e.max MT Maryland Bridges #7 & 10
15 yr. old patient just out of ortho awaiting implants #7 & 10 (congenitally missing). Single winged Maryland bridges bonded with Variolink Esthetic Neutral Cement. Patient to have some gingivoplasty as implant surgery gets closer. Will need to address anterior proportions and ortho assymetry but parents wanted something "stable" for first day of high school. #7 slightly distally angled, posted case more to show how nicely block blends in with surrounding natural dentition. Brings a totally new side to e.max esthetics and anteriors.
On 9/10/2015 at 2:04 pm, Mike Skramstad (Faculty) said... Great job. Worried about spaces later though. Will be hard to manage
Without a doubt. Have discussed a Phase 2 ortho follow up with Orthodontist to improve space issues for implant placement. Patient not real interested and in fact apparently insisted on the removal prior to starting high school. New to my office so will try to make sure they understand the esthetic and functional consequences over the next 18-24 months. Block is great though.
Dave,
Great job and thanks for posting. Interested in the new block, have so many LT/HT stocked now, need to use them up.
Sharpie
On 9/11/2015 at 10:16 am, Shawn Sharp said...Dave,
Great job and thanks for posting. Interested in the new block, have so many LT/HT stocked now, need to use them up.
Sharpie
Remember, If they are still in the box they can be swapped out.
On 9/11/2015 at 11:58 am, Daniel Wilson said...Nice case Dave! Did you create an ovate pontic for #10 as well or is that a ridge lap?
Thanks Daniel. The tissue surface of #10 was much nicer from the starting proposal because there was no primary extraction like #7 site. I was able to really smooth out the tissue surface with the form tool creating a near ovate pontic BUT because of the extraction of #7 I had to ridge lap the facial #10 for symmetry. I still need to level #7 to make it less distally inclined.
Dave / Mike
re the MT block - are you getting less "grey" shine through affect on these blocks than the HTs I assume?
in this particular case I can still see some slight greying of the pontics ( no offense intended Dave) - would the LT have reduced thus even more, or do you feel it would have looked to dense?
ps .... Very nice white flecking Dave
On 9/12/2015 at 12:03 am, Ken Heath said...Dave / Mike
re the MT block - are you getting less "grey" shine through affect on these blocks than the HTs I assume?
in this particular case I can still see some slight greying of the pontics ( no offense intended Dave) - would the LT have reduced thus even more, or do you feel it would have looked to dense?
ps .... Very nice white flecking Dave
Ken, without a doubt you will get less grey than the HT. I think the base shades of the MT blocks are going to be much more standard and true to natural teeth when placed next to them in the mouth. HT blocks were always greyish and the LT blocks did not give light any opportunity to pass. Not that there is anything wrong with that. It really is a clinical situational choice. Next to a PFM in the mouth an LT is the perfect block. On many anterior cases HT blocks are perfect. I think the MT will add to the esthetic options and really allow e.max to be an option in the esthetic areas where strength is needed and a concern.
In this case just carrying the white down further toward the cervical would have removed that grey look....I think. I left that area without charachterization because I wanted to see how the base shades looked when fired in the anterior and it does not show when she smiles. I had to slightly overlap the ridge on the facial for symmetry because of the extraction of #C so that overlap may be a little thin and allowing some grey to pass through.
No offense taken at all...lol. The best thing about this discussion board is the dialogue and constructive criticism that comes from clinical posting. Everyone gets better when we do that.
What is the current thought process of where to attach the wing? I have a case of a 40 y.o. woman who has bilateral maxillary lateral incisors replaced with conventional metal ceramic maryland bridges. She has a decent amount of greying of #8/9 because of those metal wings. This woman does not want implant restorations but is interested in replacing the metal ceramic bridges with all porcelain. What do I need to think about making a decision to go with one wing verses two? The teeth have already been slightly prepped...
BTW, Nice job Dave, thanks for posting your case.
On 9/13/2015 at 9:28 pm, Scott Morton said...What is the current thought process of where to attach the wing? I have a case of a 40 y.o. woman who has bilateral maxillary lateral incisors replaced with conventional metal ceramic maryland bridges. She has a decent amount of greying of #8/9 because of those metal wings. This woman does not want implant restorations but is interested in replacing the metal ceramic bridges with all porcelain. What do I need to think about making a decision to go with one wing verses two? The teeth have already been slightly prepped...
BTW, Nice job Dave, thanks for posting your case.
Thanks Scott. Occlusion is always my main concern with these. In this case I had more clearance on the central than the canine because of excursive function and contacts. If you think the occlusion is deep or heavy you can still use two wings. Mike showed a case earlier last week where he had used two wings for that reason. Connector size is also always a major concern. Try to keep the connectors in the 16 sq. mm. range as recommended by ivoclar but studies have shown good success at 12mm also. Sometimes the canine alows for a better size conector just based on the shape of the tooth but occlusion prohibits the wing from being placed there so really take a look at that. Since you mentioned the adjacent teeth were prepped this will help with the occlusion by having the wing slightly inset. Good Luck and hope to see you in Vegas!
Nice job -how about just venerating the centrals to add to the distal , which will allow the laterals to be narrower and more in proportion rather than more ortho - instant ortho :-)
Dave,
nice job. Thank you for the post. Did you find the MT brighter or spot on? I have only done 2 MT A2 and too bright. I'm going to open another box when I have the right case and try them again.
Carrie
