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CASE PRESENTATION: A Quick Solution for the Best Long-Term Temporary Possible

Categories: CAD-CAM

Author(s): WILLIAM R. DAVIDSON, DMD

Date: 09-18-2020 07:45:24 am



The patient presented to my office with a painful tooth No. 4 (Figures 1 and 2). On further examination, I was able to determine that the tooth/crown complex on No. 4 was mobile. We booked the patient an appointment for a 1-hour exploratory procedure to remove the composite crown that was on the tooth and to determine what needed to be done. 
When the patient came back in for her appoint­ment, I removed the composite crown and exam­ined the tooth. The post below was intact and the mobility was coming from insufficient bony support of the root. We determined that the tooth needed to be extracted. During this 1-hour appointment, the patient’s tooth had already been taken apart and she did not want to leave the office without having a tooth in the site of No. 4. With the use of the Planmeca Emerald scanner, we were able to place a temporary bridge so she did not have to walk around suffering the embarrassment of a miss­ing tooth. 
Using an ELECTROtorque Plus (KaVo), I was able to prepare tooth No. 3, which had a large metallic onlay with a poor mesial margin. We used the Solea laser (Convergent) for retraction of the margins around teeth Nos. 3 and 4. Tooth No. 3 was prepared for a full crown and pontic was cantilevered off No. 3 into the site of tooth No. 4 so that our patient could heal adequately from the extraction. 
To facilitate our design, when I prepared tooth No. 4 I cut it even with the gumline (Figure 3). I drew the crown margin for tooth No. 3, and then drew a pontic margin around the base of the re­maining root of tooth No. 4. We then designed and milled a Telio CAD temporary bridge (Ivoclar Viva­dent), and polished it so that it would be smooth and hygienic (Figures 4-7). The design was done with the Planmeca PlanCAD Software and milled with the Planmeca PlanMill 40 S (Planmeca) (Figures 6 and 7). Before inserting the bridge, we extracted the remaining root and placed some gel foam. The temporary bridge was cemented over the gap with TempBond (Kerr Restoratives) (Figures 8 and 9). 
Because we have the Planmeca Emerald, we were able to remove the patient’s tooth, restore her smile, and relieve her pain in an efficient manner—all while seeing other patients throughout the day. There is incredible flexibility in having the Planmeca Emerald scanner and the ability to mill chairside in my practice. Again, we had only scheduled her for an hour, and the goal was to give her a long-term temporary. Staff utilization for design and mill was critical to accomplishing this.
Traditionally, we would have had to take an impression, send it to the lab, get a temporary shell made, and then retrofit it in. This is a messy process that typically does not have great margins. But in this case, we were able to use digital technology to design an esthetic, fully functional, temporary bridge that had perfectly adapted margins.
Because the digital impression has already been captured and we have a digital model of what her teeth looked like before we started, we have another option, and will construct a full, 3-unit e.max bridge (Ivoclar Vivadent) when healing is complete, restoring the arch to full function. All of this will be completed conveniently in 1 additional appointment.



GO-TO PRODUCT USED IN THIS CASE

PLANMECA EMERALD 
The Planmeca Emerald is a lightweight, ergonomically designed intraoral scanner that quickly captures vivid color images in real time. A compact, slim design provides the clinician with a comfortable feel and superior control while scanning the patient and capturing an impression. Automatic fog prevention embedded into the seamless, streamlined scanner tip enables continuous scanning while the autoclavable tip prevents cross-infection and increases patient safety.
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