I thought it would be a good exercise to go through an entire implant process documenting a failure of a healthy bicuspid.  I also will include a couple tricks at the end on how I dealt with a small issue.

Healthy tooth #4 as taking on standard intraoral photographs and radiograph on routine cleaning appointment

:

One year later, she came in with significant symptoms on the tooth and it was very evident what had occurred:

We treatment planned an extraction and site preservation graft and allowed it to heal for 5 months time.  After healing the site was ready for implant planning and placement:

​

After 3 months of integration we started the restorative process.  We scanned with a tibase instead of a scanpost in this particular case and took an xray to verify the seating:

We made a decision to use a multilayer technique on this case instead of screw retained (which would have been possible) because I prefer the ease of delivery of cement retained implant restorations, but I also like having more material options.  In this case once we split the restoration and had proper thickness of the veneering structure... there was a problem of the tibase sticking through the abutment.

I left the design as is and milled the abutment out of zirconia and the crown out of e.max HT using EF milling on the 4 motor milling unit:

Once the zirconia abutment was seated, you can see that the parts fit together perfectly

However, when bonding the tibase to the zirconia abutment... the tibase was infact poking through the zirconia abutment just like the design showed and this obviously prevented the parts from seating properly

To correct the issue, you can simply use the abutment as a reduction coping and "flush" the tibase that is sticking through to the zirconia abutment.  This should not affect the final restoration if it's just a little bit like in this clinical case

Once complete, everything was delivered in the mouth.  Besides the shade being a bit light, the overall process was a success. 

I hope this process helps some of you in the tighter interocclusal spaces where you would like to use the multilayer design mode.

Mike ,

Especially well done and very easy to understand the workflow.

I very much like the emergence profile of your ti-base and abutment. 

i believe this will be a  great benefit to the patient!

Thanks,

Phil 

P.S. I would love to see one year or more follow up to see how the bone implant interface matures.

On 3/7/2019 at 7:48 am, Guy C Sutton said... Mike- I have not seen a ti-base like this. The sirona ti bases we have had all have a severe emergence from the implant, not the smoother more trumpet shape of this abutment. What specific ti base and implant is this ?

thanks
Guy

Astra EV TruAbutment 2mm collar

That's a sexy tibase, so how long before we can use the different height tibases chair side?  I'd love for them to come out with an inlab solution for us.  

On 3/7/2019 at 8:57 am, Robert Feudo said...

That's a sexy tibase, so how long before we can use the different height tibases chair side?  I'd love for them to come out with an inlab solution for us.  

You can use them now if the implant system is supported by the software.  You can use the Scanpost from TruAbutment if you would like... but I personally scan with the tibase.  IF you call it Nobel Active for instance and say you are using the tibase... Just scan with the 1,2,3,4mm collar tibase with the Sirona Scanbody and it will work.  Even though there are not different collars in the software themselves, the tip of the scanbody will be at a different height...which will virtually place the height of the analogy at a different height with what the software is assuming is a 1mm tibase.  So the emergence will never change...just the height of the virtual analog.  I know it's confusing... but it works.

On 3/7/2019 at 9:16 am, Mike Skramstad said...

On 3/7/2019 at 8:57 am, Robert Feudo said...

That's a sexy tibase, so how long before we can use the different height tibases chair side?  I'd love for them to come out with an inlab solution for us.  

You can use them now if the implant system is supported by the software.  You can use the Scanpost from TruAbutment if you would like... but I personally scan with the tibase.  IF you call it Nobel Active for instance and say you are using the tibase... Just scan with the 1,2,3,4mm collar tibase with the Sirona Scanbody and it will work.  Even though there are not different collars in the software themselves, the tip of the scanbody will be at a different height...which will virtually place the height of the analogy at a different height with what the software is assuming is a 1mm tibase.  So the emergence will never change...just the height of the virtual analog.  I know it's confusing... but it works.

 

That is pretty great work around.  Will this work with the straumann ones too???  Why isn't everyone doing this?