It’s difficult to keep up with the esthetic demand, but we tend to create more difficulty by not setting up a “system” of controls to aid the daily workflow. Establishing a “system” of controls is often viewed as creating more work and taking more time. However, systems allow us to have control over our work, providing us with consistency and simplifying difficult case scenarios.

Controlling large esthetic cases can be the most difficult. As with all case work, having a place to start is critical. The proper preparation design and impression accompanied by photography and a study cast is always the foundation. With larger restorative cases there remain several additional challenges.

One way to establish a system control is by creating a study cast to break a large case down into smaller segments (Fig. A). An index of the provisional cast is made to duplicate the provisionals in wax back to the working cast. This process is quick and need not be of photographic quality. Its purpose is to give the ceramist a smaller segment of a large challenging case, thus providing a controlled space to work within.

This technique can be accomplished in several ways. The first step is to index the provisional cast and transfer the index to your working or solid cast (Figs. B-D). If you use a wax injector, poke a few holes into the index or simply leave the index open in the lingual and use a eyedropper to inject the wax (Fig. E).

Separate the wax into single units, or sections, depending on which units you build first (Fig. F). With an anterior six-unit case, I always build the centrals first (Figs. G-I), cuspids second, and leave the laterals for last in order to control the esthetics of the centrals and establish the function with cuspid guidance. The laterals are then incorporated to fit functionally and esthetically.

The system order is not law and can be adjusted. I will sometimes change the order to fit the needs of the case. The key here is to divide the case into smaller segments (Figs. J-K).

The big advantage is that the wax allows you to keep working while parts of the case are firing.

This also works very well for press ceramics or press-to cases (Figs. L-CC). For pressable cases, use your index to guide the full contour of the case and then press out the full-contour buildup. The pressed crowns can be lightly fitted for contacts and shape, and then the original index can be modified to manage the incisal position or a new index can be made from the pressed crowns. Cut back the centrals only using the index and depending on your desired buildup. I normally cut back differently for each section. 

Setting up a processing system
Fig. A With all anterior cases, a study cast must be included.	Fig. B A buccal-lingual index can help transfer useful information and can be used to help control the final ceramic build.	Fig. C An open lingual index can be made for wax placement.
Fig. D The open lingual index can be placed on a solid or working cast.	Fig. E Either a wax injector or a simple eyedropper can be used to fill the index.	Fig. F A “rough” version of the provisionals is simply duplicated in wax and can be cleaned and cut into singles or sections.
Fig. G With the use of the waxup and a lingual matrix, the large case now becomes a simple case.	Fig. H Buildup and contour can be checked to the waxed provisionals.	Fig. I Restorations can even be glazed and finished to the wax replicas.
Fig. J Either the original waxups or final restorations can be used to simplify the builds.	Fig. K Fit final contacts and contour. Then, glaze and polish the final restorations.	Fig. L The same process works very well with pressed cases. Wax and press full contour and cut back the centrals only.
Fig. M Use the lingual index and the adjacent pressed restorations as a guide.	Fig. N There is complete control over the space required to fill, so more thought can go into the ceramic layering.	Fig. O Using the index, I always create a canvas to fill the space.
Fig. P The use of translucent materials will fill the final phase.	Fig. Q The use of mamalons and/or opacious dentin will be used for effect over the canvas.	Fig. R Breaking up the mamalon structure allows for more light transmission.
Fig. S Opacified materials should always be blended into the canvas to create a more natural effect.	Fig. T Finalize restoration with enamel.	Fig. U Check first bake back to the contacts and index.
Fig. V Again, the correction bake is controlled by the adjacent pressed materials.	Fig. W Final contour is controlled by adjacent materials and the lingual matrix.	Fig. X The cuspids can be cut back...
Fig. Y ...and built with complete control, then contoured and finished.	Fig. Z I like to leave the cutback for the laterals until the end to allow for any contour adjustments.	Fig. AA The laterals are built with a layering similar to the centrals.
Fig. BB Final contour is completed.	Fig. CC Glaze and polish the final restorations.