Combination Anterior Implant & Veneers

Transcription

1 Combination Anterior Implant & Veneers Patient with a single implant for #8 and a space that is larger than necessary needs additional restorations for a uniform result. Here s another case we just finished last week. This gentleman was referred to me by a periodontist in the area. The perio placed an implant #8. Post: 1 of 43 Fig. 1 Fig. 2 Fig. 3 Figure 1: This is how the patient walked into my office, no flipper. I asked if he walked around without a tooth and he said no. He pulled something out of his pocket and put it in the space, looked like a denture tooth. Figure 2: My biggest concern was the missing gingival architecture and the size and angulation of the implant. I personally felt the implant was undersized and placed tilted to the distal. Figure 3: Had a custom zirconia abutment made and prepped the teeth. I then took a traditional impression of the case and the ceramist worked from a model of the abutment. Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig. 9 Fig. 10 Fig. 11 Fig. 12 Figure 4: Temporary restorations to help assist in aesthetics, function, and tissue modeling, although not much could be done for the tissue. Figure 5: An example of shade communication photo to the lab. Figure 6: Lab communication back to me. Figure 7: Lab communication back to me of cutback. Figure 8: Restorations on model sent to me by ceramist. Figure 9: Photos of restorations. Figure 10: Photos of restorations. Figure 11: Final restorations in mouth. Note lop smile line so no concern over tooth showing Figure 12: Considered pink porcelain but my experience is not so good with it. continued on page 26 24

2 continued from page 24 Figure 13: Close up view. I think there is just a tad too much translucency. Figure 14: This photo shows how naturally the Fig. 13 Fig. 14 restorations integrate into the smile of the patient. He is very happy! I guess all that matters is the patient is thrilled! I wish I had this case from the beginning. jpc36 Post: 2 of 43 Beautiful case. Would you ever consider pink porcelain for the cervical area? dandds Post: 3 of 43 Beautiful result. Fortunately his low smile line will hide the cervical areas. What could be done if this was a 20-year-old model that showed this area with the big smile? I assume grafting, etc. Anyways, nice job on this case. Karim Khalife, BSc, DMD eeznogood Post: 4 of 43 Very nice case! Thanks for sharing. I wonder if in a case like this one, a free gingival graft could be placed to cover a part of the implant crown. It s probably unlikely that the entire root portion of it continued on page FREE FACTS, circle 34 on card

3 AMERICAN ACADEMY of FACIAL ESTHETICS cosmetic continued from page 26 would be covered, but if parts of it could be, then it would greatly improve the result. Is that doable? Post: 6 of 43 Can anyone pick out something that had to be adjusted by the lab that I didn t do exactly right from one of the photos? tarun Jupneesh Singh jupneesh Post: 8 of 43 Um... no stump shade picture of the prepped teeth? Post: 9 of 43 Good try, but that s not it. tarun reccoso Post: 11 of 43 Why not full crowns, almost there anyway? continued on page 30 BOTOX The #1 Botox and dermal filler training course in dentistry! & DERMAL FILLER THERAPY For Every Dental Practice This course on Botox and dermal fillers was fantastic! It was a great learning experience - it was more hands-on than any other course I have ever attended. I would highly recommend this course as the top Botox and dermal filler course that you have to take! - Dr. Bruce Cassis, Fayetteville, WV Featuring: Dr. Louis Malcmacher and the faculty of the American Academy of Facial Esthetics LIMITED ATTENDANCE! Sign up before May 10, 2010 and save up to $500! Upcoming Courses: Apr May 7-8 May June 4-5 June 9-10 June June June June July AGD PACE CE Credits Pittsburgh, PA Orlando, FL Houston, TX Louisville, KY Columbia, MD (at the MSDA) New York, NY (advanced) New York, NY Columbus, OH Denver, CO AGD Annual Session *More 2010 dates can be found on our website Call Today! or visit: commonsensedentistry.com The First Ever DVD on Botox and Dermal Fillers in Dentistry! This powerful and authoritative total facial esthetics DVD will give you an excellent foundation to integrate Botox and dermal filler therapy into every dental practice by using clear and practical demonstrations to give you an over the shoulder view of live patient treatment. Special to this DVD! You will receive two hours of AGD PACE continuing education credits with completion of questionaire. 28 FREE FACTS, circle 1 on card

4 continued from page 28 Karim Khalife, BSc, DMD eeznogood Post: 12 of 43 Saving the cingulum is worth it. The tooth is much stronger with an intact cingulum. Uwe Mohr, MDT Uwe Mohr, MDT Post: 13 of 43 Why not try next time to put the pink porcelain on the abutment? Al Hodges, CDT Al Hodges Post: 15 of 43 eeznogood, I agree. Here is a shot from the lingual. It makes for a snug path of insertion, #7 and #10 first then #9 and #8 last at least on the solid model. Seth Houwer, DMD houwers Post: 27 of 43 Can you explain the rational going for 300 degree veneer preps instead of a more conventional facial only prep? Thanks. Negotiating a Lease? Don t let the landlord take advantage of you. I called you because they said you were the best and you are! - Dr. Jaih Jackson, Bradenton, FL To level the playing field, simply call toll-free or visit georgevaill.com/dt/ doctored Very nice case Tarun! Your patient must Post: 29 of 43 be thrilled. Close up photos are excellent. Your ceramist has skills! If I was to try and make it any better I would have attempted pink gingival ceramic on the implant and have less texture on the restorations to match the texture of the patient s natural teeth. Only a dentist or ceramist would notice that these might not be natural teeth so my points are moot. Your patients are lucky to have someone so interested in raising the bar with every case. Regards. Ed Seth, This is a good question. The rationale in this case is sim- Post: 30 & 32 of 43 ply trying to close the spaces between his teeth and enlarge his laterals. Without going interproximally it is not possible to close spaces without creating some sort of ledge. [] By the way what awes me about this case is not the restorative or ceramic work; it s the patient s readiness level when he arrived to me. He was ready to have a single implant crown #8 done. That s what he was told he needed. continued on page 32 30

5 continued from page 30 I simply can t believe the specialist (perio) in this case didn t suggest doing additional teeth or give mention to the fact that it might be mentioned. When I talked with him he was floored that I would suggest doing additional teeth. It didn t make sense to him. So I popped out my trusty Smile Design blueprint and showed him how the teeth would look not doing four teeth vs. one tooth. Figure 17: This is the first blueprint we did below. Fig. 17 It showed him how big I would need to make #8 to completely close the space and how that size compared to his #9 (simply duplicate the box and overlay #9). Figure 18: Then I made this blueprint to show him how doing four teeth would allow me to readjust the spacing to give him a more appropriate smile. You can see here Fig. 18 we needed to make #7 much wider (hence the need to prep interproximally). Aesthetics is all about communication to the patient. Communication is visual to really get the point across. tarun drmckinney Post: 33 of 43 Beautiful case! Question: how did you describe the desired surface texture on the restorations to the lab? They look great. Often labs make them too smooth and uniform, which kills the life in the restoration, even if the shade and contours are dead-on. Also, did you slightly underprep the midfacial of #9? The provisional and waxup show a little show-through. If so, did the lab give you a reduction cap or did they make the restorations slightly thicker to compensate? Great work! Post: 37 of 43 drmckinney, Bingo! You caught it dead on. Figure 19: This is where I first noticed it. This is the importance of properly contoured temporaries. Figure 20: This is where I decided that we needed to do something about it. Figure 21: And here is what Al provided for me. I don t think the case would have worked as well without the reduction. I reduced this enough based on material recommendations. I simply didn t reduce enough based on the final restorative position. Again this is easily caught in provisionals if they are made as a preview to final desires. tarun Fig. 19 Fig. 20 Fig. 21 Find it online at Anterior Implant 32