Oh Bloody Hell

I was reluctant to post this case (or repost with a final) as there is a lot of things I would change and its not up to my standards from a photography standpoint.  this was one of my first CEREC Guide cases so I was learning on the fly.   But there’s lots to learn here so lets dive in!:

The patient presented with #12 loose (fractured post), and deep recurrent decay on both abutments of a bridge.  I removed the bridge, extracted #12 and did some initial caries removal, looks like #13 is salvageable with endo needed on both abutments:

Fabricated the radiographic guide.  In retrospect I would have stopped here.  Not touching the abutment teeth and did the implant first. Instead while the patient was getting scanned and the drill body was milled, I did the endo on both abutments, thus changing in the shape.  Although I ended up “hogging out” the preps and getting the guided seated later, it was a lot of work and thermoplast is not easy to drill on:

Imported the pre-op as a stone model with a little dinky inlay on #15, lazy but great for multiple units:

Another mistake in this case, I got so concentrated on eliminating the “party foul” of a sealer puff that I did not watch the depth of my implant relative to the crestal bone height.  I’m too deep!

Used the CBCT to determine the number and shape of the canals and did endo on #15 and #13.  Again, if I did the case now, I would have waited until after placing the implant to not change the shape of the abutments.

Milled out the parts and pieces, fitted the Guide back on the abutments after the endo and the buildup:

Used the Nobel Straight Keys with the Implant Direct drills.  D2 set to 22mm

Used the 2.0 Nobel pilot and the rest was done with the ID drills:

Placed Implant, did not get buccal shot.  Was not in love with my torque values so I grafted and placed a membrane and sutured over.  A little too much bleeding for my photographic standards:

Final, again way too deep.  After healing everything went well, but in retrospect I would have placed the implant more coronal:

Made the temp out of occlusion, cantilevering forward to #5.  patient came back 4 months later for the final.  She lost the bridge so we had a lot of lasering to do, especially around the deep implant on #5.  My buccal shot was a bloody mess, so I will post a better image when she comes back to recall.  Again, not my best work but things to learn and improve upon as far as sequencing and implant depth goes.