Know When to Hold Them, Know When to Fold Them

Here is a CEREC Guide case that did not go as planned, but being a good implantologist means rolling with what you have and making decisions in the field so here you get the good, the bad, and the ugly:

We have a patient that needs a lot of work, but wants to do it over time, so we are working on treating whats bothering the patient first and will move onto other things.  #14 is fractured below the bridge due to decay, so we initially planned a CEREC Guide and immediate molar replacement #14, traditional implant #13.  I know, I know #12 has a lot of bone loss, but it was solid and the patient wanted to keep as many natural teeth as possible.  I let him know that he may need to replace it with an implant at a future date, but for now its holding up his temp. I extracted #14, at the time seemed like we had enough bone.

Busted out my secret stash o’ CEREC Blocks, if I’m doing multiples I like to use two different sizes so the drill bodies do not get mixed up:

Imported two ssi files, one before I extracted and removed the bridge and one of the prepped teeth and edentulous spaces.  Just stick an inlay on #15 or the #16 area.

Here it shows the prepped vs the pre-op ssi models, much easier than trying to get proposals on cerec on #14 and #15

Milled out #13, so as #14 was milling I decided to get busy.  It takes about 15 minutes to mill.

#13 went as planned.  Got the drill body for #15 in, not great bone, lots of chipping of the interseptal bone as I was working.

These big 7mm implants require a large crestal bone drill that cant be used Guided.  It really “pops” around the socket and in doing so it “popped” some bone on the buccal.  Was all excited to try my batch of HA coated implants, but also no.  Got the implant in there at it was not only a “spinner” but a “rock and roller”.  No stability and it moved in the mesio distal dimension. So I placed #13, but grafted #14.  This guy has a lot of work to do in his mouth, so in 2 months I’ll give it another go:

Again, I know #12 is not right for this world, but its solid and he wants to keep it and has been informed that we may need to replace it at a later date.  But for now its going to be a nice “temp holder” for me as the implants heal and we work on the rest of this patient’s issues:

Grafted and temporized.  Sorry for the messy granules of MFDBA, but hey, I was tired.  Will come back in 2 to 3 months to try again!  But thats what you need to know sometimes in implantology, when to bail!