- WHAT TO DO WHEN THINGS GO WRONG - PART 1

I DON'T KNOW ABOUT YOU, BUT ONE OF THE FEW THINGS I DISLIKE ABOUT DENTISTRY IS WHEN A PATIENT COMES IN WITH A BROKEN ANTERIOR BRIDGE AND THEY EXPECT COMPLETE REPAIRS IMMEDIATELY......THAT DAY....... IF NOT SOONER....... AND THERE'S AN ANNIVERSARY DINNER...... TOMORROW NIGHT!!

WELL, I GET A COUPLE OF THESE CASES EACH YEAR AND B.I. (before implants) IT WAS ALWAYS A MESSY CONVERSATION BECAUSE I NEVER HAD THE RIGHT ANSWER FOR THEM....NEVER!!

BUT NOW I HAVE A GOOD ANSWER AND A HAPPY PATIENT. AND YOU KNOW WHAT THE ANSWER IS.....THE B.E.S.T. IMPLANT PLACEMENT SYSTEM. LET'S SEE HOW IT WORKS.....

( For more details about how to pull this off, go to Members Page #13 - "What to do when things go wrong - Part 2" )

 

THE CHALLENGE: THIS ONE IS A TOUGH ONE...AND A TRUE STORY. THIS IS MY BEST FRIEND FROM HIGH SCHOOL...KNOWN HIM FOREVER. HE CALLS AND HAS TO BE SEEN TODAY AS HIS 2 WEEK VACATION IS COMING UP IN A WEEK. I'M TOTALLY BOOKED SO I CHANGE SOME APPOINTMENTS AROUND TO MAKE ROOM FOR HIM.

HE STORMS INTO THE OP, HOLDING OUT HIS HAND ...."LOOK,...LOOK WHAT HAPPENED AND IT'S ONLY 3 YEARS OLD!" YEP....THAT'S THE MOMENT IN TIME....THAT VERY SPLIT SECOND THAT RUINS YOUR DAY AND QUESTIONS YOUR CALLING..... ALL AT THE SAME TIME! IT'S LIKE ONE MILLI SECOND AND YOUR FLOOR DROPS OUT FROM UNDER YOU. WHAM!!!

SO WHAT DO WE DO FIRST? WE CHECK THE INSERTION DATE, AS PATIENTS OFTEN FORGET, WE FIND IT WAS CEMENTED 5 YEARS AGO - NOT 3. ( ONE SMALL THREAD OF CONFIDENCE RETURNS TO THE PSYCHE. )

THEN WE HAVE A CLUMSY CONVERSATION ABOUT MINIMAL METAL THICKNESS, BITTING FORCES AND METAL FATIGUE. HE REFUSES TO FEEL MY PAIN. BUT RATHER REPEATS THE REFRAIN, "SO WHATS THIS GONIN' TO COST ME? " I'LL TELL YOU HOW I ANSWERED THAT IN THE MEMBERS PAGES. IT WAS FAIR AND REASONABLE.

WE TAKE THE BROKEN BRIDGE AND CLEAN IT. THE CANINE ENDO WILL BE EASY AND TAKE 20 MINUTES. POST 10 MORE. WE FIT THE BRIDGE BACK IN THE MOUTH TO MAKE SURE IT GOES TO PLACE PROPERLY. WE BONE SOUND CHECKING IF THE ABUTMENT ANGLE IS GOING TO WORK & DECIDE WE WILL USE A 2.5 X 10 TO HOLD THE BRIDGE TEMPORALLY IN PLACE FOR HIS TRIP. FIRST IDENTIFY THE BEST PLACE TO MAKE A HOLE IN THE BOTTOM OF THE BRIDGE FOR THE ABUTMENT TO BE CEMENTED.

MAKE A CEMENT CAVITY IN THE PONTIC OF NUMBER EIGHT, ADD SOME MARKING CREAM. THE CREAM TRANSFERS TO THE TISSUE. PROBING WITH EXPLORER VERIFIES WE CAN PENETRATE THE CREST BELOW THE CREAM AT AN ANGLE SUGGESTED BY THE MESIAL SURFACE OF THE #9 PONTIC.

USING THE GINGIVAL DEPTH IMPRESSION PIN PROTOCOL (NOT SHOWN - SEE MEMBERS PAGES) WE USE IMPRESSION VIRTUAL SURGERY TO FIX THE PROPER LINE ANGLES AND POUR A WORKING MODEL TO MAKE THE STENT ON.

 

S.F.G. PIN IS INSERTED INTO THE S.F.G. TUBE AND WE MAKE A QUICK SOFT STENT.

AT THIS POINT I'M SURE THE FACIAL/LINGUAL ANGLE IS IN THE MIDDLE OF THE BONY RIDGE. THE PENETRATION SPOT IS ON THE CREST AND THE ABUTMENT WILL BE IN THE NEW CEMENT CAVITY. ALL IS GOOD FOR CEMENTATION.

IN ABOUT 10 MINUTES, WE HAVE MADE OUR SOFT STENT. TRIED IT IN AND TAKEN AN XR. ALL STILL LOOKS GOOD SO WE PLACE A 2.5 X 10 MM MINI IMPLANT.

I SHOULD MENTION HERE THAT I ONLY USE 10 MM LONG MINIS FOR TEMPORARY SERVICE. THEY ARE LIKE PLAYING ROULETTE ...WORST ODDS IN THE HOUSE!

 

THE IMPLANT IS IN PROPER POSITION SO WE POST #6, CEMENT OUR BROKEN BRIDGE. WE TELL OUR PATIENT IT MAY LAST A MONTH OR TWO, SO WE HAVE A LOT MORE WORK TO DO WHEN HE GETS BACK FROM VACATION .

TO THE LEFT IS THE REPAIRED BRIDGE. IT TOOK ME MOST OF THE MORNING, I WAS EXHAUSTED WHEN I WAS DONE BUT KNOWING I PROVIDED A HIGH LEVEL OF CARE HE COULD AFFORD, WAS WORTH IT.

 

THE NEXT PHASE IS TO FABRICATE A NEW BRIDGE. WE DECIDE TO PLACE A 3 X 14 MM ONE PIECE IMPLANT IN THE #7 SPOT.

WE REMOVE THE MINI.

XR OF OUR NEW STENT SHOWS A NEED TO CHANGE THE MESIAL/DISTAL LINE ANGLE. AFTER DOING SO,WE PLACE THE ONE PIECE IMPLANT.

ATTAINING GOOD PARALLELISM, WE ARE ABLE TO PREP FOR A LONG SPAN BRIDGE.

 

 

BELOW IS THE FINAL 8 UNIT BRIDGE

 

MY ONLY REGRET IS THAT NOW HE HAS A NICER SMILE THAN I DO.......DAMN!