e.max CAD MT Maryland Bridge
This is a 16 year old male patient of mine that really did NOT want to wear a retainer for a congenitally missing #7 while he is waiting for an implant restoration in a few years. I initially made him a Maryland Bridge (one wing) out of Lava Ultimate and he fractured it twice. His bite is a bit tight and the overall case is tricky. He came in today with the 2nd of the two fractures. I imaged him in the morning and seated just now at the end of the day. I always had some issues with Maryland Bridges with e.max because they would turn out good, but not wonderful due to the translucency. LT was always too dead for my taste and HT was way too translucent. This one was made out of the new MT block (shade A2) that will be released next week. It was a nice middle of the road translucency for this case. I did do this as a two wing even though I know that it has more of a chance to debond. I felt that the bulk would provide a little more strength since I did not prep the linguals at all. I would rather rebond than remake!
Edit: I had a couple PM's about the length. Yes, it's a little short. I did this because I had to set the tooth to the lingual a little bit to make it work correctly with the wings, etc... His occlusion was a little bit tight so I had to make it a little shorter to avoid guidance on it. With the final implant restoration, I will lengthen it and create more of a balanced occlusion.
Mike,
Did you make an "elephant trunk" sprue off the lingual of the pontic or did you let the sprue be placed on a wing and spot grind it to fit as closely as possible after milling?
On 9/9/2015 at 3:39 pm, Mike Skramstad (Faculty) said...
Mike - have you intentionally created a wing onto a third tooth that ends up with the sprue, because it's then easier / more accurate to cut off the 3rd redundant wing?
thanks. Ken
Ken-
It's not a wing on an adjacent tooth, just a "bar" created with the Form tool to get the sprue off the wing. Works great.
Mike,
Just curious, where were the fractures occuring? Do you think it was material related or occlusal forces doing the damage? Only marylands i have currently going at this moment are 1 wing with the impulse blocks (same reason for you using the MTs) but both patients had open bites which was nice. So just curious if you felt is was connector dimensions, material, etc...
Tom
In the connector and likely material related. It's not surprising to me due to his occlusion. It's a tough one.
Mike, with a tight bite are you designing and bonding these basically to the cingulum as low as you can go?
