Matisse will provide an exact solution to each case. What proceeds next is a detailed explanation of how to correctly interpret and apply the given solution.
In the figure above, a typical ceramic advice of Matisse is shown in the case for crowns.
Step 1 (crowns): Practical application of the substructure and staining recipe
This step applies only to crowns and veneers on lithium-disilicate. Given the available space and selected brand, Matisse will find a suitable substructure of appropriate thickness for your crown/veneer on lithium disilicate. In some cases, particularly for situations with high discoloration of the preparation, the circumstances do not allow for a substructure of the specified brand. If that occurs, Matisse will automatically look for a substructure of e.max Press, to find a suitable candidate that can mask the heavy discoloration. In situations where absolutely nothing is possible, the user will be prompted about it. If such a situation occurs, it is recommended to create more labial space by preparing the tooth.
Depending on the indication, the amount of space available and color of the preparation Matisse will sometimes give the user a staining recipe for the middle area and for the incisal area of the substructure. Matisse knows exactly how much the substructures needed to be stained, and also when it is necessary. However, Matisse will always strive to give you a substructure advice that does not require staining.
What to do when Matisse generates a staining recipe ?
When receiving a staining recipe, it means that the color of the substructure needs to be adjusted using stains. Matisse generates a substructure which aims to push the
\( L^* \)-value of the substructure+preparation combination 2 points higher than the desired target \( L^* \)-value (for the middle area). Simultaneously, it tries to bring the chroma (i.e.\( a^* \) and \( b^* \)) to a fraction of the desired chroma. The result panel in Matisse displays how much the LAB values should increase after performing the staining during the wash firing process. For example, if the panel displays: \( L^*=-2.31 \), \( a^*=+1.53 \) and \( b^*=+5.03 \), this means that substructure is 2.31 points higher in luminosity compared to the target, and that the \( a^* \) and \( b^* \) should increase by 1.53 and 5.03 after staining.
What to do with this LAB numbers?
You have to measure the substructure on the gypsum model and write the
\( (L^*,a^*,b^*) \)-numbers of the substructure on paper, then calculate this with the staining recipe. Write down the \( (L^*,a^*,b^*) \)-values after calculation to use as a guide. For example, if the \( (L^*,a^*,b^*) \)-values of the substructure on the model is \( (L^*85.55, a^*0.46, b^*1.10) \) and for the staining recipe \( (L^*-2.31, a^*+1.53, b^*+5.03) \), then after staining process it will become: \( (L^*83.24, a^*3.58, b^*6.03) \). That is, the result after calculating, is the color that the substructure must have on the model after staining. (Use the staining set of your ceramic brand and use the Matisse staining charts to choose the best fit for the case)
When the stains are applied, measure the substructure on the model to see if the target color is achieved, do this before firing the crown. Another way is to stain in a thinner layer and do a fixation firing of 600C without vacuum. If the staining recipe gives an insignificant difference (the numbers are very small), you can choose to not stain because that means that the substructure + the preparation combination already comes very close to the target values.
Step 1 (veneers): Practical application of the masking recipe
This step only applies to veneers on refractory. When a preparation is discolored you will receive a masking recipe in a precise thickness until 0.5 mm, (measure this thickness with a sondes paro-instrument). Layer this recipe only on the place where the discoloration is visible. For layering advice please look at section practical application of ceramic recipes.
Step 2: Planning and Workflow
Before mixing the recipes and starting with layering, it is highly recommended to plan the case. Here are a couple of pointers:
- Make a gypsum model that is representing the color of the preparation as close as possible, use also wax to replicate the gum color. This is important to be able to control the final color.
- When uploading the case into Matisse software, Recognize how many dentins are needed to replicate the same histo-anatomy of the dentin. De-haze the polarization picture in (soon in Matisse software) and analyze the histo-anatomy of the tooth. Draw the histo-anatomy of the dentin on paper. When dehazing the picture, you will understand where the transition area from opacious dentin to translucent dentin will be. The same holds true for the transition area from dentin to enamel, and from enamel to opalescence.
- Drag the photo's of the case in Keynote to make a ceramic map of the internal effects, you do this by comparing the tooth with the photographed ceramic samples. Do the same thing with the skin enamel (you may send us an firstname.lastname@example.org, and we will send you the keynote with various samples of ceramic brands)
- The most predictable way of working is to layer the crown with all the internal effects, but without the covering it with the skin enamel. After firing, calibrate & save the picture in Matisse and drag the picture into keynote where you can use the ceramic samples (enamel and opals) to compare it with the target tooth. In this phase, make two pictures of the crown on the model: one with polarization filter to compare the Lab* values, and one without the filters to visually make the comparison with the target tooth.
- Do the same steps in keynote after firing the skin enamels and skin opals.
- After glaze firing do the last comparison with the target tooth. The most efficient and fast way is to do the try in in the patient mouth after the first bake.
Step 3: Practical application of the ceramic recipes.
Use this guidelines when layering the crown. Focus on creating the correct form (histo-anatomy) of dentin, with the dentin recipe for the middle and incisal area.
Histo-anatomy of dentin : 1st Layer. When using the ceramic recipes to create the dentin, it is important to control the correct volume or thickness. This will give you the correct color and appearance.
Internal characterizations : 2nd Layer.
This step is important to achieve an identical match. Use the internal effects planning which is done in Keynote .
- Cervical area: Use cervical translucent masses to complete the right color and appearance
- Middle area: Use bright enamels or opal effects to complete this area, most of the time a very thin layer (0.3mm)
- Incisal area: To create a natural looking incisal third, it is important to create the DEC layer, do this only on the incisal 1/3
- Seal the dentin lobes with waterthin layer of a transparent ceramic mass (opal effect)
- Place mamelons effects on top of this layer
- Seal it again with opal effects or yellowish/ orange transparent mases
Skin enamel and Skin opal: 3rd Layer.
With this layer the same depth , light reflection and appearance is created as the target tooth. Analyze and plan this step carefully in keynote. During analyzing the skin enamel and opal of a case. It will be more evident that a natural tooth has different types of external transparency, translucency and white areas. For each case to succeed there is another combination. Matisse chooses only the best skin enamel that is compatible with the color of the dentin middle area and incisal area. The user has to to do the ceramic mapping.
- Cervical area: In the previous step a translucent layer was added. Analyze it again and when needed repeat it with the same layer of cervical translucent mass. With very glass like tooth use a transparent powder.
- Middle area: use In the middle area enamel or opal effect.
- Incisal area: If the incisal area is transparent use transparent opal effects, if it is discoloured use chromatic transparent masses. If it is translucent use enamels. During this step also the Halo effect is applied on the incisal edge.
- Lustre: Lustre is the most outer layer of the tooth, also known as the Skin opal. In some cases the most outer layer is transparent, in cases like that add on top the skin enamel a very thin layer of transparent opal effect. In cases when the lustre is more translucent/whitish, add brighter opal effects.