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Inside Dental Technology

May 2012, Volume 3, Issue 5
Published by AEGIS Communications


Creating Beautiful Results with Platinum Foil

Restoring two lateral teeth with veneers using the platinum-foil technique.

By Luke S. Kahng, CDT

In the author’s opinion, custom shade matching the lateral teeth is easier than matching the shade of the two centrals. Yet, properly shade-matching laterals so that they blend with the color of adjacent teeth is critical to the natural appearance of the smile. This case study will follow the appropriate steps for custom shade matching and the use of the platinum-foil technique to create two veneers. Final touch-up to the color with staining is also demonstrated.

The patient was a 40-year-old woman who needed her two laterals replaced. To match her color, the author used custom-made porcelain shade tabs with built-in opacity, the correct amount of transparency, and shade modifications focusing on subtle white calcifications, as well as moderate translucency.

Case Report

At the custom shade-matching appointment at the laboratory, the patient’s color was noted to be warm, with an orange-brown tone overlaid with clear, whitish enamel (Figure 1). There was moderate translucency but it was still checked and noted to be of the same color tone (Figure 2). Using a different set of shade tabs, the author checked the amount of translucency and white calcification, as well as surface texture (Figure 3 and Figure 4). Next, the author checked for stump color using custom-made after-preparation shade tabs (Figure 5) to create a custom color using the foil technique.

The foil comes in a special bag, wrapped in paper, which should be opened carefully (Figure 6). The special paper around the foil serves as a guideline when the technician prepares to cut the foil for fabrication of the restoration (Figure 7).

Using the die, he measured and cut the foil to the right size to avoid waste (Figure 8), then double-checked the size (Figure 9). The author once again checked the size of the foil visually to avoid waste and expense (Figure 10). The paper then had to be carefully pulled away from the foil to make sure it did not tear (Figure 11). The author used a thin stick to push the foil down onto the die and smooth the edges into place (Figure 12). He followed the preparatory design and inside shape to achieve the correct effect for the restorations (Figure 13).

The porcelain build-up consisted of dentin overlay with a B-2 base (Figure 14). Enamel opal followed (Figure 15), and a subtle mamelon application was next (Figure 16). An application of translucency neutral was layered over the other porcelain applications (Figure 17), and a slight amount of enamel was then applied (Figure 18). Clear florescence was layered over the top of the enamel (Figure 19) and GC Initial E59 Low Fusing porcelain (GC America, www.gcamerica.com) was then applied (Figure 20 and Figure 21). After firing at 780°C, the restoration was removed from the oven and checked for appearance and fit (Figure 22). With pencil markers, the author drew texture lines on the surface of the restoration and painted the model with a Pico-Fit gold die spacer (Renfert, www.renfert.com) (Figure 23). After the surface texture was checked on the model (Figure 24), the author applied a subtle white stain using a thin brush (Figure 25). Next he layered a beige stain to the mid-section of the restoration (Figure 26). An image of the various staining colors gives the reader an idea of what the author was using to recreate the patient’s natural tooth color (Figure 27). To create a horizontal line, he used the bluish color (Figure 28). The restoration was finally glazed and placed in the porcelain oven (Ibex, www.ibexdental.com) for the final bake.

Once fired, the foil was carefully removed with tweezers (Figure 29). In this mirrored image, the author checked for the orange mamelon and calcification coloring. The gingival area had a slightly darker orange hue (Figure 30). Still, upon trying the restoration in the mouth, the author determined that the veneer needed color adjustment for a more lifelike appearance (Figure 31).

More stain was applied to the middle and incisal areas to create a better color match (Figure 32) and was tried again in the mouth. The second try-in revealed (Figure 33) that a touch of white stain would be needed to match the incisal decalcification (Figure 34). At the final try-in appointment, the author compared the veneer to the central and the canine to determine if the veneer blended naturally with the harmony, tone, opacity, and translucency of the surrounding dentition (Figure 35). The author took a photograph from above the patient’s head and to the side to view the color transition from a different angle (Figure 36) and was able to check the tone, texture, and angulation harmony (Figure 37 and Figure 38). All characteristics such as translucency, texture, and enamel combination were checked, as well as the size and angulation of the teeth (Figure 39 through Figure 43).

As mentioned earlier in this article, enamel and translucency, along with texture, is hard to mimic in natural teeth. Using the right tools and mindset, the goals for the case can be reached.

Acknowledgment

The author would like to thank Kenneth Pickett, DDS, for his clinical work in the case.

Luke S. Kahng, CDT
Owner
LSK121 Oral Prosthetics
Naperville, Illinois


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Image Gallery

Figure 1  The author created porcelain shade tabs.

Figure 1

Figure 2  The author checked and found that the amount of translucency was moderate.

Figure 2

Figure 3  Incisal translucency, calcification, and surface texture was checked.

Figure 3

Figure 4  Incisal translucency, calcification, and surface texture was checked.

Figure 4

Figure 5  After-preparation color was checked.

Figure 5

Figure 6  The platinum foil.comes wrapped in paper.

Figure 6

Figure 7  The paper is marked to serve as a guideline.

Figure 7

Figure 8  Using the die as a guide, the author double-checked the size of the foil.

Figure 8

Figure 9  Using the die as a guide, the author double-checked the size of the foil.

Figure 9

Figure 10  The author visually checked the size.

Figure 10

Figure 11  The foil was carefully unwrapped.

Figure 11

Figure 12  A thin stick was used to smooth and push the foil into place.

Figure 12

Figure 13  The technician followed the preparatory design as he wrapped the foil around the die.

Figure 13

Figure 14  The dentin was applied in a B-2 base.

Figure 14

Figure 15  The enamel opal was then applied.

Figure 15

Figure 16  The mamelon application followed.

Figure 16

Figure 17  Translucency neutral application was layered over the porcelain.

Figure 17

Figure 18  A slight amount of enamel was applied.

Figure 18

Figure 19  Clear florescence was layered over the top of the enamel.

Figure 19

Figure 20  GC Initial E59 Low Fusing porcelain was applied.

Figure 20

Figure 21  The appearance before baking.

Figure 21

Figure 22  The appearance after baking.

Figure 22

Figure 23  Texture lines were drawn on the surface of the restoration.

Figure 23

Figure 24  After baking, the texture was noticeable.

Figure 24

Figure 25  Using a very thin brush, the author applied a subtle white stain.

Figure 25

Figure 26  A beige stain application was applied to the mid-section of the restoration.

Figure 26

Figure 27  Various stain colors are available to recreate the natural color of the tooth.

Figure 27

Figure 28  A bluish horizontal line was created.

Figure 28

Figure 29  Tweezers were used to carefully remove the foil.

Figure 29

Figure 30  The gingival area was given an orange hue.

Figure 30

Figure 31  Upon trying in the mouth, the restoration was still not.complete.

Figure 31

Figure 32  More stain was applied to create a better color match.

Figure 32

Figure 33  The restoration was tried in for a second time.

Figure 33

Figure 34  It was decided that white stain was needed to match the decalcification.

Figure 34

Figure 35  At the final appointment, the author checked to see if the veneer.compared to the adjacent teeth.

Figure 35

Figure 36  Angled photography was used to view the color transition.

Figure 36

Figure 37  The author checked the tone and texture.

Figure 37

Figure 38  The author checked the tone and texture.

Figure 38

Figure 39  All characteristics were checked in the mouth.

Figure 39

Figure 40  All characteristics were checked in the mouth.

Figure 40

Figure 41  All characteristics were checked in the mouth.

Figure 41

Figure 42 

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Figure 43  All characteristics were checked in the mouth.

Figure 43