A Holiday Miracle
This was a case I did this week just before hopping on a plane to travel to Scottsdale. The patient called and reported he had "chipped his tooth". No big deal let's give him a 30 minute emergency time slot. Upon exam he actually fractured the facing on #6. Game on! The original prosthesis is a 12 year old 3 unit PFZ bridge. Now he needs a new bridge. Before CEREC this was a challenge on a few levels at this time of year. In an insurance based practice like mine. there is no way to get this project done before year end. This means all of the insurance benefits this patient has for 2017 would go unused. The other hassle is that with 2 major holidays coming this month, we wouldn't get the case back from our lab until early January. Nothing better than wearing a temporary bridge for 4 weeks during the holidays. I guarantee you I would get a phone call from this guy at the worst possible time during the holidays.
The way we handled this case was to take care of him that very same day. A same day 3 unit bridge for us is a 2.5 hour visit whether we use zirconia or emax. If you have multiple operatories this is a really simple work flow. Remove the bridge, refine the preps, image and design. This will take the average dentist 30-60 minutes. Even if it takes 90 minutes, that is all the doctor time needed as the rest of the time is simply milling and crystallizing. After the bridge is processed the cementation is another 15 minutes. At most this procedure will require 1.5-2 hours of doctor time. This is a $3600 procedure with a lab bill of $105 (block), which is great hourly production. When you consider you are likely doing additional procedures on another patient or 2 during the processing this is a great day. Don't worry about the patient sitting around for 2-3 hours. These folks are thrilled to get their bridges same day!
Super result Bob. This is exactly why chairside cadcam is a must have in my opinion. We do lots of great things for our patients but you just checked every possible box for this patient.
The extra production around the "insurance deadline" time of year is always a plus for CEREC. Nicely handled.
Nice use of technology and time... AND it looks MUCH better than the old one.... double win!
Mark
Tough case! I hope it last.
Bob, is it the same bridge before sintering picture. Looks like canine and 2 premolars. Gregory
On 12/14/2017 at 11:33 am, Gregory Mark said...Tough case! I hope it last.
Bob, is it the same bridge before sintering picture. Looks like canine and 2 premolars. Gregory
Good pick up there Gregory. This being an education site I just wanted to add a picture on how to support bridges for firing. Many folks are using pins incorrectly.
The education worked! I am fascinated how much I learn just reading these posts! Know I will support my bridges during firing accordingly.
On 12/14/2017 at 1:26 pm, Bob Conte said...On 12/14/2017 at 11:33 am, Gregory Mark said...Tough case! I hope it last.
Bob, is it the same bridge before sintering picture. Looks like canine and 2 premolars. Gregory
Good pick up there Gregory. This being an education site I just wanted to add a picture on how to support bridges for firing. Many folks are using pins incorrectly.
In this photo, are you using pins at all? How would you describe using the pins correctly for firing a bridge? I just simply fill the two abutments like i would a couple crowns, place the pins as I would a couple crowns, and fire. I definitely have not been using the large amount of quickpeg shown in your photo.
Casey. emax can shrink and slump during firing if not well supported. If you peg the abutments of a bridge without supporting the pontic you can potentially get some slumping as demonstrated in these images. 
THAT is the pic I show all assistants or new owners in training when they have questions or don’t understand the purpose of the object fix to support the ceramic at crystallization temps...
Mark
Nice save for Christmas.
@gregory: Given that the previous prosthesis was 12 years old and failed due to a veneer ceramic fracture, I think Bob will be just fine. Control the excursives to give more group function and it will be fine. Since it is monolithic there is not the inherent weakness of the veneering ceramic. As long as the connectors are adequate and the occlusion is controlled, meaning no centrics contacts on the pontic or near the connectors, the longevity is not really a question.
On 12/30/2017 at 8:30 pm, Bob Conte said...Casey. emax can shrink and slump during firing if not well supported. If you peg the abutments of a bridge without supporting the pontic you can potentially get some slumping as demonstrated in these images.
Wow, okay, thanks for the information. Ya, I'll start supporting the ceramic more. Interesting.
Great case and great visual of what happens to unsupported emax Dr. Conte!!! It's one thing to hear it said, it's another to see the importance of the putty
