Very difficult case. Experts only !!

[cosmicsport]

I did Waxup, prepguide and talked to the Dr.!!!

 

[rkm rdt]

Did he prep the teeth similar your prep guide?

 

[bigdawg1890]

Hey Rkm what does a prep guide have to do with the differences between the impressions that cosmicsports is saying he is having? Last time i checked prep guide allows for dr to do adequate reduction for a lab to fabricate restorations. If i am wrong then egg on my face. Even though this case is prepped like garbage, if everything seals on the first model then that should translate to the mouth, if it doesn't how does this fall on the lab tech. We may create teeth but we arent gods.

 

[user name]

Is it possible that the impressions arent being dissinfected and you poured them with thick saliva in them? Doctor might be reprepping some when getting ready to seat? It looks in your photo like youve got bubbles in your stone and lots of chipping along your saw cuts. NO amount of bad model work would cause the amount of discrepancy in these poor fits, but when your dealing with problems...all steps have to be looked at. Before going solo I had a disgruntled employee squeeze an impression, swap porcelains between bottles, and who knows what else. Good luck.

 

[rkm rdt]

Poorly prepped teeth ,especially with undercuts, will distort any impression.

If you proceed with a case that has been prepped completely different than what you have designed with your diagnostic waxup and your prep guide then you have assumed all responsibility.
You can't lay all of the blame on the doctor when it takes both parties to communicate.

 

[cosmicsport]

Case got cemented and fit good after we did it on the CAD Model. So strange ??!!! Why he did not use it in the first place ???

 

[kcdt]

You are a brave man! I understand accepting a challenge, but this one is really not your financial responsibility.

I agree. I've lost the client on BS like this, but made sure I was fully compensated for all that wasted labor.
Now that I'm older, I'd just pull the plug before it got started.
Have you worked with this one before?

P.S. I agree with RKM in that something that doesn't look right has to be nipped in the bud. However, having said that, we've all heard the "patient is a gagger, etc" tale of woe and proceeded against our better judgment. Drs can be pushy like that. It's a hard lesson to stand your ground.

I am glad however, that it worked out at the end.

 

[rkm rdt]

We,ve all been there.

 

[corbett]

Just got in on the tail end of this and I know the case is delivered. Here is a procedure that I always follow. I always duplicate large case models as soon as they are separated from the imp. If a case fails, I get the Dr. to tell me what happened and what I could have done to prevent it. That usually solves the blame game immediately. This forces them to share responsibility. I keep the duplicates and present them with the failed case to show there is no tampering with margins etc. When new impressions are taken I return the duplicate of the old and new impression with the failed case mounted or seated on the new duplicate. This keeps a physical record of the case. If a case fails for a third time I include it in the progression and all the models and failed cases stay in the case pan until the case is finished. I keep all failed cases for future reference. I include other technicians and dentists and quote their recommendations, not so much my own. Of course the Dr and PT remain anonymous. This diverts any animosity away from me. I got sick of taking the blame for failed cases. This is what worked for me.
I believe some dentists will send cases knowing they will fail, just in the hope that you will some how make it work anyway. I blow one out of the water on occasion but when I do and show how it was my fault and what I will do in the future to prevent it, this strengthens my integrity. The result is,I have never lost a client due to failed cases or poor workmanship and certainly not BS.
Damage control is essential, long before the damage occurs.

 

[Piotr]

Hello everybody, hi cosmicsport. About yor case, ask your dentist what kind of silicon he use ? - We had simmiar problems with Heraus Kultzer material specialy if impression was made in two time metod. (the abutments were extended ) so final job was not fiting at all.
Also if he's using shrinking liquid with silver, polieter material can grow snd your job will be too small. Best material that mostly solve our problems is polieter material violet colour Impregnum from 3M. Also your dentist have to use full metal spoon and press it in the mouth with same forece until it hard.
In the case that you have prep. full upper jaw dentist before should register patient with facial bow and took CR centric relation. It is a key to do a good restoration with muscle and joint comfort . Other way is a matter of luck ! tHE WHOLE job should be done in articulator.

WE ARE MAKING JOBS FOR A PATIENTS NOT FOR A STONE MODELS !

 

[paulg100]

Impregnum!...Impregnum!...Impregnum!

Best stuff by miles for those that can use it.

the down side is its expensive, taste horrid and is technique sensitive (almost a waste of time without the auto dispenser)

If you can get him to switch to this and start using rigid body trays then you are half way to saving alot of future hassles.

 

[Piotr]

Yes you'r right I forgot to mension about auto dispensers, but your dentist will get one for free if he will buy some more material from 3m.