Bicon Dental Implants
Friday, November 21st 2008 4:40PM EDT

Immediate Stabilization and Function / All-Ceramic Crown: Maxillary First Bicuspid Restored with an Extra-orally Cemented Crown
This case demonstrates the removal of an all-ceramic maxillary second bicuspid crown to facilitate the immediate stabilization of a contiguously positioned immediately placed first bicuspid implant. It also demonstrates the extraction, immediate placement and stabilization, abutment and implant level transfer impression as well as the insertion of two extra-orally cemented all-ceramic crowns in only two clinical appointments.
     


1. Radiograph of existing implant with all-ceramic crown and a carious first bicuspid.


2. All-ceramic crown and shouldered abutment being removed from implant.


3. All-ceramic crown and shouldered abutment after having been removed from implant.


4. First bicuspid tooth being extracted.


5. 2.0mm pilot drill preparing initial osteotomy.


6. Paralleling pin in pilot osteotomy confirming trajectory.


7. Reamer preparing osteotomy at 50RPM without water irrigation.


8. Final reamer being removed from osteotomy.


9. A 5mm x 8.0mm HA coated implant being transported to osteotomy with its black polyethylene healing plug handle.


10. Abutment shoulder depth gauge seated in well of implant facilitating the selection of an appropriate abutment shoulder height relative to the crest of the soft tissue.


11. A white 3.0mm impression post seated in the previously integrated implant for the making of an implant level transfer impression and a 4.0mm x 3.5mm plastic temporary shouldered abutment with a short 4.0mm one-piece acrylic sleeve for the making of an abutment level transfer impression.


12. Impression material being injected around the white impression post for an implant level impression of the integrated implant and around the one piece acrylic sleeve for an abutment level transfer impression of the new immediately placed implant.


13. Transitional composite material "Integrity" by Dentsply being injected around two one piece acrylic sleeves forming a strut prior to the application of additional material in a vacuum formed template for the fabrication of a transitional stabilization prosthesis.


14. Digital photo being taken of shade guide against a black background for transmission to a technician.


15. Newly made first bicuspid all-ceramic crown on a white plastic transfer die and the existing second bicuspid all- ceramic crown on a 5.0mm x 2.0mm titanium shouldered abutment in a white implant analog.


16. Blue acrylic occlusal orientation jig on all-ceramic crowns.


17. Occlusal view of two all-ceramic crowns.


18. Labial view of one new and one existing all-ceramic crown.


19. A 5.0mm x 2.0mm titanium shouldered abutment in a white implant analog and a white 4.0mm wide abutment transfer die in a stone model.


20. Mirror view of the existing and newly fabricated all-ceramic crown.


21. Transitional stabilization prosthesis at the time of the patientÍs second clinical visit eleven weeks after the immediate placement of a maxillary first bicuspid implant which was immediately loaded or stabilized.


22. Transitional stabilization prosthesis being removed.


23. View of a 4.0mm x 1.5mm titanium shouldered abutment and a 4.0mm x 3.5mm plastic temporary shouldered abutment after the removal of the transitional stabilization prosthesis at the patientÍs second clinical visit.


24. Removal of the 4.0mm x 3.5mm plastic temporary shouldered abutment.


25. Shoulder depth gauge confirming selection of a 3.5mm abutment shoulder height.


26. Second bicuspid crown and abutment being inserted into implant for confirmation of fit.


27. Blue plastic orientation jig facilitating trial seating of all-ceramic crowns.


28. Micro-sandblasting of abutment prior to extra-oral cementation.


29. Metalic coupler being applied to 5.0mm wide abutment.


30. Ceramo-coupler being applied to 5.0mm wide aluminum oxide core.


31. Bonding agent being applied to 5.0mm wide shouldered abutment.


32. Bonding agent being applied to 5.0mm aluminum oxide core.


33. Light curing of bonding agent on abutment.


34. Cement being applied to abutment.


35. All-ceramic crown being extra-orally cemented.


36. Extraneous cement being removed with cotton applicator.


37. Extra-orally cemented all-ceramic crown and shouldered abutment being inserted into implant well.


38. Blue plastic orientation jig being tapped providing initial seating of restoration.


39. Definitive seating of extra-orally cemented all-ceramic crown.


40. Micro-sandblasting of abutment prior to extra-oral cementation.


41. Metalic coupler being applied to 4.0mm x 3.5mm shouldered abutment.


42. Ceramo-coupler being applied to 4.0mm aluminum oxide core.


43. Bonding agent being applied to aluminum oxide core.


44. Bonding agent being applied to 4.0mm x 3.5mm shouldered abutment.


45. Cement being applied to titanium shouldered abutment.


46. Extraneous cement being removed from extra-orally cemented crown with a cotton applicator.


47. Extra-orally cemented all-ceramic crown being inserted into well of implant.


48. Blue articulating paper being used to identify inter-proximal area preventing the complete seating of the first bicuspid all-ceramic crown.


49. Contact area being adjusted prior to being reseated.


50. Occlusal view of two extra-orally cemented all-ceramic crowns.


51. Radiograph of two all-ceramic crowns.


52. Labial view of two extra-orally cemented all-ceramic crowns.
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