Porcelain fractured off bridge: advice?

Look like Osstem (hiossen) implants to me.

With all the implant companies today, it is getting harder and harder to try to identify an implant from a panoramic film. I will always try to contact the original dentist. The practice may have been bought by another dentist that has kept those records and it would simplify everything a great deal. If not then I would disassemble the case. Remove the bridge. If you want to treat it as a regular crown and bridge case, take an impression of the prepared abutments (modify them if you need to) and fabricate a new bridge. This is the easiest solution. Anything else means removing the abutments to identify compatible parts and ordering them. Make sure you take a preoperative alginate or PVS impression before destroying the bridge to create a temporary bridge while waiting for parts needed to restore the case. Good luck!

I think it would be beneficial to do some searching and get the background history on this patient's implant treatment. I think you will be seeing a lot of her when the lower natural teeth fail since they are abutted to implants. The maxillary anteriors are very large and close together. Just good follow up care upon inheriting a complex case. Good luck.

Interesting problem. I hate it when this happens. Cut off and remake or try cutting through the occlusals/lingual and unscrew. You could section the pontic from the abutments and prep the abutments. Use a lot of water. Carefully evaluate to occlusion and for parafunction!

cut the bridge off and do like regular C&B with an impression of the abutments as if they were crowns

My best guess is that this is a cement retained bridge on two stock abutments. The best option is to remove the bridge, send it to a lab for repair and re-insert the repaired bridge with the existing abutments. First, identify the implants and confirm that the abutments are screw retained rather than single piece. Send radiographs to Darwin at Attachments International for identification and order a long screwdriver, two lab analogs, two new screws and two healing abutments. Second, patient appointment. Take impressions (bite, alginate opposing and polyvinyl upper). Make access holes in the occlusal, use the screwdriver to remove the screws. The bridge (with the abutments attached) should now be easy to remove, it may even fall out. Place healing abutments. Using the old screws, attach the lab analogs to the bridge and place in the polyvinyl impression. Third, send to lab for repair. I would advise the lab to not remove the cemented abutments from the bridge and to leave the access holes. I would treat it as a single unit screw retained bridge rather than three parts. Finally, using new screws, replace bridge as a single unit screw retained bridge. Cover the access holes with composite. I would pad the models, put them in a box and ask the patient to put them in his sock drawer so that it will be available in case this bridge ever needed to be repaired again. I may be missing something, but I am having trouble understanding the logic behind making a new metal framework for the bridge. The implants are stable the, the abutments are fine, the metal frame is fine. Screw retained abutments provide a "quick release" that is not available with traditional crown and bridge. This should be a very simple repair for anyone with an understanding of the restorative parts and pieces involved.

Today's porcelain to porcelain bond is fairly strong, what you can do is prepare the fractured porcelain hopefully it is not to the metal, scan area CAD/CAM either an emax or empress "veneer" and apply hydrofluoric acid and use one of the newer generation bonding agent such as futurabond U and bond back. There is an opaque resin should break is into the metal.

Dr TK, Wouldn’t the ceramic firing cycle actually damage the abutments ..? Also with the luting agent, what if it was luted with resin cement by the previous operator..? Am not sure whether glass ionomer takes up high temperatures as well. Any insights on cases done like this before..? There are many variables which could offset our outcome, hence the person above advised to start over fresh – new frame et al. However painstaking it may seem, i would go with the first course of action. Try to identify the implant by any and all means and order the components – the hex driver, new screws, lab analogues. (For any eventuality) Take putty index of the crowns first. Try to section and remove the crowns vertically , without touching the underlying abutments. Another option is tapping (controlled forces – use pneumatic crown remover), or with ultrasonics - the crowns are going to be replaced anyway, but you don’t want to damage the underlying abutment and screw. More often than not, the bridge will pop out. At this stage if you haven’t managed to find what system it is, go ahead like normal crown and bridge. Only meticulously verify the marginal fit and finish of the final restoration. All the best and keep us posted. Dr B # Dr Peter – that’s a great option that you have suggested. Do u have adequate success with this ..? I have tried chairside repair with composite – after meticulous etching, silanation and bonding etc, but with poor results. Have never tried with emax or empress.

Before you attempt to remove the bridge and/or abutments make sure you order new parts ( healing abutment, screw, impression copings etc.)to be ready for every possible situation. Most importantly never use same screws which has greater chance to fracture and make the problem worse.