This poor patient. We just completed an implant crown on a tooth she broke about 6 months ago (#4) and in she walks with this. Fractured #7. I wanted to use CERECguide, but as you can see the small Ref-Body did not seat, so I had to do this free hand. I know…the horror. We had her scan from before so no need to take another. Removed #7 with Luxators and spared the buccal plate.
As you can see that due to the noise, its hard to tell anything above the CEJ with all her crowns and movement. So we scanned her for, used a Bio-Indivual Crown form just to get a feel for angulation. I had a 3.5 by 16 rolling around my drawer and decided to use it as she had great bone.
I start all my immediates with a lance bur. The trick in single unit teeth is to make a purchase at an angle about a third back from the apex. So come in straight, feel the apex then ride that lance bur up the lingual and come at an angle. If you don’t, the slope of the socket will kick you buccal and its game over.
Now with the 2.3 you have to straighten it out. If you stay in the same trajectory as the lance bur your platform will end up too far facial. Take a film and visualize where you are. Look for adequate gap distance on both the buccal and palatal. Furthermore, look at the “notches” in the drill. In this case the most superior notch is the 16mm line and I am about 2-3 mm subcrestal, so a little long.
Insert the implant and get at least 35Ncm of torque. Hold on to the implant HP with both hands, the implant may still deviate as the implant is being held by only apical bone. Use the ratchet to index.
Although my angulation may look wonky in the bone you can see that the abutment is dead center between 6 and 8 and the platform is in a restorable position with a gap distance on both the buccal and lingual.
Placed a stock Re-plant abutment and prepped with the ID Zirc kit. Don’t use regulardiamonds as the Zirconia will chip. Just a little on the facial. Had a bear of a time with a luxatemp temporary as the interproximal was thin and ket getting locked on. Everyone asks why I don’t usually do my temps in CEREC. Its always just been a time issue, I thought. Well this seemed like the perfect occasion to give it a go.
I am a new convert! That temp took no time, the fit was, well what you would expect from a final crown! Easy to make sure it was out of occlusion digitally. I’m making all my long term temps this way!! Did not have a temp block so I just used an Empress CAD Multi with a little Diashine from the Augustdds Polishing Kit. Will wait 4 months and have the final crown ready from my CEREC file. I’ll fix that mesial incisal embrasure and use an LT block instead of a multi.