My First (Restoring) Implant Case

[rkm rdt]

@Rex
Thanks so much for the suggestion. It's interesting, I have the supereruption on one side, and the tipping on the other. We disk for cast RPD's I see no reason why we couldn't to improve embrasure form and gingival health in implant scenarios as well. I'll bring that up to my professors. Plus, the rotation plus abraction/abrasion lesion of #20 is going to really exacerbate the embrasure issue which is really apparent in this photo.

My original post asked how to address the pfm which can't be disced.Would you go so far as to replace a crown if food impaction was inevitable?

You can only adjust the adjacent teeth so much.I have seencomposite bonding to close the embrassure as another option for severe spaces.

This thread proves that a diagnostic waxup for a single tooth is valuable.

 

[patmo141]

Did you use baseplate wax?

Well not entirely by choice. It was available and I couldn't find my tin of ProArt. It handled a little funny but it worked for the moment. Plus, pink is trendy these days.

 

[Rex Kramer]

patmo141,
Thats exactly how I presented the idea to my accounts, "you cut guide planes for RPD's dont you?"

Designed many crowns using the RPI concept as well. (Rest, Proximal plate, I-bar)

rex
--------

 

[patmo141]

My original post asked how to address the pfm which can't be disced.Would you go so far as to replace a crown if food impaction was inevitable?

I think so if the impaction was severe and causing periodontal trauma or inflammation that couldn't be managed with reasonable oral hygiene. It would be tough to explain since this crown was just cemented 1.5 years ago :-/ (See comment below)

This thread proves that a diagnostic waxup for a single tooth is valuable.

The unfortunate thing is that this isn't really a single tooth case. The crown on 31 and the implants were Tx Planned in May of 2010 and the crown was cemented in September 2010. So, they should have been waxed up together. This is definitely one of the challenges in a dental school setting. I inherited this Tx Plan 3/4 of the way through. Granted, we don't just take a Tx Plan blindly, we have to spend an entire appointment re-evaluating and verifying the existing Tx Plan whenever a new student is assigned. The mouth in the photos is the point where I received the case. Based on the photos, how would you rate the embrasure (31/30) next to the PFM? Eg...based on your experience, how severe of a food trap does that appear to be? How about 19/20?

 

[rkm rdt]

If the path of insertion of the implant and crown( assuming it is screw retained) is somewhat parallel to the mesial wall of the pfm then there should be no issue.It appears to be a fairly short crown, however you may have to address the distal contact of the 2nd bi as a result.

Having said that , I really don't see any problems with the contacts.

 

[Affinity]

I have the newest I pad here and I don't see pictures. So it can't be out dated technology.

Even the 'newest Ipad' doesnt play flash.. so it can be the technology....

 

[rkm rdt]

Tell him the best way to get disappearing margins is to stop using retraction.