6-11 Veneer/Nobel 3.0 combo

[Affinity]

I have a case coming for the hygenists 18yo daughter, with 2 nobel 3.0 in the lateral positions, and doing veneers on the centrals and cuspids. The pt has pfm crowns over the implants now, but wants to eliminate the gray.

Million dollar question is: Should I , or has anyone had success using e.max as a press over abutment on nobel 3.0?

What other options are there? On any other fixture I would do a zr hybrid abutment with emax over it, but I would like to try emax abutments. Anyone have any failures with emax over 3.0? TIA

 

[Contraluz]

I have a case coming for the hygenists 18yo daughter, with 2 nobel 3.0 in the lateral positions, and doing veneers on the centrals and cuspids. The pt has pfm crowns over the implants now, but wants to eliminate the gray.

Million dollar question is: Should I , or has anyone had success using e.max as a press over abutment on nobel 3.0?

What other options are there? On any other fixture I would do a zr hybrid abutment with emax over it, but I would like to try emax abutments. Anyone have any failures with emax over 3.0? TIA

I have done Ti - base/cemented e.max on similar situations. The Multi link cement blocks out the Ti base nicely. Granted the screw access hole is not an issue. Now, the grayness, of the existing restorations, is it in the layered porcelain or more an issue of the tissue?

M

 

[sidesh0wb0b]

how old is the pt? how transparent is the tissue? hows the placement?
the multilink cements are pretty solid for blocking out, just want to be sure the ti base doesnt bleed through

 

[Contraluz]

just want to be sure the ti base doesnt bleed through

Hence the question about the grayness. Unless you have to compensate for a deep placed implant (in which you would use an abutment with a different cuff hight),the Ti Base shouldn't be an issue in regards to the grayness.

 

[rkm rdt]

The only failures have been with the 3.0 abutments

 

[Affinity]

Thanks for your input, in my eyes, and I will post some pics later, there is nothing wrong with her smile (other than the previous pfms suck!, done by one of the supposed best labs in the area too, wow),the tissue is not so gray, I think the grayness comes from the metal support under the porcelain, it comprises 80% of the width and height in the xray, so I think it is just not allowing light transmission, I dont think the grayness of the abutment will show through. I think I will use HO1 or MO1 for the abutment.

Just testing the waters to see if anyone has had these type of abutments break. Nothing is perfect, but I want the best chance of not having to fix things later, especially with a 18yo. Anterior bite is several mm open and pt is easy on the anteriors.

 

[Affinity]

I am assuming I will just use a GoldAdapt abutment .. there arent many options here.

 

[rkm rdt]

Thanks for your input, in my eyes, and I will post some pics later, there is nothing wrong with her smile (other than the previous pfms suck!, done by one of the supposed best labs in the area too, wow),the tissue is not so gray, I think the grayness comes from the metal support under the porcelain, it comprises 80% of the width and height in the xray, so I think it is just not allowing light transmission, I dont think the grayness of the abutment will show through. I think I will use HO1 or MO1 for the abutment.

Just testing the waters to see if anyone has had these type of abutments break. Nothing is perfect, but I want the best chance of not having to fix things later, especially with a 18yo. Anterior bite is several mm open and pt is easy on the anteriors.

ah yes,I had 3 break.all in a row on the same patient.all stock with no modifications. Use original they said.
If you can get a ucla then you may need to beef them up with metal as the super lab did.
You may wish to be in China afterall.

 

[Contraluz]

I am assuming I will just use a GoldAdapt abutment .. there arent many options here.

Have a look at this page (i guess you did already, though ):

https://store.nobelbiocare.com/us/en/abutments/final-abutments?implant_platform=3.0

I have used the esthetic and narrow abutments as 'Ti bases'. You most probably will have to modify them, though. All depends how much space you have available. But, by using these abutments, you will have exposed Ti between the Implant platform and the crown (grayness...).

 

[Contraluz]

on the same patient

Has it crossed your mind the problem may have been the Pt? Or an inadequate lateral disocclusion?

I agree the 3mm platform isn't the most 'robust' one. It should be only used when there is no other option. Wishful thinking...

 

[Affinity]

Im not really concerned if the ti abutment breaks, thats a nobel issue, Im more concerned about breakage of the e.max, but the asst. mom knows the risks and thinks its acceptable..

Thanks contraluz, I thought about the esthetic abutment, but I think I can go deeper with the goldadapt.

 

[rkm rdt]

Has it crossed your mind the problem may have been the Pt? Or an inadequate lateral disocclusion?

I agree the 3mm platform isn't the most 'robust' one. It should be only used when there is no other option. Wishful thinking...

The problem was the surgeon who placed it.

 

[Contraluz]

The problem was the surgeon who placed it.

That is what I hear from the clients in every other case...

 

[2thm8kr]

It's the client's fault for not guiding the surgeon. Really, what does a surgeon know about restoring implants??

 

[Contraluz]

It's the client's fault for not guiding the surgeon. Really, what does a surgeon know about restoring implants??

You got a point. However, another thing, I have heard a lot, lately, that the surgeon would not use the provided surgical guide...

 

[2thm8kr]

Old school guide without 3d imaging technology I would agree, but with 3d digital planning almost all surprises are eliminated. I quit working with a surgeon I have worked with for over 20 years because he wouldn't use our guides. Awesome surgeon, but times are changing.

 

[rkm rdt]

I make a guide that is a vac shell with an arrow on it. You should be here!

 

[doug]

You could use composite opaque to cover the abutments and treat it with Emax no problems

It's the client's fault for not guiding the surgeon. Really, what does a surgeon know about restoring implants??

NOTHING!!! And for the most part they don't care because what they do is hidden

 

[JohnWilson]

I do Procera custom abutments in the 3.0 cc that we try and convert into a screwmentated restoration. IF the access hole is favorable we design as far sub g as possible, we then either opaque the abutment OR anodize, this decision is based on the restorative material going over it. EMAX we opaque it and zirconia we anodize