Bicon Dental Implants
Friday, November 21st 2008 6:20PM EDT

Full Arch / Bicon Integrated Abutment Crowns™: Lateral Sinus Lift with SynthoGraft™, Two Stage Full Arch Placement of Ten 5.0mm x 6.0mm Short Implants and Two 4.5mm x 8.0mm Implants, and their Restoration with Twelve Maxillary Full Arch Integrated Abutment Crowns™
This case demonstrates the use of SynthoGraft™ pure phase Beta-Tricalcium Phosphate for bilateral sinus lifts, two stage surgical full arch placement of ten 5.0mm x 6.0mm short implants and two 4.5mm x 8.0mm implants, implant level impression and insertion of twelve Integrated Abutment Crowns™.

 

    


1. Pre-operative radiograph.


2. Post-operative radiograph of right lateral sinus lift.


3. Pre-operative site of left maxilla.


4. Pre-operative radiograph of left maxilla.


5. Initial incision.


6. Full thickness flap elevated in preparation for external sinus lift with floor augmentation using SynthoGraft™, Beta-Tricalcium Phosphate.


7. View of sinus membrane after prepared osteotomy.


8. Sinus lift curette being used to elevate sinus membrane.


9. Sinus lift curette being used to elevate sinus membrane.


10. Venipuncture in the antecubital region of the arm.


11. Vial of SynthoGraft being removed from its packaging.


12. Patient’s blood being mixed with SynthoGraft in dappen dish.


13. Mixture of patient’s blood and SynthoGraft™, Beta-Tricalcium Phosphate.


14. The mixture of patient’s blood and SynthoGraft™, Beta-Tricalcium Phosphate, being injected into the sinus floor.


15. View of SynthoGraft™, Beta-Tricalcium Phosphate, graft material being packed with a cotton swab.


16. View of SynthoGraft™, Beta-Tricalcium Phosphate, graft material prior to closure of the flap.


17. Sutured closure of flap.


18. Post-operative radiograph of left lateral sinus lift two weeks after the right lateral sinus lift.


19. Post-operative radiograph of the six anterior implants, two 4.5mm x 8.0mm HA coated implants and four 5.0mm x 6.0mm HA coated short implants, placed two weeks after the left lateral sinus lift.


20. View of paralleling pins seated in the osteotomies of right posterior maxilla three months after the right lateral sinus lift.


21. Osteotomy being enlarged with a blue 3.5mm latch reamer bur rotating at 50 RPM without water irrigation.


22. A 5.0mm x 6.0mm HA coated short implant being inserted into the osteotomy with the implant inserter/retriever device.


23. A 5.0mm x 6.0mm HA coated short implant being inserted into the osteotomy with the implant inserter/retriever device.


24. View of paralleling pins seated in the osteotomies of left posterior maxilla ten weeks after the left lateral sinus lift.


25. Osteotomy being enlarged with a blue 3.5mm latch reamer bur rotating at 50 RPM without water irrigation.


26. A 5.0mm x 6.0mm HA coated short implant being inserted into the osteotomy with the implant inserter/retriever device.


27. A 5.0mm x 6.0mm HA coated short implant being inserted into the osteotomy with the implant inserter/retriever device.


28. A 5.0mm x 6.0mm HA coated short implant being inserted into the osteotomy with the implant inserter/retriever device.


29. Post-operative radiograph of two 4.5mm x 8.0mm HA coated implants and ten 5.0mm x 6.0mm HA coated short implants.


30. View of incision prior to the two-stage uncovering twenty-two weeks after the anterior implant placements and fourteen weeks after the posterior implant placements.


31. The trimmed polyethylene healing plug being removed from the well of the implant with a healing plug remover.


32. The trimmed polyethylene healing plug being removed from the well of the implant with a healing plug remover.


33. Tall stealth acrylic sleeve being modified.


34. Modified stealth acrylic sleeve snapped onto 5.0mm x 4.0mm shouldered abutment being inserted into the well of the implant.


35. Modified stealth acrylic sleeve snapped onto 5.0mm x 4.0mm shouldered abutment being inserted into the well of the implant.


36. Modified stealth acrylic sleeve snapped onto 5.0mm x 4.0mm shouldered abutment being inserted into the well of the implant.


37. The trimmed polyethylene healing plug being removed from the well of the implant with a healing plug remover.


38. Modified stealth acrylic sleeve snapped onto 5.0mm x 4.0mm shouldered abutment being inserted into the well of the implant.


39. Vacuum-formed template seated over modified stealth acrylic sleeves to confirm the appropriateness of their placement.


40. Occlusal view of maxillary arch with seated modified stealth acrylic sleeves.


41. Transitional composite material, Integrity by Dentsply, being injected into vacuum-formed template.


42. Transitional composite material being added to stealth acrylic sleeves to form a transitional prosthesis.


43. Transitional prosthesis being formed.


44. View of polished transitional prosthesis in place.


45. Patient’s smile.


46. Green 3.0mm plastic impression post being inserted into the 3.0mm well of the implant for a full arch implant level transfer impression, ten months after the right lateral sinus lift, nine months and two weeks after the left lateral sinus lift, nine months after the anterior implant placements and seven months after the posterior implant placements.


47. Green 3.0mm impression reamer being inserted onto guide pin to remove any tissue which might inhibit the complete seating of an impression post.


48. Green 3.0mm plastic impression post receiving its mandatory seating tap.


49. Healing plug being removed with a healing plug remover from the well of the implant which was previously left covered for further integration.


50. View of impression posts seated in the implant wells.


51. Impression material being injected around the impression posts for the making of a full arch implant level transfer impression.


52. Tall stealth acrylic sleeve being modified.


53. Green 3.0mm plastic impression post receiving its mandatory seating tap.


54. Green 3.0mm plastic impression posts being trimmed.


55. View of full maxillary arch with seated shouldered abutments and trimmed plastic impression posts.


56. View of modified short stealth acrylic sleeves snapped onto the shouldered abutments.


57. Modified long stealth acrylic sleeve being snapped onto a shouldered abutment.


58. Vacuum formed template seated over stealth acrylic sleeves and abutments to confirm the appropriateness of their placement.


59. Transitional composite material, Integrity by Dentsply, being added to reduced impression posts and stealth acrylic sleeves to form a transitional prosthesis.


60. Transitional composite material being injected into vacuum-formed template.


61. Transitional prosthesis being formed.


62. Transitional prosthesis incorporating modified stealth acrylic sleeves.


63. Polished transitional prosthesis in place.


64. Integrated Abutment Crowns™ on stone model with acrylic orientation jig.


65. Facial view of Integrated Abutment Crowns™ on stone model.


66. Occlusal view of Integrated Abutment Crowns™ on stone model.


67. View of transitional prosthesis prior to its removal for the insertion of the Integrated Abutment Crowns™ six weeks after the implant level transfer impression was taken.


68. Transitional prosthesis being removed.


69. View of reduced green 3.0mm plastic impression posts and transitional shouldered abutment.


70. Reduced impression post being trimmed.


71. View of implant wells and soft tissue sulci.


72. Integrated Abutment Crown™ being inserted.


73. A 5.0mm sulcus reamer attached to a threaded knob is being inserted onto a guide pin to remove soft tissue and bone which might inhibit the complete seating of the Integrated Abutment Crown™.


74. Integrated Abutment Crown™ being inserted.


75. An orientation jig being used to initially position the Integrated Abutment Crown™.


76. White healing abutment in a straight handle is being used to tap the Integrated Abutment Crown™ into the well of the implant.


77. A gold 5.0mm sulcus reamer being used to remove soft tissue and bone.


78. Integrated Abutment Crown™ being inserted.


79. Crestal relieving incision being made to facilitate the seating of the Integrated Abutment Crown™.


80. A green 6.5mm sulcus reamer being used to remove soft tissue and bone.


81. An orientation jig being used to initially position the Integrated Abutment Crown™.


82. View of seated Integrated Abutment Crowns™.


83. Height of buccal gingiva being marked to facilitate the adjustment of the cervical aspect of the Integrated Abutment Crown™.


84. Polishing strip being used to lighten the interproximal contact area eliminating the possibility that the contact may prevent the engagement of the locking taper connection.


85. Buccal aspect of Integrated Abutment Crown™ being reduced with #7404 bur.


86. Buccal aspect of Integrated Abutment Crown™ being polished with pink acrylic wheel.


87. Buccal aspect of Integrated Abutment Crown™ being polished with small pink acrylic wheel.


88. Well of implant being cleaned with alcohol on a cotton tipped applicator.


89. Initial seating of Integrated Abutment Crown™.


90. Crestal relieving incision being made to facilitate the seating of the Integrated Abutment Crown™.


91. A gold 5.0mm sulcus reamer being used to remove soft tissue and bone.


92. A green 6.5mm sulcus reamer being used to remove soft tissue and bone.


93. Height of buccal gingiva being marked to facilitate the adjustment of the cervical aspect of the Integrated Abutment Crown™.


94. Buccal aspect of Integrated Abutment Crown™ being adjusted.


95. An orientation jig being used to initially position the Integrated Abutment Crown™.


96. Articulating paper being used to confirm interproximal contacts.


97. Polishing strip being used to lighten the interproximal contact area eliminating the possibility that the contact may prevent the engagement of the locking taper connection.


98. Yellow thermoplastic custom seating jig, which was formed with a crown alignment device, in a crown seating tip attached to a straight handle facilitates directing the tapping forces in the long axis of the abutment post and implant well.


99. View of green 3.0mm guide pin in the well of the implant.


100. Green 3.0mm impression reamer being inserted onto guide pin to remove any tissue which might inhibit the complete seating of an impression post.


101. Well of implant being cleaned with alcohol on a cotton tipped applicator.


102. A green 6.5mm sulcus reamer being used to remove soft tissue and bone.


103. Integrated Abutment Crown™ being inserted.


104. An orientation jig being used to initially position the Integrated Abutment Crown™.


105. Integrated Abutment Crown™ being inserted.


106. Interproximal contact is being reduced with pink acrylic polishing wheel.


107. Polishing strip being used to lighten the interproximal contact area eliminating the possibility that the contact may prevent the engagement of the locking taper connection.


108. View of seated Integrated Abutment Crowns™.


109. Yellow thermoplastic custom seating jig, which was formed with a crown alignment device, in a crown seating tip attached to a straight handle facilitates directing the tapping forces in the long axis of the abutment post and implant well.


110. Buccal aspect of Integrated Abutment Crown™ being polished with pink acrylic polishing wheel.


111. Integrated Abutment Crown™ being inserted.


112. An orientation jig being used to initially position the Integrated Abutment Crown™.


113. White healing abutment in a straight handle is being used to tap the Integrated Abutment Crown™ into the well of the implant.


114. White healing abutment in a straight handle is being used to tap the Integrated Abutment Crown™ into the well of the implant.


115. Articulating paper being used to confirm interproximal contacts.


116. Occlusal view of seated Integrated Abutment Crowns™.


117. Facial view of seated Integrated Abutment Crowns™ immediately after their insertion.


118. Facial view of seated Integrated Abutment Crowns™ in occlusion.


119. Facial view two weeks post insertion.


120. Facial view.


121. Right profile view.


122. Patient’s smile.


123. Post insertion radiograph of two 4.5mm x 8.0mm implants and ten 5.0mm x 6.0mm short implants which were restored with twelve Integrated Abutment Crowns™,
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