Blue Man Group: Emax Screw retained crown on Immediate Molar Implant

 

Here is a cool case using both CEREC Guide as well as CEREC 4.2 to place an implant and restore it as well as its neighbors.  #14 decay into the furcation and #15 decay into the pulp.  Planned for an extraction of #14 and endo #15.  Patient had an existing CEREC crown #13 plus was leaving the next day for Italy, so we made him a 3 unit temporary bridge and planned to restore with 3 individual crowns from 13.  Flattened the occlsusal of #14 and placed a hole with a carbide 557 into the furcation and fabricated the Radiographic Guide for CEREC Guide.

 

Easy proposal, scanned in both the Omincam and in Galileos

 

 

 

Endo completed #15, #14 using my tried and true technique of starting with the pilot through the furcation with CEREC Guide and then sectioning and extracting the remaining roots.  Graft n this case with MFDBA and a collagen membrane.  Placement of a 7 by 8mm Legacy 2 Implant.

 

Using a Scan Post for a TSV 5.7 mm Zimmer Ti-base (compatible with the Implant Direct Implant, we then scanned a full arch upper and lower and lined up the models.  We then used two 14 Emax blocks and a 16 for the Screw Retained Crown.  Remember do not select multi layer if you want just a screw retained crown.

 

 

Made the mistake of taking the bite with the scan post, no worried just use the Buccal Bite tools to remove it.  Now after I take the Gingival Mask, I then do my Buccal Bite without the scan post.

 

 

 

Very simple design, not a lot of work with the tools, remember, no splitting the file if you want screw retained, it does not even give you the option.

 

 

 

Milled out.  Big Ass sprues.  One drawback with the abutment blocks is that you cannot select sprue position and the sprue is usually in the inter proximal.

 

Tried in and adjusted pre-sintering.  One great thing about emax is that it fits the Ti-base right out of the mill.  With Zirconia you have to sinter first before you try it on the Ti-base as Zirconia shrinks big time, around 25%.  Don’t shove the object fix too hard around the firing pin.  Just lightly set the pin in the hole.

 

 

Sintered first then stain and glaze if you are bringing the patient back, which we did here as the patient could not wait around.

 

 

 

Tried in, look at how small the screw hole is!!!  This really is going to change how I restore implants.  I always liked the idea of screw retained but hated the esthetics.  This looks really easy to fill in with composite, no cement sepsis, and the benefit of a retrievable restoration!!

 

 

 

Final!  Cemented with multi-link.  Flow it ALC opaque and Filtek Opaque with a little Ochre stain. Not perfect but much better than many screw retained crowns I have done!!!