How I Roll

Some times cases don’t go as planned and you have to roll with it!

Patient needs Implants #18, #19.  Loose Bridge on #30, planned on 3 crowns with Implant on #30.

Removed the loose Bridge and took CEREC scan for the Opti Guide.  Then I took a scan with the Bridge in instead of planning a bridge or crown proposal 29-31.  CEREC Proposals on #18 and 19.

I love knowing exactly where the nerve and Sub Mandibular Fossa is:

Initial plan was for a 5.7 by 8 in the #18 position.  Planned a 5.2 by 10 for #19, not sure why the lab gave me the smaller sleeve, but like I said, I just roll with it!

Seated Guide, this patient had a gagging issue, so no Isolite, which made it tough with the amount of Irrigation I use, again just roll with it!:

Planned for #18 to be a 5.7 got to where you see in the lower left before it torqued out.  Switched to the 5.7mm crestal bone drill.  Went to place the implant, its a spinner.  FML!  Time to switch gears.

So what do you do when an osteotomy for a 5.7mm Legacy 3 gets over instrumented?  Usually I only use the 7mm for immediates but thats all I could use, so we widened the osteotomy with the crestal bone drill:

7m went down to length.  Not as parallel as I thought, but #18 does tip more mesial as per the curve of spee, but I am not splinting them, so I should be fine:

Planned and placed, I think because I used the crestal bone drill free hand on #18 is why I am leaning medial, but again it won’t matter in the restoration, just lose some style points.  #30 next!

Removed the bridge, punched the tissue as we had 2mm of attached tissue on the buccal:

Going through the series using the head of the hand piece as a stop.

Placed the Implant, I ended up torquing the implant deeper to get the tissue to the 1mm level on the buccal of the abutment (margin/collar is at 2mm)

Final, adjusted the pontic under the bridge to clear the healing abutment.  Would have liked to use the 5.7 instead of the 7mm on #18, but we should have a nice result

Stock abutments used.

Decent shape of crowns, although a bit bulbous.  #30 could have been deeper

Nice tissue response, no gingival recontouring needed.

Final, on right I think if I went with a custom abutment I could have gotten a better emergence, but overall I think a decent result.