Compromised case

Brett Hansen CDT

Brett Hansen CDT

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This patient had a 3 unit bridge fabricated by another lab and another doctor. He did not like the bridge because he could feel the abutment margin on the lingual. The doctor is asking me to restore this using a UCLA abutment and a 3 unit screw retained zirconia bridge. The implant is a 3.0 Biohorizons tapered internal implant. If I try and cast a UCLA abutment for this case, I think I will be right back in same situation as the old bridge. The lingual of the abutment margin would be right at the crest of the tissue. I would also have to design the lingual shoulder of the abutment with enough width so the zirconia would have the required thickness. My plan is to suggest that we restore this case by casting a framework to the abutment. The lingual of the restoration will be in metal so we can keep it as thin as possible. He asked that I see if any of my tech friends have any suggestions, so I am putting this out here for all of you. :) I will post more pics as this case progresses. IMG_5545.JPG IMG_5544.JPG
 
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Xydorf

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This seems like a bad idea... either a 2nd implant or a bridge with tooth support also of some sort...
 
CoolHandLuke

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This seems like a bad idea... either a 2nd implant or a bridge with tooth support also of some sort...
s1200_award_understatement.jpg
 
Brett Hansen CDT

Brett Hansen CDT

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I did tell him that fabricating a three unit cantilevered bridge on this implant isn't a great idea for long term success.
 
Brett Hansen CDT

Brett Hansen CDT

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I could put lingual wings on to the two teeth adjacent to the restoration site.
 
JMN

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This patient had a 3 unit bridge fabricated by another lab and another doctor. He did not like the bridge because he could feel the abutment margin on the lingual. The doctor is asking me to restore this using a UCLA abutment and a 3 unit screw retained zirconia bridge. The implant is a 3.0 Biohorizons tapered internal implant. If I try and cast a UCLA abutment for this case, I think I will be right back in same situation as the old bridge. The lingual of the abutment margin would be right at the crest of the tissue. I would also have to design the lingual shoulder of the abutment with enough width so the zirconia would have the required thickness. My plan is to suggest that we restore this case by casting a framework to the abutment. The lingual of the restoration will be in metal so we can keep it as thin as possible. He asked that I see if any of my tech friends have any suggestions, so I am putting this out here for all of you. :) I will post more pics as this case progresses. View attachment 25694 View attachment 25695
Best bad idea I have is if 22 & 25 are healthy, put singulum rests on them over the root like a mini inlay, or with a bonded 1/2 or full wing to spread the force that 3.0 is not going to take well. Unless you cast this, they will feel any material interface points it if it's supragingival, and they still may anyway. the tongue is just too sensitive to fool - supposedly capable of feeling 1/1000'' in the right circumstances.

Your frame and coping idea will keep it thinner in the lingual, but you are fighting patient expectations more than technical limitation.
 
Getoothachopper

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I feel sorry for the Donkey, errr ,,,,,,,I mean Implant :(
workload-balance.jpg
 
cipro

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Don´t feel sorry for the surgeon, feel sorry for the patient, tx planning key element in overall prognosis of a case.
 
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Id never combine an implant and natural tooth supported bridge. If another implant isn't possible at this time, put it to sleep and wear a partial, but definitely place another implant.

Please invite the surgeon to visit this thread. When he gets here, please let me know...Ive got a few things Id like John Wilson to say to him.;)
 
JMN

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Id never combine an implant and natural tooth supported bridge. If another implant isn't possible at this time, put it to sleep and wear a partial, but definitely place another implant.

Please invite the surgeon to visit this thread. When he gets here, please let me know...Ive got a few things Id like John Wilson to say to him.;)
I was thinking that combining 2 natural teeth, one on either side, would be okay. A natural abutment on one side of a bridge with an impant as the other abutment would certainly increase chances for super-erupting the tooth as the tooth can shift up to 80-150 microns under force, but the implant cannot.
I conceed the very valid concern, but with the implant as the fulcrum point, my thought was the super-eruptive forces would ballance out. But you are right that it is a chance, not a certainty.
 
CoolHandLuke

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make it fail as fast as possible so it HAS to be removed and proper planning can be done. or at least a 5mm one put in place instead.
 
CoolHandLuke

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send the case to china, mark it up, and send them a GFYS letter along with the case.
 
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Jammin

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make it fail as fast as possible so it HAS to be removed and proper planning can be done. or at least a 5mm one put in place instead.

in this case, would be a prime candidate for the salta beer opener.. might as well make it good for something even if its temporary
b29c456a48b12a27de9997ec3d85f3c7.jpg
 
TheLabGuy

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Nothing...I wouldn't do a dam thing here. As others have stated, the Chief Complaint of the patient says it all, and their isn't anything you can do but put that 3.0 to asleep for good and properly placed implants and/or a fixed bridge placed. Still smfh!!!
 
KentPWalton

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He needs to be honest with the patient and let them know that this is a tough case and he is going to refer you to a specialist that handles hard cases like this on a daily basis.
 

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