Measure Once Cut Twice

Here is a case that required some on the fly thinking:

This patient had two bridges:  One from 7-11 and another from 12-15.  #11 was decayed through and through and #12 had been extracted towards the buccal and the patient had a cantilever now from 12-15.  Pretty amazing that it lasted as long as it did.  This patient went to another dentist who had quoted her for an implant bridge from 11-14 with just two implants.  I felt we could do a little better so I treatment planned 4 can offered to throw one in at no charge.

I say this a lot in my lectures, but as important as generating a proposal, CEREC can really help in the noise department.  This patient had a lot of existing crowns and even with MARS (metal artifact reduction software) it was tough to see past that.  Enter CEREC and hoila!  No noise, very easy case to plan.  In this case we got an email from SICAT stating that my Guide Sleeves were too close and I know I could do the case so I requested a pilot sleeve (2.3mm) for #13 and I’m off to the races.

Removed the bridge and ended up with a lot of mush!  #15 was not right for this world either so out it came along with #11:

Went through the series as usual.  Due to the length of the implant on #16, my handpiece head was banging into #10 so I used the extender:

Although I was cool with the spacing of the osteotomies, #14 was confluent in the coronal half with the extraction socket and I could not get any stability of the angulation pin.  #15 socket was very conical with no interseptal bone for an immediate implant, but in the #16 position we have a ton of great bone, so I decided to free hand an extra implant there, 5.2 by 11.5

In the implants went, we got about 35Ncm on all the implants.

Final placement, we advanced #11 a little further into the socket:

Grafted #11  with ID DirectGen and a membrane.  #14 graft with Gelfoam.  PTFE 2 week resorbable sutures.  “Temporary-Temporary”, PVS Impression taken patient will return in 2 weeks for Bio-Temp and I’ll post a shot.

Bio Temps for long temporization periods

Final, a little pink porcelain to make it symmetric with the other side.