Here is a case that just gets me..right there! One of my favorite CEREC guide cases came back after a while with a broken crown, but lets go back and review shall we. This patient originally had a horizontal root fracture of #8. Reference body and radiographic guide planned after extraction to evaluate the buccal plate.
Nice smooth surgery, pilot placed in osteotomy to help determine of the angulation was on. Stock Zirconia abutment and final crown.
Lets fast forward to about two weeks ago. Patient has a very deep bite. Fractured the crown as well as the Zirconia off the Ti-base. As you know in stock Zirconia as well as custom, the week link is the interface between the Ti-base and the Zirconia. In a custom abutment, a greater thickness of Zirconia can be achieved in areas where the occlusion will allow. Sirona TSV 3.5 Ti-base and scan body imaged in 4.2.
Gingival Mask added to the acquisition window and scanned first then the scan body. LIke Bio-Copy the computer will stitch these two images before you proceed. Buccal bite and model axis windows are both really cool in 4.2
I can’t wait to start planning .ssi files with the new Smile Design feature to determine platform position vs lip line. But you can see that the patient has a pretty favorable lip line if we can’t get what we want from the final crown.
Another great feature is the Virtual Articulator. You can see in the “Occlusal Compass” all the interferences she has in protrusion.
Final design, super big Thanks to Mohammed Al Zubi and Jay Black for helping with designing and sintering this. I love making the gingival mask transparent and determining the tissue depth. You can see now we have a much longer abutment and the position of the Zirconia is maximized.
One thing to note is that when using the Meso-Blocks you have to enter a code as well as use the size 20 burs in the MCXL for the abutment but change back to the 12S for the Crown.
Got the Zirconia portion back from Jay Black sintered and I put the pieces together with Max-Cem. The indexing max be moved to a more ideal position while milling but don’t worry, the abutment ends up in the same position.
Tried in the mouth, lots of blanching but the abutment is seated. I undercontoured my temp to see if we could re-grow the papillae. Pick up impression of the Emax crown sent to my lab for cutback.
Final torqued down. You can see the blanching subsiding. Pay attention to the Si-Cat torque recommendations. Will have the patient work on that distal papilla but overall, I think we got a decent result.