The world of all digital, model free Hybrids is a bit like the Wild West these days. First, there is almost zero literature on the subject. Second we have docs that do it every day, and docs on the sidelines with there arms cross s=telling you you can’t do it. It doesn’t work. Its not passive. So one thing Dr Joe Mehranfar and I set out to do was to try different techniques that docs have used, or to prove that you CAN do certain things. In this case we were told you could not take a bite without first having a fixed hybrid to scan off of, second we were told you could only scan at the MUA levell, not picture level. Finally, we were told that you could only cement ti bases extra orally. We wanted to cement in the mouth to dissipate stress. So we tried all 3.
This was a Bio Horizons case from students at the Brighterway Institute, here we teach hands on implantology on live patients in need. Brighteway serves the homeless, low income vets and the working poor. They get world class implant supported restorations either for fee or a sliding scale based on income. In this case I scanned the patients dentures and cut them in Meshmixer to get a bite. Patient was scanned in 3shape using Bio Horizons IMPLANT LEVEL scan bodies. I’ll most definitely agree that MUA is the way to go both for angle correction and ease of scan. But we would need to get her out of her OVD and hog out and reline the thing, so we wanted to try this. Design by Jacob Farber. That implant on 9 was my nemesis, and Jacob too care of it with a crown, over the buccal screw access.
Gorgeous Lab work by Andrew Sedler at Burbank Dental Lab!! Hybrid printed on the Carbon printer as a single monolithic hybrid and layered with gingival composite. We have now seated about 8 arches of printed hybrids at Brighterway and about 3 arches of Zirconia in the last 2 months. All have passed the “Sheffield Test”, in which you screw on one screw and push on the contralateral side. However a number have felt “tight” when screwing in the abutment screws. Andrew Sedler at Burbank suggested cementing in the ti bases in the mouth. At first, that sounded really scary. But think about this, usually you just cement on a bench top. You put the cement on the ti base, wipe off the excess and wait. We are doing the same, just in the mouth. The images above show another case, but you can see how we do it. Used Max Cem Elite which has a 5 minute working time. Screw it down with the patient in occlusion, then remove and clean at 5 minutes. That being said, we had no flash.
I think we got a great result!!! No occlusal adjustment on basically a full mouth Rehab!! We will go straight to final. Most likely a Trilor frame with individual Emax crowns. And the patient was thrilled. It will be interesting to see if this hybrid fractures, we had some issues with them cracking in the past.
Patient was really happy and excited to go to final!
Want to learn more about 3D Printing and Digital Hybrids? Come to a printing party!! Next one is April 4 and 5 in Sonoma!!!
If you want to learn all the cool techniques featured come to our very first Live Patient digital dentistry course, Digital Dentistry Live:” Level 1. Over 3 days you will get to design surgical guides, restorations, 3D print and mill!! We spend a full day in the clinic helping the homeless, the vets and the working poor get high end digital dentistry and implants! Anyone with a valid US license can get a license to treat patients at Brighterway!! Now you can get live hands on training without leaving the US! 21 hours CE. Register below!!