Full reconstructive ZR case!!

shane williams

shane williams

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This patient presented with heavy bruxing. So the Dr planned on doing a full mouth but didn't want metal occlusals. So he went with ZR. On the upper he prepped singles 2-14. 2-4 are FCZ 5&12 are ZR occlusals with cut backs for vennering porcelain. 6-11 are ZR linguals with cut backs for vennering porcelain. On the lower the patient had a partial so we created 3 bridges, 18-20, 23-26, and 27-31, with 21 and 22 being single crowns, all out of FCZ.

So I origanially had done a diagnostic wax-up for approval. Once we recieved the impression we had to transfer the wax-up onto the new prepped model. Then scan the wax-up, scan the preps, dies, and design the crowns to fit the diagnostic wax-up. Since the wax-up was created on on the mounted prepped models and waxed with perfect occlusion. So when I designed the crowns I knew if I stay within the wax-up my occlusion will be "spot-on"!! So I scanned and designed the upper first, then milled it out of wax so I could check my work. Make sure occlusion was good, as well as contours of FCZ. Once I got the green light, I started on the lower and followed the same steps, keeping the design within the wax-up. Then milled them too.

This was a fun case, long procces but fun!! I hope I get to do more like this in the future.

Oh yeah here are some pics of the design, and milled wax units(once I get the ZR milled, sinterd, and stained more pics will follow)!!!
1.jpg 2.jpg 3.jpg 4.jpg 5.jpg 6.jpg Custom000.jpg Custom001.jpg Custom003.jpg Custom004.jpg Custom005.jpg 2012-03-15 12.18.54 (1).jpg 2012-03-15 12.19.06.jpg 2012-03-15 12.19.27 (1).jpg 2012-03-15 12.20.04.jpg 2012-03-16 12.57.13.jpg 2012-03-16 12.57.35.jpg 2012-03-16 12.58.04.jpg 2012-03-16 12.58.13.jpg 2012-03-16 12.58.27.jpg
 
stumpf

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First of all congrats for this work.I like to ask you what kind of technique did you use when you align together the pre preparation scan and the dies model scan?I had problem iwhen i had to make a full mouth case...
 
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paulg100

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"So I scanned and designed the upper first, then milled it out of wax"

great work and thanks for sharing, but is there such thing as technology for technologies sake?

You already had the diagnostic, you could have taken a putty mould and wax injected it onto the prep model in 5 minutes.

i understand doing these kind of things for experience and for presentation purposes as i go around the houses with cases myself for that reason, but to hope to do more like it im not so sure.

sorry if this sounded a bit negative.
 
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paulg100

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ok sorry, i think i missed the point of the wax milling. it was just to check the digital design and then mill in ZR once confirmed.

for a minute i thought youd gone throuh all that hoo har to press em :eek:
 
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shane williams

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I had tissue data that scanned great on both the pre prep scan and prepped scans. The key is having a wax up on the prepped model so the tissue is the same for reference points. Thanks by the way I'll be sure to post the end result
 
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paulg100

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re correlation this is technique that we used to use with the Sirona craplab.

Maybe you know it already, but if you dont have enough teeth or cant correlate off the tissue, make a putty index that seats around the teeth or within the palate and put little dimples in it.

Then you can transfer that across each model and the dimples will act as ref points.

of course its not completely accurate as the index never seats and it only has to be eeever so slightly off and cases this size get completely thrown off.

Has 3shape found a way around this problem yet?
 
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CoolHandLuke

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This patient presented with heavy bruxing. So the Dr planned on doing a full mouth but didn't want metal occlusals. So he went with ZR. On the upper he prepped singles 2-14. 2-4 are FCZ 5&12 are ZR occlusals with cut backs for vennering porcelain. 6-11 are ZR linguals with cut backs for vennering porcelain. On the lower the patient had a partial so we created 3 bridges, 18-20, 23-26, and 27-31, with 21 and 22 being single crowns, all out of FCZ.

So I origanially had done a diagnostic wax-up for approval. Once we recieved the impression we had to transfer the wax-up onto the new prepped model. Then scan the wax-up, scan the preps, dies, and design the crowns to fit the diagnostic wax-up. Since the wax-up was created on on the mounted prepped models and waxed with perfect occlusion. So when I designed the crowns I knew if I stay within the wax-up my occlusion will be "spot-on"!! So I scanned and designed the upper first, then milled it out of wax so I could check my work. Make sure occlusion was good, as well as contours of FCZ. Once I got the green light, I started on the lower and followed the same steps, keeping the design within the wax-up. Then milled them too.

This was a fun case, long procces but fun!! I hope I get to do more like this in the future.

Oh yeah here are some pics of the design, and milled wax units(once I get the ZR milled, sinterd, and stained more pics will follow)!!!

well done, sir. milling in wax or plastic is definitely a great tool to use, to see and shape/modify the final product before it is final. when you get more comfortable, you wont need to mill this stage. but always good for safety sake or if theres some discrepancies in the dies or scan models.

some people just can't wrap their ears around the virtual stages and need elaborate matrices and waxups and in the end will just mill stuff too big and cut the hell out of it. i'm glad you at least know that what you see is what you get - and are confident enough to at least get it double-checked before proceeding into invested zirconia.

good luck on your next big case!! post more pics!!!
 
rkm rdt

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That is very inspiring Shane.

I look forward to the rest of your pics.
 
shane williams

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1 278.jpg 1 279.jpg 2 006.jpg 2 009.jpg 2 008.jpg 2 011.jpg 2 014.jpg 2 015.jpg 003.jpg 008.jpg 019.jpg 009.jpg 010.jpg 011.jpg 013.jpg 014.jpg 017.jpg 018.jpg
2 006.jpg 2 009.jpg 2 008.jpg 2 011.jpg 2 014.jpg 2 015.jpg 003.jpg 008.jpg 019.jpg 009.jpg 010.jpg 011.jpg 013.jpg 014.jpg 017.jpg 018.jpg 1 278.jpg 1 279.jpg
 
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CoolHandLuke

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cool beans, shane. great job.
 
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charles007

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Shane, what shade was the zirconia before glaze /staining, and what brand of stains are you using ?
 
shane williams

shane williams

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I believe it was an A-2. We use Tanaka pre sintering stains. Then e-max stain and glaze
 

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