Fun with implants(facepalm)

[Alistar]

"Please make e.max restorations 1mm out of occlusion." Thanks!






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[JohnWilson]

While I have seen this way to many times, the bite looks like it could be off.

Lets hope that is the case, becuase if you have to make reduction copings for those solid abutments they clinical height of the abutment is going to be short and the crown will have a very good chance of coming uncemented. Looks like another perfect screw retained case to me.

Good luck,

 

[2thm8kr]

I really like how the surgeon planned the implant collars to be supragingival.
Sweet.

 

[CatamountRob]

Yeah hopefully John is right and the bites off, I'd be asking for a new bite registration. Those highly esthetic e.max crowns will be lovely with the implants showing....

 

[DMC]

I was going to say the bite was off as well.

Just give yourself some room....we won't tell anyone. (shhhhh)

 

[JSnyder85]

great planning dr. lol

 

[JohnWilson]

What these cases sometimes are a result of a OS that does not have any clue about restorative and actually dictates treatment and puts stock abutments on and lets the GP deal with the circumstances.

Other times its just an inexperienced GP that has the Implant rep come by and the Implant rep sells him some solid abutments with out seeing the patient. Then again tis the inexperience of the GP that leads him to take an impression knowing full well there is not room hoping we the lab can make miracles happen.

And the final reason is that the GP is cheap and is looking for the least expensive way to do the case. Sadly if its this it will actually cost the DR more in the long run when he has to remake things when they fail.

If in fact the bite is not off I would use this case as a learning tool and actually take it to the GP's office and outline the proper steps on how to proceed with this specific case. Explain OPTIONS, lots of guys new to implants have no understanding as to what CAN be done, they have an idea in there head and gravitate to what they remember seeing or reading somewhere. Explain the PRO's and CON's of each modality and explain that each case will have its own challenges and not to just lump implants into a one size fits all situation. Again as in the past when a case comes in like this after models are poured and mounted I aways write up the estimate, explain any issues I may for see with the case, make a notation how to correct those issues and have them sign off on treatment prior to ordering parts/scanning.

Trust me this path does many good things, when you have an opportunity to boost your worth to the team it makes no sense at all not to grab hold and run with it.

 

[DMC]

Grind on implant replicas....make reduction copings (and charge for it!)

Tell Doc to take another impression of the modified abutments, then try again....

 

[CatamountRob]

What these cases sometimes are a result of a OS that does not have any clue about restorative and actually dictates treatment and puts stock abutments on and lets the GP deal with the circumstances.

Other times its just an inexperienced GP that has the Implant rep come by and the Implant rep sells him some solid abutments with out seeing the patient. Then again tis the inexperience of the GP that leads him to take an impression knowing full well there is not room hoping we the lab can make miracles happen.

And the final reason is that the GP is cheap and is looking for the least expensive way to do the case. Sadly if its this it will actually cost the DR more in the long run when he has to remake things when they fail.

If in fact the bite is not off I would use this case as a learning tool and actually take it to the GP's office and outline the proper steps on how to proceed with this specific case. Explain OPTIONS, lots of guys new to implants have no understanding as to what CAN be done, they have an idea in there head and gravitate to what they remember seeing or reading somewhere. Explain the PRO's and CON's of each modality and explain that each case will have its own challenges and not to just lump implants into a one size fits all situation. Again as in the past when a case comes in like this after models are poured and mounted I aways write up the estimate, explain any issues I may for see with the case, make a notation how to correct those issues and have them sign off on treatment prior to ordering parts/scanning.

Trust me this path does many good things, when you have an opportunity to boost your worth to the team it makes no sense at all not to grab hold and run with it.

Excellent post John Wilson!

 

[Alistar]

You guys all hit close to the mark.

I think the bite is off, as well, but he didn't take the bite with the abutments in, so all we had to go off of was the relation of 12 to the endentulous area it poked into....

This is the 3rd time in a row we have gotten a case like this from this doc. His office manager/treatment planner actually orders the parts for him after the patient accepts the treatment plan, but after this he said "3 strikes and your out". We informed him of the different options and from now he's going to do custom abutments, and try a couple guided cases.

Score one for us.

As for this case, he is going to have the patient back in, reduce the abutments, and take a new bite and impression. We could have done reduction copings for him, which is what I did before, but since this is through the mail he said he could get it done faster if he just did it and re-impressed.

Thanks for the all the suggestions everyone.

 

[CoolHandLuke]

 

[disturbed]

I would love to see pics of the "fix"..

 

[Alistar]

I would love to see pics of the "fix"..

I'll put'm up.

I'm sure it'll be world class *%$&show.

 

[Jo Chen]

These are Straumann Bone Level RC implants. Theoretically you could reverse engineer this case to get back to a fixture level model. A costly solution but the Dr. would not have to re call the patient for a new impression.

 

[disturbed]

I'll put'm up.

I'm sure it'll be world class *%$&show.

well?

 

[Alistar]

Nothing new to post yet.

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[JMN]

Nothing new to post yet.

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*cough*