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Implants
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<blockquote data-quote="Clear Precision Dental" data-source="post: 21453" data-attributes="member: 499"><p>Temporary cement isn't that temporary when it is placed between an abutment and a crown (or bridge). Most of the time it is just as permanent as any permanent crown cement. I've heard that even TempBondNE mixed 50-50 with Vaseline still sticks like a banshee if the preps are even approaching ideal.</p><p></p><p>My vote: Fabricate custom abutments that correct the problem with angulation (Zr if possible). Make an esthetic restoration that everyone will be thrilled with [but keep the framework thinner over the location of the abutment screws]. </p><p></p><p>Then, make a guide that fits over the bridgework (and a few adjacent reference teeth) that will give information as to the location and angle of the screw-access holes via holes drilled in the guide and cross-checked with some longer screws from a transfer coping.</p><p></p><p>Have the Doc torque everything down, and cement the bridge. In the future if there is a problem, the Doc places the guide over the bridge and "punches through" the bridge porcelain and framework in the areas where the abutment screws are located and UNSCREWS the bridge. This is much quicker to remove than trying to section the bridge while dinging up the custom abutments. He would then need to place healing abutments and a provisional (aka "flipper"). </p><p></p><p>The bridge can then be placed in an oven (600 deg for 40 min) and the cement will break down enough to separate the components. Then things can be repaired or remade on the original casts, if needed.</p><p></p><p>In reality, the biting pressure and vector of forces on the anterior teeth are less (at least in psi) than other locations. In this case you have 3 abutment screws for 4 teeth, so the predictability is high that the restoration should have longevity.</p><p></p><p>We get a lot of these "RESCUE ME" cases where some untrained dentists or oral surgeon/periodontists are trying to jump aboard the implant restoration bandwagon without thinking through the entire process. Then the lab has to come in and make the dang thing clinically successful. Without some conversation, they will do it to you AGAIN thinking this is the standard way to get the best result. Conversations and education will result in a paring that is favorable for the dentist, the surgeon, the patient and the lab!</p></blockquote><p></p>
[QUOTE="Clear Precision Dental, post: 21453, member: 499"] Temporary cement isn't that temporary when it is placed between an abutment and a crown (or bridge). Most of the time it is just as permanent as any permanent crown cement. I've heard that even TempBondNE mixed 50-50 with Vaseline still sticks like a banshee if the preps are even approaching ideal. My vote: Fabricate custom abutments that correct the problem with angulation (Zr if possible). Make an esthetic restoration that everyone will be thrilled with [but keep the framework thinner over the location of the abutment screws]. Then, make a guide that fits over the bridgework (and a few adjacent reference teeth) that will give information as to the location and angle of the screw-access holes via holes drilled in the guide and cross-checked with some longer screws from a transfer coping. Have the Doc torque everything down, and cement the bridge. In the future if there is a problem, the Doc places the guide over the bridge and "punches through" the bridge porcelain and framework in the areas where the abutment screws are located and UNSCREWS the bridge. This is much quicker to remove than trying to section the bridge while dinging up the custom abutments. He would then need to place healing abutments and a provisional (aka "flipper"). The bridge can then be placed in an oven (600 deg for 40 min) and the cement will break down enough to separate the components. Then things can be repaired or remade on the original casts, if needed. In reality, the biting pressure and vector of forces on the anterior teeth are less (at least in psi) than other locations. In this case you have 3 abutment screws for 4 teeth, so the predictability is high that the restoration should have longevity. We get a lot of these "RESCUE ME" cases where some untrained dentists or oral surgeon/periodontists are trying to jump aboard the implant restoration bandwagon without thinking through the entire process. Then the lab has to come in and make the dang thing clinically successful. Without some conversation, they will do it to you AGAIN thinking this is the standard way to get the best result. Conversations and education will result in a paring that is favorable for the dentist, the surgeon, the patient and the lab! [/QUOTE]
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