Implant Case - Suggestions?

PRO ARTS DL

PRO ARTS DL

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So I got this case with 2 implants placed like this... It seems Dr had already sent it to another lab and the result wasn't satisfactory. Food trap on the lingual, patient not pleased with esthetics (patient wanted it to look like 2 different crowns),and I believe it kept on falling off. Patient has 2 custom abutments with a cemented 1 piece restoration over both implants.

Any advice? I was thinking maybe a screw retained "base" which would include the tissue and 2 abutments in proper position. Cement 2 crowns over the abutments to get a 2 separate crown look. :confused:

Yi9Lu3Y.jpg
 
zero_zero

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I'd suggest a long time PMMA temporary to start, till the patient gets accustomed the the new resto..also the good doc could tinker on it, till they reach a consensus. Might be wise to sit down with the doc and patient and discuss the possibilities and options, at least they wont have unrealistic expectations to begin with...
 
Sevan P

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Like zero said, maybe a screw retained? I thought I got a bad case last month, man this is out there.

Sent from my SM-G920V using Tapatalk
 
cadfan

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Same as on every case first wax up manually or digital than you find the answer . they are so hard on the labial side that maybe screw retained( on the labial side) , direct screwed zi on glue bases . or milled in co cr or titan as pfm is your solution depends on smile line and gingiva thickness .
 
Sda36

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So I got this case with 2 implants placed like this... It seems Dr had already sent it to another lab and the result wasn't satisfactory. Food trap on the lingual, patient not pleased with esthetics (patient wanted it to look like 2 different crowns),and I believe it kept on falling off. Patient has 2 custom abutments with a cemented 1 piece restoration over both implants.

Any advice? I was thinking maybe a screw retained "base" which would include the tissue and 2 abutments in proper position. Cement 2 crowns over the abutments to get a 2 separate crown look. :confused:

Yi9Lu3Y.jpg
You could attempt an esthetic base which you would bond to the abutment then the Dr. Would then cement the crown. Its "at gingival level" no risk in clean up.Try to ensure adequate retention for crown above the base. I did modify after this particular photo, just to give you an idea. This one is basically a Zr washer with tissue ceramic to be added on the labial creating a crown with a normal gingival sulcas when all done.

20170315_120217_HDR.jpg
 
Sda36

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So I got this case with 2 implants placed like this... It seems Dr had already sent it to another lab and the result wasn't satisfactory. Food trap on the lingual, patient not pleased with esthetics (patient wanted it to look like 2 different crowns),and I believe it kept on falling off. Patient has 2 custom abutments with a cemented 1 piece restoration over both implants.

Any advice? I was thinking maybe a screw retained "base" which would include the tissue and 2 abutments in proper position. Cement 2 crowns over the abutments to get a 2 separate crown look. :confused:

Yi9Lu3Y.jpg
Still a major challenge you have to deal with on this case. TGIF [emoji33][emoji4]
 
CoolHandLuke

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make crowns and a set of braces.
 
PRO ARTS DL

PRO ARTS DL

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I'd suggest a long time PMMA temporary to start, till the patient gets accustomed the the new resto..also the good doc could tinker on it, till they reach a consensus. Might be wise to sit down with the doc and patient and discuss the possibilities and options, at least they wont have unrealistic expectations to begin with...

I had a chance to see the patient. Very reasonable and he understands that the outcome will not reach his initial expectation.

Gotta love it, placement that bad but it was the first labs fault it didn't come out looking right.

Totally agree!

You could attempt an esthetic base which you would bond to the abutment then the Dr. Would then cement the crown. Its "at gingival level" no risk in clean up.Try to ensure adequate retention for crown above the base. I did modify after this particular photo, just to give you an idea. This one is basically a Zr washer with tissue ceramic to be added on the labial creating a crown with a normal gingival sulcas when all done.

View attachment 25505

Thanks this is what I had thought I could try. Make the screw retained base for the gingiva and cement the crowns on top.


Will the implants even stand the loading they will go through? :confused: I'm not sure if I should go with custom abutments with a cemented base on top and then crowns cemeted over it? (Zirconia will probably break?),metal substructure with crowns cemeted? :confused:

There's not a lot of space for gingiva before it gets bulky :confused: Would 2-Connect work here? :(
 
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2thm8kr

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I had a chance to see the patient. Very reasonable and he understands that the outcome will not reach his initial expectation.

It just sucks that this guy paid several grand to have implants placed rather than wear a partial or destroy the adjacent teeth for a bridge.
This sort of thing can be avoided easily with a DX work up. Digital wax up merged into a CBCT scan. At that point you know if there is enough bone and ridge width to place the implants as I deal as possible or advise the patient that a compromise may need to be made and let them decide before they shell out the bucks.

Sorry, this little rant doesn't really help you situation, but this sh!t chaps my arse.
 
Juko

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I think the word is malpractice.
That was the word that popped into my head.

This must be the new standard of care as I'm sure we've all seen more and more cases like this. It seems more and more surgeons are "shooting first and then asking questions".
 
Drizzt

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remove the implants have the patient sue the surgeon who placed them . This is totally unaccepted . No satisfactory solution for this case
 
rkm rdt

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I'd refuse to do the case. I've done it before, and I'd do it with this one.
And then don the black outfit,grab some rocks and smash the first Starbucks you see.
Kick a garbage can over and set it on fire.
When the cops arrive ,jump on the roof of their car and give them the finger.
These one percenters have got to get the message that we're not happy with the establishment.
 
Car 54

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"We're as mad as hell, and we're not going to take this anymore"

 
rkm rdt

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That and you get free weed,hippie chick love and a regulars pay check .
 

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