Copy Milled OD case

[PCDL]

This was a case that my techs did for a Dr. in WV. It was a challenge, and the long distance communication was a bit of a challenge, but the patient was happy, as was the client. The reason for the this as opposed to a hybrid design was the facial access holes, as well as the clients dislike for lingual set screws. All the crowns are temp cemented in for individual unit retrievability, and the gingival mask is done with Ceramage.

Ryan

 

[AshleyMarkDMD]

That is a great outcome.

As a learning point, why do folks request a full cast/porcelain hybrid boat anchor versus a screw retained bar-hybrid acrylic denture? I see RDP clasps on the mandibular dentition which indicates that the patient has plastic teeth opposing a really great looking maxillary prostheses. I suppose my questions are not only from a wear, functionality standpoint, but also cost. Would it not be a more affordable option to place plastic teeth on both (and be able to get 3 sets over time),rather than a mercedes on top and a yugo on the mandible.

Great work, thanks for the post. I'm interested to hear your response, as we come across these situations on a month to month basis.

Ashley

 

[TheLabGuy]

Looks milled, was that titanium?

 

[kcdt]

Looks milled, was that titanium?

I assume from the title that it's milled, but not necessarily Cad Cam.

 

[PCDL]

That is a great outcome.

As a learning point, why do folks request a full cast/porcelain hybrid boat anchor versus a screw retained bar-hybrid acrylic denture? I see RDP clasps on the mandibular dentition which indicates that the patient has plastic teeth opposing a really great looking maxillary prostheses. I suppose my questions are not only from a wear, functionality standpoint, but also cost. Would it not be a more affordable option to place plastic teeth on both (and be able to get 3 sets over time),rather than a mercedes on top and a yugo on the mandible.

Great work, thanks for the post. I'm interested to hear your response, as we come across these situations on a month to month basis.

Ashley

Great questions. First off, this patient wanted a fixed storation. With the flare of the anterior implants, we would have screw access holes coming out mid facial to incisal on 3 or 4 visible implants. Sure , you can fill these with flowable, or some indirect material, but over time they will stain and become noticeable. My first choice is normally acrylic and denture teeth, but this case was a little too far gone on the divergence of the implants for it. I couldn't do fixed crown and bridge easily either, as the custom abutments would have been massive and angled, and the frame would weigh a TON! So this was a compromise of that. The frame is titanium, and was CAM milled by 3i. The frame is, compared to a cast alloy, quite light. I would still have a titanium bar in an acrylic hybrid restoration. We went with the crowns on top, really, to show off a bit. The case is used in my lectures, and it's a nice one to lecture on and discuss.

If you are seeing cases like this, you should look at:
Quantity and quality of implants
Patients wants and needs
Patients dexterity (important for removable OD)
Amount of soft/hard tissue to replace
Budget

This will give you a roadmap to treating these cases. OD restorations are nice restorations, but they have narrow applications. You have to choose the right one or you can get burnt.

 

[JohnWilson]

Great questions. First off, this patient wanted a fixed storation. With the flare of the anterior implants, we would have screw access holes coming out mid facial to incisal on 3 or 4 visible implants. Sure , you can fill these with flowable, it some indirect material, but over time they will stain and become noticeable. My first choice is normally acrylic and denture teeth, but this case was a little too far gone on the divergence of the implants for it. I couldn't do fixed crown and bridge easily either, as the custom abutments would have been massive and angled, and the frame would weigh a TON! So this was a compromise of that. The frame is titanium, and was CAM milled by 3i. The frame is, compared to a cast alloy, quite light. I would still have a titanium bar in an acrylic hybrid restoration. We went with the crowns on top, really, to show off a bit. The case is used in my lectures, and it's a nice one to lecture on and discuss.

If you are seeing cases like this, you should look at:
Quantity and quality of implants
Patients wants and needs
Patients dexterity (important for removable OD)
Amount of soft/hard tissue to replace
Budget

This will give you a roadmap to treating these cases. OD restorations are nice restorations, but they have narrow applications. You have to choose the right one or you can get burnt.

I am right there with you on most of your points. Angeled transmucosal abutments may have helped, but the way you did it allowed for less alloy and got you away from having to cast something and get it as passive as a cad/cam substructure will be on a properly verified master model.

Plus like you said you wanted to show off a bit

Nice case!

 

[kcdt]

Thanks for sharing Ryan! I could see why you didn't go with a resin F/D on your photo of the temp. Really overcame some difficult problems.

 

[Talk2Geno]

I know you wrote this a long time ago, but I'm still giving you a HIGH FIVE!

 

[corona]

great case!!! the plus on this as well is that if one of the crowns need to be replaced then the whole thing is not lost . just replace what is needed . also .... i have seen some OD hybrids after 6 mon. to a year and they are a cornucopia of bacteria everywhere. something in ti or alloy or even zirconia as the frame will inhibit the havoc that bacteria would cause this patient . patient probably paid more but will get it all back in quality and not having to replace over and over as with acrylic . nice touch and treatment planning . your turned a implant placement nitemare into a dream for restorative. these are the results that a great lab can return . nice job!!!!!

 

[DMC]

Temp cement disolves and breaks down very fast, no?

Maybe One-Two months at max?

Nice solution! Porc. looks a little bit like Denture teeth IMO.

Opaque and mono-chromatic.