Case Presentation: A Quick Solution for the Best Long-Term Temporary Possible
A Quick Solution for the Best Long-Term Temporary Possible
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.
Figure 1—Preop occlusal view
Figure 2—Preop buccal view
Figure 3—Prep and reduction on tooth No. 4
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).
Figure 4—Completed various design steps using Planmeca PlanCAD Software
Figure 5—Scan of the bridge showing upper and lower models with bite
Figure 6—Temporary bridge milled from Telio CAD (Ivoclar Vivadent) on the PlanMill 40 S (Planmeca)
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.
Figure 7—The Telio CAD temporary bridge was polished so it would be smooth and hygienic
Figure 8—Buccal view of the temporary bridge after it was inserted
Figure 9—Occlusal view of the temporary bridge after it was inserted
Tags: Kavo Kerr, ELECTROtorque Plus, Solea, IPS e.max, Nobel Biocare, Ivoclar Vivadent Inc., Telio CAD, Planmeca USA, TempBond, Convergent Dental, Planmeca PlanCAD® Easy, Digital Impressions|Scanners, Chairside Milling units, CO2 Lasers, CAD CAM Blocks & Materials, Cement temporary, Kerr Dental, CAD|CAM Software, Electric Handpieces