Peter Gardell Measure twice - cut once!
Words carpenters live by, because cutting a second piece of wood is the most expensive cut. The same holds for dentistry.
With the new Ivoclar e.max mesoblock, we have a new concern. Since it is bonded to the TiBase, we can’t easily add to the ceramic after it is assembled . You can see a case I went to deliver how this can be a potential problem. After I designed and fabricated the hybrid crown, I went to deliver the restoration. Something appeared to hang up the seating of the crown. Contact seemed a bit tight so it was adjusted, and adjusted until it seemed just right. Unfortunately, when the implant was torqued in, the end result was not what was wanted. Wide open contact, totally unacceptable. Since the crown and TiBase were bonded together, there were three solutions. Do nothing and buy the patient a case of Superfloss, do a large mesial restoration on 18, or remill and redo the implant restoration. Redoing it was the right and proper way to fix my error.
If I had only followed the guidelines from Ivoclar, I could have avoided wasting a precious e.max mesoblock. I would have avoided wasting my time to remake the restoration, avoided wasting the patient’s valuable time to have to return, avoided wasting the valuable chair time required to place a new restoration. Most important, avoided the erosion of the potential profit from this procedure.
The expensive second cut!
The recommended try in process utilizes light body PVS to lute the TiBase to the abutment/hybrid crown. Due to the exact fit of the mesoblock on the TiBAse, anything that sets up harder than light body impression material, such as bite registration material, should be avoided. This could make it more difficult to separate the components after try in. The light body material will keep the components securely together during the try in of your restoration. More importantly, it allows for the restoration assembly to be broken apart easily. It does not contaminate the e.max material so if re-firing is required, you can do so with normal firing cycles.
The process is straight forward and there is a video in the digital learning section of cerecdoctors showing how I did it with this case. It is http://www.cerecdoctors.com/digital-learning/view/id/1199
Try in before bonding - a wise move!
