Dave Juliani I am always amazed we still hear these words. As CEREC users, I truly believe we have a unique understanding of ALL phases of our patient’s restorative needs. The ability to directly restore almost every dental need has made us very familiar with material choices, adhesive needs, and yes, implants. In many cases this is a BLESSING and a CURSE. The case below represents a patient I recently inherited when I purchased a small practice in town from a retiring dentist. The general practitioner did not place the implants and relied on the surgeon for implant selection and placement. Without a guide or restorative direction, the surgeon placed two Nobel implants (6 months earlier) in the #11 and #12 spaces. The implants were placed nearly parallel (which is not what this case needed), integrated well and the patient was asymptomatic.
To make matters worse, the patient presented with zirconia stock abutments in hand (that he had already paid for), expecting final restorations and frustrated with the time delays he had encountered. After removing the healing caps and placing the stock abutments, the severity of the restorative issues became very apparent.
As you can see, the placement of the implants has caused a total overlap of the stock abutments, with no room for any restorative options without re-prepping the abutments. #12 implant should have been placed more distal and angled slightly. After the abutments were re-prepped, space was still limited but restorable.
Though Omnicam was able to read the margins of both abutments, the restorative esthetic results were compromised interproximately. Also the ability of the patient to keep the tissue between #11 & #12 healthy is severely compromised. Even ideal hygiene will not ensure tissue health due to abutment proximity and impingement. The case was restored temporarily with empress until after the holidays when custom abutments can be made and crowns completed to acceptable standards (if possible). Amazing what a little communication and direction from the restoring doctor can do for a case.
