Bicon Dental Implants
Friday, November 21st 2008 7:33PM EDT

Immediate Stabilization and Function / Bicon Integrated Abutment Crowns™ : Extraction, Immediate Placement and Stabilization of Six Bicon Implants and their Restoration with Integrated Abutment Crowns™ and a PFM Bridge
This case demonstrates the extraction of six anterior teeth, insertion of four maxillary and two mandibular immediately placed, stabilized, and functioning implants, implant level transfer impression, metal try-in, and their restoration with Integrated Abutment Crowns™, a PFM bridge, as well as two Procera crowns cemented on natural teeth.
 
First clinical visit:


1.
Pre-operative radiograph.


2.
 Pre-operative smile


3.
 Pre-operative view.


4.
 Pre-operative site prior to the extraction of the three mandibular anterior teeth.


5.
 A mandibular anterior tooth being extracted.


6.
 Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.


7.
 Parallel pin confirming appropriate trajectory and acting as a guide for subsequent osteotomy.


8.
 Osteotomy being enlarged with an olive green 2.5mm latch reamer rotating at 50RPM without water irrigation.


9.
 Osteotomy being enlarged with a teal 3.0mm latch reamer rotating at 50 RPM without water irrigation.


10.
 Osteotomy being enlarged with a blue 3.5mm latch reamer rotating at 50 RPM without water irrigation.


11.
 Harvested bone within the blue 3.5mm hand reamer.


12.
 View of harvested bone being placed into dappen dish.


13.
 A 3.5mm x 11.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


14.
 A 3.5mm x 11.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


15.
 Implant seating tip attached to a straight handle being tapped to seat implant farther into the osteotomy.


16.
 Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height.


17.
 A 5.0mm wide with a shoulder height of 4.0mm stealth shouldered abutment is being inserted into the implant well with only finger pressure.


18.
 A 5.0mm wide with a shoulder height of 4.0mm stealth shouldered abutment is being inserted into the implant well with only finger pressure.


19.
 Shoulder of the stealth shouldered abutment being adjusted.


20.
 The abutment being re-seated after modification.


21.
 Autogenous bone graft being placed around the shoulder of the stealth abutment with sterile cotton applicator.


22.
 Suture being placed over the bone graft.


23.
 Sutured site.


24.
 Tall acrylic sleeve being snapped on to stealth abutment.


25.
 Tall acrylic sleeve being modified.


26.
 Vacuum formed template seated over modified tall acrylic sleeves and abutments to confirm the appropriateness of their placement.


27.
 Etchant being applied for the bonding of the transitional stabilizing prosthesis.


28.
 Bonding primer agent being applied.


29.
 Light curing of bonding agent.


30.
 Vaseline being applied to protect the sutures.


31.
 Transitional composite material in vacuum-formed template being formed around acrylic sleeves.


32.
 Transitional composite prosthesis incorporating modified acrylic sleeves being removed for polishing.


33.
 Bonding material being light cured.


34.
 Composite material being added to transitional prosthesis.


35.
 Transitional prosthesis being seated.


36.
 Added composite material being light cured.


37.
 Incisal contacts being adjusted.


38.
 Incisal contacts being polished.


39.
 Finished transitional prosthesis.


40.
 Post operative radiograph immediately after implant placement.


41.
 Pre-operative view prior to the maxillary implant placement.
Second clinical visit:


42.
 Pre-operative site prior to the extraction of the maxillary anterior teeth.


43.
 Extracted maxillary tooth.


44.
 Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.


45.
 Parallel pins confirming appropriate trajectories and acting as guides for subsequent osteotomy.


46.
 Parallel pins seated in pilot osteotomies indicating their trajectories.


47.
 Osteotomy being enlarged with a red 4.0 mm latch reamer rotating at 50 RPM without water irrigation.


48.
 A 4.5mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


49.
 A 4.5mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


50.
 A 4.5mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


51.
 View of the wells of the seated implants.


52.
 View of initial incision.


53.
 Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.


54.
 Osteotomy being enlarged with an olive green 2.5mm latch reamer rotating at 50RPM without water irrigation.


55.
 Osteotomy being enlarged with a teal 3.0mm latch reamer rotating at 50 RPM without water irrigation.


56.
 Osteotomy being enlarged with a blue 3.5mm hand reamer


57.
 Harvested bone within the silver 4.5mm hand reamer.


58.
 A 4.5mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


59.
 View of seated implants with polyethylene healing plugs.


60.
 Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height.


61.
 A 5.0mm x 2.0mm, 10º Stealth shouldered abutment with 3.0mm post being inserted into the implant well with only finger pressure.


62.
 Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height.


63.
 Seated stealth shouldered abutment.


64.
 A 4.0mm wide, 0° stealth shouldered abutment with a shoulder height of 1.5mm is being inserted into the implant well with only finger pressure.


65.
 Vacuum formed template seated over the abutments to confirm the appropriateness of their placement.


66.
 Tall acrylic sleeve being modified for clearance.


67.
 Tall acrylic sleeve being modified.


68.
 Vacuum formed template seated over the modified acrylic sleeves and abutments to confirm the appropriateness of their placement.


69.
 Transitional composite material, “Integrity by Dentsply”, being added to vacuum formed template to form a transitional prosthesis.


70.
 Transitional composite material being added to the modified acrylic sleeves snapped onto abutments.


71.
 Transitional composite material in vacuum-formed template being formed around acrylic sleeves.


72.
 Transitional composite prosthesis incorporating modified acrylic sleeves being removed for polishing.


73.
 Transitional composite prosthesis incorporating modified acrylic sleeves and a stealth shouldered abutment.


74.
 View of immediately stabilizing transitional prosthesis in place.


75.
 Post-operative radiograph.


76.
 Post-operative radiograph.


77.
 Post-operative radiograph.
Third clinical visit:


78.
 Facial view prior to the removal of the lower anterior transitional prosthesis for metal try-in, thirteen weeks after the implant placements.


79.
 Red 2.0mm plastic impression post receiving its mandatory seating tap for the making of an implant level transfer impression.


80.
 Digital image being taken of shade guide against a black plastic background to facilitate the fabrication of aesthetic Integrated Abutment Crowns™.


81.
 Two milled abutments in red plastic implant analogs in stone model.


82.
 Two-piece cast metal framework joined with red acrylic resin seated on two milled abutments in stone model.


83.
 Two-piece cast metal framework joined with red acrylic resin seated on two milled abutments prior to an intra-oral confirmation of its appropriateness.


84.
 View of cast metal framework and two milled abutments.


85.
 The close-up view of the two-piece cast metal framework.


86.
 Transitional stabilizing prosthesis eight months after the immediate placement and stabilization.


87.
 Transitional stabilizing prosthesis being removed for metal try-in.


88.
 Metal framework being used to orient milled abutments into the wells of their implants.


89.
 Separated metal framework being removed from the initially seated milled abutments.


90.
 Milled abutment being tapped into its implant well.


91.
 Milled abutment being tapped into its implant well.


92.
 Metal casting being seated to reconfirm a passive fit after the definitive seating of the two milled abutments.


93.
 Transitional composite material in vacuum-formed template being formed around acrylic sleeves.


94.
 Transitional prosthesis being removed for polishing.


95.
 Cement being applied.


96.
 View of finished transitional prosthesis.
Fourth clinical visit:


97.
 Confirmation of try in prosthesis.


98.
 Try in


99.
 Post operative radiograph immediately before the cementation of four-unit porcelain fused to metal crown.


100.
 Separating medium being applied to the four-unit porcelain fused to metal crown to facilitate removal of extraneous cement.


101.
 Minimal cement being added only to the cervical area of casting.


102.
 Four-unit porcelain fused to metal crown bridge being cemented.


103.
 View of cemented four-unit porcelain fused to metal crown.


104.
 Green 3.0mm plastic impression posts seated in the wells of integrated maxillary implants for the making of an implant level transfer impression.


105.
 Polyvinylsiloxane material injected for the recording of an occlusal registration.


106.
 Occlusal registration being recorded.


107.
 Impression material being injected around the impression post for the making of a full arch implant level transfer impression.


108.
 View of maxillary full arch implant level transfer impression.


109.
 Digital image being taken of shade guide against a black plastic background to facilitate the fabrication of aesthetic Integrated Abutment Crowns™.


110.
 Four Integrated Abutment Crowns™ and two procera crowns on stone model.
Fifth clinical visit:


111.
 Facial view of mandibular four-unit porcelain fused to metal crown and maxillary transitional prosthesis five weeks after the maxillary full arch implant level impression.


112.
 View of temporary healing abutments after the removal of the transitional prosthesis for the insertion of the Integrated Abutment Crowns™.


113.
 View of implant wells and soft tissue sulci.


114.
 Integrated Abutment Crown™ being inserted. Note the angulation of the abutment post.


115.
 Integrated Abutment Crown™ being inserted.


116.
 Crestal relieving incision being made to facilitate the seating of the Integrated Abutment Crown™.


117.
 Integrated Abutment Crown™ being inserted.


118.
 Crestal relieving incision being made to facilitate the seating of the Integrated Abutment Crown™.


119.
 An acrylic orientation jig being used to initially position the Integrated Abutment Crowns™.


120.
 A green 6.5mm sulcus reamer being used to remove soft tissue and bone which might inhibit the complete seating of the Integrated Abutment Crown™.


121.
 Cervical aspect of the Integrated Abutment Crown™ being reduced with #7404 bur.


122.
 White healing abutment in a straight handle is being used to tap the Integrated Abutment Crown™ into the well of the implant.


123.
 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.


124.
 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.


125.
 Cement being applied to the procera crown.


126.
 Cement being applied to the procera crown.


127.
 Procera crown being cemented.


128.
 View of seated Integrated Abutment Crowns™ and two procera crowns immediately after being inserted.


129.
 Postoperative radiograph.


130.
 View of seated Integrated Abutment Crowns™ and two procera crowns three months post insertion.
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