and core.
6. Light cure 20 seconds
Ok, now we are ready to start blocking out the post and core and the dark tooth structure, so a few more steps:
7. Using an artist’s brush, paint a thick layer of pink opaque (Creative Colors, Cosmedent) over the metal, feathering onto the tooth structure and light cure, 10 seconds.
8. Evaluate to see if there is still metal shine thru – if so, add another layer, though thinner to complete masking of the metal. Light cure 10 seconds.
9. Using the same artist’s brush, cleaned with an alcohol gauze, place a layer of the opaquer (Creative Color, Cosmedent) of the Vita shade that you want for your tooth prep (i.e. A2). Light cure 10 seconds.
10. Place a thin layer of dentin composite (Renamel Hybrid, Cosmedent) to complete the proper tooth form. Light cure 30-60 seconds for final cure.
11. Reprep and polish for final crown preparations.
Using these layers, with the pink opaque to raise the value, I was able to create a natural tooth color substrate that will make the porcelain crown fabrication very predictable.
That’s it for the technique. Touch base with any questions!
Yours for better dentistry,
That’s it for the technique. Touch base with any questions!
Yours for better dentistry,
Dennis Hartlieb, DDS, AAACD
DOT Founder
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Meet Dr. Dennis Hartlieb
Dr. Dennis Hartlieb owns his own practice in Chicago,IL and has been teaching dentistry for over 30 years. Dr. Hartlieb is the CEO and the main instructor at Dental Online Training. He is an active member in the American Academy of Cosmetic Dentistry where he’s both an Accredited Member and Examiner for Accreditation.
Dr. Hartlieb is also the President of the Chicago Academy of Interdisciplinary Dentofacial Therapy, and a member of the prestigious American Academy of Restorative Dentistry.
Dr. Hartlieb is also the President of the Chicago Academy of Interdisciplinary Dentofacial Therapy, and a member of the prestigious American Academy of Restorative Dentistry.
Meet Dr. Angela Luek
Dr. Angela M. Lueck is a Wisconsin native and was the youngest female in her class from Marquette University in 1998. Since completing her residency she has consistently taken more than 100 hours a year of continuing education to keep current on the latest trends, techniques, and materials available in dentistry.
She volunteers her time to teach at Marquette University providing the students additional training with anterior and posterior bonding techniques as well as dental photography. She is also the co-chair of the mentorship program at the University. Dr. Lueck has been voted as one of Milwaukee’s top dentists multiple times by Milwaukee Magazine.
She volunteers her time to teach at Marquette University providing the students additional training with anterior and posterior bonding techniques as well as dental photography. She is also the co-chair of the mentorship program at the University. Dr. Lueck has been voted as one of Milwaukee’s top dentists multiple times by Milwaukee Magazine.
Meet Clare O'Neill
Clare O’Neill is the Director of Operations at Dental Online Training and has a professional background in digital marketing. Clare has certifications in content marketing and digital advertising. Clare has expertise in social media marketing, email marketing, content marketing, website management, and project management. Clare has been using Canva for over 5 years and is a self-proclaimed Canva Queen.
Clare graduated from Georgia State University with a Bachelor’s degree is Sociology. Clare wanted you to know that she is a dog person, loves the colors emerald green and periwinkle, and would eat french fries at every meal if she could!
Clare graduated from Georgia State University with a Bachelor’s degree is Sociology. Clare wanted you to know that she is a dog person, loves the colors emerald green and periwinkle, and would eat french fries at every meal if she could!
Meet Dr. Jim Mckee
Dr. McKee is a member of the Spear Resident Faculty. He has maintained a private practice since 1984 in Downers Grove, Illinois where he treats a wide variety of cases with a focus on predictable restorative dentistry. He is a member of the American Academy of Restorative Dentistry and former president of the American Equilibration Society.
He has lectured both nationally and internationally for over 25 years and directs several study clubs. Dr. McKee graduated from the University of Notre Dame in 1980 and earned his dental degree from the University of Illinois College of Dentistry in 1984.
He has lectured both nationally and internationally for over 25 years and directs several study clubs. Dr. McKee graduated from the University of Notre Dame in 1980 and earned his dental degree from the University of Illinois College of Dentistry in 1984.
Meet Kirk Behrendt
Kirk Behrendt is a renowned consultant and speaker in the dental industry, known for his expertise in helping dentists create better practices and better lives.
With over 25 years of experience in the field, Kirk has dedicated his professional life to optimizing the best systems and practices in dentistry.
Kirk Behrendt is the founder of ACT Dental, and his vision is driven by the commitment to provide highly personalized care to the dental profession. By creating a talented team of experts, Kirk and his team continue to positively impact the practice of dentistry on practice at a time. Kirk lectures all over the world to help individuals take control of their own lives.
With over 25 years of experience in the field, Kirk has dedicated his professional life to optimizing the best systems and practices in dentistry.
Kirk Behrendt is the founder of ACT Dental, and his vision is driven by the commitment to provide highly personalized care to the dental profession. By creating a talented team of experts, Kirk and his team continue to positively impact the practice of dentistry on practice at a time. Kirk lectures all over the world to help individuals take control of their own lives.
Meet Dr. Melissa Seibert
Melissa Seibert is a comprehensive dentist proudly serving in the Air Force. She holds a dual faculty appointment at Uniformed Services University and Creighton Dental School. She serves on the editorial board for Inside Dentistry.
Her current research projects involve investigating ceramic overlays, zirconia and salivary contamination of universal adhesives. Dr. Seibert is the creator and host of the top dental podcast, Dental Digest. She lectures to national and international audiences.
Her current research projects involve investigating ceramic overlays, zirconia and salivary contamination of universal adhesives. Dr. Seibert is the creator and host of the top dental podcast, Dental Digest. She lectures to national and international audiences.
Meet Olivia Wisden
Olivia Wisden is the founder & CEO of TwoLips Creative. What started as an events discovery app pivoted into a creative agency that specializes in working with startups, small businesses, and organizations who are looking for bold, impactful designs and strategies.
She has worked with dozens of brands over the years ranging from the City of Madison to product launches and beyond.
She has worked with dozens of brands over the years ranging from the City of Madison to product launches and beyond.
Meet Dr. Sofya Kats
Dr. Sofya Kats is local to Milwaukee, WI. She grew up in Bayside and attended Nicolet HS, UW-Milwaukee and Marquette University School of Dentistry. Dr. Kats is a member of the Greater Milwaukee Dental Association, Wisconsin Dental Association, American Dental Association, and The Forum Study Club (oldest Dental Study Club in the United States).
Dr. Kats loves the art of dentistry, and healing it can bring to her patients. She volunteers her time by going on international dental mission trips and local events, such as the Mission of Mercy (free dental care sponsored by the Wisconsin Dental Association).
Dr. Kats loves the art of dentistry, and healing it can bring to her patients. She volunteers her time by going on international dental mission trips and local events, such as the Mission of Mercy (free dental care sponsored by the Wisconsin Dental Association).
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Day 1 (8 - 4 pm CST)
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Erosion and wear – the why and the how
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Adding length to teeth – when is it safe
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Opening VDO to compensate for lost tooth structure – where to begin
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Records visit and key points you need to understand before you start
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The smile – the 7 strategic points to consider when evaluating the smile
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Anterior tooth shape, morphology
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Clinical case review
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Upper Putty matrix construction
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Build lingual incisal wall with putty matrix #6 - #11/ Upper anteriors
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Full contour build-up #6, #7, #8, #9, #10, #11, shape and polish/ Upper anteriors
Day 2 (8 - 2 pm CST)
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Who – which patients are candidates
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Why – explaining to patients the value of the prototype
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How – step-by-step techniques to maximize predictability, efficiency and success
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Getting to Yes: conversations with patients about esthetic and reconstructive dentistry
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The ‘Smile Preview’ – techniques to show the possibilities
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Lower Putty matrix construction
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Build lingual incisal wall with putty matrix #22 - #27 / lower anteriors
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Build-up #22 - #27, shape and polish / lower anteriors
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Build-up lower occlusal posteriors
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Demonstration of Smile Preview