Thank You Sir Can I Have Another? Yet another CEREC Guide case

Ok, so my Portuguese brother Dr. Lou Paulerio told me to keep posting simple CEREC Guide cases so here is another one! Non restorable #14, good bone in the furcation. Fabricated the radiographic guide with the reference body. Scanned the tooth in CEREC for the .ssi file.

 

 

When I am designing the CEREC crown form I look out for two things, central fissure position and cusp position. If I want to go screw retained I really want that screw access to be right in the center of the tooth. (Spoiler Alert: I didn’t end up there, but at least I tried ;})

 

 

 

And again, you know my deal. Drill a hole through the furcation with a surgical carbide. Drill through the furcation with a 2.3mm pilot, get your glide path then section and remove the roots with luxators. Then replace the CEREC Guide and finish the osteotomy.

 

 

 

 

Nice 7 by 11.5 HA Coated Legacy 2. Why not the Legacy 3 or 4? I don’t need or want the stock abutment as I am going with a custom Emax as my final. Not in love with the final position of the implant ;{ I am a little too distal with the screw access. The problem with all immediates is that you really are hanging on with a little bone and although it does grip the apex, the platform is sometimes free to deviate.

 

 

 

Also by now you know my deal with grafting. Leave the Legacy 2 mount on and pack some DFDBA around it. make a hole in your membrane and pass your healing abutment through that hole so that you can skew down the membrane. I am really not in love with my placement. I could have had my apex more distal and my platform angled a bit more medial as my screw access will now be in the distal half of my crown leaving a mesial cantilever. I am a little close to the pre-molar. No bueno! I may end up with a separate custom abutment and crown just to hide that! Oh well, the more I place implants the more I am craving finding a fully guided system especially in immediates.