Matching A Central Incisor: Communication Is Key

mm Written by Andrew Sedler

The maxillary central incisor is one of the most difficult indirect restorations to fabricate. Several factors affect the final results of any restoration, but the single central offers unique challenges even for the most experienced technicians.

The biggest challenge stems from the technician needing to match the surrounding dentition. In the case of centrals, it is the close proximity to one another that creates the challenge.

When matching any other teeth in the maxillary anterior, the teeth are evaluated within the surrounding dentition and by matching the contralateral tooth. The single central match entails more critical evaluation in terms of color, shape, texture, and translucency.

Challenges with Matching Central Incisors

After restoring thousands of single centrals, Burbank Dental Lab clearly understands what is needed to make these types of cases successfully.

Managing patient expectations will go far in making this process an exceptional one. Any dentist who has restored a central should understand that in most cases, it will take more than one attempt to make a restoration that will meet the esthetic requirements that result in a successful match. This understanding needs to be communicated to the patient to know what to expect in this process.

A few things contribute to the difficulty in matching a central incisor.

  1. Poor communication is a significant factor. In addition, if the proper shade is not provided with quality photographs, matching the tooth becomes difficult.
  2. Taking an accurate shade is critical in achieving the desired outcome. The teeth can become dehydrated during a dental procedure such as shade taking. This dehydration can influence both the color and value of the teeth.
  3. Several factors contribute to the restoration matching, which include:
  • The thickness of the restoration
  • The ceramic color
  • The cement color
  • The color of the underlying natural tooth

There are ways to help make the matching process more predictable.

Request a free laminated Success Guide by Burbank Dental Lab

Shade Communication

One of the most critical factors in matching a single central incisor is to accurately choose the initial shade. Understanding the nuances of the natural tooth shades and characteristics is essential when effectively selecting a shade.

The information then must be communicated with the lab for an indirect restoration to blend well with the natural tooth.

The following are some steps to take a shade effectively:

  • Color corrected lighting
  • The walls, floors, and furniture color should be non-reflective and have low saturated colors.
  • The windows should have coverings that block out outside light influences.
  1. You should take the shade in a room specifically made for taking accurate shades. The room should have the following:

    – Color corrected lighting
    – The color of the walls, floors, and furniture should be non-reflective and have low saturated colors.
    – The windows should have coverings that block out outside light influences.
  2. Make sure the patient is not wearing lipstick prior to taking the shade.
  3. Covering the patient’s clothing with a neutral gray cloth mitigates any color influences from the clothing.
  4. Take the shade early in the patient’s appointment to avoid the teeth becoming dehydrated.
  5. Make sure cheek retractors are used to remove any shadows.
  6. Take the shade at eye level with the patient’s teeth.
  7. Place the incisal edge of the shade guide to the incisal edge of the tooth.
  8. Hold shade guide in the same plane as the teeth, not lingual or labial to the tooth.
  9. If stuck between two shades, choose the lighter of the two, as corrections will be much easier if needed.
  10. Take photos of the shade tabs in the mouth in relation to the teeth.
All On X Success Guide

Case Study

The following case was sent to Burbank Dental Lab by Dr. Sergey Zakharov of Family Dentistry at Riverside Crossing to help correct a discolored tooth #9.

This central incisor was treated with endo approximately 20 years before the patient coming in. According to the patient, the tooth became discolored and internal bleaching was ineffective in creating a more blended match to tooth #8.

To communicate the tooth’s color, Dr. Zakharov sent in a variety of high-quality photos. (see images below). This was essential in helping to create an indirect restoration that would blend well within the patient’s mouth.

Matching A Central Incisor - Maxillary Central Incisor - Burbank Dental Lab - Los Angeles
Matching A Central Incisor - Maxillary Central Incisor - Burbank Dental Lab - Los Angeles

A Vita 3D shade guide was used to choose the shade. It is a good idea to hold up several shade tabs as it helps the technician to see the color in relation to the other closely related colors (see image below). Shade OM3 was chosen for this case. Dr. Zakharov also communicated that the prepared tooth was a 2m2.

Matching A Central Incisor - Maxillary Central Incisor - Burbank Dental Lab - Los Angeles

This case was then digitally impressed, and the scans were sent over to Burbank Dental Lab along with the shade information and photos.

A working model was then printed.

A stump die was also fabricated in the shade 2m2 to give a similar working background as the natural tooth.

It was determined that this case would have great results with an e.max layered restoration necessary to match tooth #8.

An e.max restoration was then designed using digital design software (CAD). This restoration was designed with a cutback on the facial to allow for porcelain layering to achieve the final end result.

The crown was then milled and checked for margin integrity. Using the photographs, the final layering process was done to achieve the desired OM3 color, shape, and contours.

Try-In

Burbank Dental Lab always recommends trying in a restoration before final cementation. This is because the final result is not only determined by the ceramic restoration itself but by a combination of things, including the underlying tooth color, the cement, and thicknesses. Therefore using a try-in paste that represents the final cement is a great way to evaluate prior to final insertion.

The try-in paste needs to represent the same color, opacity, and value. Using glycerin or water when trying in a restoration does not produce the same effects as resin cement.

Dr. Zakharov tried in the crown and cemented the case with a translucent Calibra resin cement. The patient was happy with the improvement in their smile.

Thanks to the excellent communication from Dr. Zakharov and the skill of Burbank Dental Labs’ ceramic team, this case was completed in one try.

Matching A Central Incisor - Maxillary Central Incisor - Burbank Dental Lab - Los Angeles

Understanding the difficulties associated with matching a single central incisor is key to creating cases that bring favorable results. These difficulties can be hard for patients to understand but managing their expectations is key to ensuring that they find the experience satisfactory.

Some cases will take several tries, and in some cases, the results can be achieved quickly. Communication is the key to getting as close as possible as quickly as possible.

Contact Burbank Dental Lab to find out more about us and how we can help you.

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Fabrication
of the future
is here!

Burbank Dental Lab has three new state-of-the-art Carbon M2 printers. We are very excited about the options that these cutting-edge printers will allow us to offer our dental clients. Here are some of the advantages that these printers will begin to deliver to you and your dental practice.

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Carbon offers a highly dependable 3D manufacturing solution for many dental applications with its breakthrough Digital Light Synthesis™ technology, enabled by a wide range of dental materials.