CEREC doctors.com - Q4 2016 - page 66

64 | CERECDOCTORS.COM | QUARTER 4 | 2016
| | | D I S C U S S I O N F O R U M
DAVID STANGL
Good case and photos. I think cosmetics turned
out really well and match what he has. Was that
a DigiGuide?
STEVEN HERNANDEZ
Nope. OptiGuide.
MIKE SKRAMSTAD (FACULTY)
Nice work. You are braver than I am, I hardly ever
immediately provisionalize laterals anymore. Too
many failures.
STEVEN HERNANDEZ
Probably not braver. More foolhardy? More naive?
Big grin, but thanks.
ANDREW HALL
Absolutely great result. I think I would have passed
on the immediate provisional, given that occlusion,
but you made it look easy!
DANIEL BUTTERMAN
Great job!
Makes for a long appointment, doing the provi-
sional out of e.max, but it looked really good.
ANTHONY TISONCIK
Great job Steve, and nice pictures. Did you extract
the root with EasyXtract or one of those systems?
STEVEN HERNANDEZ
No. Old school. Periosteal. Luxator. Forceps.
JASON RETTER
Thick biotype, square teeth, no soft- or hard-tissue
deficiency, reasonable patient expectations. Great
case for an immediate and nicely done!
PATRICK CONAGHAN
It looks good, but just curious why you wouldn’t
do a screw-retained final restoration? It looks like
you had enough room for one?
FARHAD BOLTCHI (FACULTY)
Overall nice result, and great documentation
Steve. Question: Why the blunted papillae and
dark triangles?
STEVEN HERNANDEZ
Patrick, I would have preferred this. His “temp”
was screw-retained, but he wanted his final to
be more “tucked-in” like #7 (see initial photos). Placing #10
there made the access hold come through the incisal edge.
Farhad, great question. My inexperience? Too much pres-
sure on the tissue with provi-
sional? Trauma from extraction?
Improper implant placement
depth? I’m attaching the plan;
note that the platform is more
than4mmfromCEJ. But I didn’t
feel safe going more shallow.
Your thoughts? The final posi-
tion of the gingival zenith is
pretty close to where we started
but thepapillaareblunted ... true.
DANIEL BUTTERMAN
If I had to guess, I would say the temp was a little
overcontoured interproximally, not leaving much
room for the papilla. Shaping the temp a littlemore like you did
the permanent by opening the gingival embrasures may have
helped. Did you suture this case? I may be completely wrong
and the case turned out well. Curious as to Farhad’s thoughts.
FARHAD BOLTCHI (FACULTY)
Dan’s point above is part of the issue. I think this
is what happened:
Going “old school” with the extraction technique caused
trauma to the papillae and necessitated the reflection of a