82 The Journal of Cosmetic Dentistry Spring 2004 Volume 20 Number 1

T
oo many cases begin with the dentist completely prepping
away all the enamel, characteristics, and shape of their patients
natural teeth; then a perfect cookie-cutter provisional is placed,
followed by perfectly shaped and positioned cookie-cutter per-
manent restorations. The problem with this is that all of our pa-
tients end up looking alike. And more often than not, our patients
smiles end up looking like our mentors patients smiles.
Our mentors have given us guidelines and parameters that in-
clude golden proportion, axis of inclination, and height-to-width
ratio; without these fundamentals, we would not know where to
start. But these guidelines, while a means to an end, are not the
end in themselvesthey should go into the equation but not be
followed precisely to the letter. We must prevent ourselves from go-
ing to a catalog and picking from four or ve standardized smiles.
Nature and beauty do not follow strict guidelines, and smiles have
as many varieties as there are people.
Before doing the diagnostic wax-up for this case, I looked at the
preoperative model and photography. Instead of approaching the
case thinking, whats wrong with this mouthwhat do I need to
x, I asked myself, what do I like about this smilewhat esthetic
qualities should I preserve? (Fig1). I found that when everything I
liked about the patients preoperative scenario was maintained, the
Mentored by Nature
CLINICAL SCIENCE JONES
Bradley Jones owns and operates
a boutique laboratory, Profession-
al Dental Arts, in Boise, Idaho.
He also is co-director of Total
Team Advantage, Live Patient
Seminars in Virginia. An Accred-
ited member of the AACD, he lec-
tures and teaches advanced layer-
ing porcelain techniques around
the country.
by
Bradley L. Jones
Volume 20 Number 1 Spring 2004 The Journal of Cosmetic Dentistry 83
results were strikingly more natural
and personalized (Fig 2). For exam-
ple, if a patient presents with a tooth
rotation (Fig 3), we can correct a per-
centage of that rotation. If a patient
presents with malaligned arch form
we can correct a great percentage of
the misalignment, but still preserve
the patients natural characteristics
when function allows. The patients
natural tooth shape and proportions
should also be our guide when de-
signing an individual smile make-
over; thus, mentored by nature
(Fig 4).
ADDITIVE REDUCTIVE MODEL
The purpose of this model is to
correct arch form and tooth position
before making depth cuts. Figure 5
shows tooth #10s rotation, which
was straightened only slightly (Fig
6). The rotation of the cuspids was
corrected to achieve proper guidance.
The protruding composite build-up
of tooth #9 was reduced and both
centrals incisal edge damage was re-
paired in wax. I also wanted to take
approximately 1 mm of tissue from
the centrals, for gingival symmetry
and zenith placement (Fig 7).
After these enhancements had
been made to the additive reduc-
tive model, I made a Sil-Tech putty
matrix (Ivoclar Vivadent; Amherst,
NY). This matrix was seated over a
prepped duplicate of the additive re-
ductive model (Fig 8).
To prep the duplicate model, I
used the same burr my clinician uses
when prepping teeth. The lingual
margins were dictated by the addi-
tive reductive model and the labial
margins were placed paragingivally.
Keeping in mind that I wanted this
case to be a d.SIGN (Ivoclar Viva-
dent) on refractory, I reduced the
Figure 1: Preoperative, full smile, 1:2. Figure 2: Postoperative, full smile, 1:2.
Figure 3: Preoperative, left lateral view. Figure 4: Postoperative, left lateral view.
CLINICAL SCIENCE JONES

84 The Journal of Cosmetic Dentistry Spring 2004 Volume 20 Number 1
vertical 1.75 mm across the incisal
edges of teeth ##611. I then made
a .7-mm facial depth cut, keeping
the reduction consistent on all three
planes of the facial surface. I paid
particular attention to bevel back
the incisal one-third; this is essen-
tial to prevent a head light (show-
through) created by a aring prep
tip. It also provides necessary room
for the incisal-edge magic in the
ceramics.
Preparation of the bicuspids in-
cluded the buccal cusp and fossa
and removal of the old composite
llings. Depth cuts of .7 mm were
made just as on the anteriors.
Only after all the depth cuts were
made on the model was I able to
smooth and round the edges, just as
would be done in the mouth. Lastly,
I carefully broke contacts with an ul-
tra-thin diamond disk; this would be
done clinically using sanding bands.
These slightly open contacts enable
the plaster technician to separate the
dies without destroying the inter-
proximal margin.
This prep-guide model was then
duplicated and cross-mounted on
the Stratos 200 articulator (Ivoclar
Vivadent). A 2-mm hole was then
drilled through the matrix at the
incisal edge of a central. The matrix
was seated tightly over the prepped
model and wax was injected into the
matrix with a jewelry wax injector
(Fig 9).
The matrix was removed and the
shapes and contours were nalized.
A nal matrix was then made for the
provisionals. This matrix was placed
in a pressure chamber (40 psi) while
setting to ensure perfect adaptation.
At the preparation appointment,
all of the essential communication
tools were gathered: polyvinyl im-
pressions of the preps, the opposing
teeth, and the provisionals; photos
of the preoperative situation, pro-
visionals, and stumps; horizontal
plane guide (stick-bite); and a photo
of the stick-bite in place.
Figure 6: Additive reductive model showing
corrected arch form and tooth rotation.
Figure 7: Additive reductive model showing contour
enhancement and incisal repair.
Figure 8: Matrix on model.
Figure 5: Preoperative model.
CLINICAL SCIENCE JONES
Volume 20 Number 1 Spring 2004 The Journal of Cosmetic Dentistry 85
Figure 10: Duplicating ask and refractory dies.
MODEL AND DIE WORK
I require my model and die work to be clean, beautiful,
and awless. This enables me to concentrate on recreat-
ing nature. After the model and die work were completed
with the Zeiser pin and die system (Meteor Design; Boise,
ID), I asked and duplicated the dies that had to be in
refractory material (Fig 10). I prefer Shofu Lamina Vest
(Shofu; San Marcos, CA) because of its superior strength
and tooth-colored appearance (stump 9).
TOOTH COLOR COMPOSITION
One of the most common mistakes I see in cookie-
cutter restorations is that each and every tooth is ex-
actly the same color (usually all TC1 or all O1 from the
centrals to the molars). In nature, however, centrals are
commonly higher in value and laterals are lower in value.
Canines are denser and more chromatic, especially at the
cervical. Bicuspids are closer to the chroma and value of
laterals.
Many technicians and clinicians think of value as a
gray scale. This would be true if we were painting these
teeth on a canvas, but because dentition has depth, we
have to think of value as light-reecting (high-value), and
light-absorbing (low-value). Also, I see orange-pink tooth
color in the cervicals of photographed natural teeth. To
recreate this effect, I use d.SIGN orange-pink cervical in-
cisal, which I mix one part to two parts dentin.
In this particular case I chose Chromascop (Ivoclar
Vivadent) O3O for the centrals, O4O for the laterals, 110
for the canines, and back to O4O for the bicuspids (Fig
11).
INTERNAL EFFECTS
Internal effects also can appear cookie-cutter-like.
In order to create natural internal mamelons, we must
rst look at real teeth (Fig 12). Here we see mamelon
structures in a natural tooth after the enamel has been
removed. I recreate these effects in ceramics (Fig 13).
CLINICAL SCIENCE JONES
Figure 11: Shade tabs.
Figure 9: Injecting wax.
Figure 12: Internal characteristics of natural teeth.
(photos by Claude Sieber)

86 The Journal of Cosmetic Dentistry Spring 2004 Volume 20 Number 1
Figure 13: Reposed lips and incisal edges.
FINAL SHAPES AND CONTOURS
I used silver Hi-Light (American Dental Supply;
Easton, PA) to give me important information about re-
ective and deective zones of the patients preoperative
tooth shape and form. This helps to individualize each
case and to keep me from standardizing the shapes of my
restorations (Figs 14 & 15).
REFLECTIVE SURFACE
The silver Hi-Light also provides information on
the patients natural surface morphology. Again, I may
choose to modify this surface rather than giving her a
standardized surface reection.
I applied the silver Hi-Light to the restorations on
the solid model and worked the surface with a tapered
diamond # 850 016 (Brasseler; Savannah, GA). Then, I
rubber-wheeled the surface for natural glaze with a knife-
edge pink wheel (medium-grit Dia-lite L26DRM [Bras-
seler]). The ceramics were then red at 840 Celsius,
50/minute rate of climb. After the restorations cooled
I used the same pink rubber wheel to soften the exter-
nal lobe surfaces. Next, I wet-pumiced the surface using
extra-ne our pumice on a lathe at the slowest speed.
I nalized the restorations by highlighting the external
lobes with a knife-edge yellow wheel (ne grit CeraGlaze
P30010 [Axis Dental; Irving, TX]). In nature, I see each
tooth surface broken up by highly polished areas and
not-so-polished areas. It is most important to mimic this
natural surface.
In conclusion, I believe that this relationship with na-
ture is key to creating undetectable dentistry. It is my goal
to have at least one undetectable case in my career. The
only way I am going to accomplish this is to continue to
be mentored by nature.
Thanks go to Dr. Chad Roskelley of Boise, Idaho, for
his excellent dentistry.
______________________

CLINICAL SCIENCE JONES

Figure 15: Bisque bake.
Figure 14: Silver Hi-light.