Jeremy Bewley This nice lady was referred by an endodontist after it was determined that #9 had untreatable external resorption on the palatal side. She was congenitally missing her maxillary laterals and had 6x8 and 9x11bridges. Both 8 and 9 had been previously endo treated.
Based on CBCT examination and probing depths, along with the location of the resorptive lesion, we had a high confidence that she would have defects in both the facial and palatal walls of the socket after tooth removal:
She is a rather high dental IQ patient, and her first question was if we only remove one of the bridges when we take out the the failed tooth, how can we possibly match something to her other bridge while she is healing? She was also concerned about trying to match the porcelain of a final prosthesis to her existing bridge on the other side. Knowing that she was going to have an extended period of time in some sort of provisional restoration while she heals from her graft, and then later her implant, she requested we remove both bridges so that her provisional would look uniform and allow her to "go to work and function with a little dignity."
I printed a model and measured 6x11, with the idea that I might be able to mill a provisional bridge for her:
It was very very tight, but worth a try. We selected TelioCAD B1 in a B55 block size. I reserved 3 hours of time for this procedure, and right off recorded a preoperative biocopy of her existing restorations. I removed her bridges, refined her preps, and reduced #9 to the gingiva. At this point I imaged the preps and 4.5.1 had no trouble merging the biocopy with the prep folder.
While the bridge was milling I removed the root, placed membranes facial and palatal, and grafted:
The bridge milled well, but you can see there were some compromises I made in order to complete the case this way, namely I couldn't get the entire facial of #9 in the block
I was able to contour and enhance this a bit so that it was not an esthetic concern for her
I was very happy that I could leverage CEREC and CBCT in a way to help me provide what the patient wanted. She was very happy with the result of her provisional, and told me that she felt she would indeed be able to conduct herself with dignity through the process.
I wish I had scheduled a little more time so that I could have contoured the provisional a bit more to improve the line angles and embrasures. I am tempted to mill another one and do just that so that when she comes in for her suture and membrane removal I can swap it out for her.
