Extraction and Immediate Maryland Bridge
Here is a fun case I did this morning where I extracted tooth #25 and made an immediate Maryland Bridge with 2 facial wings on #24 and #26. I created an ovate pontic that went a bit down into the extraction site in order to compensate for the healing. Love this technology and what we can do with it.
Material was e.max A3 LT with Lustre Paste
Here is the preop:
Extraction and Wing Veneer preparations:
and Final Maryland Bridge:
Very nice, especially because this is not a good site for am implant.
How long did it take you to do this entire treatment?
Farhad
Very slick, Mike. I like how you re-created the overlap and rotation to keep a natural appearance. I would never use LT without a cut-back, though
did you graft that site? looks like the prognosis for 23 AND 25 is somewhat guarded and now that he can't easily floss that area, I would be concerned about future loss of more teeth, as I'm sure you are. what are your expectations regarding long term treatment for this site (I have done similar tx in a case like this, replaced both 24 and 25 with 2 wing Md bridge but on a pretty old patient that this will likely be definitive treatment).
On 12/14/2015 at 12:44 pm, Ross Enfinger said...Very slick, Mike. I like how you re-created the overlap and rotation to keep a natural appearance. I would never use LT without a cut-back, though
I had to do a lot of work to make that LT look good Ross :)
Nice Skram. Lustre paste looks good. Why 2 wings vs 1 in that scenario? I was in the lab when you were talking about that upstairs.
On 12/14/2015 at 12:49 pm, Greg Zlock said...did you graft that site? looks like the prognosis for 23 AND 25 is somewhat guarded and now that he can't easily floss that area, I would be concerned about future loss of more teeth, as I'm sure you are. what are your expectations regarding long term treatment for this site (I have done similar tx in a case like this, replaced both 24 and 25 with 2 wing Md bridge but on a pretty old patient that this will likely be definitive treatment).
I have done this several times and it has worked out good. He is a bit older and this is his definitive treatment. We practiced flossing and he has no problem. I made the pontic easy to floss underneath (plus the tissue will shrink a little bit as well making it even easier). Time will tell, but we are hopeful that it will work out great for him.
Here is another one that has been in for a long time that is working out very nicely
On 12/14/2015 at 12:55 pm, John Pasicznyk said...Nice Skram. Lustre paste looks good. Why 2 wings vs 1 in that scenario? I was in the lab when you were talking about that upstairs.
Based on the fact that lower incisors all function relatively the same (forces). With Lateral replacement, the canine and the central really do not....hence one wing.
Got it. I like the prep design, gives you something solid to seat against.
On 12/14/2015 at 12:57 pm, Mike Skramstad (Faculty) said...I have done this several times and it has worked out good. He is a bit older and this is his definitive treatment. We practiced flossing and he has no problem. I made the pontic easy to floss underneath (plus the tissue will shrink a little bit as well making it even easier). Time will tell, but we are hopeful that it will work out great for him.
Here is another one that has been in for a long time that is working out very nicely
Still one of my favorite cases of yours
Mike,
Wonderful job! I can see the seating into the adjacent teeth, great. Anything else we should know? Was that your wings, just into the prepped areas.
Carrie
On 12/14/2015 at 12:51 pm, Mike Skramstad (Faculty) said...On 12/14/2015 at 12:44 pm, Ross Enfinger said...Very slick, Mike. I like how you re-created the overlap and rotation to keep a natural appearance. I would never use LT without a cut-back, though
I had to do a lot of work to make that LT look good Ross :)
And didn't that make you feel sooooo artistically accomplished?! Haha. But seriously, it looks great.
Mike,
Very nice case! I am curious on your prep and design. Is there any pictures of the imaged teeth and your design?
Again nice case
Mike,
It must have been rewarding to be doing something "fun" when returning to work today!!! The case looks great..Have a nice, relaxing holiday.
On 12/14/2015 at 3:09 pm, Robert Lang said...Mike,
Very nice case! I am curious on your prep and design. Is there any pictures of the imaged teeth and your design?
Again nice case
Prep and insertion axis:
Design:
Very nice job blending in the facial margins with the natural tooth structure. It illustrates how in thin section the LT blocks can blend in nicely but the material has to be thin.
Beautiful stain and glaze as usual.
Mike,
Nice case . Where did the sprue end up on this? Most likely, on one of the wings. Any way to avoid that?
On 12/14/2015 at 8:48 pm, Dhaval Patel said...Mike,
Nice case . Where did the sprue end up on this? Most likely, on one of the wings. Any way to avoid that?
It was on the apical portion of one of the wings. You can move it by creating a bar that goes around the wing OR extending the wing... but it's not difficult to remove. I have been using the EF burs for bridges and the sprue is small.
Mike,
Thank you for the additional information. Great job, thank you for sharing it with us.
Carrie
On 12/15/2015 at 4:30 am, Jeff Levy said...why not lingual wings?
Impossible insertion axis. Would lead to terrible proposal and overall bad result.
Just out of curiosity, what are the connector sizes on that case? Obviously there isn't going to be a lot of occlusion there, but all the contours look so natural, it seems like it would have to be somewhat smaller than normal.
Beautiful, by the way.
I Think the connector size was 8 or so... cannot remember. It's end to end occlusion and pontic is out of occlusion. I think it will be fine . I hope :)
Looks great but I'm pretty sure I've seen those teeth on Walking Dead
On 12/14/2015 at 12:57 pm, Mike Skramstad (Faculty) said...
On 12/14/2015 at 12:49 pm, Greg Zlock said...did you graft that site? looks like the prognosis for 23 AND 25 is somewhat guarded and now that he can't easily floss that area, I would be concerned about future loss of more teeth, as I'm sure you are. what are your expectations regarding long term treatment for this site (I have done similar tx in a case like this, replaced both 24 and 25 with 2 wing Md bridge but on a pretty old patient that this will likely be definitive treatment).
I have done this several times and it has worked out good. He is a bit older and this is his definitive treatment. We practiced flossing and he has no problem. I made the pontic easy to floss underneath (plus the tissue will shrink a little bit as well making it even easier). Time will tell, but we are hopeful that it will work out great for him.
Here is another one that has been in for a long time that is working out very nicely
On 12/14/2015 at 4:02 pm, Mike Skramstad (Faculty) said...On 12/14/2015 at 3:09 pm, Robert Lang said...Mike,
Very nice case! I am curious on your prep and design. Is there any pictures of the imaged teeth and your design?
Again nice case
Prep and insertion axis:
Design:
Mike,
Thanks! That was what I was looking for. I would have never thought to do it that way, love the simple design. Sometimes I just think too much and complicate it.....
