Blog Author: Andrew Hall
First case here - very nice work flow for sure. Hope they will keep the cost down for it to make sense for us to utilize....have more in the works will continue to post as I know others have more experience. Any questions welcomed.....
Anterior Celtra Duo Case shade LT C2, bonded with Calibra Ceram Resin Cement, milled in EF mode, designed in biogeneric individual but I always grab a pre-op "biocopy" catalog for reference during design. I only imaged two catalogs in this case as I again utilize the biocopy overlay to asses my occlusion during design phase - areas I could have improved on would have been to make the teeth more square like original teeth but she was very happy with the outcome - enjoy your weekend everyone.
ACTUALLY we don't but I thought this might get your attention and also it is a tribute to the patient in this case. Meet John he is a NASA engineer, a real rocket scientist and one the nicest guys you will ever meet. One day I actually bumped into him on a flight from Chicago to Denver and I asked him what he did at NASA and he said that if the astronauts utter those words "Houston we have a problem" he is the guy that they call. John lives in my city but works in Houston every week so he is only home on Friday - Sunday mornings and is a vibrant 75 year old man. You can see from his before photos that he has severe attrition/wear. He does not report any history of GERD or any intestinal disease. I had patched up a few teeth over the years and always discussed the need for FMR. He finally committed to the treatment.
The treatment plan given his work schedule and limited availability was to get a FM wax-up done, do the upper arch in one sitting and place over provisionals which he would wear for a minimum of 3 months to asses the new vertical etc. I TENS and took a bite and got the wax-up completed. You may notice from his before photos that his incisal edge position is actually not bad.
So we called in CADSmiles and he helped with the case since I wanted to get the uppers completed in one day and the provisionals in place on the lowers. Having him do the design and post-mill contour freed me up to prep the lower arch. Eddie has a great approach to these larger cases and they are divided into smaller segments all of which has been discussed on these forums several times. This case was done all with Celtra Duo LT A2 just polished and fired. Not going to win AACD and I did learn several things from this case but the patient was happy with the outcomes. The uppers have been in service for 1 year and the lowers were completed 7 months ago.
I am by no means an expert in 3d printing but I have enjoyed getting acquainted with the process - thanks for all that post on here and those that I have contacted that helped me to start to utilize this work flow. Here is a case that highlights the blending of CEREC implant planning and 3d printing with the Astra EV line-up.
Initial presentation - history of trauma as a child and this long time patient called with significant discomfort and a mobile tooth - he wanted the most predictable long term solution which I felt was a dental implant. Patient is a medical doctor and did not want a flipper so I milled a splinted temp with teliocad for use as an interim.
Tooth was extracted in June and I waited 5 months for healing
CEREC and Gali images merged and plan completed
I sent this case out to Sicat for guide design and then downloaded and printed the guide. The metal sleeves I got from Sicat directly.
Guide was printed on moonray printed in office - I also printed a model just to verify the fit
Time for surgery, removed splinted provisional
Surgery completed Astra Tech 3.6 X 9mm implant and I did place healing collar, modified provisional to relieve all pressure from surgical site and placed provisional back on. I do use Durelon on these long term provisionals as I have had better success than using temp-bond
I will post final restorative pictures once that phase is complete - suggestions and ideas to do this better are always appreciated!!
This is a case were we sometimes have to meet the patient at their primary need. He presented to me to" fix his front teeth." There is a lot to deal with here, hygiene issues, assessment of diet as patient is high caries risk. Yes we discussed a lot of options and the need for change in order for anything to be successful long term. Ultimately we decided that we would crown the canines and the goal is to place two implant in the anterior segment and restore #7-10.
Here is initial presentation:
Set the case up to mill the interim bridge with Telio Cad:
My plan was to grind #7-10 down to the gum line, prep #6,11 and get a provisional bridge milling and then come back and extract the teeth. Lesson learned here was that I should have taken the teeth down even more to allow for a better design of the interim bridge.
Next was to design the case - I did utilize biojaw in this case and the harmonic positioning. This may not be the final restorative position, but you can see how it placed the proposals well in front of the extraction sites, given the position of the canines. The case required a Telio Cad block B55. I have attached the rst if anyone wants to play around and design the case.
While that was being milled it was time to extract the teeth, utilization of the Benex allowed for atraumatic extraction
I did opt to place bone graft as well - curious how others would have handled this
After grafting it was time to seat the bridge - I certainly needed to spend more time contouring and need to work on making the embrasures look better. Many lessons learned, hope this helps someone out in the future with this type of case. The patient was happy given the initial presentation and it's at least a start point for this case that is certainly a work in progress.....
Thoughts and ideas welcomed.....
There has been some discussion about Celtra Duo on the boards recently - I have found it to be a very nice material both in how it mills and also handling of the material posst mill. I thought it would be good to share an anterior case recently completed in which we can all evaluate the esthetics of the material.
Teeth #7-10 Celtra Duo LT A3 fired, completed in two visits using biogeneric individual, bonded with Variolink esthetic cement (neutral)
This pre-op photo is from 2010 - patient had continue to wear and was also looking for improvement in apperance of his front teeth
Prep pics from Omni A/C
Comments and critques welcomed, have a great weekend everyone!!
We have all been there clinically when we are trying to image in the anterior segment of the mouth with the CEREC Omincam and found it to be somewhat challenging. I will say that with every upgrade of the software the imaging has been vastly improved. I have found clinically that there are two keys to successful imaging in the anterior segment of the mouth with Omnicam. The first key is to have a strategy or technique in which you image, by that I mean a specific pattern you guide the camera. My preferred method is to start along the lingual aspect of the anterior teeth and then use either a canine or premolar, something with more surface area than an incisor to make my transition to the facial aspect. After the transition to the facial aspect, I then work back towards where I started on the lingual aspect thus capturing the lingual and buccal aspects in essentially two passes. From this point it becomes much easier to fill in the missing data and capture all the incisal edges and embrasures now that I have a nice framework.
The second key to imaging in the anterior is isolation. This is just as critical as the first key and will make the process much easier if you get the field isolated properly. When working on the upper anterior teeth quite often an Optragate from Ivoclar is sufficient. The real challenge is the lower anterior teeth. One trick that you may find helpful is to use both an Optragate and also a retractor that most everyone has laying around the office. These retractors are commonly used for in office bleaching. The unique aspect of these retractors is they either have a cup or ledge in which you can have the patient position the tongue behind. As you an see in the picture, by using both of these devices, the lips are out of the way and the tongue is positioned in such a manner that you can very easily image the lower anterior teeth.