Need HELP!!!!

[BobCDT]

I agree with Afinnity. If you and it back he will likely send the case to another lab. Dentists definitely tend not to through there specialists under the buss.
In addition, the photos do not provide adequate info to really determine the outcome. If the implant is deep enough and the patient has a low lip line you may get an acceptable result.

 

[DMC]

Bob, I enjoy having someone else on this forum that sucks at the english language.

We are Two peas in a pod, you and I. LOL

I would love to hang out sometime and slaughter/mis-spell the english language together.

 

[Affinity]

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.

Look, medicine is an unethical business, always has been, since Drs had to secretly dig up corpses for dissection because it was against popular opinion/religion. Im not saying we should participate in being unethical, but I think theres a way to provide the Dr a restoration on HIS implant, and have him sign off on the liability. "The undersigned, assumes full responsibilty in event of a failure.. etc etc" Explain to the Dr why you dont agree with the placement.. but at the end of the day.. theres nothing short of a malpractice suit that will force the Dr to change this technique. There are no colleagues that see this.. there is no one other than the assitant or the lab tech that sees what these dentists do wrong. There is no peer review in most medicine... its a 'practice'.. lots of gray area, very little gray matter.

and ultimately, what gives an assistant or lab tech the knowledge or the right to second guess someone with a higher education, practicing something we never have or never will.. (with the exception of the prostho. on this thread)

 

[2oothguy]

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?

Yes i agree why would they wast the patients time and money with crap like this. They would have been better off with a three unit bridge. This kind of stuff infuriates me, i am so frustrated right now with this pos. But like you said time to shine, but its cases like this when you called in to the office with the patient in the chair and they are asking you ( UH COULD YOU MAKE THIS A LITTLE MORE BLAH BLAH BLAH ). At that time you look at the doc and give him that you ******* smile. I mean is it not are responsibility to not do a restoration if we feel it is not done correctly. But if we refuse to do it because we think it is not proper or good for the patient from our yrs. and yrs. of experience doing restorations then we lose that acct. That my friends is backwards in my book.

 

[Levire]

I know how ya feel!

 

[2oothguy]

I know how ya feel!
Yea ouch I am srry. Well let me know how you fix that mess.

Ouch Let me know how you fix that mess. I feel better now.

 

[BobCDT]

Looks like the same surgeon!
Or, maybe a new technique were not up on:-(

 

[2oothguy]

Looks like the same surgeon!
Or, maybe a new technique were not up on:-(

Must be a gypsy surgeon. Taking some bong hits before he starts.

 

[Jmvisa]

It is really difficult to judge all the implications in this case by just this two pictures. Because of the way the forces will be applied in the implant, amd the size of this implant, I would expect failure of a Zirconia abutment sooner that the implant itself, and if you go this way you should notify the dentist, that way if a remake comes, it will have a full charge. The safest in my opinion is UCLA or titanium with a gold hue with pfm on top. if you go with Zirconia, you can do full contour with veneer preparation and a e-max veneer to cover the access whole, you can bake a wash of porcelain in the abutment and etch for bonding. It looks like facial tissue levels are ok and you don't need any pink porcelain. I am sure you will find many more ideas, good luck this is a complicated case.

 

[Levire]

Fortunately, this case was done two years ago.

 

[paulg100]

given what you had to work with, thats a fair result in my book.

well done.

 

[lcmlabforum]

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.

What manufacturer are you using for your pink zirconia?
LCM

 

[2oothguy]

Some update photos with the new abutment. I modified it even more after we got it back from the mill. Went with the titanium abutment I was afraid that i would not be able to adjust it that much if i went with the zirconium. I was thinking abutment failure if i need to do heavy modifications.

 

[Sevan P]

Dude those images make it look like it was a simple deal, but that image with the transfer coping made it look really bad! Actually turned out ok. Now there is an awful amount of room whats the plan on the restoration type?

 

[BobCDT]

What's the plan for having the implant in the embrasure? Looks like your going to have some significant esthetic compromise. Would love to see how you handle the final restoration.

 

[2oothguy]

Going to do a pfm and try to close some of the space on 10. There was and will be a diastema between 8,9.

 

[kmgold1234]

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.

I hate seeing cases like that which could have been avoided with the proper planning, guides, training, etc.
My philosophy that I spew to my clients is spend your money on training and not on implant inventory especially so the labs do not have to work with such horrible placement.

If you do decide to go with a UCLA we provide them - the system is Logic - compatible with Nobel Active on our Dental Implants, Prosthetics, Instruments & Bone - Implant Depot website

We also started selling stainless steel analogs on our implantpart.com sitep $11 each or 50 and more $9 each
Systems include- Nobel Active, Replace, Zimmer, Astra, 3i, and I will have Straumann bone level in 1 week
if I can help my email is [email protected] and or [email protected]

 

[dharvey]

This is why there is guided surgery! This whole scenario could have been avoided.