oye....

[disturbed]

screw retained case, lingual cusps are higher on #17 due to occlusion. Empty spaces chew no food, also a good idea to keep occlusal forces centered over implants as much as possible, metal support, LOTS of metal support .. the rest speaks for itself. Think they will last? Splinted, balanced occlusion with pin point contacts... done all I can do. any suggestions or comments appreciated. PLEASE CRITIQUE popcorn

 

[doug]

Are those two different implants? As in different companies.

 

[wwcanoer]

Looks like you did the best considering. . . .

Sure hope patient has excelent home oral care to keep things clean on the buccal emergence angles area.

 

[TheLabGuy]

screw retained?...from the lingual, set screws? Nice implant placement...someday Lord, may oral surgeons give us a wand for all of our magic in the lab...lol

 

[disturbed]

Are those two different implants? As in different companies.

yup..../cry

 

[disturbed]

screw retained?...from the lingual, set screws? Nice implant placement...someday Lord, may oral surgeons give us a wand for all of our magic in the lab...lol

screw retained...

 

[Jo Chen]

You are pressed between a rock and a hard place. Difficult to criticize the surgeon without a post op CT. Too many unknown constraints. Did the patient refuse a bone graft to effect a more favorable implant placement?
:frusty:
In general I would have tried to keep the occlusal table narrower buccal lingually. Maybe sacrifice esthetics and reduce the buccal. This would reduce the buccal cantilever and help hygiene issues. Metal lingual to reduce lingual thickness. Trying to make contact with the opposing produced a reverse curve of Wilson. Dr. should have considered treating the opposing in some form to avoid this.
You did the best you could under the circumstances. Thank you for sharing this case. Good to know I am not the only one to struggle with less than ideal cases. Banging your head on the bench in frustration.

 

[TheLabGuy]

Difficult to criticize the surgeon without a post op CT. Too many unknown constraints. Did the patient refuse a bone graft to effect a more favorable implant placement?

Not necessarily, it's like putting on your clothes in the morning, you do it right or you don't. If by chance you do put them on wrong, then everyone is going to know. Therefore, why not just do it right the first time and if you have to do a sinus lift, a flap, a graph, a cbct, then you do it because there is just no excuse for that type of placement with today's technology IMO or just walk around undressed all day . Great job Disturbed.

 

[rkm rdt]

I'm not sure I would have countersunk the set screws. I would have extended the lingual band interproximally and contoured the band to allow for a flush seating of the screws.That will be tough to keep clean.

 

[paulg100]

"In general I would have tried to keep the occlusual table narrower buccal lingually."

That was gonna be my comment. You shouldn't have a wide or steep occlusual table on implant retained molars.

Aesthetics are definitely secondary to function here.

regards the ceramic, are you using a ton of high opacity dentine here?
the crowns look very opaque and non vital.

Ive stopped using stright opacious/deep dentine on all metal based work now. Theres no need for it and it just kills vitality generally.

 

[disturbed]

I'm not sure I would have countersunk the set screws. I would have extended the lingual band interproximally and contoured the band to allow for a flush seating of the screws.That will be tough to keep clean.

IMO if there is some bone left and the tissue displacement is done well a papilla will form there, I also removed a LITTLE tissue in that area in the hopes that the tissue will fill the void. Extend the lingual band? Would that not have made MORE of a food trap in that area?? maybe I don't understand what you are describing..popcorn

 

[disturbed]

"

regards the ceramic, are you using a ton of high opacity dentine here?
the crowns look very opaque and non vital.

Ive stopped using stright opacious/deep dentine on all metal based work now. Theres no need for it and it just kills vitality generally.

no, just LOTS of metal support, kinda killed the vitality.

 

[paulg100]

"IMO if there is some bone left and the tissue displacement is done well a papilla will form there"

How do you know without knowing the distance to crestal bone?

 

[rkm rdt]

IMO if there is some bone left and the tissue displacement is done well a papilla will form there, I also removed a LITTLE tissue in that area in the hopes that the tissue will fill the void. Extend the lingual band? Would that not have made MORE of a food trap in that area?? maybe I don't understand what you are describing..popcorn

Carry the lingual bands towards the interproximal providing support for the porcelain.Inrease the height of the bands to allow for a flush seating of the screws instead of countersinking them.

You have 2 holes that will fill with mung.

 

[JohnWilson]

I'm not sure I would have countersunk the set screws. I would have extended the lingual band interproximally and contoured the band to allow for a flush seating of the screws.That will be tough to keep clean.

Those are not set screws, the fixtures are so ling that he has ridge lapped the restorations, those are the axis holes through the top of the UCLA's

As others have stated you have a tremendous amount of off axis load to these restorations based on fixture/occ table placement. Its great that they are screw retained because screws will most likely loosen quickly over time.

I can't tell but I sure hope they are splinted, that will aid in this tough situation.

 

[rkm rdt]

Those are not set screws, the fixtures are so ling that he has ridge lapped the restorations, those are the axis holes through the top of the UCLA's

As others have stated you have a tremendous amount of off axis load to these restorations based on fixture/occ table placement. Its great that they are screw retained because screws will most likely loosen quickly over time.

I can't tell but I sure hope they are splinted, that will aid in this tough situation.

You're right John,
my mistake Disturbed, I thought they were set screws because of their positioning.

DUH!

 

[TheLabGuy]

You're right John,
my mistake Disturbed, I thought they were set screws because of their positioning.

DUH!

I asked that in the fourth post...come on rkm, get with the program

 

[rkm rdt]

Those are not set screws, the fixtures are so ling that he has ridge lapped the restorations, those are the axis holes through the top of the UCLA's

As others have stated you have a tremendous amount of off axis load to these restorations based on fixture/occ table placement. Its great that they are screw retained because screws will most likely loosen quickly over time.

I can't tell but I sure hope they are splinted, that will aid in this tough situation.

So why bring the lingual cusps into contact?

 

[CoolHandLuke]

nice work disturbed.

 

[disturbed]

Those are not set screws, the fixtures are so ling that he has ridge lapped the restorations, those are the axis holes through the top of the UCLA's

As others have stated you have a tremendous amount of off axis load to these restorations based on fixture/occ table placement. Its great that they are screw retained because screws will most likely loosen quickly over time.

I can't tell but I sure hope they are splinted, that will aid in this tough situation.

yep, splinted.