Need HELP!!!!

[2oothguy]

OK you guys i need some advice on this case i received today. It is noble active 4.3, the placement on this is quite messed up. So i am thinking what to do, Any recommendations on what material and how you think the best way to correct the angle. I was thinking custom titanium abutment, but i still don't think the allowance for the angle would be enough. So i though ok a zirconium abutment then i could do a coping and place some pink tissue to try to mask the fact it was sticking out so far facial. I don't know so any input would be appreciated.

 

[ParkwayDental]

Pics pics pics please.

 

[2oothguy]

OK sorry i could not figure out how to post them but i am running kinda slow today. Must be the weather

 

[Affinity]

seems pretty standard to me. Custom Zr abutment, keep your margin 1-1.5mm subg. on the labial. Im not sure if I would add pink to this case, only if the Dr asks (pays) for it..or I would call to see if the smile line is high enough to reveal it. Make the CEJ match the other central.

Another tip would be bring your gingival mask all the way to the adjacent teeth.. Maybe thats just a personal preference.

 

[donnypros]

As a prosthodontist, I think the patient is better having the implant removed and replaced properly. No amount of fancy labwork will give a stable long term esthetic result. Also I think the implant is a 3.5 because it is purple. That is going to give even more problems and chance of breakage of prosthetics or even the implant. Just my 2 cents!

 

[Affinity]

I dont think the angle is a big deal..i it only looks dramatic with the imp. coping in. I would assume its placed there because of available bone. Looks like it will have a diastema, but hard to tell from that angle. Get a pic from straight on.

 

[doug]

I was thinking the same thing from the color.

 

[2oothguy]

Well its defiantly not standard in my book it is around 35 deg angle maybe a touch more. The dr did say the placement was that way because of the bone issue, but i think they could have done something with the bone in that case. An yea i prob should have done tissue on the whole thing.

 

[DMC]

I would LOVE to make a solution after you are done playing with it.

Can I have the old model??

I'd do a screw hole cover with a Pink-tissue "cap" of Zirconia to place after the Doc screws in a custom abutment.

Then a seperate crown over the abutment, and also slightly overlapping the "cap" to help it stay put.

Three pieces.

 

[shane williams]

I don't think you can get the angle of the abutment back to come close to match the adjacent teeth. Not unless you form the lingual of the tissue. It looks like the current tissue stops in the middle of the neighbor teeth. If you can adjust the tissue making the lingual a little deeper, it would help get the angle of the abutment more lingual. It's not going to help the facial being bulky as hell IMO. Please put pics of final restoration and describe what was done for abutment design. Maybe the doc on here is right, have them remove the implant and start over. It looks pretty deep, that will help getting the angle lingual and keeping the facial not bulky

 

[2oothguy]

Yea sure just email me your info. As long as you let me see the results.

 

[2oothguy]

Yea shane I think your right. I will see about getting them to redo the implant but fat chance i think. I will try your idea and drop the ling as much as i can. And yes *** you can, send me your info and when i am done with the case and if i can get the model back from the dr i will send it to you. I send all my implants on the model and mounted.

 

[Marcusthegladiator CDT]

Things look awful with that analog in place. I would love to see a photo of the implant without it. Even better would be some photos of the patients mouth. There's a solution for everything. The easiest answer would be to replace that implant but that's likely not an option or you wouldn't have received the case. But now it's your time to shine and do your best at solving this problem. I hope you update this thread with your solution in the coming days or weeks...

 

[Sevan P]

UCLA that thing and have the Doc relief the lingual tissue and ramp that sucka back into line with the others, Tough case but should work out in the end. Some would be opposed to wax and cast but looks like your only option.

 

[2oothguy]

Yea i thought about wax cast but i think it may be easier to go custom and then modify. I will post pics of the progress. Thanks guys

 

[Affinity]

You can make lemonade from lemons but you cant make lemonade from onions.. The placement stinks. This is not uncommon, so its a bit tongue in cheek when I say its standard. Our job is to do the best we can with what were given.. And Ive never heard of a Dr pulling an implant because the lab guy asked him to! Ha! Good luck with that. Or a pt. waiting another year for their front tooth.

Like marcus says, get your shine on! These are the cases we live for..

 

[BobCDT]

This is dentistry at it's worst. You have to feel for the patient. The patient is probably paying $3K (or more) for this BS placement and subsequent compromised end result. If the bone would not support a proper placement there should have been an augmentation or a totally different Rx plan. This looks like the dentist has a college tuition bill coming and needed a fast buck.
I agree with donnypros, why restore this? this case will have poor esthetics with the CEJ being several MM's apical to the adjacent teeth, replacement tooth likely being buccal to the arch form, poor hygiene and a significant chance of failure?

 

[2thm8kr]

This is dentistry at it's worst. You have to feel for the patient. The patient is probably paying $3K (or more) for this BS placement and subsequent compromised end result. If the bone would not support a proper placement there should have been an augmentation or a totally different Rx plan. This looks like the dentist has a college tuition bill coming and needed a fast buck.
I agree with donnypros, why restore this? this case will have poor esthetics with the CEJ being several MM's apical to the adjacent teeth, replacement tooth likely being buccal to the arch form, poor hygiene and a significant chance of failure?

Not to mention the bone loss to what's left of the buccal plate since the
occlusal forces won't be distributed down the axis of the implant.

 

[Affinity]

I would much rather see the outcome of you explaining to the Dr to replace his sorry implant than see this restored... but the reality is, the Dr will send this to another lab 9 times out of 10 if you give it back to him.

I really dont see what the big problem is.. Its definitely hard to judge a case like this from these two pictures and without an angled abutment or the bite.. Worst case scenario, #9 will stick out more labially than #8, maybe you can make it shorter to keep it out of occlusion and at the same time shorten the overall length to appear the same size as 8.

 

[CoolHandLuke]

I would much rather see the outcome of you explaining to the Dr to replace his sorry implant than see this restored... but the reality is, the Dr will send this to another lab 9 times out of 10 if you give it back to him.

if that truly is the case, i would think it ethically better to cut the loss at this point rather than continue down this line and encourage business irrespective of following practical guidelines.

recently i got a model from a certain doctor. he requested we scan it for him and send him the STL file. fine. 2 bucks later his email ringer dings.

3 months later he sends us a request to remove one of the teeth, scan again, and email him. fine.

now he wants to make an implant jig. his prescription is clearly marked "i do not use any software" and this has set off several alarm bells - as not only now does he think that by scanning a model, it qualifies as a digital representation of the caliber of a CT scan, but also qualifies as enough of a diagnostic tool to assess the patient for an implant.

clearly this guy is far misled about the nature of digital dentistry. for it, we must either re-educate him or cut off this bad apple.

he's old enough and stuck up enough to say re-education isnt a priority. had he been in his 30's or even remotely fresh out of school then this might be a worthy time-waster. this doc has his nose in the air as though he knows this case will go ahead without a hitch. its a cut that must be made before he makes an enormous cut in a patient.

i'd advise you to consider the same; consider re-education in the use of implant jigs, or consider letting this bad apple float about from lab to lab. either that or charge a large premium to fix this case (one that will cover legal fees in a malpractice suit). the cost of not following proper healthily documented procedure.