Case Presentation: A Quick Solution for the Best Long-Term Temporary Possible

Published Date 01/09/2019
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
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).
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)
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.
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
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.
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.
Dr. Davidson received his Doctor of Dental Surgery degree from Case Western Reserve University in 1981, and opened his Northfield, OH, practice, Tomorrow’s Dentistry, in 1985. He regularly implements new technologies that make treatment more efficient, more comfortable, and minimally invasive. He is a certified instructor in CAD/CAM technologies and has taught more than 800 dentists in the use of digital impressions and the fabrication of top-quality dental restorations using CAD/CAM systems. He also teaches 3D diagnostics, computerized implant treatment planning, and advanced implant placement procedures.
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