Page 63 - CEREC Q1 | 2014

QUARTER 1 | 2014 | CERECDOCTORS.COM | 61
Damian Chung | Port Lincoln (AU)
Had to laugh at your post, Mike. That’s exactly
what I’mdoingwithmy “day off” (Friday) to have
them ready for Tuesday. Just waiting for the sintering to
finish up so I can check the purple crowns on them. My staff
are hassling me to deliver these types of restorations same-
day, but for now I’m resisting. It’s more relaxing being able to
complete it all without any pressure.
Luis, for my cement-retained crowns, I sneak the margin
about 0.5-1 mm subgingival, but this is when you have the
tissues and emergence profile how you want it. If you need to
expand/compress tissuewhen you insert the abutments, it can
beveryunpredictable, particularly inthe longterm(oreventhe
followingweek you can see dramatic changes if not careful).
Mike Skramstad (Faculty)
As far as the e.max abutments, the abutments
on the bridge are MO1 e.max. The other three
are zircona.
I still actually do quite a few of my split cement-retained
crowns with zirconia via
InfiniDent. Lots of reasons for
this, but mainly it’s because I
don’t deliver them same day;
it’s $12 cheaper a unit, and I
have to do a ton less work (no
milling, removing sprue, crys-
tallizing, etc.).
I used the e.max abutments on the bridge because the
margins are supragingival and I’m going to stain the abut-
ment above the tissue to match the crowns. This patient
obviously has a lot of bone loss and you needed the abut-
ments supragingival in order to have the restorations fit the
block. If he had a high smile line, we would have splinted
together abutments and used pink porcelain likely.
Here is the pre-op:
As far as the screw-retained
versus cement-retained crowns,
I am doing a ton more screw-
retained versus cement-
retained in the posterior with
the e.max abutments (this
is new to me because before
these blocks I was not a fan at all; never wanted to drill
in the ceramic). I also do a lot still cement-retained (like
these). Depends on the case, the patient and my mood :)
screwed versus cemented thing, I’d just like to ask how
deep do you hide the margins?
I’m asking mainly because I’m going to have a diffi-
cult case next week with implants on #5, #7 and #9, and
veneers on #6, #8, #10 and #11. Even though I could
make the implant crowns screwed (my favorites, since we
almost always use external hex implants), I was consid-
ering doing abutments and cement crowns on them, the
same color and translucency as the veneers. Any sugges-
tion? Thank you.
Ross Enfinger
Luis,
What you have planned can be much more
difficult than it sounds: attaching veneers to implant
crowns while doing all the ceramics simultaneously. I’m
not saying it can’t be done, but the unpredictable part is the
veneers, especially if they are minimal prep.
It’s hard to predict the influence of the underlying tooth
structure, cement layer, etc., when attempting to match
that next to something as opaque as a custom abutment.
The best advice would be to either prep the veneers heavy
withat least 1mmreduction, essentially taking theunderlying
tooth shade out of play andmaking the shade-match easier.
On the other hand, if you are dead-set on minimal prep
veneers, then you can actually complete all the veneers and
bond them in first before fabricating the implant restora-
tions. After 2-3weeks, to allow for the final veneer shade to
settle, you can then take your final impression and photos
for the implant crowns. Otherwise, I’m afraid you could
easily end up remaking this case more than once.
Justin Gates | Marion, Va. (U.S.)
Nice work, Mike! Looks awesome.
Thanks for sharing.
Luis Filipe Mata
Ross,
Thanks a lot. You guys are the best!
Ross Enfinger
Luis, be sure to post the case! I look forward
to seeing it.