Metal Framework on Procera Abutments

First, I would call your local Nobel-Biocare rep for advice. If it was milled by Nobel, it has a five-year warranty. I'm not quite sure why you think a cast metal bridge would have any more retention than the original CAD Procera bridge using the same abutments. The original abutments and bridge were probably produced simultaneously, thus giving an abutment margin suited only for a metal-free restoration esthetically. If possible, a screw-retained restoration might have better retention, but you have to consider the reasons why the original bridge is failing (ie. parafunction, inadequate abutment design, etc.). Closer examination of the occlusion and/or the abutment design might help determine the correct treatment plan. Good luck!

You mention that the procera bridge has dislodged several times and that you plan to remake it, but, have you figured out why it keeps loosening? Assuming that remaking the bridge will solve the patient's problem without determining the reason that the bridge keeps loosening is asking for trouble since now the bridge that will be loosening will be your bridge. Rodgeu above gave you some good advice. Look for reasons that may cause the failures, parafunction, lack of posterior support, inadequate abutment design such as lack of retentiveness, etc... You may find that you need to do more than just remake the bridge. As far as the porcelain fused to metal bridge, there is no advantage to using it and a layered zirconia such as Lava would be more indicated in the anterior region. Good luck!

By the way, inspect the "custom" abutments and discern if they are "customized" angled stock zirconia abutments. I have seen cases where the lab or dentist preps into a stock abutment, leaving an abutment with inadequate retention. that's yet another possible reason for the lack of retention.

Would love to see adequate X-rays and photos! As above, but also suspect deep bite in combo with parafunction. May be part of reason we don't still have natural teeth here! Can you say 'orthodontist'?