Liar Liar Pants On Fire: 2D vs 3D on an Emax/Legacy Immediate case

 

Here is just a “meh” kinda case that shows a few things, including my big pet peeve with 2D, which is arch curvature.  Patient broke off #11, usually I do not do immediates on #11, but this patient was opposed to a flipper and did not occlude on that area (open bite) so I gave it a go.  Usually I can get the small reference body in that area, but there was some crowding so no dice on the CEREC Guide.  Had to improvise.

 

 

 

Love my little periosteal, got a purchase with a lance bur and followed the bone with the pilot.  Per the cross sectional image in the CBCT the bone was pretty sloped in the pre maxilla.

 

 

 

Placed the implant (Legacy 3 4.2 by 16) and got some great torque.  Big socket so I compressed it bait and placed a TSV 3.5 Scan post and imaged for an Emax “temp”

 

This radiograph freaked me out so I took a follow up scan. Again, the limitations of 2D are that when dealing with a curved arch things get superimposed.  The canine can be tricky itself, and its easy to hit it as it leans to the mesial and the apex is distal.  But it looks like I am good.

 

 

Thought that I could quickly do a screw retained Emax “temp” but due to the angulation of the canine and also just my implant placement, there was no way to do this screw retained.  So I went with a #2 MO block and traditional emax on top.

 

 

 

I know its an extra step, but I still like to try in my framework and work out the occlusion on my crown.  Lots of good ferrule on that abutment.  I trimmed down the incisal edge of #10 as it had super erupted due to the open bite.  Forgot to tell my lab that.

 

 

Took a PVS and sent to the lab for a cut back on my “temp”  since I know this will always be out of occlusion on with the open bite I went ahead and torqued down to 35Ncm and cemented the crown (I know..I know..its long I trimmed it later but the pic was too bloody to post)  I am going to wait and see how the tissue heals. If we don’t get some “creep” coronally of the tissue I will cut off the crown, prep the abutment lower and design a new one.  Not my best stuff but still fun.