I saw the other thread about dual maryland bridges and this case was in my office today.  forgive the pics immediate post op as I will not have time to take photos till later this summer when she returns from a school trip to Ireland.  This pt has been a pt of mine since I bought my practice 11 years ago.  she had 7 and 10 congenitally missing.  we had her in maryland bridges made with lava ultimate since she was a soph in HS.  she wore those for over 5 years and they held up well.  I'll have to dig up pics of it.  We used an HT block and it was a mistake.  looked grey.  she was happy to just have something while she waited for us to say she could get implants to replace the missing teeth.  Very difficult access due to the lack of space between the roots of 6/8 and 9/11.  she went back to ortho and they put her in invisalign last year to get more room to place some thin implants.  We removed the Maryland bridges and she wore her aligners while back at school.  Mom tells me that her daughter is going away to Ireland for a few weeks this summer and really wants this implants in to heal over the summer so she can have these restored sooner rather than later.   Her daughter was coming home on may 7th and leaving on the 25th so this did not leave a lot of time.  We needed to take a new 3D scan, cerec scan, plan the implants, make the maryland bridges, have the implants placed and seat the maryland bridges in less than 3 weeks.

She came in and I removed all the buttons from invisalign and scanned her upper, lower and BB.  I took a new scan.  I do not have a printer and my MCXL is one of the originals so I can't mill guides.  This is where the beauty of this community comes into play.  Dave Honey works in the next town.  He lives close to me too.  I contacted him and he was able to mill a guide and get me keys to give to my periodontist this past monday.  The surgery went great.  He put in healing abutments, stitched her up and told her to wait a few days and come to me to get the restorations bonded in.   Dave, you are the best and thanks so much for your assistance to make this happen in the time frame we were stuck with.

She just left the office.  I had to adjust the underside of the maryland bridge to allow them to seat over the healing cap.  These were lava ultimate shade A1LT with wings on the canines.   The stitches are still in.  she is having them removed next week right before she leaves.  I don't like the position of 7 when I look at the photo because it does not come in mesially enough for my liking.  that being said, she is very happy to have the permanent solution.  My perio wants her to wait till xmas to restore these.  He is fantastic so I'm not messing with him.  She has an invisalign retainer she was wearing with the fake teeth in 7 and 10.  we'll take off the maryland bridges when she is home for xmas break and then have her wear the retainers while we make the final crowns.  I'll take photos of what she looks like when she returns so we can see tissue response and such and then I'll post the final case next year when we seat.  This technology made a much easier surgery for my periodontist.  It allowed me to get him a guide in a very small time frame.  It allowed me to make fixed temporary restorations and I was able to rely on a friend and fellow cdoc community member to help me out in a time of need.  I love the place and I love this technology.  

Completely awesome Rich....!   Just need some pink sutures....

Great to see these cases planned well over the long term, and utilizing all that we can do along the way...

Mark