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.