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Nightmare case
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<blockquote data-quote="Brett Hansen CDT" data-source="post: 259652" data-attributes="member: 3194"><p>Learn from my mistake. </p><p></p><p>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...</p><p></p><p>I did the lower bridge first. Screw-retained, monolithic zirconia. Patient loved it, fit great.</p><p></p><p>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. </p><p></p><p>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. </p><p></p><p>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. </p><p></p><p>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.</p><p></p><p>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. </p><p></p><p>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?</p><p></p><p>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.</p></blockquote><p></p>
[QUOTE="Brett Hansen CDT, post: 259652, member: 3194"] 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. [/QUOTE]
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