Facepalm cases

[patmo141]

Cmon guys. Sometimes you have to be brave.

Wow...Is what I am seeing a rotational joint that still provides vertical resistance, allowing you to rotate the crazy angluations into place and becoming essentially rigid once you screw the other half of the bar in. Very elegant solution.

 

[rhicks3302]

Wow...Is what I am seeing a rotational joint that still provides vertical resistance, allowing you to rotate the crazy angluations into place and becoming essentially rigid once you screw the other half of the bar in. Very elegant solution.

Exactly. It's a little invention called passive plus. I haven't used it very often but sometimes it comes in handy. I've probably used it 5 times in the last 10 years. It's laser-assembled and costs A LOT more than a surgical guide.

 

[droberts]

Case was referred to me. Patient class III posterior crossbite. Originally had 6 Thommen implants, 5 ended up in the sinus. Reconstructed and placed 5 Straumann, leaving one Thommen. Had prelim models and set up with a clear splint in relation to where the implants where already placed. Patient wanted FIXED, no denture! Doctor liked the wrap around hybrid. This is where I took over. Custom tray, new impressions, verfication jig, bite rim, set-up verified. Due to the Straumann implants being divergent, I needed to fabricate a frame that would be passive fit. Using the Octa abutment on the implants would not allow due to divergence. So I came up with using the Straumann temp abutments leveling off the internal insert to create a platform fit. The Thommen implant was not an issue at all. Note this same design was also used of the verification jig. The set-up was approved, putty matrix of set-up was fabricated, and bar substructure was fabricated. Tooth set-up transfered to the bar, waxed up and processed. Note the photo, that I was deflaking the case. Notice the amount of shrinkage and the flash left from using the Ivocap injection. Very minimal amount can be seen. Case was a success, patient very pleased.

 

[Jo Chen]

This is a case for a Dr. who lectures. Can't take credit for the "plastic" work though. R. Kreyer did his magic to hide it all.

 

[rhicks3302]

Here's a beauty!

 

[Jo Chen]

rhicks3302
What was (is) your solution? Did you ask the Dr. to take a (new) fixture level impression and make a bar?
popcorn

 

[rhicks3302]

He wasted a lot of money on o-ring abutments. I suggested bi-lateral bars and overdenture with metal horseshoe frame. He balked at the price. We didn't do the case. I did, however, get a great picture of a real mess.

 

[Jo Chen]

Makes you wonder sometimes. I just don’t like it when the Dr. chooses the abutment and installs it and then takes an impression. Prefer to have the Dr. take a fixture level impression and let us decide what abutment to use. It is hard to work in the patient’s mouth, cheeks, tongue, lips and saliva making for a difficult work environment. Why make your life harder than it has to be?

The pictures below show a case where the Dr. did not want to call the patient back for new impressions and I ended up reverse engineering the case. Dr. ended up with three sets of abutments and only one set being used.

Oh yeah, it was no problem to get a papilla on this case. Maybe the surgeon tried a new technique, transplanting the uvula?

 

[droberts]

Makes you wonder sometimes. I just don’t like it when the Dr. chooses the abutment and installs it and then takes an impression. Prefer to have the Dr. take a fixture level impression and let us decide what abutment to use. It is hard to work in the patient’s mouth, cheeks, tongue, lips and saliva making for a difficult work environment. Why make your life harder than it has to be?

The pictures below show a case where the Dr. did not want to call the patient back for new impressions and I ended up reverse engineering the case. Dr. ended up with three sets of abutments and only one set being used.

Oh yeah, it was no problem to get a papilla on this case. Maybe the surgeon tried a new technique, transplanting the uvula?

These cases should have treatment plans and good communication before they ever get that far.

 

[disturbed]

Here's a beauty!

WOW..I realize most of us would not touch this with a ten foot spatula but how do you all think it was done?? even possible with this setup???? not possible right????!!!!???

awesome thread coolhand

 

[CoolHandLuke]

i know rite!!!

amazing how it has turned into a sort of "feats of engineering" thread

 

[rhicks3302]

WOW..I realize most of us would not touch this with a ten foot spatula but how do you all think it was done?? even possible with this setup???? not possible right????!!!!???

awesome thread coolhand

This was impossible. Gotta know when to walk away.:flypig:

 

[Jo Chen]

These cases should have treatment plans and good communication before they ever get that far.

You are absolutely right. Working in a mega lab we get only involved from the get go maybe 5% of the time. The other 95% you try to make it work. It is part of the excitement and fun. How creative can I get to make this work (see the articulated bar design above, beautiful and elegant solution).

The mouth is a harsh enviroment but also very forgiving. We all have seen cases that had a poor prognosis but survived for decades and others fail without apparent reason despite perfect execution. And then there are the ones with a poor outlook and fail quickly. That is when we have the "I told you so" moment.
Lets face it; we are sick people. We enjoy a challenge despite all the negative talk and bickering. The little known gems (Al and others) are our inspiration.

 

[Jo Chen]

Ok, here is another one.

 

[doug]

Ok, here is another one.

He put it where the bone was, quit yer bitchin' LOL

 

[subrisi]

Originally Posted by Jo Chen
Ok, here is another one.

He put it where the bone was, quit yer bitchin' LOL


Have they ever heard of bone grafting???

 

[paulg100]

"Ok, here is another one."

Coincidentally this just came in..



Look familiar Jo



Custom Abutment. Bulge at collar is due to insert for zirconia abutment. NO i wouldnt trust this in zirconia either, but thats what client wants.

At least in zirconia we can build pink porcelain directly on to the abutment, but we have no gum shade, so you just know its gonna look horrid.

 

[Jo Chen]

paulg100
LOL, maybe your Dr. and mine are brothers?
Looks like this is a Straumann RP tissue level implant. The octa abutment ads considerable stack height if you go with a Straumann zirconia abutment. Maybe the surgeons madnes has method. Nobel makes a zirconia abutment for Straumann with a small metal converter press fit in to the zirconia abutment, maybe that would give you more design freedom.
Good luck with that one. popcorn

 

[paulg100]

"Nobel makes a zirconia abutment for Straumann with a small metal converter press fit in to the zirconia abutment"

Yep its a straumann RN. Thanks for the heads up on the nobel. I dont have the cad equipment for doing Nobel at this time, but ill keep it mind for future.

 

[JohnWilson]

The nobel/Straumann ZI abutments for the "Bone level" are hybrid ti/zi cement interface, not press fit like the replace select. They are also milled in Europe and not in New Jersey for some reason.

I have not restored a tissue level Straumann abutment with Zi so I am unaware of what they look like, not to many of those are placed in the ant these days.

The turn out very very nice, the base fit extremely precisely to the ZI.

I have 4 coming in on Monday.

On a side note we are doing so many Zirconia screw retained crowns these days on this system. The are such a fast money maker for us and when the support can be ideally achieved because of the blank size it truly is a very pretty restoration.

Using the slow cooling is a must for my ability to sleep at night with fears of marginal ridge fractures.

Now when and if Nobel buckles to the FCZ pressure and allow me to do SOLID zi screw retained units the price for this restoration will all but eliminate the use of metal for simple single units.