PMMA to Zirconium Finish

[Noke Re Ani]

Hello all,

[This is regarding a physical model but being worked on 3shape]

I been having a big issue with my doctors who refuses to cooperate with me to get full arch case done. Doctor wants Zir hybrid abutment and PMMA round house from the start and will go for the finish later. I told the doctor that if we are going to go for the finish then we need all of the original model work back and abutment and PMMA IF there were any adjustments. This is so we can double check on the digital design once more with the contacts and such, especially after we do some stain and glazing.

Few months later the doctor sends the case back with only an abutment level impression and the old opposing and it makes me wonder what happen to the original working model that had the lab analogs and soft tissue.

The abutments and PMMA is on the patient and doctor tells me patient refuses to remove them.

So I am left here with a crappy impression with no margin being visible and doctor is expecting me to read his mind on where he did adjustments on the PMMA.


So my question is what would you do with this kind of sitation where you are left Honda parts and the doctor expecting you to make a Porsche?

 

[Jo Chen]

Duplicate the model with the abutments on it and each abutment individually. Mount the duplicated model before you send out the pmma. Ask the dr to take an impression over the pmma after adjustment. Now you have mounted models, dies with clear margins and a model showing you what the adjusted pmma looks like.
I'm sure some of the digital wizards on here have better ideas on how to pull this off

 

[Drizzt]

Next time , mill two PMMA , one for the patient , one for you , and buy twice the Ti bases . Good luck on that case .

 

[JKraver]

Next time , mill two PMMA , one for the patient , one for you , and buy twice the Ti bases . Good luck on that case .

Good idea,
I would tell Dr. that you will charge for duplicate model work/materials upon delivery of first bridge unless original model work is returned.

 

[Noke Re Ani]

Thank you all for all the great ideas!

We originally told the doctor about the double charge because we need something back to work with. You know what the doctors tell me? "Why would I pay for something that you need to finish the case?"

Trust me - I wish I could tell them off but I am not the boss here haha.

I really like the new impression method alot but now another issue I might run into is this.

If doctors trys the PMMA and sees that the bite was off then I would need to re-scan the new bite. But the model that is originally was scanned is not identical to the impression that I took for study models. Gotta see where I could make land marks so the computer can merge the files together. Or something. Still brain storming.

But thank you all again for the help!


Noke

 

[PearlZ]

that's pretty ridiculous.

you are doing the same work twice, he should pay twice.

 

[Noke Re Ani]

Tell me about it.

I believe that the reason they do not see the importance of getting those parts back to me is because they dont understand - Not educated. Probably believes that if its digital then anything can be done with no limitation.

If I ever have free time I was going to make a slide presentation of the procedure. Might as well give them a degree after I explain everything.

 

[PearlZ]

do it.

anyway you could try to establish the bite again by having the previous pmma rapid printed, its probably only slightly different anyway.

if the doctor complains you can tell them they need to do these adjustments because they didnt sent the previous pmma to copy. twice the work for you means twice the work for him in the chair.

 

[cadfan]

Tell me about it.

I believe that the reason they do not see the importan ce of getting those parts back to me is because they dont understand - Not educated. Probably believes that if its digital then anything can be done with no limitation.

If I ever have free time I was going to make a slide presentation of the procedure. Might as well give them a degree after I explain everything.

Maybe it helps if you scan the modell and make a SLA dublikate or a milled in pu only less upcharge they are nobrainer

 

[Drizzt]

Doctors are so stupid to understand , that if you deliver him a non-accurate case , it will cost him more because of the chair time he will consume ? Cheap b@st@rds

 

[aqdental]

Hello all,

[This is regarding a physical model but being worked on 3shape]

I been having a big issue with my doctors who refuses to cooperate with me to get full arch case done. Doctor wants Zir hybrid abutment and PMMA round house from the start and will go for the finish later. I told the doctor that if we are going to go for the finish then we need all of the original model work back and abutment and PMMA IF there were any adjustments. This is so we can double check on the digital design once more with the contacts and such, especially after we do some stain and glazing.

Few months later the doctor sends the case back with only an abutment level impression and the old opposing and it makes me wonder what happen to the original working model that had the lab analogs and soft tissue.

The abutments and PMMA is on the patient and doctor tells me patient refuses to remove them.

So I am left here with a crappy impression with no margin being visible and doctor is expecting me to read his mind on where he did adjustments on the PMMA.


So my question is what would you do with this kind of sitation where you are left Honda parts and the doctor expecting you to make a Porsche?

Hi, so you are making a provisional full arch bridge cemented on definitive zirconia hybrid abutments (please correct me if wrong). Why not a screw retained temp bridge ( maybe on ti temp cylinders) and after delivery retain the master ( if accurate ) and using a putty matrix of temporary construct your final ( which btw we don't know the type). Doc should take an alginate of temp to show any alteration or signs of wear. Unfortunately reducing clinical steps seems to be the trend ). Another way you could make 2 temp bridges. Patient wear one for few months then gives back to you to copy for final restoration and wears the spare one during that time.

 

[JKraver]

Can you give one of those Walmart certificates of achievement, and scrawl the name in red crayon.