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QUARTER 1 | 2014 | CERECDOCTORS.COM | 37
He was happy, and he functioned well
on these until he came in the office and
said he had bitten on something causing
a screw to loosen again. I had to respond,
“Larry, unfortunately it isn’t the screw.”
In Larry’s case, I don’t think it is fair
to evaluate his implant restoration from
today’s perspective. We can’t say that
anything that functioned successfully
in the patient’s mouth for 22 years is a
failure. If you think about the average
lifespan of a fixed splint, this implant
therapy was very successful.
Now, we have the chance to hopefully
use some of our knowledge and techno-
logical advancement to help Larry get
restored. Due to the bone loss in the area,
Larry was referred out to an oral surgeon
who had done some other work on him.
A bone graft to augment the site was
performed, and two implants were
placed after the graft had matured.
These were placed free-
hand by the surgeon; a
template was supplied to
indicate desired final posi-
tion of restorations. Healing
was uneventful, and clearancewas
granted to restore after seven months.
Implant position was OK for the
most part; angulation could have been
a bit better, but it wasn’t anything that
couldn’t be addressed with the resto-
rations. Unfortunately, there was not a
TiBase available to restore these with
InLab-produced custom abutments for
this implant system.
The height of the final restora-
tions prevented the restoring of these
implants with a simple stock abut-
ment and a single e.max block. Figure 3
shows models of the case with stock
abutments in place, showing the interoc-
clusal distance and the angulation of the
implants. The e.max size 16 block was
not available at the time these implants
were restored. Some ingenuity was
required, and CEREC offered the tools
needed to complete this successfully.
As can see in Figure 4, the solution
for Larry was to create custom e.max
abutments on a stock abutment. A final
cement-retained restoration was fabri-
cated to top the complex off. The new
restorations are un-splinted, single units
with emergence developing from the
implant interface up to the tissue level.
Mimicking nature and allowing the
restorations to look like teeth — not just
like teeth placed on an implant. Instead,
4
5
Fig. 4: Abutment
solution
Fig. 5: Galaxis
planning software