Oh Boy....Options???

[Brett Hansen CDT]

Periodontist called me and told me he had trouble with this implant. The following pics are of the proposed abutment design from Atlantis. The abutment is at the maximum 30% angulation.

This is on a Keystone Prima 3.5mm implant. The doctor said the patient has a low lip line so the length of the crown isn't an issue. What is an issue is how I am supposed to design a restoration that won't create a huge bulge in his upper lip. Anyone have any suggestions?

 

[CatamountRob]

Not that it will help you now Brett, but sometimes a traditional 3-unit bridge is the best option. This just isn't going to end well.

 

[Car 54]

I take it the Dr saw these pics of your concerns? Can you get it gold hue and use a more opaque type zirconia, or a emax HO ingot micro layered, and bring it back as far as you can? Or, if you can get a UCLA version of this abutment, forgo Atlantis and wax, cast design it yourself, and opaque the prepped part, and go from there?

Either way, it will be a compromise.

 

[CoolHandLuke]

make the lateral stick out buccal.

 

[user name]

Pass on it. Poor patient. Dr should have to justify his placement to a board.

Im betting there was no diagnostic wax up or surgical guide.

 

[CoolHandLuke]

Pass on it. Poor patient. Dr should have to justify his placement to a board.

Im betting there was no diagnostic wax up or surgical guide.

if the words "i had trouble" are any indication, then i also think there was no guide. theres no excuse for this.

 

[doug]

Dear Dr Lazy, Every implant deserves a guide. Respectfully, Lab

 

[edwarddental]

hand wax and cast to angulate more than 30 degree . If you do thru Atlantis design as bicuspid and then cut back facial. Atlantis software have limits

 

[CoolHandLuke]

hand wax and cast to angulate more than 30 degree . If you do thru Atlantis design as bicuspid and then cut back facial. Atlantis software have limits

tell it to the FDA. they say CADCAM limits don't properly create abutments.

a banana shaped implant + crown would probably instantly fail and almost never be insertable.

 

[user name]

Im just giving myself high marks for not saying what I was thinking.

That pt got screwed. Makes me sad.

 

[Mike2]

Could you cast a coping and design it to then cement a crown to? Opaque it pink and create a stumpf toward the lingual for a properly placed lateral, maybe layer some pink porc. on the lower half of coping....my 2 cents.

 

[Terry Whitty]

Love to see an X-Ray or CBCT..then I can start to make an informed comment about it. There may be underlying issues.....

 

[cipro]

Best option would be to remove de implant, GBR with soft tissue ( more than one most likely) and a conventional bridgework. Sometimes no implants is a better treatment alternative, besides more surgeries does not justifies the patient`s additional suffering with another implant placement.

 

[cipro]

Best option would be to remove de implant, GBR with soft tissue ( more than one most likely) and a conventional bridgework. Sometimes no implants is a better treatment alternative, besides more surgeries does not justifies the patient`s additional suffering with another implant placement.

 

[JMN]

I'm vaguely remembering someone doing emax plugs for the facial of a implant emax crown. Would that be a design option in your lab?

I know it doesn't help much, but ....stupid people causing stupid mistakes is why we get lots of work- hey y'all watch this.

 

[user name]

I'm vaguely remembering someone doing emax plugs for the facial of a implant emax crown. Would that be a design option in your lab?

I know it doesn't help much, but ....stupid people causing stupid mistakes is why we get lots of work- hey y'all watch this.

The last thing said before going to the hospital.

 

[JMN]

The last thing said before going to the hospital.

I said something similar before an ER trip too. I think it's a symptom of saying 'Howdy' to people.

 

[lcmlabforum]

While I have seen my share of bad placement, without looking at the bone images, not knowing
if there was a bone cleft, fixation plate, I would not jump to judge the decision or skills of the surgeon.
LCM

 

[2thm8kr]

While I have seen my share of bad placement, without looking at the bone images, not knowing
if there was a bone cleft, fixation plate, I would not jump to judge the decision or skills of the surgeon.
LCM

I would, look at the defect in the buccal plate in the scans. There was no planning except to put money in their pocket IMO.

 

[sidesh0wb0b]

put it to sleep and do a single wing maryland bridge
or
say no