Shade-Matching Challenge

A Single Central Incisor

Achieving a good color match when restoring a single incisor is probably among the most difficult aesthetic challenges for any dentist (Figure 1). While the latest technology can be found in most modern dental offices such as CBCT; laser; CAD/CAM; and less common, the more expansive spectrophotometric instruments;1 the vast majority of clinicians still conduct dental shade selection by using a nearby window for a natural light source or, if they are fortunate, pass the buck by simply sending the patient to the dental laboratory technician to take and map the shade. There must be a better way and, in the authors’ opinions and experience, there is! A simple and inexpensive handheld portable LED light source, the Rite-Lite 2 HI CRI Shade Matching Light (AdDent), is now available help achieve an excellent restorative shade match.^2-4

Figure 1. Pre-op photos of mismatched crown on nonvital central incisor with gingival inflammation.

DESCRIBING A SHADE

Shade matching is an interdisciplinary process that requires the clinician to communicate with the dental laboratory team using a common language and images (shade-mapping and photographs). Thus, shade matching relies on perception and interpretation of the evidence.

Color, commonly referred to as the shade, is divided into 3 components.

Hue refers to the basic color (eg, red, blue, green).
Chroma refers to the intensity of the color (eg, fire-truck red versus pastel pink).
Value refers to the brightness of the color (eg, the range of gray from black to white).

All these components should not be overlooked, or else a wrong interpretation of color may lead to an undesired result. For example, how often have you told your ceramist to make the cuspids slightly darker when restoring an anterior case? However, your real intent was to make the cuspids warmer with more chroma but not darker (lower value).

It is important to realize that the correct language helps in the interpretation of the evidence. Acquiring the evidence relies on the physiology of our eyes and the transmitted light.⁵

How We Perceive Color

We perceive color using cone cells that are located in the fovea in the middle of the retina. Cone cells are few in numbers and are divided into 3 groups. Each group responds to a specific color: red, blue, or green.6 Cone cells fatigue extremely fast, since they are limited in number. For example, if you stare at a color, such as red lipstick, the red cone cells will shut down after 30 seconds. This will leave you seeing only the combination of colors provided by the green and blue cells. This is why it is necessary to create a neutral background for your eyes before selecting a shade. Ideally, the walls in the room should be gray or white. Ask your female patients to remove their lipstick and place a pale blue or grey bib over their clothes.⁷

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When Will All-Ceramics Surpass PFM’s?

There’s no doubt about it: all-ceramics are on the rise. More and more, labs are delivering zirconia, IPS e.max lithium disilicate, and full contour restorations. As this trend continues, the shift from metal-based to metal-free restorations will grow steeper and steeper. Don’t throw away your PFM’s yet, they’re still a strong option (and our preference) for posterior restorations. For now.

According to LMT Magazine, Ivoclar Vivadent’s Bob Ganley had this to say at last year’s Cal-Lab meeting: “Although most sections of the industry are up, precious alloys were down 10% [this year].” He continued: “Both press and CAD/CAM all-ceramics are seeing a high growth rate while metal-ceramics are down 2.5%.”

While the numbers indicate otherwise, PFM’s are still a widely popular and effective option in restorative dentistry. So, it becomes a question of when our synthetic restorative materials will pass the tipping point of PFM’s in terms of durability, aesthetics, and cost. And when they do, will we say goodbye to the tried-and-true porcelain fused-to-metal for good?

And what about full-contour? Lee Culp, CDT, CTO at DTI-Dental Technologies, Inc. had this to say.

“The days of using 20 different porcelains to build up a tooth, as the first option, are long gone. You can get aesthetics out of full contour. Everything I have always done has been based on simplicity,” he said, while building a case for the increasing number of dentists going with the full-contour option. He added: “We’ve been doing full contour for a long time—it was called a gold crown. Nobody said it wasn’t artistic then.”

While PFMs still have plenty of practical applications today, full-contour all-ceramic restorations are clearly where the industry is headed. The human tooth is “full-contour,” afterall. Shouldn’t we aspire to make restorations as strong, aesthetic, and natural as possible?

Until then, we wait.

Why We Do What We Do: A Case Study

Every now and then, we get the privilege of hearing exactly how our work on a case made an impact on someone’s life. It’s cases like these we’re reminded exactly why we’re in business in the first place: to change people’s lives by giving them a new smile.

This is just one of those cases.

Meet Tammy. Tammy was missing her four front teeth (implants which were in a configuration and position that’s not-so-restoration-friendly).

She was told there was nothing that could be done by several dentists. However, Dr. Hopkins of Plano’s Advanced Dental Center decided to take the case. With a bit of creativity and a ton of experience, she was able to develop a custom plan that would have Tammy smiling bright yet again.

It was a long road to recovery; the plan involved additional bone and gum grafting and the sacrifice of one of the implants. After a year and a half, Tammy had a beautiful smile again!

We’d like to thank Dr. Hopkins for taking this case and sharing this incredible story with us, as it truly makes our work worthwhile!

The All-on-4™, Presented by Dr. Almasri: A Recap

First and foremost, we’d like to thank everyone for coming out to last week’s study club and making the event a success! Without you, we wouldn’t be able to host events like these.

For those of you who weren’t able to attend, Dr. Almasri gave us a thorough run-down of the preliminary steps of the All-on-4™ technique, including patient selection and case presentation. We learned some diagnostic considerations, as well as how to recognize which patients would benefit most from this procedure.

Spotting potential patients for this procedure is only the tip of the iceberg. After they’re sold on the idea of the procedure and its treatment plan comes the discussion for patient financing options. Dr. Almasri discussed a few of these, making the somewhat expensive procedure much more accessible to patients on a limited budget.

The Man Behind the Lab, Part II

The owner of YDL sits down and shares his remarkable past. From Lebanon to Los Angeles, all the way to Texas, this classic American success story started with little more than two suitcases and a relentless work ethic.

Last month, we began a spotlight segment on the owner of YDL, Sami Yared. We discussed his past, his hardships, and how he coped with those hardships and even used them to his advantage. You can read that article here. We’ll continue right where we left off: Sami had been working in California for some time, and was getting ready to make the move to the Lone Star State.

You moved from California to Texas. How did you come to this decision?

Back in Lebanon, we had a simple, flat tax rate of 10%. There were no local taxes, income taxes, property taxes, and so on as we have here in the States. I learned this the hard way when I first started working for Dr. Ibsen. I couldn’t wrap my brain around the fact that taxes were being held from each and every check I was earning.

This was one of the key reasons that led me to own my own business again. I knew I’d still be paying taxes, but at least I’d be able to hire someone to do them for me. So, when a friend told me there was no state income tax in Texas, it already sounded like the place for me. Shortly thereafter, I packed everything I owned into my old Dodge and headed east to Dallas.

In Dallas (after a bit of a job-hunt), I started working for Dr. Guy Keeter in a small lab at the back of his practice. Pretty soon, I had several accounts of my own to manage, and needed a bigger workspace. I rented a space right across the street, and in 1986, YDL was born.

Tell us about the successes and setbacks of YDL in its early years.

Well, in the late 80’s and early 90’s, growth in dental technology was fairly stagnant. To set YDL apart from other labs, I shifted the entire organization’s focus to quality, artistry, and customer service.

These three facets became the biggest equalizer for YDL. We took the standpoint that large labs are only as good as their best technician. Rather than become a large lab of average technicians, I preferred to grow organically as a small lab with great technicians.

How did you go about creating that change?

I went on a ‘pilgrimage,’ if you will, to learn from all the best masters the field had to offer. Highly recognized names such as Kuwata, Klauss, Seiber, Yamamoto, Geller, Aiba… at equally great institutions like Pankey. I traveled, I learned, I honed my craft, and I demonstrated my ability to create beautiful crowns, earning a great deal of new clients along the way.

After that, I had to bring the entire staff at YDL up to my level. That’s when we began our commitment to continuing education. To this day, we hold various courses throughout the year for staff and our clients alike. We’ve already had two in 2013: the first in January, and one just a couple weeks ago at the beginning at February.

Obviously, you’ve invested quite a bit of money in the look and feel of the lab. What went into the decision behind this?

We view the lab as an extension of our product. We want our clients to feel comfortable the minute they walk in. We want them to know all the restorations they need are being made in a state-of-the-art, sterile environment conducive to such a business. I like to think it gives them the confidence to reassure their patients that they’re investing in a quality product, and that their teeth aren’t being made in the back of someone’s garage somewhere (laughs).

Before we moved into our new building in 2008, YDL had outgrown its old lab. We didn’t even have enough room for parking! With future growth in mind, I designed the new lab to be flexible enough to accomodate upwards of 40-50 employees. I envisioned a modern, clean, high-tech facility designed as much for efficient workflow as well as to make a statement. My goal is to become the lab in Dallas, as well as among the flagship laboratories in the country.

Has the way you do business (or the industry as a whole) changed much since you began? Where can you see it going in the future?

Absolutely. Everything’s changed, really. From the technologically stagnant 90’s to the rapidly expanding and ever-changing world of CAD/CAM dentistry we work in now, the industry’s certainly seen its ups and downs.

On the down side, technology has also led an industry trend of sacrificing quality and artistry for lower costs and quicker turnarounds. YDL firmly believes in using technology only to supplement the skill of our technicians (not to replace it), and only when it results in a higher quality product or satisfies a client’s specific preference. As I’ve said before, if adapting to a new “industry standard” limits our ability to serve our clients in any way, we’re just going to keep what we have.

The Man Behind the Lab, Part I

The owner of YDL sits down and shares his remarkable past. From Lebanon to Los Angeles, all the way to Texas, this classic American success story started with little more than two suitcases and a relentless work ethic.

26 years ago, one man had a vision to create the nation’s premier dental laboratory, focused on: delivering the finest customer service possible to its clients; creating high-quality, artful restorations; utilizing the most cutting edge dental technology; and maintaining a commitment to continuing education, for clients and staff alike.

This man was Sami Yared, CDT. Somehow, we were able to separate him from his work long enough to ask him some questions about himself, how our business came to be, and where it’s going in the future. Here’s what he had to say:

For those who don’t already know, describe your experiences growing up, your reasons for leaving your home country, and your transition to the U.S.

I was born and raised in Beirut, Lebanon. I went to a French-language Jesuit school known as Collège Notre Dame in East Beirut. The school was very prestigious, and as such, fully prepared me for my college days, or so I thought. I planned to major in Chemistry at The Lebanese University, but my plans were changed by the onset of the civil war.

While many of my closest friends left the country to finish their studies abroad, I opted to stay and get involved with the war effort. I just couldn’t leave my family, my community, and my home behind. After about 4 years of combat, the fighting started to get really serious. With a heavy heart, I decided to leave for France and get to the United States as soon as I could, so I could finally finish my studies.

In spite of all this, life in Lebanon was wonderful, even a bit surreal sometimes. The country is full of with sunny beaches, beautiful mountains, and a view of the Mediterranean Sea. The people there were full of life and love, and certainly lived to the fullest extent they could.

Explain your educational opportunities here in the States. What inspired you to work in the dental industry?

Coming from Lebanon, a very cash-based society, I didn’t even entertain the thought of taking student loans to go to school. Luckily, my brother was able to help me financially. To save us some money, I decided against going to dental school, instead opting for a degree in dental technology. It was a cheaper, faster option that allowed me to start working (and making money!) far sooner than dental school would have.

What inspired me to work in the dental industry? I haven’t really thought about that before, I guess just the magic of completely restoring someone’s smile, and the way it affects their self-esteem, confidence, and quality of life.

What’d you do after school?

Regrettably, my father’s business in Lebanon was burnt to the ground as a result of the civil war. I went back to help my family by starting my first laboratory. It actually ended up being pretty successful, but doing business in Lebanon had its downsides. First, there was the problem of electricity. It would stay on only about 4 to 6 hours per day, and I didn’t have access to any generators big enough to produce the amps necessary to run the equipment. It wasn’t unusual for me to sleep at the lab, and wake up whenever the electricity came back on (whether it was 4am or midnight). Needless to say, I became very imaginative at creating shortcuts to allow us to do more business.

When did you decide to come back to the U.S.?

Somewhere around 1985, I went to Los Angeles to visit my cousin, and ended up deciding I’d rather stay there and look for a job. I called my brother and asked him to shut down the lab in Lebanon. While the decision seemed easy at the time, I think internally, my body was in shock. I couldn’t get a good night’s sleep for weeks, and my hair was falling out in clumps. Once I found a new job, it slowly but surely went away.

Where’d you find a job?

After 3 of the longest months of my life, I finally found work in Santa Maria, CA. The owner of my company, Dr. Ibsen, was the visionary behind laminate veneers (called Cerinate at the time). He was a great mentor to me, but about 9 months in, I started to realize I really wanted to be my own boss again.

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