2 visit implant workflow: ext, immediate implant, custom healer, mayland bridge, final crown

Jonathan Ford

7 years ago

Here is a case that I just cemented this morning.  I couldn't have imagined this workflow until taking Level 3. Thanks Sam, Mike and Mark!

Visit 1: Extraction, immediate implant placement with surgeon. Custom healer, maryland bridge with myself. Both of us were finished in just under 2 hours.

Visit 2 (today, 4 months after visit 1): Custom abutment and final crown delivery.

There was one 2 minute appointment two weeks ago to check the final shade since the patient was bleaching. 

The patient initially reported with #8-crown, post and some tooth in hand. At the initial visit, I took two preop scans. One for the biocopy with the tooth back in place and another with the crown back out to fabricate the Maryland bridge.

The extraction was completed and an immediate implant was placed. I personally like to fabricate the entire crown out of enamic when making making a custom healer, so I can get an idea if my design is on the right track. I then mark the crown where I want the custom healer to be and cut it down extraorally. I then cemented the already made maryland bridge in place.

Since I liked the look of the temp/custom healer, I split the design and finalized the custom abutment and crown. Staining and finishing is truly an art that I'm constantly trying to get better at. I know some of you are truly artists on here. The patient was ecstatic, so I was too. I am fairly confident the papilla will move down over the next few weeks. 

I know this was technically 4 visits, but the main procedures were done in two with some planning.

Visit 1: Emergency recement with a couple quick scans (15 minutes)

Visit 2: ext, implant, custom healer, maryland bridge (2 hours)

Visit 3: Shade check (30 seconds)

Visit 4: torque custom abutment and cement crown (3o minutes)

I can't imagine going back to the "traditional" implant workflow!