Part 1.100% digital CAD/CAM Cantilever Bridge on wide molar implant.RRR 4-year follow up

106 Rating(s).


Posted on By Anton Andrews In Digital Scanning & CAD/CAM

50y.o. female had her #17-20 three-unit bridge failing due to secondary caries on #17. The wisdom tooth shifted and inclined mesially. The old bridge was cut off distal to #20 and 7X7mm Ti-MAX (Keystone, USA)wide molar implant was placed immediately, mesially to the extraction site with simultaneous GBR. Russian AAA surgical technique was used.
The preference was made to restore #18,19 using one wide molar implant. Two-implant restorative alternative would had required difficult augmentation of severely atrophic ridge in the area of the first molar.
Intraoral scans were taken with TRIOS (3Shape) for the lower and upper left quadrants, scan body position and the bite.I designed 2-unit FCZ screw-retained cantilever bridge using Dental System (3Shape) utilizing Andrews RRR (Reversed Restorative Rehabilitation) method. The design file was outsourced to a milling center. Once received the case was stained and glazed by a dental assistant in the office. The final restoration was delivered with minimal adjustments.
There were neither impressions nor models made for the case. There were no dental technicians involved in the design or fabrication, other than for milling and sintering FCZ.

Andrews RRR Technique
Lingual and posterior views

"before" and 6-months after loading
Ideal Emergence profile delivered with Andrews RRR (Reversed Restorative Rehabilitation)


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14 Comments

Andrew,
Very nice work with a digital crown production.
I see you used a scan transfer but no abutment was used.
You had to take an analogic impression and then scanned ?
How did you otherwise decide about emergence profile of the crown?
My question is how confident you are on long term stability with a screw retain crown and cantilever.
I'm on your same truck and i 'm very interested about your digital solution.
Thanks for sharing.


Reply

Armando,
There was no analog impressions or models made for the case. There were no dental technicians involved in the design or fabrication, other than for milling and sintering FCZ.
A low profile (0.5 mm high) prefab ti base was glued to FCZoutside the mouth after try in. The scan body and ti base has to come from the same manufacturer ( 3D digital library).
Emergence profile was created according to Andrews RRR method.
I am not concerned about stability or long term prognosis since it was restored on a wide implant (7X7; 5.7 mm platform). You cannot do that on regular ones because of laws of Physics and Physiology.


Reply

Hi Dr. Anton, even for 7 diam. implant, in my opinion, looks that 2 crowns has more mesiodistal distance that could be suported by a single implant.
I would use another thin implant plus GBR.
Let´s see how it works on the long run.
Thanks for sharing!
Jorge


Reply

Anton. Nice case. Could you please explain how you index your "try in" to glue (with accuracy) the .5mm ti base to the TCZ outside the mouth. Thank you for sharing. Regards. Chuck


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Chuck, I'm working with blueskybio and I'm going to make a video how utilize digital scan into your practice. You know I use CEREC, but my process would be how you can utilize a free blueskybio software, any implant system, one guided surgical guide for any implant system and apply 2 visit procedure how Andrew shows, even you do not own a scanner. Surgical guide less than $100. Are you interested? Gregory


Reply

Great question Charles,
I used NT-trading 1-piece pre-fab Ti-component base , which has a definite anti-rotational feature. The only problem that milling has to be quite precise so the fit between Ti base and FCZ restoration is not too loose. Another words , "the devil is in the detail".


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Very interesting discussions. Thank you both. Dr. Salama


Reply

2-year follow up demonstrates stable bone, stable soft tissue and no breaking/chipping on the restoration

dental-continuing-education.com
stable soft tissue after 2 years


Reply

Great discussion and case result...why no 2nd implant in cantilevered space? Dr. S


Reply

Thank you Maurice,
the ridge on the mesial part is only 3mm wide,
it would require GBR or a split in addition to an extra implant with an abutment.
I found that cantilevers based on wide (=>7mm) implants with 5.7 zimmer platform are very solid and reliable.
I've seen no failures so far, not even a screw loosening.


Reply

Anton,really nice case and great service to your patients with two visit procedure.How many cases like this have you already done?Have you thought about doing some statistics?
Do you give courses? It would be great to learn from you or from Armando.
Thank you for sharing your knowledge
Best regards
Snjezana


Reply

Thank you for compliments Snjezana,
I like your work as well.
I've started doing 2-visit cases around a year ago and now around 80% are them. If an implant/s are stable enough to scan them during surgery - it's 2-visit . 20% I am not able to scan, then it becomes 3-visit affair,where I scan on uncovery appointment.
The biggest case I've done so far in 2 visits, was the entire side implant based posterior rehab with VDO
Increase.
Regarding classes, I have some plans, but want to write few papers first, although everything is changing so quickly that I am afraid of being outdated when they finally will be completed. I do speak , occasionally, on CAD/CAM topic.


Reply

4-year follow up.
Dense crestal bone is evident. It shows that stress distribution around the implant is within limits of physiological adaptation. ST is also stable - at the same level as after the delivery.

4-year PA
4-year buccal view


Reply

Very stabile mid therm result. Thank you for sharing!
Best regards
Snjezana


Reply

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