Milled Modeless Crowns
A healthy 57-year-old female presented with pain and buccal swelling on her maxillary left first molar. Radiographs revealed an endodontically treated tooth No. 14 with an area of external root resorption on the distal buccal root that was deemed nonrestorable. After discussing the alternatives, the patient agreed to have No. 14 extracted and an implant placed.
The first procedure was an extraction of tooth No. 14 and socket preservation. A vacuum-formed prosthetic surgical thermoplastic template was constructed. An iTero digital scan (Align Technology) was taken and ?refractory? models were ordered. An aluminum crown former (3M ESPE) was shaped to fit into the missing tooth area of No. 14 and a thermoplastic template formed. A 1/8 inch hole was drilled to locate the stent tube (Biomet 3i), secured with light cured Triad clear gel and trimmed to clear the tissue.
After 6 months of healing, a lateral sinus lift and implant placement procedure was performed. The sinus opening lift was filled with Puros allograft material (Zimmer Dental). A Nobel WP Replace Select 6.0 x 10 implant fixture was placed at the No. 14 site. Puros allograft material was packed to surround the implant. A Bio-Gide resorbable membrane (Geistlich) was cut to shape and tacked in place. A Nobel WP healing screw was placed.
The second molar No. 15 had a mesial ?crack? that was becoming symptomatic. A screw-retained provisional restoration was made using a screw retained temporary abutment titanium engaging WP cylinder (Nobel Biocare) with TPH3 composite resin (DENTSPLY Caulk) to create the provisional body. The tooth was prepped for a full-coverage, all zirconium modeless crown. An iTero digital scan was completed and a modeless full coverage all zirconium BruxZir crown (Glidewell) was cemented with Fuji II cement (GC America).
The screw-retained provisional on the implant No. 14 was removed and a Glidewell Inclusive WP scan body placed for an iTero digital scan. The custom abutment was torqued to 35 Ncm. Tefl on plumbers? tape was packed into the access hole and Implantlink semi-permanent dual cure cement was used to cement the implant crown to the titanium abutment. The contacts and occlusion were checked. No adjustments were necessary.