Now What?

[dmonwaxa]

This is a 4 unit, 3 implant anterior case. Pictures show the model, esthetic zone, angulations and projections of the screw access out the facial. Now what? s?

 

[DMC]

You cementing a four unit bridge ontop of the abutments, right?

I hope to God you are not trying a screw retained bridge!

Why did you wax it up? Just curious. I would not have done that just yet.

Custom Zirconia abutment, with pink porcelain actually on the abutment.

or

We make Pink Zircionia abutments at the gingival, and a second tooth color above the margin using Zircon Zahn Zirconia stains on Lava.

A double dose of color is needed to get a good effect. We use the darker color more often.

??

Scott

 

[Wyolab]

Why not a cemented bridge? Does it have to be screw retained.

 

[dmonwaxa]

Doc said screw retained

 

[TheLabGuy]

Doc said screw retained

Well you can tell your Doc he needs to lay off that peace pipe.........

 

[Al.]

You should be able to use lingual set screws.

John does alot of these talk to him.

Bredent - Friction Splint FS1

http://www.attachments.com/attachmentpropdf/tube_and_screw_case.pdf

This one may be what you need.

http://www.attachments.com/attachmentpropdf/tapping_setscrews_pro.pdf

 

[dmonwaxa]

So far 3 to 1 cement vs set screws.

 

[TheLabGuy]

I think the only purpose for lingual set screws is if you were worried about the abutment screws loosening up. You still have to make a abutment, then a framework over that so it doesn't really save any time as it would if it was like a normal screw retained restoration. I wonder what his reasoning was for the screw retained? Did the Dentist think the path was good to go?

 

[dmonwaxa]

Take a look at the angulations on these try in abutments Rob, would you be concerned about a path. What would be your approach to restore it.

 

[TheLabGuy]

Take a look at the angulations on these try in abutments Rob, would you be concerned about a path. What would be your approach to restore it.

Custom abutments and make sure he torques it into place. I'd go cementable all the way and teach him/her what a surgical stent is for the next one.

 

[JohnWilson]

These are fun huh?

What is the goal here? Max esthetics or retrievability? What are the patients expectations?

I see lots of talk about screw retained is this a must? Was it a passing suggestion from the client?

Angle looks pretty bad but luckily you have a lot of room to upright with some custom abutments. Does the patient have a high lip line? Do you have to match the CEJ of the Cuspids? Pink porcelain requested?

Is the patient wearing a removable partial now? Are the denture teeth butted to the ridge or is there a flange?

Lots of questions here, but with a few answers we can help put together a definitive treatment with what we have to work with.

 

[Al.]

So far 3 to 1 cement vs set screws.

Oh no my vote is not for screws unless the dr insisted.

 

[Al.]

Angle looks pretty bad but luckily you have a lot of room to upright with some custom abutments. Does the patient have a high lip line? Do you have to match the CEJ of the Cuspids? Pink porcelain requested?

I agree it looks like it can have a decent outcome with those custom abuttments.

It looks like 7 and 10 are placed close to the connection area so the facials of the abuttments will have to be brought back and a papilla built with pink porc there ?

 

[dmonwaxa]

These are fun huh?

What is the goal here? Max esthetics or retrievability? What are the patients expectations?

I see lots of talk about screw retained is this a must? Was it a passing suggestion from the client?

Angle looks pretty bad but luckily you have a lot of room to upright with some custom abutments. Does the patient have a high lip line? Do you have to match the CEJ of the Cuspids? Pink porcelain requested?

Is the patient wearing a removable partial now? Are the denture teeth butted to the ridge or is there a flange?

Lots of questions here, but with a few answers we can help put together a definitive treatment with what we have to work with.

John, you are good! Very intelligent questions posed. Yes to all the above with the exception of the patient requesting screw retained. Patient has high esthetic index, retrievability is a major concern . Pics of rpd included.

 

[kcdt]

The patient requests screw retained???? If that pt has enough dental "knowledge" to even know there is such a thing, but not enough common sense to realize this aint that situation, I'd punt- preferrably recommending someone I hate.
I think there's some pieces missing here.
If retrievability is the issue, go with lingual set screws. This must be designed as a crown over the abutment- there's no way you'll get esthetics as a fixture level. If you go along with this, you might as well just write a hefty check and hand it over now, 'cause you'll remake this mess over and over till reality sets in and it gets done differently.

 

[dmonwaxa]

kcdt, no no no the patient did'nt request set screws, he "demanded" esthetics. The doc's major concern was retrievability.

 

[24kt k9]

Would this work? Custom abutments.......satisfies the draw. Temporary cement the bridge...... satisfies retrievablity. Just a suggestion. aka Golden Dog

 

[Gdentallab]

i would make full wax up. Then make a silicone or putty key over the waxed model. And explain to the dentist what's best to do.

 

[dmonwaxa]

Full contour waxup done,,,see 1st thread in msg.

 

[JohnWilson]

Lots of neat ways to do a case like this.

I think that the retrievable issue complicates things enormously but proper planning will allow you a great chance of success.

This case could be done with either ling set screw off of custom abutments as mentioned earlier or a cooler way could be to do the case like a telescopic bridge. With cad cam we can make 3 very parallel and upright abutments with like a 2* taper. You could then cast a substructure that would friction fit.

Before cad cam we would use the UCLA'S and cast out of gold, mill in our taper, then we would use our Gramm system and make galvanic copings straight to the abutments. We would wax our bridge substructure over the galvano cores and cast. Stack up the bridge and lute the galvano copes inside the frame and you would have a very very precise fitting restoration. The gold abutment and the gold galvano cope would actually wear into one another for an even more precise fit.

Trouble is that when you do this technique today with CAD CAM TI the abutment is harder than the galvano copes and they will wear. On top of that depending on the patient it may be a detriment to have them be able to take the bridge out themselves. Hygiene would be tremendously easier to maintain and you could ridge lap if necessary. It would simplify the ability to get the proportions correct since the fixture placement is less than ideal.

OK just slinging ideas out.