I thought I would create a blog post to share with all of you the results of the implant case that I wrote about last year.

I placed the final crown a couple of months ago and I am pleased to report that the crown was inserted on the first attempt. I can’t really say that this happens to me all of the time with a single central incisor restoration. There are cases that I am not satisfied with the results and I return it to the lab to modify.

I think the key to nailing one of these restorations on the fist attempt lies with excellent lab communication. Harald Heidl, a master dental ceramist from Seattle, fabricated this case. The case consisted of a custom Etkon Zirconia abutment and an IPS e.max layered ceramic crown. In this case I also used some limited bonding to improve the shape and form of the adjacent central and lateral incisor and recommended a bite splint to protect the restorations from future attrition.

Due to the distance involved, Harald never was introduced to the patient in person so we communicated with digital photography. I have discovered over the years that excellent digital photography can replace the need for the patient to drive to the lab for a custom staining appointment. The system that I follow is to send a series of shade photos that I take using my Nikon D3s camera using the Nikon Micro 105mm lens and the Nikon RICI Micro flash kit.

I find that this body, lens, and flash system produces excellent results but I have also tested the Nikon D7000 body with this set up and it offers great results at a lower price point.

I will share with you two different tips for excellent shade photos.

The first tip is to pick the shade tab that you feel is closest to the tooth you are matching and photograph that tab as well as one with higher value and one with lower value. For an anterior tooth I typically shoot shade photos with 3 different shade tabs from two different angles but sometimes I can use 5 or 6 shade tabs if the tooth in question has a complicated shade map.

The second tip is that I would recommend that you angle the lens and flash of your camera so that it is not perpendicular to the teeth and shade tabs that you are photographing. With this tip, you will find that the teeth and the shade tabs have less reflection on the surface and you can diagnose the shade more effectively.

If you follow these two tips and set your camera up correctly with proper exposure and white balance you should have great results matching even the elusive central incisor.

If you would like more detailed photography training feel free to check out my Mastering Digital Dental Photography DVD set. As always if you have any questions or comments feel free to use the link above.

Remaining tooth before extraction and implant site development.

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Shade photo with the provisional implant crown and the surrounding dentition.

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Shade photo with the provisional implant crown and the surrounding dentition.

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Shade photo with the provisional implant crown and the surrounding dentition.

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Shade photo with the provisional implant crown and the surrounding dentition.

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Shade photo with the provisional implant crown and the surrounding dentition.

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Shade photo with the provisional implant crown and the surrounding dentition.

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Final crown and zirconia abutment.

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Final crown and zirconia abutment.

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Zirconia abutment seated on the dental implant

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Final restoration.

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Final restoration.

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Final restoration.

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I wanted to follow up last weeks post with a quick article to demonstrate how I would replicate the soft tissue contours in a final impression.

When I left last weeks post I had just spent a significant amount of time to create and perfect the provisional crown contours that would produce the soft tissue outline form for my final implant restoration. The question now becomes how would I transfer that information to the dental ceramist?

You have two options if you are going to take a final implant impression.

1.    You can use a stock open or closed tray impression transfer.
2.    You can create a custom impression transfer.

Some of you may be thinking why would you bother spending the time to create a custom transfer? I will answer that I feel when you have spent time and effort to create a specific soft tissue form that the extra time you spend to create a custom transfer is worth the effort.

You may think that a standard transfer will capture the tissue contours well enough but I would argue that when you remove your provisional the soft tissue will not be supported and will collapse slightly. This may not be an issue with a molar but with a central incisor I think it is a huge concern.

So, for arguments sake lets assume that you want to make a custom impression transfer for anterior cases and you will use a standard transfer for molars and decide on the need with bicuspids depending on the case. Let me share with you a fairly simple way to create a custom transfer.

The first thing you need is an impression analog and for a number of years I would just hold them in a hemostat but for the past six months I have them mounted in a plaster cup and ready to use for cases.

I remove the provisional from the patient’s mouth and screw it onto the analog that is mounted in the plaster. I then inject Mach 2 Die Silicone around the cervical half of the provisional and let it set.

The next step is to remove the provisional from the analog and if you look at the result you have an exact replica of the soft tissue form created by the provisional in the Mach 2 Die Silicone.

I will then screw the appropriate impression transfer onto the analog. In this case a Straumann RC bone level implant was used with the Straumann closed tray RC impression transfer. The final step is to fill in the space between the transfer and the silicone with flowable composite resin and light cure.
When you remove the impression transfer from the analog you have a customized surface created by the flowable composite that is an exact copy of your provisional contours.

I hope this post helps to clear up how I create this transfer with a technique that is simple and easy to use in your dental practice. As always thanks for reading and feel free to add any comments or questions using the link above.

Best regards,

Dr. Stephen Phelan

Completed soft tissue outline form.

Completed soft tissue outline form.

Standard impression transfer in place with the soft tissue starting to collapse.

Provisional seated on stone mounted analog.

Injecting the Mach 2 Die Silicone.

Provisional with the die silicone setting around it.

Completed soft tissue outline form replicated in the silicone.

Completed soft tissue outline form replicated in the silicone.

Creating the custom transfer with flowable composite.

Completed custom transfer being removed from the silicone mould.

Comparison of the custom provisional and custom impression transfer.

Custom impression transfer in place.

Custom impression transfer in place.

Final Permadyne impression.

The iPad and iPod Touch winners for the early-registration draw for my new seminar are …

Click on the video below to find out if you won and congratulations to our winners.

If you are the one of the winners, you will receive your iPad or iPod Touch at the seminar.

For this weeks blog post I thought I would share with you a product review for the new Nikon D7000 Digital SLR. Clinical dental photography is a really valuable tool for patient communication, lab communication and personal education. In the video below I share with you some of the D7000 features and I also show you some settings to use for clinical photography; such as,  your image size, white balance, picture control and colour space.

The winners for the Phelan Dental Seminars Sponsors contest are …

Click the video below to find out if you have won….

The winners will receive their prizes at the seminar.

1. 3M ESPE RelyX Veneer Cement Kit – Winner – Dr. Tim Sellner
2. National Dental FlashMax Curing Light – Winner – Dr. Michel Brunet
3. CRD Heatwave and Quad Tray Intro Kits – Winner – Dr. Uyen Ahh Nguyen
4. Henry Schein Dentsply SmartCem 2 Kits – Winner – Dr. Louis-Rene Dubois
5. Henry Schein Axis CeraGlaze Kit  – Winner – Dr. Brian Croppo

Congratulations to our winners and I look forward to seeing you at the seminar. 

The iPad winner for the Phelan Dental Seminars pre-registration contest for the April Occlusion seminars is …

Click the video below to find out if you won the iPad and remember if you are not the winner you could still win by joining our online community by entering your name and email address on the webform on our blog and by liking our Phelan Dental Seminars facebook page. You can also have another chance to win an iPad by liking  Dr. Stephen Phelan facebook page.

Congratulations to our winner and best of luck to everyone else for our future contest.