Here is a fun case I just completed today that shows you the great power of 4.4 Biojaw in the anterior.

This patient had a very old Maryland Bridge Replacing #8 with metal wings on the lingual of 7 and 9... and an old PFM with RCT on #10.  Her main concerns were:

• spacing below pontic (blackness)
• Dark hue on 7 and 9 from metal showing through
• Overall shape and symmetry of all anterior 4 teeth
• Unesthetic PFM on #10

I first thought of placing an implant in the #8 spot and then restoring 7,9, and 10... However, as you can see from the Implant Planning...that was going to be very difficult without extensive grafting (which she did not want to do).

I then thought of doing a new maryland bridge with veneers on the facial of 7 and 9... but then thought smarter and decided not to make my life tremendously difficult... so we prepped for a conventional bridge 7=9 and new crown on 10

I wanted to try Biogeneric/Biojaw... so no Biocopy or waxup here. 

Here is my initial proposal (which would have taken forever to get right!!!)

I then went back to Biojaw and used this unadapted design:

Which gave me the new proposal... after redrawing the baseline of the pontic to match the other central (and some other tweeking)... got a quick final design

I decided just to temp with Teliocad (milled) so I could spend more time on the final....

And here are the finals today:

Before and After

All e.max Cad LT A1... Pontic was modified ridge lap

Lustre Paste Characterization

The laterals are different heights, but she had no desire to do Ortho because her lip covers it anyway. 

Biojaw saved you so much time and effort to get to your result, really nicely done, interesting case, beautifully executed as usual

questions:

1. tell us about how you photographed the case

2. can you show and occlusal and lingual view of the maxillary before?

3. how will the lower anterior craziness be affected by the restoration?

4. how do you think the wear on 9 occurred?

5. when staining, did you uses the enamel mix on the lingual of 8 and 9 or just the facials?

6. if you started over from your excellent result, how would you change it, or not?

re: ?6, we are always looking too critically at our own work and I know you have some thoughts about this. I have a hard time feeling like posting my work as I am never satisfied with how it turns out and of course see it later on recall or such and think, hey, that turned out well, what was I obsessing about

On 12/16/2015 at 5:06 pm, Jim Stein said...

Biojaw saved you so much time and effort to get to your result, really nicely done, interesting case, beautifully executed as usual

questions:

1. tell us about how you photographed the case

2. can you show and occlusal and lingual view of the maxillary before?

3. how will the lower anterior craziness be affected by the restoration?

4. how do you think the wear on 9 occurred?

5. when staining, did you uses the enamel mix on the lingual of 8 and 9 or just the facials?

6. if you started over from your excellent result, how would you change it, or not?

re: ?6, we are always looking too critically at our own work and I know you have some thoughts about this. I have a hard time feeling like posting my work as I am never satisfied with how it turns out and of course see it later on recall or such and think, hey, that turned out well, what was I obsessing about

• How do you mean "how did I photograph it?"
• The occlusion was pretty balanced in the end... don't think the lower will affect it too much....  checked it pretty carefully.  Plus, she was a little retroclined overall.  I created a little more "freeway space" for her by moving the incisal edge more facial...
• #9 is not wear... it was trauma.  She told me how, just cannot remember what she said :)
• I'm not sure if I would change things much at this point.  I was pretty pleased on how it turned out based on what I had to work with.  The contouring was very time consuming on this bridge... I'm glad I had two appts because the temp helped me visualize what I needed to change in the finals (specifically the contact length)...
• No enamel mix.  There is just LV A, LV 5 (blue), LV 2 (white), and LV N (glaze).  Very light glaze for more of a dull finish.

I don't have an occlusal shot, but here is the biocopy (I used this to guide the Biojaw Proposal)

Looks really nice! 

Looks awesome!

Mike,

Beautiful result. The embrasures are the best I have seen on an milled Emax bridge.The preps look divergent. Did you run into any undercut issues? How do you deal with undercut issues for bridges?

i really like the embrasures also. it brings up something that has been on my mind.

so far i have been very disappointed with the aesthetics from the emax bridges i have provided using my cerec unit (i know others have more skill and have been doing just fine). I uploaded the 4.4 this week and i have noticed the occlusal anatomy is much more defined. is there a similar improvement with the milling of the bridge embrasures?

i see alot of talk about connector diameter and ensuring sufficent connector diameter when designing the bridge but for me the embrasures in the milled bridge are not cut out in anyway as deep a fashion as in the design so why worry about connector diameter when the machine was leaving a much greater diameter in reality? i know i need to  hand cut in definition with my own handpiece but i am really hoping this has been improved with the 4.4. as i am not as good at this as i would like to be. i hope improvements in the technology continue to make up for my lack of laboratory skills and busy schedule.

Dhaval-
Thank you. The teeth had draw, but barely. The part that was the hardest was the facial. Moving the teeth and not getting too this was very difficult. I could have prepped 7 more.

John-
EMax bridge esthetics are difficult. 4.4 will bring some advantages, but only if you have a 4 motor mill and can use the EF (extra fine) burs. Can mill embrasures slightly better.

Lab work can be learned and it's not terribly difficult if you know the right method. Keep working at it.

I try and follow the recommended connectors as close as possible. However, j will violate them if I need to for esthetics. If it doesn't look good... Doesn't matter how strong ;)

On 12/16/2015 at 4:13 pm, Mike Skramstad (Faculty) said...

Here is a fun case I just completed today that shows you the great power of 4.4 Biojaw in the anterior.

This patient had a very old Maryland Bridge Replacing #8 with metal wings on the lingual of 7 and 9... and an old PFM with RCT on #10.  Her main concerns were:

• spacing below pontic (blackness)
• Dark hue on 7 and 9 from metal showing through
• Overall shape and symmetry of all anterior 4 teeth
• Unesthetic PFM on #10

I first thought of placing an implant in the #8 spot and then restoring 7,9, and 10... However, as you can see from the Implant Planning...that was going to be very difficult without extensive grafting (which she did not want to do).

I then thought of doing a new maryland bridge with veneers on the facial of 7 and 9... but then thought smarter and decided not to make my life tremendously difficult... so we prepped for a conventional bridge 7=9 and new crown on 10

I wanted to try Biogeneric/Biojaw... so no Biocopy or waxup here. 

Here is my initial proposal (which would have taken forever to get right!!!)

I then went back to Biojaw and used this unadapted design:

Which gave me the new proposal... after redrawing the baseline of the pontic to match the other central (and some other tweeking)... got a quick final design

I decided just to temp with Teliocad (milled) so I could spend more time on the final....

And here are the finals today:

 

Beautiful case Mike.  I am loving it for anteriors as well and have tried a few in biogeneric and loved the outcome.  Looks like an amazing wax up!

Looks gorgeous Mike! Curious if you photoshopped first and if so will you post it? I want to see how you match your photoshop to real life...
Also- did you block out #10 with anything?

Mike - thank you for posting - great case - did you think about doing gingival contouring with a laser on 10 so it would match 7 a little better?  any reason for not throwing a class V fill over the abfraction / recessison on #6 ?

Greg