Dan Butterman I much prefer to post cases that are a slam dunk and turn out looking beautiful like this pre-op and 4 year post op case....
But unfortunately, some cases don't go this way. I hesitated to post this failure, but I tend to learn more from the cases that don't work out. This patient has broken almost every restoration that anyone has placed. She fractured the endodontically treated tooth #14 and I extracted it. I think I only waited 3 months to place the implant.... maybe too soon for this patient. I also went with a shorter implant to avoid sinus grafting.... mistake? Maybe with this case. I let her heal for another 3 months and placed a screw retained e.max/TiBase restoration.
Over the course of about 9 months, things went from bad to worse. I took the crown off, put her in a healing abutment, and grafted, but nothing worked.
So now what? The patient is asking for a bridge, and I'm honestly afraid that she'll fracture the retainer teeth in a few years. Like a lot of you, I offer to re-do everything for free. Right or wrong, she agreed to a new implant, so I changed everything about how I did the last one.
I did a sinus lift, with a bigger, longer implant and re-grafted.
I went with an Atlantis abutment ( I do think a TiBase would have been fine on this case), and I put the softest material I could think of on top, Enamic.
Although I kept the occlusion light, the patient still was functioning heavily on the crown. When she bites hard, I think her natural teeth move apically a lot more than normal.. this is the wear on her Enamic crown after less than a year (delivery and about 11 months).
She appears to be doing well now as far as bone levels around the implant, but time will tell. In the end, I waited longer, grafted more, used a bigger implant, better contour abutment, and softer crown to try and take up some force. Maybe none of this mattered and the case failed for other reasons, but hopefully this is the end of a very long story :)
