Full Arch Screw Retained + Cemented 100% ZR Bridge

[jamesdno]

Hello Everyone,
I must say this forum is very helpful and I would love to hear what you have to say. First time posting here. So, be friendly.
Thanks.









Zirkonzhan CAD/CAM TEC-5 System
Zirkonzhan Prettau Zirconia
Zirkonzahn Color Liquid
Zirkonzahn Stain and Glaze

 

[Labwa]

Good post James. Why did you decide no pink tissue?

 

[amer84]

nice show
I work on zirkonzahn system too
but I would ask you about the first photo
did you point the mould as stiu or wax up ?? or you disigning it dirctly by software ?
why you didn't make a tissue ?it will be nice

 

[Affinity]

Needs pink.. But bravo

 

[Bobby Orr ceramics]

I'm sorry to sound critical.....but,the smile design set up on this arch is brutal......loaded with mistakes.....axis', golden proportions, zeniths, CEJ's, and basic characterizations.

 

[corona]

i have to agree with Orr ....in the best interest of improving the next one please follow golden ratio and add pink porcelain to complete the setup . The way you have desgned the frame looks like you were using the abutment locations as the epicenter of your emergence profile thus making the teeth/zenith to appear emerging from the opposite side . Easy to fix once you incorporate the missing bone and gingivae allowing you to be more creative with the design of your teeth .. think of it as a denture in which you have two different things you are replacing . Nice post and pics .... bravo on taking on the big cases . corona

 

[charles007]

James, thanks for posting such a gutsy post as your first one. Please share your pre- planning steps in the designing of this difficult case, and who made the decision to not use pink porcelain..
James, since I know your looking for tips on how to improve this case, I'm going to take my gloves off for a minute and be as gentle as I can...... This is an ideal case to remake for you and your doctor to learn from so this won't happen again in the future.. Its obvious there was little to no planning..
Your using a good system for doing cases like this and using the most expensive zirconia on the market, so I know your trying to do a good job and not trying to pinch pennies on materials. I would suggest you go to ZirkonZahn and other places to take hands-on course to sharpen your skills. CAP is also working on a video and course for implants, they may be able to help with your next case..These kinds of highly technical cases separates talented labs from the below average labs and your not that far off the mark. Implant work is the future for labs and can be very profitable if you have the skills and training..
James, to be honest with you, I haven't done a case like this yet with my scanner, so your ahead of me in the learning curve. I'm going to take courses for implant cases like this rather than just jumping in mouse first so I want make major mistakes...
What would you do if you remade this bridge...What kind on planning did you and your doctor have with the case.

Lets hear from some of the implant specialist on the planning out of cases like this guys and gals !
Charles

 

[yourfriend]

Hi,
I would have to agree with Bobby. This case has a lot of problems. First of is this case a class III bite ? If so this makes things more difficult, but setting that aside the ceramic appears way overfired and dead looking with very poor blending and surface texture not to mention other things already said. I think I would consider a different ceramic. It looks to me this case involves a combination of natural abutments combined with implants. If that's correct this case will eventually fail sooner than later. Never-never- ever integrate natural teeth splinted to implants . Good luck on your next project.
Mario

 

[technician]

Hi James,
I made something in paint just to show you how I would have made it. I think the vertical overbite is way to long (see black line).
And I think you should consider adjusting the bite towards a class III bite.

Also that you should have made a try-in with wax and acrylic teeth
I hope you take this as a positive criticism.
!

 

[rkm rdt]

Why incorporate a screw retained abutment when the natural abutments are to be cemented?
Will temp cement be used on the natural abutment teeth? If so there will be compressive stress on the connectors between the Screw retained abutment and the rest of the bridge.

If the bridge will be cemented with permanent cement then what is the point of the screw retained abutment?

 

[jamesdno]

Thank you all for your comments. I inherited this case after a failed PFM restoration from another lab. 6 implant abutments in the front were fixed, and in order to build a monolithic zr bridge, the only option left was to incorporate it with screw channel design as workability was very limited. Prior to final milling of the bridge, the functional and aesthetics analysis was performed with wax try-in, and vertical dimension, overjet, midline and incisal edge position, and smile line etc. were verified and approved by the doctor and the patient. As you may all know, 100 % zirconia restoration would not look as nice as good porcelain work, however, considering this bridge is 100% ZR and no addition of porcelain powder, it turned out very well, IMHO. And this ZR bridge will not chip or break. Thank you again for your comments, and I’ll post an update later.

 

[CoolHandLuke]

possible to have photos of it in the patient ?

 

[dhdc]

Looks like one of those awful jobs Al.will have to save in a few years.I respect the technology etc, but really is this what we want to produce??
Looks terrible....sorry!

 

[paulg100]

:shocked:

"I think the vertical overbite is way to long (see black line)."

functionally maybe. Impossible to say if thats where the incisal edge position needed to be for aesthetics without seeing photos/study models etc though.
given the average length of centrals is 11mm though, your probably right.

my advice would be go back to basics and learn tooth morphology, and stop relying on a computer to tell what something should look like.

 

[RJS8669]

Bravo. I don't like back bench technicians any more than I like backseat drivers...

 

[rkm rdt]

"... and stop relying on a computer to tell what something should look like."

You mean like digital photos Paul? C'mon,I thought we were past that"computers aren't as good as humans debate" ?

 

[paulg100]

we are, im not debating it any more

not when the majority of the anterior/large multi unit cad/cam stuff i keep seeing looks like a car crash.

Is it because the operators are not properly trained in basic aspects, is it because the software is not capable, is it just lack of planning or is it the logistics of the user interface.

Who knows, but either way theres no debate when the lack lustre results are routinely posted on forums and published in magazines over and over and over again.

this is probably one of the best examples:

http://www.ddn-online.net/info/index.php?catid=1&id=2&lang=english

I love seeing what people are doing and where the tech is going but other than that i always come away from reading that publication feeling like theres a looooong way to go.

Compare what you see there to something like dental dialogue where the majority of the work still seems to have a strong element of traditional techniques and theres an obvious difference.

Its not a personal attack on you rob! just my personal opinion from what i see and my own experiences

im not trying to enforce that on anyone else, if your happy with the results your getting and earning lots of money then great news.

 

[rkm rdt]

No offence taken Paul.

I've seen some crappy handmade work as well .
Heck I've been called an above average tech in both digital and analog LOL!

 

[paulg100]

hiring people from cad/cam backgrounds as technical cad/cam designers seems to be a growing trend.

I wonder if things will get better as software improves or worse as our industry de-skills. :noidea:

 

[k2 Ceramic Studio]

I think techs need to move with the software and hardware, learn how things work. Learn how and why systems have limitation and how to manipulate software & hardware, milling systems are just another one of our tools like a wax knife is. I have enrolled on a cnc program and a cad software design program near to where I live. I am a trained tech who is curious as to how things work It just seems crazy to me to hire non dental people to do a job that takes a life time to learn.