Pmma temp bridge

[rkm rdt]

I'm not sure Paul,I haven't got that far yet.

 

[CoolHandLuke]

newer incarnations of 3shape system (2.6+) have a "smile composer" feature which is supposed to save time by aligning finalized shapes from a number of libraries, which are nice looking of course. but nobody has those teeth naturally. it doesnt work to do "half" a case unless your dentist supplies a full arch impression/model to work from. you can use the smile composer to "mirror" teeth around the arch but you can't use it to create a nicely morphed adapted wax up. at best this feature allows you to get the incisal heights and interproximal data, but not much else.

at least in my own experience i have not seen a good case done with it that was anything less than full arch.

RKM: very nicely done, sir. hats off to you on that super temps. if i had to change anything for the final product it would be the embrasures; you can make them sharper and crisper (more well defined) by bringing the connectors a bit further to the lingual. if you do this exact bridge in zirconia, have the lab courier the green state milled product to you and just go over it with a razorblade. completely up to you, and of course its just my opinion.

i'm going to do something here that people will be quoting for years to come...

"i'd want that in my mouth."

 

[paulg100]

Anyone else able to chip on on the wax up copy thing?

Can anyone confirm that you can replicate a multi tooth wax-up EXACTLTY by using an outline and copy function (a bit like the sirona software).

I really hope so or this is a major blow for me as i save for 3shape system.

there is NO software solution that can acheive anything close to a diagnostic set up from an experienced high end technician.

smile composer-genric junk
mirroring a smile - no mirroring in nature
biogenerics (sirona) - currently junk.

Wax up and copy design is the only way for high end morphology still.

you can do it for single units in 3shape right? but multiple units?

 

[rkm rdt]

Here's a situation where the patient didn't want anything but a unlateral type removable denture.Something low cost and fast!!!

I suggested this pmma maryland which I scanned from the original alginate /model.The Dr bonded it in place to fill in the undercuts and improve the strength.Since it was opposing a pld and there was composite buildup on the 26 abutment,the Dr and pt were willing to go for it....patient loved it but no introral pix
We shall see....

 

[TECHARTISAN]

Here's a situation where the patient didn't want anything but a unlateral type removable denture.Something low cost and fast!!!

I suggested this pmma maryland which I scanned from the original alginate /model.The Dr bonded it in place to fill in the undercuts and improve the strength.Since it was opposing a pld and there was composite buildup on the 26 abutment,the Dr and pt were willing to go for it....patient loved it but no introral pix
We shall see....

Interesting piece indeed....but I am curious..is it removable still? or bound?

 

[rkm rdt]

It's bonded in place.

 

[JohnWilson]

I give it three weeks

No occ rest on the adjacent (Unless those little arms are above the H.O.C). and a thin occ joint is a recipe for a joint fracture.

Was this totally cad designed or waxed up?

We have been doing a tone of Telio cad and the stuff seems to be holding up well but I have never designed a pontic only temp such as this.

Thanks for sharing this.

 

[thetoothfarie]

John beat me to it. 2nd thing I noticed was no rest. 1st thing I noticed was how nice it looked!

Blessed Be,

 

[rkm rdt]

Well if it lasts 3 weeks then we make a pud.I'm sure the patient won't mind another beautiful chrome ortho appliance like the lower.

What would you suggest John?

 

[rkm rdt]

This was a total cad designed case.I basically designed the abutments as onlay copings where the margins where the lower perimeter of the wings.Once I received it back,I trimmed the occlusal to create the arms.I probably removed too much from the bicuspid and could have left a small rest contour however the arms do not engage any undercuts but rather sit on top of the height of contour.


If it does break,I can always resend the file with an improved design.

The patient was willing to be a guinea pig when given all other options.

 

[JohnWilson]

Well if it lasts 3 weeks then we make a pud.I'm sure the patient won't mind another beautiful chrome ortho appliance like the lower.

What would you suggest John?

Essix

 

[JohnWilson]

This was a total cad designed case.I basically designed the abutments as onlay copings where the margins where the lower perimeter of the wings.Once I received it back,I trimmed the occlusal to create the arms.I probably removed too much from the bicuspid and could have left a small rest contour however the arms do not engage any undercuts but rather sit on top of the height of contour.


If it does break,I can always resend the file with an improved design.

The patient was willing to be a guinea pig when given all other options.

In the last post I mentioned Essix because you mentioned cheap and fast. Truth is the standard of care here is an implant restoration, anything less than that is a compromise.

But as we are talking about this case lets just say that using PMMA and having it cemented is not making the unit any stronger. If it was composite and a flowible composite was used to lute it to the enamel it could be a bunch stronger, but still wouldn't last.

We have done literally 100's of accetal or valplast unilaterals and they all eventually fail, some wear out, some last much longer than others. For a removable device a unilateral this small is always a choking hazard so again I don't like this as anything more than a temporary treatment.

Doing anything direct bonded is a way more invasive solution so choosing a material and design that will last is way more important in my opinion. No prep cases such as this in a fixed situation rarely if ever work as far as I am concerned.

Every onlay bridge I have ever made eventually fails unless its cast.

While I am not a dentist and my suggestions are based on anecdotal evidence of a few simple photographs, I would imagine from a general standpoint that adding a pontic essentially off the molar is going to contribute a lot off stress to that tooth as the patient functions. From a look at the lingual, that molar isn't in the best of health already so again its something we should most likely not have considered.

A lot of times when we try and come up with solutions to treatment that is essentially being dictated by the patient we are forced to push the edge of what we know is safe and effective. I just hate to be the one to try out something new for the first time and have it actually cause more trauma to a compromised situation.

Again, I am not judging in anyway just pointing out stuff to think about.

 

[rkm rdt]

Of course the case is dictated by the patient.That's why you guys are making Bruxers instead of gold crowns.

Removable unilaterals are illegal here so other than a conventional pud,a fixed appliance is the next option.

The patient is aware that it may not last long but was willing to give it a try .She is buying time with the molar as well so bonding is the best option here.

I work chairside with my dentists here and I can assure you that direct bonding is usually the primary restorative option prior to any c&b.

How long is long?

I am looking forward to the next generation of pmma like materials that will enable us to offer less invasive options.

 

[iloveteeth]

Beautiful work...What brand pmma is this?

 

[rkm rdt]

Thankyou,

Wieland

 

[rkm rdt]

I give it three weeks

Week 4 ..so far so good:hail:

 

[rkm rdt]

Talked to the Dr today and its still there!

 

[Vazone]

Talked to the Dr today and its still there!

Nice to hear that. We also mill PMMA in our milling center and dentists always ask about time for that it can be used. But in any case its more or less temporary.. i read somewhere that it can be used up to 6 month.. but for price from file - 15E piece it's best temporary esthetic offer i think

 

[YMS96]

If you already have the waxup you can scan it in and 'copy mill' it. It pretty much duplicates the wax and you can smooth it out and be done with it without having to morph the library teeth into the same shape. With 3Shape though you would need the waxup bridge holder (or make your own).

 

[CoolHandLuke]

If you already have the waxup you can scan it in and 'copy mill' it. It pretty much duplicates the wax and you can smooth it out and be done with it without having to morph the library teeth into the same shape. With 3Shape though you would need the waxup bridge holder (or make your own).

toothpicks work wonders.