One of the most frequently asked questions for us is about restoring premolars – when to layer and when to use full contour e.max. There are several factors to take into consideration when selecting what type of restoration to prescribe, such as occlusal space, margin design, and prep shade. One of the considerations that should be at the top of your list is the shade of the adjacent teeth. The more characterized the adjacent teeth, the greater the need for layering as opposed to a full contour restoration. As far as strength is concerned, there is no doubt the layered restoration is weaker, so this will need to be a point of discussion with your patient.
Case #1: Full Contour HT e.max Press on #12
In the first case, the teeth are somewhat monochromatic but very translucent, so we used full contour high translucency IPS e.max, and you can see the exceptional results. This is a strong restoration with great esthetics, the perfect material for this case.
Case #2: Layered e.max restoration on #12
In the second example, notice how characterized the natural teeth are and how bad the old pfm restoration is on the second premolar. For this situation, we chose a layered e.max restoration to allow room for the ceramist to customize the porcelain to match the photos provided by the doctor. A monolithic restoration could not have provided this exceptional esthetic result.
Here we have two great results, but with different materials, dictated by the characterization and translucency of the natural teeth. The good news is that you don’t have to worry about it when working with us. Just provide a couple of pictures with the shade guides clearly visible in the photographs, and we will help make that determination with you. We look at three things:
#1. Tooth reduction and available space
#2. Shading of natural or adjacent teeth
#3. Shade of preps
We are happy to provide jump sticks to make transferring the photographs easier, and if needed, we will even help train your staff to take great photos. Don’t have a good camera yet? No problem, we have a great camera set-up we’ve recently put together specifically for use in the operatory. For less than $2,000.00, we will be glad to help you order it and get you on the road to taking great pictures.