So I know one of my doc is going to send me a full upper implant case maybe it has about 6 or 7 implants with few different types of implants ( nobel , straumann, or thommen) usually he uses those. And the implants sites on anterior section the hole is coming out very facial and on top of that the anolog on patients mouth is visible already(not enough gum) so i dont think i can use any metal type of restoration (I think). I wanted to do full zirconium screw retained restoration but knowing the holes are coming out too facial i guess this option is not a good choice. What other options do i have? any recommendation? And another question is if i want to make full zirconium framework with the model + wax up I have, is it possible someone can scan my model with wax up and mill it? are most of digital brand out there can do this double scan option like nobel procera? I only have experience with nobel biocare scanners so i dont know what 3shape or other brands out there are capable of doing.
So the OS didn't/wouldn't/couldn't use short enough implants to make the interface sub-gingival and now you have to make it look natural. Charge enough to go get root beer floats for your team at the soda fountain afterwards.
If you can't adjust the angle enough to get the screw channel off the facial of the teeth, you can
A: Make the offending implant crowns cemented to pre-torqued abutments instead of screw retained. You're going to have, it sounds like, the implant and ti base showing some no matter what you do.
B: make case all screw-retained with channel coming out where least noticable-maybe more apically even if it's that bad. Mill plugs of the same material to fill the screw channel. Dip/stain case with plugs in place and put them in separate mini-bags labeled with tooth # for ease of keeping things straight in lab and at delivery. Pretty sure Mr Wilson said he does this when needed, I know someone here has/does.
(Ohhh Mr
@JohnWilson am I correct?)
C: Make a substructure to be torqued first and use individual crowns for all if you can, or if you are looking to reduce headaches and time just the offending abutment teeth.
D: Go on vacation until 2 days after seating appointment.
Opinon:
In any scenario you undertake for this case, make it clear and document document document that you cannot be responsible for whatever happens if to this thing because of the incomplete sinking of the implants. Your crown/root ratio just went way up with the implant not even being fully burried and integrstion with the bone will not be as much total strength as it would have were they at proper depth. The short seating coupled woth angulation, with nothing but me guessing why, is suspicious. Was the bone quality that poor? Pt driven case and no sinis lift or grafting when it was needed?
You can polish his turd to a high mirror shine, I'd just be clear that it's still his, and still a turd.
