Posted March 31, 2014
A super nice patient of mine fell and came in shortly after. Took a scan and everything seemed fine, we waited for the swelling to go down and it turns out the #9 was fractured. From the PA it looks restorable, but after removing the mobile crown, you can see that the fracture went vertical palatally. CEREC Guide Medium reference body. Patient has large pre existing diastema.
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When scanning in CEREC the big thing I harp on in my lectures is tracing the margin so that the CEJ of the proposal mimics that of the contralateral tooth. Why, you may ask? We know we want to be 3-4mm apical to that with our implant platform and no more than 5mm apical to the base of the adjacent teeth contacts, thats why.
While milling the CEREC Guide we extracted the tooth with osteotomes. Smooth surgery. Placed a drill in the socket to check for angulation bucco lingually as well as mesio distally.
Implant placed and torque tested. Not a huge gap around the impant.
Stock Zirconia abutment. Look at how well Omnicam images that! Just packed a 2 cord just to keep the artifacts at bay from the socket space.
Final CEREC “temp”. Again, patient had a large diastema to start and did not want it closed. (it would look really bad with a giant asymmetric #9 anyway). I just love the face import with Smile Design. Will wait for it to heal and evaluate if we need a custom abutment. In this case I may not, just cut off the crown and do a nicer one.
Patient came back at 6 months. Removed composite and sponge and re-torqued to 30 Ncm, Went with a PFM as the rest were all PFMs. Did I have to do Zirconia? No not at all and if I had done this case now, I would have gone with custom titanium since we were not going with all ceramic. But I think we have an acceptable result, even if the chroma is slightly off.
