wwcanoer
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The Case from H!!!
From my perspective, nothing went right on this case. But, it fit perfect, occlusion was right on and looked great!
Restore 5 -- 11 anterior bridge supported by 4 implants. 8 and 10 are supra, 5 and 11 sub gingival, nothing parallel. Number five with an angled stock abutment, the other three were UCLA custom abutment's. Framework was designed with metal centric stops, cast in three pieces out of Aquarius Hard for D.Sign porcelain and laser welded together by different lab down the street. I do an initial wash bake on bridges, followed by dentin build up, and third firing is incisal. After the second bake a crack appeared across the bottom of number nine pontic. Figured I had jostled something, so just ground it off and rebuilt the dentin along with the incisal. But on a third firing, crack reappeared. Okay, maybe I had a sharp edge on my framework, so stripped it all down to start over. Nothing looked obvious, but retouched the pontic surfaced.
Second time around. Crack showed up again! Called up the patient, canceled his appointment and rescheduled.
Stripped the porcelain off again. Took the framework down the street to the other lab to see what they think. Their consensus was maybe I was trying to hang too much porcelain off the tip of the pontic, although I thought it was within normal limits. We decided that they would cast up and weld on a small extension. It would take them a couple of days, but if everything went smoothly I'd still be able to meet the new cement date. So I get the framework back, looks great, I get to work re-stacking the porcelain. So have you guessed where this is going yet? Yup, crack reappeared.
Another consultation. Everybody's scratching their heads. By now, my framework has been through the oven at least 18 times, so I'm thinking it's time to start over again from scratch. Discuss things with the Doctor, and he suggests making it out of the third generation of Bellglass -- Premise Indirect. Fine with me, except that I have to order the required shade materials, which means canceling another appointment.
Strip the bridge down again, and start over using the Premise Indirect. This goes smoothly except that they no longer carry a gingival pink material. . . . but Bisco carries a pink gingival in their Tescera line of indirect composites. So finally, after almost 2 months the case is finally finished. Cemented this last Friday , patient was very happy with the final result, and said it was worth the wait. Of course he didn't know the full story, I just told him that his case was uniquely challenging to design because of the number of implants involved.
In retrospect, I think the big problem was the large metal mass required for that span.
Unfortunately, I didn't get pictures of the framework, just of the finished case before delivery. And in case you're wondering, the fingers you see, are the patient's.
Carol
From my perspective, nothing went right on this case. But, it fit perfect, occlusion was right on and looked great!
Restore 5 -- 11 anterior bridge supported by 4 implants. 8 and 10 are supra, 5 and 11 sub gingival, nothing parallel. Number five with an angled stock abutment, the other three were UCLA custom abutment's. Framework was designed with metal centric stops, cast in three pieces out of Aquarius Hard for D.Sign porcelain and laser welded together by different lab down the street. I do an initial wash bake on bridges, followed by dentin build up, and third firing is incisal. After the second bake a crack appeared across the bottom of number nine pontic. Figured I had jostled something, so just ground it off and rebuilt the dentin along with the incisal. But on a third firing, crack reappeared. Okay, maybe I had a sharp edge on my framework, so stripped it all down to start over. Nothing looked obvious, but retouched the pontic surfaced.
Second time around. Crack showed up again! Called up the patient, canceled his appointment and rescheduled.
Stripped the porcelain off again. Took the framework down the street to the other lab to see what they think. Their consensus was maybe I was trying to hang too much porcelain off the tip of the pontic, although I thought it was within normal limits. We decided that they would cast up and weld on a small extension. It would take them a couple of days, but if everything went smoothly I'd still be able to meet the new cement date. So I get the framework back, looks great, I get to work re-stacking the porcelain. So have you guessed where this is going yet? Yup, crack reappeared.
Another consultation. Everybody's scratching their heads. By now, my framework has been through the oven at least 18 times, so I'm thinking it's time to start over again from scratch. Discuss things with the Doctor, and he suggests making it out of the third generation of Bellglass -- Premise Indirect. Fine with me, except that I have to order the required shade materials, which means canceling another appointment.
Strip the bridge down again, and start over using the Premise Indirect. This goes smoothly except that they no longer carry a gingival pink material. . . . but Bisco carries a pink gingival in their Tescera line of indirect composites. So finally, after almost 2 months the case is finally finished. Cemented this last Friday , patient was very happy with the final result, and said it was worth the wait. Of course he didn't know the full story, I just told him that his case was uniquely challenging to design because of the number of implants involved.
In retrospect, I think the big problem was the large metal mass required for that span.
Unfortunately, I didn't get pictures of the framework, just of the finished case before delivery. And in case you're wondering, the fingers you see, are the patient's.
Carol
