Bicon Dental Implants
Friday, November 21st 2008 6:10PM EDT

Polyceramic Material Fused to Metal: Placement and Restoration of Four Maxillary Implants with an Eleven Unit Polyceramic to Metal Fixed Prostheses Attached to a Natural Tooth

This case demonstrates the two stage surgical placement of four maxillary implants and their prosthetic restoration with a single polyceramic to metal crown on a natural tooth and a ten unit polyceramic to metal fixed prosthesis involving a single natural abutment tooth.
     


1. Patient’s pre-operative smile.


2. Pre-operative radiograph.


3. Pre-operative periapical radiograph.


4. Pre-operative periapical radiograph.


5. Pilot osteotomy being prepared at 1100RPMs.


6. Pilot bur after being removed from osteotomy.


7. Latch reamer preparing osteotomy at 50RPMs as clinician’s finger monitors the integrity of the buccal bone.


8. A 4.0mm x 11.0mm HA coated Implant being inserted into the osteotomy with the handle of the black polyethylene plug.


9. Implant seated in its osteotomy.


10. Polyethylene plug in seated implant.


11. Second implant with a 2.0mm well seated in its osteotomy prior  to being covered as part of the two stage surgical technique.


12. Radiograph of two maxillary right implants with 2.0mm wells.


13. Radiograph of two maxillary left implants with 3.0mm wells.


14. View of two 2.0 metal impression posts and two 3.0 white plastic impression posts prior to the making of an implant level transfer impression.


15. Impression material being injected around gold copings and metal impression posts for the making of an implant level transfer impression.


16. Digital image being recorded of shade guide and tooth against a black metallic background to facilitate the fabrication of an appropriately aesthetic restoration.


17. Metal impression post being inserted into a 2.0mm metal implant analog.


18. White plastic impression post being inserted into 3.0mm metal implant analog.


19. Soft tissue acrylic material being injected around impression  post and implant analogs prior to the pouring of a dental stone model.


20. Four milled abutments and two metal castings on dental model.


21. Metal framework on dental model.


22. Mirror view of metal  framework luted together with red acrylic.


23. View of maxillary arch revealing red 2.0mm and white 3.0mm temporary abutments.


24. Plastic jig facilitating the alignment and seating of milled abutments.


25. Plastic jig facilitating the alignment and seating of milled abutments.


26. Plastic jig facilitating the alignment and seating of milled abutments.


27. Plastic jig facilitating the alignment and seating of milled abutments.


28. Plastic jig facilitating the alignment and seating of milled abutments.


29. Plastic jig facilitating the alignment and seating of milled abutments.


30. Seated metal framework prior to being re-aligned and luted together with red acrylic.


31. Seated metal framework prior to being re-aligned and luted together with red acrylic.


32. Red acrylic being used to join metal framework together as well as to record occlusal relationship.


33. Seated milled abutment is being removed by the tapping on the handle of the grasping instrument.


34. Polyceramic to metal restoration on stone model.


35. Mirror view of polyceramic to metal restoration.


36. View of dental arches prior to the removal of the four plastic temporary abutments.


37. Red 2.0mm temporary abutment being removed.


38. Occlusal view of four implant wells prior to the insertion of milled abutments .


39. Milled abutment with cervically applied polyceramic material below its height of contour providing for a gingivally aesthetic restoration  is being inserted into the prosthesis.


40. Prosthesis is facilitating the alignment and seating of the milled abutment.


41. Prosthesis is being tapped to engage the abutment’s locking taper.


42. Note the polyceramic material bonded to the abutment below its height of contour. When the prosthesis is cemented with a polyceramic cement the interface will seamlessly achieve a gingivally aesthetic restoration.


43. Abutment is being definitively tapped to insure the engagement of its locking taper.


44. A second milled abutment is being placed in the prosthesis for its alignment and seating into the well of the implant.


45. A third milled abutment is being placed in the prosthesis prior to its alignment and seating into the well of its implant.


46. Milled abutment being definitively seated.


47. Radiograph revealing inadequate seating of the prosthesis.


48. Radiograph revealing appropriate seating of the prosthesis.


49. Radiograph revealing appropriate seating of the prosthesis.


50. View of initial placement of the prosthesis revealing the interface between the polyceramic material of the prosthesis and that of the seated abutment.


51. View of initial placement of the prosthesis revealing the interface between the polyceramic material of the prosthesis and that of the seated abutment.


52. View of initial placement of the prosthesis revealing the interface between the polyceramic material of the prosthesis and that of the seated abutment.


53. Polyceramic to metal fixed prosthesis in occlusion.


54. Seated prosthesis.


55. Radiograph of finished restoration.


56. Patient’s smile without prosthesis.


57. Patient’s smile with prosthesis.


58. Patient’s smile with polyceramic to metal prosthesis.
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