2 visit implant workflow: ext, immediate implant, custom healer, mayland bridge, final crown
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!
Great documentation and excellent work showcasing the CEREC with a custom healer, provisional Maryland bridge and final restoration! The only thing you're missing is placing the implant yourself with a milled CG2!!! =)
Next thing on my list is the cone beam and the CG2.
I didn't touch on this in the first post. In regards to the custom healer, I like fabricating the entire crown and then cutting it down later because I feel like it saves some time . I don't have to split the case and then fiddle with the scale radial and scale occlusal tools (which I think are really cumbersome to use). I also think it saves time in the milling unit. With implant restorations, the larger the restoration, the quicker the mill time. It is the opposite of most crowns and inlays since the unit has to mill around the screw access hole. The shrunk down custom abutments/custom healers are tiny and take a little more time.
