Charles Lo Giudice This is a Dental Lifeline Network Donated Dental Services case done for a disabled veteran. There is plenty that can be improved with this case. Ross Enfinger, Chris Aadland, Daniel Wilson, and especially Mike Skramstad would never post something like this. I accepted this patient because I saw an opportunity to gain experience doing a comprehensive esthetic implant case, but with lower esthetic demands than if this were a soccer mom. It is the best I could do under the circumstances. I received some coaching along the way from Farhad and Emil Verban. The patient presented with an edentulous space that was too narrow for a normal looking central incisor. Clear Correct generously donated their orthodontic services. The ortho isn't perfect but the patient is 40 years old with some serious space issues. The edentulous space was enlarged enough to provide some room with which to work. Straumann graciously donated the 3.3 x 10 BLT Roxolid implant, the healing abutment, and the Variobase. The osteotomy was carried out using a CEREC Guide 2 milled in house with Densah Osteotomy drills and the old Verban Drill stops. Emil loaned me one of his reduction gear handpieces, a pilot drill, and some drill stops--he wanted to spare me the expense of purchasing the drill stops which were available at the time because he was rolling out his new drill stops a few months after this implant was placed. I did purchase a set of his new drill stops. A membrane was placed under the reflected labial gingiva, FDBA was placed between the membrane and the ridge to increase the width of the ridge for better esthetics, the site was sutured shut and allowed to heal for six months. After the six month healing period, the implant was uncovered and a healing abutment was placed. After two weeks of healing, a fixture level impression of the upper arch and an alginate impression of the lower arch were obtained, models were poured, and the split custom zirconia abutment and e.Max crown were fabricated. 
The pre treatment planning pictues
The custom abutment and implant crown. It was necessary to reduce the mesial of #9 because it was too large. I could have done a better job. Now it is too small with a cant.
The distal of #9 was rotated to the lingual. A veneer pretty much solved the cant and size discrepancy. It was necessary to polish out some orange peel in the glaze on the veneer. In the process, some of the white stain was lost. The veneer should have been restained and reglazed but we were running out of time. The result is still an improvement over what the patient presented with. The gingiva has almost covered the abutment margin.
Don't be too hard on the old man.
