Hybrid case help

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CWilliams

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Hey all! I received this case about a month ago (a patient (24yo) transferred Drs and new we inherited his implant placement and old temps that went all the way to the gingiva) He wanted 'a normal looking smile,' and we tried the hybrid approach- Doctor has requested zr substructure w/ thimble prep for individual teeth for final restoration... call me novice but I've only done monolithic or layered mono hybrids, both direct and bar.

How does one get a seamless transition from crown to gingiva? Just trying to picture a nice tissue 'overlap' or emergence profile post cementation and I got nada... any advice/ direction is welcome!

{I've included a rough photo, it's all I have right now- as you can see the channels are all facial and the need for individual crowns or a bar.. (composite was added to meet the tissue in the gapped areas during temp delivery etc, and I didn't get a tissue shade prior).}
 
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Had to change file name.. my b
 

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Contraluz

Contraluz

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I recently had a very similar case, but for the lower incisors. I did a screw retained metal frame with preparations. I filled in the soft tissue part with pink porcelain, as ideal as possible. After I did the crown, I added more pink porcelain to fill in the caps. A pain in the a**...

Don't do it that way.

Make a frame, that gives support for pink composite. Model your tissue as ideal as possible, do the crowns and add pink composite where needed, afterwards. You will find a lot of info in the social media. Mostly on full arches, but you just scale it down. It's called the BDT technique. Google it and you will find info. Facebook has a whole group, too.
 
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@Contraluz but then Dr has to add that last step of gingiva composite after he torqs framework and cements crowns... yeah I'm just not seeing a better alternative ugh- I'll google away thanks!
 
Contraluz

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@Contraluz but then Dr has to add that last step of gingiva composite after he torqs framework and cements crowns... yeah I'm just not seeing a better alternative ugh- I'll google away thanks!
You should be able to deliver a finished case. All the Dr. would do is cement the crowns onto the "pink" frame.
 
JMN

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BDT technique:

 
Contraluz

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@Contraluz but then Dr has to add that last step of gingiva composite after he torqs framework and cements crowns... yeah I'm just not seeing a better alternative ugh- I'll google away thanks!
BDT technique:
I just want to add, it is not necessary to do your case in PEEK or Pekton, if you don't have access to it. A conventional metal frame will work too.
 
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CWilliams

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So I checked out the page- seems like they're primarily composite ging with w/e teeth of choice- trying to keep this case w/ ging porcelain, but just not seeing how the porcelain could be so closely adapted to the teeth, where the Dr wont have to 'seal' the ging margin with some kind of composite after cementing the crowns.. maybe I'm having a brain fart..

also call me crazy but this seems like a hell of a lot of work for something that could be just as well as one piece on a bar Hmmmm2
 
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[...]

also call me crazy but this seems like a hell of a lot of work for something that could be just as well as one piece on a bar Hmmmm2
You're not the first to say that.
 
Contraluz

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but just not seeing how the porcelain could be so closely adapted to the teeth
Yeah, it took me several firings to get it somehow adapted. Hence the use of composite.
You're not the first to say that.
Nope...

PS. The BDT technique produces beautiful cases! But if you dont have the workflow figured out, it will be a pain to get the results showcased here, Facebook and other places.
 
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The only thing I would add, is make sure the crowns fit intimately to the margins of the thimble bar. Plan to finish the tissue colored porcelain or MiYo to the margin of the thimble but take great care to not go over this area. I stack these cases that use zirconia because it's easier to control than the MiYo in the tight area, and I do the stack with the crowns on the bar, then remove to fire.
 

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