Nightmare case

Brett Hansen CDT

Brett Hansen CDT

Well-Known Member
Full Member
Messages
1,679
Reaction score
102
Learn from my mistake.

I was presented with a full upper arch reconstruction on 6 implants and a lower 8 unit anterior restoration on 4 implants. The implants were already placed and the patient was in a temporary when I got involved in the case. I should have walked away right there...

I did the lower bridge first. Screw-retained, monolithic zirconia. Patient loved it, fit great.

Then we moved to restore the upper arch. Got my models mounted, did a verification jig, scanned the case in, designed a diagnostic waxup. This is when things went off the rails. The screw holes for the diagnostic were coming through the facials. The abutments were not angled lingually enough. New abutments were used for some of the implants. Still wasn't ideal, but we moved forward with the bridge.

Initially, I wanted to do a monolithic zirconia screw retained bridge. The implant company rep who was involved in the process told me and the doctor that monolithic zirconia against monolithic zirconia "clicks" and that we should do a chrome-cobalt bridge and layer it with porcelain. I let the doctor and the sales rep make the call on the material because I didn't want to be responsible.

The implant company milled out a Cr-Co bridge from my diagnostic. We had to do a ton of adjusting on it when we got it back. I see how these bridges look in magazines...this looked nothing like those. We applied porcelain to the bridge and returned it to eh doctor for delivery. Two months later, porcelain fractured off the bridge.

The doctor sends the case to another lab to have a temporary denture made. His old temp didn't fit the changed out abutments. They changed more of the abutments out for the temporary and the patient has been in the temporary for six months now. We are going to restore this case again.

This time, I want to use zirconia monolithic. The implant company can't mill zirconia bridges this big. Makes me wonder if that is the reason the sales rep pushed us to do Cr-Co the first time. I am going to get ti abutments for each implant site and then cement them into the zirconia bridge once it is finished.

I am going to outsource the milling of this bridge since we only have a Zenotec Mini Mill. I would prefer not to layer anything on this bridge except for the pink porclain. My plan is to use Ivoclar's Zenostar zironcia and then presinter stain it. Do any of you have experience using this material for a resoration like this? Is my plan sound?

Of course we are eating the cost of this case. The implant company will mill another bridge out of Cr-Co and but will not help pay for a zirconia bridge. We should have been involved with this case before the implants were placed. I won't do this again.
 
eyeloveteeth

eyeloveteeth

Well-Known Member
Full Member
Messages
2,169
Reaction score
275
sorry to hear about this. There really is no harm in listing which implant company forced you to make a PFM out of THEIR Cr-Co - alway good to know.


yeah, sounds like you already know everything yall should have done from the start.

The rep that said it clicks and suggested a PFM is certifiably good enough to be brought out to a dessert and you know...... any ceramic to cearmic will click a little - the only way to avoid this woudl have been to do a denture on the upper anyway.....
 
JMN

JMN

Christian Member
Full Member
Messages
12,205
Reaction score
1,884
natural teeth click if you try to make them. It wouldn't click from existing, only from an irrationally exuberant closure speed.
 
Patrick Coon

Patrick Coon

Well-Known Member
Full Member
Messages
1,174
Reaction score
565
Learn from my mistake.


I am going to outsource the milling of this bridge since we only have a Zenotec Mini Mill. I would prefer not to layer anything on this bridge except for the pink porclain. My plan is to use Ivoclar's Zenostar zironcia and then presinter stain it. Do any of you have experience using this material for a resoration like this? Is my plan sound?

Hi Brett, Sorry for your troubles. It is always worrisome to not be involved from the beginning.

As for the Zenostar, It is now ZirCAD (same material different name) and will definitely work for this type of restoration. I would recommend ZirCAD LT0 for what you are working on along with the ZirCAD LT liquids (or Zenostar Color ZR liquids if you still have them). If you were opposing natural dentition, I would recommend layering the facial only with Ceram, but since you are opposing a full contour Zr02 bridge you made then definitely only layer the gingiva. I will say, unfortunately we don't have a pink infiltration liquid for your gingival areas. I normally recommend the ZirconZahn's Aquarell Tissue B. It seems to be a good light pink base for layering on top of.

Good luck and let me know if you need anything?
 
millennium

millennium

Active Member
Donator
Full Member
Messages
878
Reaction score
78
Learn from my mistake.

I was presented with a full upper arch reconstruction on 6 implants and a lower 8 unit anterior restoration on 4 implants. The implants were already placed and the patient was in a temporary when I got involved in the case. I should have walked away right there...

I did the lower bridge first. Screw-retained, monolithic zirconia. Patient loved it, fit great.

Then we moved to restore the upper arch. Got my models mounted, did a verification jig, scanned the case in, designed a diagnostic waxup. This is when things went off the rails. The screw holes for the diagnostic were coming through the facials. The abutments were not angled lingually enough. New abutments were used for some of the implants. Still wasn't ideal, but we moved forward with the bridge.
Initially, I wanted to do a monolithic zirconia screw retained bridge. The implant company rep who was involved in the process told me and the doctor that monolithic zirconia against monolithic zirconia "clicks" and that we should do a chrome-cobalt bridge and layer it with porcelain. I let the doctor and the sales rep make the call on the material because I didn't want to be responsible.

The implant company milled out a Cr-Co bridge from my diagnostic. We had to do a ton of adjusting on it when we got it back. I see how these bridges look in magazines...this looked nothing like those. We applied porcelain to the bridge and returned it to eh doctor for delivery. Two months later, porcelain fractured off the bridge.

The doctor sends the case to another lab to have a temporary denture made. His old temp didn't fit the changed out abutments. They changed more of the abutments out for the temporary and the patient has been in the temporary for six months now. We are going to restore this case again.

This time, I want to use zirconia monolithic. The implant company can't mill zirconia bridges this big. Makes me wonder if that is the reason the sales rep pushed us to do Cr-Co the first time. I am going to get ti abutments for each implant site and then cement them into the zirconia bridge once it is finished.

I am going to outsource the milling of this bridge since we only have a Zenotec Mini Mill. I would prefer not to layer anything on this bridge except for the pink porclain. My plan is to use Ivoclar's Zenostar zironcia and then presinter stain it. Do any of you have experience using this material for a resoration like this? Is my plan sound?

Of course we are eating the cost of this case. The implant company will mill another bridge out of Cr-Co and but will not help pay for a zirconia bridge. We should have been involved with this case before the implants were placed. I won't do this again.
 
dmonwaxa

dmonwaxa

Well-Known Member
Full Member
Messages
2,740
Reaction score
233
Brett.. Sorry to hear about your experience. I remember this case from a previous post. I share your experience with theperfect glitzy images in publications and receiving something back that's completely butchered....and by a baaaad butcher at that.
 
Brett Hansen CDT

Brett Hansen CDT

Well-Known Member
Full Member
Messages
1,679
Reaction score
102
Hi Brett, Sorry for your troubles. It is always worrisome to not be involved from the beginning.

As for the Zenostar, It is now ZirCAD (same material different name) and will definitely work for this type of restoration. I would recommend ZirCAD LT0 for what you are working on along with the ZirCAD LT liquids (or Zenostar Color ZR liquids if you still have them). If you were opposing natural dentition, I would recommend layering the facial only with Ceram, but since you are opposing a full contour Zr02 bridge you made then definitely only layer the gingiva. I will say, unfortunately we don't have a pink infiltration liquid for your gingival areas. I normally recommend the ZirconZahn's Aquarell Tissue B. It seems to be a good light pink base for layering on top of.

Good luck and let me know if you need anything?

Thanks Patrick! We are using the Zircad and the liquids. Thanks for the tip on the pink stain.
 
PDC

PDC

Well-Known Member
Full Member
Messages
997
Reaction score
232
Thanks Patrick! We are using the Zircad and the liquids. Thanks for the tip on the pink stain.

The tissue colored Zirliner will work also.

I never have gotten a good fit with the milled Co Cr alloys. The Ti alloy fits great in comparison but what a pain to deal with.
Best of luck!
 
kcdt

kcdt

Well-Known Member
Full Member
Messages
2,845
Reaction score
632
My two thoughts:
Never listen to a sales rep discuss materials. They don't know **** from shinola.

And
Of course he recommended it because they make it. Salesman can't sell what they don't make...

As for the rest: if you're not in the loop on treatment planning, don't offer a warranty. Protocol exists for a reason.

Sucks and is becoming far too commonplace
 
Sevan P

Sevan P

Well-Known Member
Full Member
Messages
3,413
Reaction score
641
Dynamic abutment solution. Just did a all on 6 dentis implants and here is a snip of how I angled the screw channels. But you will need a 5axis mill with 25° or more of angulaion on a and b axis. And a cam thay can do angled screw channels. Hype4dent, and wieland cam, heard sum3d but not sure.
a7bcc1f841410c747e776c4ebb78c411.jpg


Sent from my SM-G920V using Tapatalk
 
A

aqdental

Active Member
Full Member
Messages
299
Reaction score
48
Is there any way you can modify the co-cr frame and cement monolithic crowns and build some pink composite? Since is a pfm alloy you can opaque the preps and the tissue area with ceramic opaque. Just a thought.
 
Last edited:
Contraluz

Contraluz

Well-Known Member
Donator
Full Member
Messages
1,883
Reaction score
275
Is there any way you can modify the co-cr frame and cement monolithic crowns and build some pink composite? Since is a pfm alloy you can opaque the preps and the tissue area with ceramic opaque. Just a thought.

I like your idea.

But I wonder if the cost of the time to rework the frame, apply opaquer and pink porcelain, plus the new crowns, all twelve of them, don't surpass the cost of a monolithic zr frame?
 
S

slotboom.f

Member
Full Member
Messages
51
Reaction score
15
Make a pekton/mineral peek substructure with timbles use solitairy crown ( layered or monolitic)
Or even just in the front region and use composite in the (pre)molar region to reduce clicking sounds. Pinks in composite this all will grant you a very flexible solution for now and days to come


Verzonden vanaf mijn iPhone met Tapatalk
 

Similar threads

millennium
Replies
18
Views
250
millennium
millennium
Brett Hansen CDT
Replies
0
Views
213
Brett Hansen CDT
Brett Hansen CDT
Brett Hansen CDT
Replies
1
Views
263
Brett Hansen CDT
Brett Hansen CDT
L
Replies
7
Views
254
tuyere
T
Top Bottom