Try Digital Impressions for Lab Cases
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Boy, I love digital impressions!
I have very small lab bills in my practice. I have some months where the only lab bill I have is the occasional retainer or bruxing appliance. Ninety-five percent of my indirect restorations are done chairside with my CEREC machine. I don't do a lot of bridges, as I prefer implants. I do my smaller anterior cases chairside, and the last few years I have not done the cosmetic cases that I used to do.
This past month, I actually did three gold crowns and a bridge, which was a lot of lab cases for me. I did all the gold crowns using the CEREC software, designed the restorations myself, milled out the temp and seated with no adjustments, and sent the file to Keating Dental Arts via yousendit.com. They got the file within a few minutes, milled out my restoration in CAD Wax, invested it, cast it, polished it and sent it back to me within a day or two of getting it. I seated the gold crowns and knew there would be no adjustment, since my temps had no adjustment. It was awesome!
Yesterday, I seated a three-unit bridge. A simple bridge, one would think, from 18 to 20. This was no simple bridge. My patient, who was fantastic, was a very heavy salivator. I tried three times to take impressions on her and have a bridge made. The bridges were always high, and I mean high to the point of adjusting down to metal. I had margins open every time on the three separate cases I sent. I would not seat them.
I believe the poor fit had everything to do with the fact that the patient was such an extreme salivator, and this likely displaced the impression material upon placement. This patient is a young college student who came to me because of a failed bridge that was done less than 12 months previous. I didn't want the same thing to happen. We were going on seven months with her in a temp, since she was away at school and could not easily get back to the area often for appointments.
As soon as the new CEREC Connect software update came out, I decided to give this a shot. I tried to use Connect on her previously, but had a tough time with the full-arch scan and the Isolite, and I prefer a full-arch scan for bridges.
With the ability to image quadrants separately and then stitch them together, I placed an Isolite, kept her completely dry, and did a full-arch impression so easily. The software worked amazingly. Before I got her numb, we did the buccal bite on the opposite side so she could tell she was biting normally. I got the case back and had my fingers crossed. We already were past the 'third time is the charm' appointment! I placed the bridge, and did a minor occlusal adjustment, and it fit perfectly. We were both so happy. The bridge was done by Burbank Dental Lab, and I really appreciated their patience while we tried to get this case right.
I always believed that digital impressions are even more accurate than impression material, but this case really proved it to me. So much less can go wrong when you have proper isolation and can manage the bite before the patient gets numb.
I can't remember being so happy to have inserted a bridge. My patient thanked me for being such a perfectionist, and I kissed my CEREC machine because along with the lab, it saved the day. I encourage everyone to try digital impressions for lab cases. Boy I love digital impressions!
