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Oopsie Ouchie: Completed CEREC Guide/CEREC Temp/Legacy3 Case Case Study by: August de Oliveira, DDS

A super nice patient of mine fell and came in shortly after. Took a scan and everything seemed fine, we waited for the swelling to go down and it turns out the #9 was fractured. From the PA it looks restorable, but after removing the mobile crown, you can see that the fracture went vertical palatally. CEREC Guide Medium reference body. Patient has large pre-existing diastema.


Oopsie Ouchie: Completed CEREC Guide/CEREC Temp/Legacy3 Case

When scanning in CEREC the big thing I harp on in my lectures is tracing the margin so that the CEJ of the proposal mimics that of the contralateral tooth. Why, you may ask? We know we want to be 3-4mm apical to that with our implant platform and no more than 5mm apical to the base of the adjacent teeth contacts, that’s why.

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Oopsie Ouchie: Completed CEREC Guide/CEREC Temp/Legacy3 Case

While milling the CEREC Guide, we extracted the tooth with osteotomes. Smooth surgery. Placed a drill in the socket to check for angulation bucco lingually as well as mesio distally.

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Oopsie Ouchie: Completed CEREC Guide/CEREC Temp/Legacy3 Case

Implant placed and torque tested. Not a huge gap around the implant.

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Oopsie Ouchie: Completed CEREC Guide/CEREC Temp/Legacy3 Case

Stock Zirconia abutment. Look at how well Omnicam images that! Packed a 2 cord just to keep the artifacts at bay from the socket space.

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Oopsie Ouchie: Completed CEREC Guide/CEREC Temp/Legacy3 Case

Final CEREC "temp". Again, patient had a large diastema to start and did not want it closed (it would look really bad with a giant asymmetric #9 anyway). I just love the face import with Smile Design. Will wait for it to heal and evaluate if we need a custom abutment. In this case I may not, just cut off the crown and do a nicer one.

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Oopsie Ouchie: Completed CEREC Guide/CEREC Temp/Legacy3 Case

Patient came back at 6 months. Removed composite and sponge and re-torqued to 30 Ncm. Went with a PFM as the rest were all PFMs. Did I have to do Zirconia? No not at all, and if I had done this case now, I would have gone with custom titanium since we were not going with all ceramic. But I think we have an acceptable result, even if the chroma is slightly off.

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.

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Oopsie Ouchie: Completed CEREC Guide/CEREC Temp/Legacy3 Case