Finding the Perfect Shade.

There are several differences between men and women in dentistry, many of which I have blogged about before.  However, one was brought to my attention the other day which is very interesting.  In case you didn’t know 7% of all men are colored blind, while only 0.4% of women are.  That is interesting as color blindness is encoded on the sex hormones and therefore many women are carriers but are not color blind.  But how does that interesting anomaly affect dentistry?  Well in my case, I am part of the 7%.   Specifically I can’t see many blues and reds.  Well let’s say I was doing a porcelain crown on your upper right central incisor and we need to match the shade to your upper left central incisor exactly.  When the laboratory technician is stacking the porcelain they use blue shades to mimic the translucency that many people have in their incisal edges of their central incisors.  Well if I can’t see the blue I can’t tell if the incisal edges match and it could look perfect to me but in actuality it is way off.  This is probably made worse with the fact that many teeth have orange or red tinges which I also cannot see.  Well, there is technology to the rescue.  We have used electronic shade matching computers for several years that can actually map several sections of your tooth to come up with a precise shade match on every portion of your tooth.  Is it perfect?  No, but with the help of an experienced and qualified laboratory technician we can get the shades really really close. And by the way, who are the best and most talented as techs at the laboratory to check shades?  Women of course.  Good Luck with those colors!  

Hi-tech

High tech is all the rage and it does affect dentistry.  If it weren’t for computers, iPhones, tablets and the internet, where would we all be?  Some love it, and others hate it.  I assume the difference is whether your “toys” are working or not.  But these are really more than “toys,” they have become part of our everyday life.  The one thing I have learned over the years however is that there is a place for technology, and other places where the old tried and true methods work better.  For example when my kids were little and they got a new hand held calculators that were available at the time, they thought that they were great.  But I would constantly drive them crazy by doing mathematics calculations on my old slide rule faster than they could push the buttons on their calculators.  Now to be honest, I have not used my old K + E Log Log Duplex slide rule for some years as I have learned to use computers just as they did.  But I believe the concepts of old versus new is still valid.  Now what does that have to do with dentistry?  I am sure you have heard advertisements for a new process in which they can do crowns (caps) in one visit.  It utilizes digital scanners, that we already use (Itero), with a milling machine attached  These offices can mill a new crown out of a solid "block" on the spot without having to send the impression off to a laboratory.  This means not having to deal with temporary crowns and need to return in a few weeks for a second appointment.  Sounds great doesn’t it?  But as always there must be a catch, and indeed there is.  You can only mill certain materials and today those materials fall into two categories.  The first one is one of the new “super composites” which are basically hardened plastic tooth colored filling material.  The second material is a new ceramic material called E-max, which does look great, but is not nearly as durable as many of the other materials that we have used for years.  Therefore, especially on the molars, you are risking cohesive failure of the material in a single visit crown just for the convenience of avoiding a temporary crown.  I don’t know how you feel about it, but I don’t like Novocaine shots that much.  So redoing a new crown because it broke is not my idea of fun.  Therefore, although we use the latest technology for scanning images for crowns, until the manufacturers develop new "blocks" with a wider range of restorative materials, in my opinion milling a crown on site is not the best option for the vast majority of our patients, especially on their molars, which take a tremendous amount of force and are prone to mechanical failure.  I will watch for continued improvements however and will jump on the band wagon if possible.