Part 2. LOWER IMPLANT FIRST MOLAR | Model-less | Andrews RRR

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

Long awaited Part 2.
Patient came back one year later, since the last visit and finally I had a chance to deliver his crown.
Slight vertical/lingual drift of the upper molar was managed with Intrusion Via Hyperocclusion.
Comments, discussion, suggestions are welcome.

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6 Comments

Nice clean work as usual.
2 Questions:
1. Is the screw access channel milled by your milling machine or free hand.
2. Is there a reason why you`re doing the try in in 2 pieces and then cementing crown to abutment while the patient is in the chair. Why not do it prior to try in?
Also I`m still unconfortable with your hyperocclusion technique. Sure there will be intrusion of the opposing tooth, but potential TMJ issues with the fulcrum created, enamel chipping, fracture lines, patient discomfort ...


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thx Laurent,
1. Is the screw access channel milled by your milling machine or free hand - all milled by 5-axis mill

2. Is there a reason why you`re doing the try in in 2 pieces and then cementing crown to abutment while the patient is in the chair. Why not do it prior to try in
Because if the shade doesn't match....

Regarding Intrusion via Hyperocclusion, in this particular case its about to push #14 buccaly co compensate for the lingual drift.
I am very comfortable, now I know the limits of this technique and how and where to use it.


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Anton. Nice video. It tells the story well. What do you think you would see and happen if you reflected your flap into the vestibular region at the uncovery stage? Now that you have explored the limits "Hyper-occlusion Intrusion" what are the realistic indications vs equlibration? Always a pleasure to hear from you my Friend. Thank you for the updates. All the best. Chuck


Reply

thx Charles,
I reflect on both - buccal and lingual for ST to adapt ideally around my bio-mimetic emergence profile.
I like your logic about doing that on uncovery stage. Its called 2-visit tooth replacement protocol. I use 2-V every time where its possible :}


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Compliments...well done and great documentation. Have you or will you try immediate restoration on molar site by surgical guide and dual scan sent to milling center and have guide and final abutment and crown ready at insertion?? regards Dr. S


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Thx Maurice,
I haven't done an immediate final implant restoration yet. That would be 1-visit tooth replacement concept AKA teeth in an hour:)
There are few reasons.
Most of my cases are either immediate placement or quite extreme , requiring GBR and they have lack of adequate initial stability that I am confident restoring at the same time in final shape and function.
The second reason that CBCT have certain degree of distortions which will cause definite pressure due to non-passive fit for screw-retained cases. Allthough I had seen few multi-unit cases in blogs demonstrating at least that it's possible with PMMA temps.
I have too much at stake to risk a multiunit case with that approach.
Delivery of a final custom abutment is possible and it was done but I like my cases to be screw-retained , not cemented and it's less lab work as well to do in a single piece rather than two.


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