CASE STUDY BY
JOSEPH A. BLAES, DDS Dr. Blaes has a general practice in the St. Louis area. He is known for his expertise in dental materials and techniques and his innovative systems designs. He writes and lectures on "How To Increase Productivity and Profitability." Dr. Blaes is a member of the American Academy of Dental Practice Administration.
DIAGNOSIS AND TREATMENT PLANNING
Examination of patient revealed that an MOD porcelain inlay on the upper right first bicuspid had a fracture. The upper left first bicuspid had some new decay on the lingual mesial margin of an MO porcelain inlay. Both teeth were treatment planned for full coverage restorations. (Figures 1 and 2)
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| Figure 1 | Figure 2 |
This patient had prior history of allergy to metals in her mouth. Some reactions had been severe. All teeth have been restored with non-metal restorations. This presented an ideal opportunity to use a biocompatible metal like Goldtech Bio 2000¨.
This patient was also interested in improving her smile by restoring the right and left cuspids and laterals with porcelain veneers.
TREATMENT
After anesthetizing the patient, a rubber dam was placed and the upper right first bicuspid was prepared for a full crown. The preparation of choice here was a shoulder crown with no bevels or feather margins. Because this metal can be cast in a core that is about 0.2 mm thick, the preparation can be conservative. The metal core will add to the strength of the finished crown. The upper right cuspid was prepared for a veneer and the upper right lateral was prepared for a full crown. (Figure 3)
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| Figure 3 | Figure 4 |
Impressions were taken and temporaries placed. Notice the tissue has not been traumatized because of Dr. BlaesÕ superior preparation techniques which can be seen in a soon to be released video on tooth preparation techniques. An A-1 shadewas picked for the crowns and the veneer. Aesthetic Porcelain Studios was picked to fabricate the case. (Figures 5 and 6, temps in place)
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| Figure 5 | Figure 6 |
This is a very interesting case because we will be using two different materials. The cuspid veneers and the lateral crowns will be made with IvoclarÕs Empress, a pressed ceramic material. The Goldtech Bio 2000¨ core will be fused with porcelain. It should also be noted that the second bicuspids on both sides of the mouth are restored with Empress crowns. It will be interesting to see if this new material will match up with the beautiful Empress shades as fabricated by David Block at Aesthetic Porcelain Studios.
David has a particular challenge because the patient is a good friend of his, of mine, and my wife, Sue. He told me not to worry since he had a lot of experience with this metal and has had very good results.
The patient was seen again two weeks later and was again anesthetized for temporary removal and cementing of the crowns and veneers. Once the temporaries were removed, the crowns and veneers were tried in for fit and shade. Both were perfect. The veneers and the lateral crowns were cemented with resin cement and then the bicuspid crowns were cemented with 3M Rely X VLC. The excess cement was cleaned off and the restorations were adjusted for occlusal contact. (Figures 7 and 8)
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| Figure 7 | Figure 8 |
RESULT
The results were amazing! The fit of the Goldtech Bio 2000¨ crowns were perfect. But even more surprising was the shade match to the existing second bicuspid crown and the Empress veneers and crowns. (Figure 9) Before gold went off the standard, all crowns were made of gold. I can remember some beautiful warm shades that I have not seen for years. The Goldtech Bio 2000¨ crown showed the porcelain shade that I remember. We have a winner from the Argen Company! A casting metal that is totally biocompatible, can be cast into a thinner core and some porcelain shades that to be believed, must be seen.
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| Figure 9 |
