Ross Enfinger So this case ended up being one of the more difficult esthetic cases I've dealt with recently. The patient was referred by my periodontist after having teeth #8 and 9 extracted from beneath the existing bridge. So I came on board and started as usual with facially-generated treatment planning. Here are the pre-op photos...
Clearly, we wanted to improve the reverse smile line and hide the pink ceramic transition beneath her lip line. We discussed further attempts at vertical grafting, but this likely would have brought the transition into view and actually make the case less esthetic. So here are my temps and the implants in sites #8 and 10 (placed by the referring periodontist)...
So I looked at doing the ceramics and number of ways, but ultimately decided to maximize my Cerec usage and push my technical limits. I first milled custom abutments and then biocopied the approved provisionals and milled a full-contour zirconia framework. Next, I used my depth cut burs to reduce the framework and refined the "preps" and "gingiva", taking care not to lose my reference points and keep ideal contours. Here are the photos of these steps...
Once I had fully prepped the zirconia framework, I biocopied again to mill the individual crowns out of e.max Impulse. After a couple stain and glaze firings, it started to look like this...
Being happy with the esthetics so far, I then cut back the "gingiva" and layered with pink composite. Last, I bonded the e.max onto the framework, and this was the lab result...
Final intraoral photos will follow in a week or two. Has anyone tried something like this and what has been the long-term outcome? This is especialy pertinent as we want the ability to mill full-arch implant prostheses, but few have chairside experience with layering multiple materials.
