Now What?

dmonwaxa

dmonwaxa

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Thanks Al. Incisal stops on the lingual in metal. Had to place the screws more cervically. Also since these were set screws rather than tube and screw they're secured to a dimple in the substructure requiring a 90 to 105 degree angle of engagement.
 
kcdt

kcdt

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Sorry if I seem like one who'd shout expletives... FWIW, that isn't exactly how I'd put it to a dr.
I also have to say I feel a little snookered here. The background of this situation wasn't really on the table, so we were left to assume that all parties had been involved from the beginning.
My statements still stand as far as the placement goes. I understand ortho and all that, but why not grafting before placement if the bone is gone?
I know we don't operate in an ideal world, but still...(this is not to blame your team, but someone placed these).

I think your outcome was really nice, considering the situation. I would like to see a smile shot to get a feel for the patient's display and how that worked out at the junction between pink ceramic and tissue.
 
dmonwaxa

dmonwaxa

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Sorry if I seem like one who'd shout expletives... FWIW, that isn't exactly how I'd put it to a dr.
I also have to say I feel a little snookered here. The background of this situation wasn't really on the table, so we were left to assume that all parties had been involved from the beginning.
My statements still stand as far as the placement goes. I understand ortho and all that, but why not grafting before placement if the bone is gone?
I know we don't operate in an ideal world, but still...(this is not to blame your team, but someone placed these).

I think your outcome was really nice, considering the situation. I would like to see a smile shot to get a feel for the patient's display and how that worked out at the junction between pink ceramic and tissue.

kcdt, lol on the expletives. wasn't refering to you or anyone, just me thinking out loud, had some flashbacks ptsd....
Now, I apologize to you and everyone else for feeling snookered. However we live in a mobile society and sooner or later others might be faced with a similar situation. Our team was completely out of the loop on this one and certainly out of the equation. We just picked up an drove on. Not being a surgeon I can't say what could have been done and if it was feasable. As technicians we often wish for better soft tissue architecture and implant placement, but have to settle for whats presented. Could things have been done differently? Certainly. Was a diagnostic wax up done prior to implant placement? I dont know but what i do know is a wax up does not guarantee optimal prosthetic placement. And as such we're left to clean up the mess. Having a lot of information is great but only if it's relevant. Just as I did not have all the info, so did you. I did not know of the full impact ortho had in this case until weeks after delivery; would knowing that or questioning the placement by the surgeon have made a difference on the outcome.....at that point we had what we had so the answer is no. Why? Because it wasn't relevant.
 
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kcdt

kcdt

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Ptsd can do that...

You make a valid point about how often we get left out of the loop, but it's hard for me to have spent years learning how to make things predictable only to be stymied by the way it all goes down.
It just that when there is a plan and every one does their part wonderful things can happen...
I still tink you did a great job with what was obviously a compromised situation.
 
dmonwaxa

dmonwaxa

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kcdt, thanks for the kind words and compliments. talk about going in blind on that one, but like you said; we do that all too often. We make silk purses out of sows ears; as they say. In an ideal world we ( the lab) and the surgical-restorative team would all be involved from the begining, but how often does that happen. "Begin with the end in mind", if so, since the laboratory is making the end product then shouldn't we be there at the begining? Hmmmmm
 
rkm rdt

rkm rdt

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since the laboratory is making the end product then shouldn't we be there at the begining?

Well said!
 
kcdt

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Preaching to the choir...
 
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