Managing Patient Expectations: IPS E.max Restorations

RESTORATIONS THAT FIT WHAT THE PATIENT & CLINICIAN ENVISIONED

Written by Andrew Sedler, COO

Written by Andrew Sedler, COO

Written by Andrew Sedler, COO

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The overall quality of care in dentistry is measured not only by clinical outcomes but also by overall patient satisfaction. While clinicians are often concerned with patients’ dental health as a whole, patients can be focused on other issues such as esthetics or costs. Understanding a patients’ concerns is paramount in ensuring a positive experience. By uncovering their goals, a case plan can be developed to incorporate managing the patients’ expectations and ultimately ensure their satisfaction.

Treatment Plan

At Burbank Dental Laboratory, our role in the dental process is to take the direction of the clinicians we work with and create restorations that fit what the patient and clinician have envisioned. The more planning that goes into a case, the closer we can come to fulfilling the desired results.

Even before a handpiece is used for preparation, a case should be well planned.  This will ensure the proper preparation design, shade match, and material selection are made to achieve the agreed-upon results.

The following case came to Burbank Dental Lab, where Dr. Mitchell Rubinstein prescribed tooth #8 (figure 1, shown below). It is no secret that working on matching single-units is one of the most challenging things to do in dentistry. It is not uncommon for cases to need a few adjustments to get these cases just right. Without managing patient expectations, these cases can lead to frustration. When matching a single central incisor, it is very common for a clinician to choose to do both central incisors at the same time to ensure proper symmetry is achieved.

AFTER Result - Dr. Mitchell Rubinstein
Patient Expectations

This patient was unhappy with the shape, size, and color of tooth number 8 and disliked the diastema between 8 and 9. The patient was happy with the rest of his teeth. He was presented with a treatment plan that included preparing both 8 and 9 to ensure symmetry and handle the spatial issues.

He, however, was adamant about only adjusting tooth #8. It was explained that the space for #8 would be wider than #9 and that we could make it look better but only by about 50 to 60% if only tooth #8 were restored. The patient indicated that he would be happy with this amount of improvement.

All On "X" Success Guide Coming Soon
Photographs

Dr. Mitchell Rubinstein took several pictures to help the Burbank Dental Lab technician match the tooth to the adjacent teeth (Figures 2 & 3, as shown below). Photographs are essential for revealing the characteristics of the surrounding dentition being matched. Pictures reveal character traits such as crack lines, calcifications, and degree of color transitions.

The following images should be sent along with the case to help with the matching process:

  • Photo showing the patient smiling.
  • Photo with the lips retracted.
  • Pictures showing the shade tabs directly in the same plane as the dentition being evaluated.
Figure 2 - Dr. Mitchell Rubinstein
Figure 2
Figure 3 - Dr. Mitchell Rubinstein
Figure 3
Success Guides of Burbank Dental Lab
Shade Evaluation

In addition to photographs, Burbank Dental Lab also recommends the following steps to ensure adequate information is provided:

  • Take the shade before preparation, and prioritize it early in the appointment to minimize dehydration.
  • Take the shade while the patient is in an upright position.
  • Eliminate possible shadowing by using cheek retractors.
  • Hold up the entire shade guide to start the process.
  • The shade tab should be held directly under the area being evaluated. For best results, the shade guide's incisal edge should be placed at the tooth’s incisal edge.
  • Take a shade of the tooth after preparation.

This case was then prepared for a veneer on tooth #8 (Figures 4 & 5, shown below). A provisional was placed for the patient to wear while the final restoration was being fabricated (Figure 6, shown below).

Figure 4 - Dr. Mitchell Rubinstein
Figure 4
Figure 5 - Dr. Mitchell Rubinstein
Figure 5
Before Photo - Dr. Mitchell Rubinstein
Figure 6
Material Selection

The ultimate success of a case relies on material choice. When evaluating what material to choose, the key factors include strength and esthetics. IPS e.max is an excellent option as it is both a strong and esthetic material. Specifically, this material is one of the most widely used and highly successful materials in dentistry.

To restore tooth #8 for this case, it was determined that IPS e.max would be the best option.  E.max is a lithium disilicate ceramic that provides excellent esthetic results and a precise fit.

Also necessary is the flexural strength of 500 MPa, helping to ensure that the restoration will last.

The benefits of this material are as follows:

  • Versatile applications as this material can be used for:
    • Crowns
    • Veneers
    • Inlays/Onlays
    • Three unit bridges
    • Implant crowns
  • A wide variety of ingot colors and translucencies, making this an excellent esthetic choice.
  • High Flexural Strength (500 MPa).
  • Conservative preparation design.
  • Less wear to opposing teeth than some other materials.
The Advantages of IPS e.max
IPS e.max
Veneer Fabrication

Once the information was provided to Burbank Dental Laboratory, the case was waxed up to an ideal contour to ensure the restoration would address all of the patient's concerns.

One of the main concerns was the large diastema that was between teeth 8 and 9. Once the desired shape was achieved, the case was pressed and then layered to match the existing dentition using the photographs and other information provided by the clinician.

The case was returned to Dr. Mitchell Rubinstein for insertion (Figure 7, shown below). This case had a great result, and most importantly, the patient was happy.  It required a team approach that consisted of the input of the patient, clinician, and laboratory. The proper plan was created and then implemented.

Proper preparation design, material selection, data gathering, and ultimately appropriate insertion techniques all played a role in achieving an excellent result.

This treatment plan was driven by listening to the patient's desires and Dr. Mitchell Rubinstein's pre-op vision.  When working on a single unit matching, it is by far the most challenging type of case and can often lead to unmet expectations for the patient. They don’t always understand the challenges that these types of cases pose for the dental team.

Managing the patient's expectations is a vital step in ensuring these cases provide patient satisfaction, and this case exceeded the patient's expectations.

After Result - Dr. Mitchell Rubinstein

Before & After

Before Photo - Dr. Mitchell Rubinstein
After Result - Dr. Mitchell Rubinstein

If you would like more information about Burbank Dental Lab or your next restorative case, call us at (800) 336-3053 or click the Chat icon in the right corner to start a conversation with our ceramic team.

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