Page 1

Liar, Liar, Pants On Fire: 2D vs. 3D on an Emax/Legacy3 Immediate Case Case Study by: August de Oliveira, DDS

Here is just a "meh" kinda case that shows a few things, including my big pet peeve with 2D, which is arch curvature. Patient broke off #11, usually I do not do immediates on #11, but this patient was opposed to a flipper and did not occlude on that area (open bite) so I gave it a go. Usually I can get the small reference body in that area, but there was some crowding so no dice on the CEREC Guide. I had to improvise.


Liar, Liar, Pants On Fire: 2D vs. 3D on an Emax/Legacy3 Immediate Case

Love my little periosteal, got a purchase with a lance bur and followed the bone with the pilot. Per the cross sectional image in the CBCT, the bone was pretty sloped in the premaxilla.

2|P a ge


Liar, Liar, Pants On Fire: 2D vs. 3D on an Emax/Legacy3 Immediate Case

I placed the implant (Legacy3 4.2mmD implant by 16mmL) and got some great torque. Big socket so I compressed it, bait and placed a TSV 3.5 ScanPost and imaged for an Emax "temp".

3|P a ge


Liar, Liar, Pants On Fire: 2D vs. 3D on an Emax/Legacy3 Immediate Case

This radiograph freaked me out, so I took a follow up scan. Again, the limitations of 2D are that when dealing with a curved arch things get superimposed. The canine can be tricky itself, and it’s easy to hit it as it leans to the mesial and the apex is distal. But it looks like I am good.

4|P a ge


Liar, Liar, Pants On Fire: 2D vs. 3D on an Emax/Legacy3 Immediate Case

Thought that I could quickly do a screw retained Emax "temp" but due to the angulation of the canine and also just my implant placement, there was no way to do this screw retained. So I went with a #2 MO block and traditional Emax on top.

5|P a ge


Liar, Liar, Pants On Fire: 2D vs. 3D on an Emax/Legacy3 Immediate Case

This was taking a while so I dismissed the patient and made a temp.

6|P a ge


Liar, Liar, Pants On Fire: 2D vs. 3D on an Emax/Legacy3 Immediate Case

I know it’s an extra step, but I still like to try in my framework and work out the occlusion on my crown. Lots of good ferrule on that abutment. I trimmed down the incisal edge of #10 as it had super erupted due to the open bite. I forgot to tell my lab that.

7|P a ge


Liar, Liar, Pants On Fire: 2D vs. 3D on an Emax/Legacy3 Immediate Case

Took a PVS and sent to the lab for a cut back on my "temp" since I know this will always be out of occlusion on with the open bite. I went ahead and torqued down to 35Ncm and cemented the crown (I know, I know, it’s long. I trimmed it later but the picture was too bloody to post). I am going to wait and see how the tissue heals. If we don't get some "creep" coronally of the tissue, I will cut off the crown, prep the abutment lower and design a new one. Not my best stuff but still fun.

Dr August de Oliveira graduated from dental school in 1997 from the University of Washington and completed his General Practice Residency in Los Angeles in 1998. Dr de Oliveira has been lecturing on 3D technology since 2004, when he started as a CEREC Basic trainer. Since 2008 he has been involved with Implant Direct’s R and D department developing Guided Surgery Software and Hardware and testing their CAD Milled Bars and Substructure Department. Dr de Oliveira has written two books on Implantology: Implants Made Easy and Guided Implantology Made Easy. He has been involved with beta testing Sirona’s Sidexis Program, as well as developing the Opti and CEREC Milled Surgical Guides. Dr de Oliveira lectures nationwide for Sirona on the Galileos Cone Beam system and Sirona Guided Implant Surgery. He also teaches for Implant Direct at their Las Vegas Educational Facility and with the Engel Institute in Charlotte NC. Dr de Oliveira lives and practices in Los Angeles CA.

8|P a ge

Liar Liar Pants On Fire 2d vs 3d On An Emax & Legacy3 Immediate Case  

Liar Liar Pants On Fire 2d vs 3d On An Emax & Legacy3 Immediate Case

Read more
Read more
Similar to
Popular now
Just for you