Bicon Dental Implants
Friday, November 21st 2008 5:44PM EDT

Immediate Stabilization and Function / Bicon Integrated Abutment Crowns™: Extraction, Immediate Placement and Stabilization of Maxillary Left Central Incisor, its Restoration with a Bicon Integrated Abutment Crown™ and the Subsequent Aesthetic Treatment of a Metallic Gingival Margin
This case demonstrates the extraction of a failed endodontically treated maxillary left central incisor, placement of an immediately stabilized and functioning implant, implant level transfer impression, insertion of a Bicon Integrated Abutment Crown™ as well as an aesthetic treatment of its metallic gingival margin.
     


1. Pre-operative radiograph.


2. Pre-operative site.


3. Pre-operative smile.


4. Extraction of failed endodontically treated maxillary left anterior incisor.


5. View of extracted tooth revealing the area of resorption.


6. Curette removing soft tissue remnants of periodontal ligament.


7. View of 2.0mm pilot bur preparing the osteotomy.


8. Parallel pin seated in pilot osteotomy indicating its trajectory.


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


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


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


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


13. View of well of seated implant.


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


15. View of seated implant with polyethylene healing plug.


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 tall acrylic sleeve snapped on to stealth abutment being inserted.


18. View of seated stealth abutment.


19. Tall acrylic sleeve being adjusted for occlusal clearance.


20. Tall acrylic sleeve being adjusted.


21. Bonding agent being applied.


22. Light curing of bonding agent.


23. Vacuum formed template seated over modified acrylic sleeve to confirm the appropriateness of its placement.


24. Additional polyceramic material is being added to vacuum formed template for aesthetic contouring.


25. Transitional stabilizing prosthesis being light cured.


26. Transitional stabilizing prosthesis being light cured.


27. Transitional stabilizing prosthesis being contoured.


28. Additional material being added to prosthesis.


29. Polishing of transitional stabilizing prosthesis with a pink acrylic wheel.


30. Polishing of transitional stabilizing prosthesis with a nylon bristle brush.


31. Polishing of transitional stabilizing prosthesis with a soft bristle brush.


32. Etchant being applied in preparation for the bonding of the transitional stabilizing prosthesis.


33. Bonding primer agent being applied.


34. Bonding agent being applied.


35. Light curing of bonding agent.


36. Additional polyceramic material being applied to prosthesis for bonding.


37. Bonding material being light cured.


38. View of polished transitional stabilizing prosthesis.


39. Radiograph of immediately placed and functioning implant at the completion of the first clinical visit.


40. Bonded stabilizing prosthesis prior to its being removed at the patient’s second clinical visit five months after the implant placement.


41. Radiograph prior to the making of a full arch implant level transfer impression.


42. A 3.0mm guide pin being inserted.


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


44. Crestal relieving incision being made to facilitate the seating of the impression post.


45. Green 3.0mm plastic impression post being inserted into the 3.0mm well of an integrated implant for the making of an implant level transfer impression.


46. Impression post being tapped into place to assure its proper seating.


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


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


49. View of Integrated Abutment Crown™.


50. Integrated Abutment Crown™ being inserted four weeks after the implant level transfer impression was taken.


51. 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.


52. Seated Integrated Abutment Crown™ immediately after being inserted.


53. View of Integrated Abutment Crown™ five weeks after the insertion.


54. Radiograph of Integrated Abutment Crown™ five weeks after the insertion.


55. View of Integrated Abutment Crown™ six months after the insertion.


56. Radiograph of Integrated Abutment Crown™ six months after the insertion.


57. View of Integrated Abutment Crown™ thirteen months after the insertion. Note the gingival recession.


58. Implant well and soft tissue sulcus after the removal of the Integrated Abutment Crown™.


59. Different shades of white and pink polyceramic material on a glass slab being mixed to match the shades of the soft tissue.


60. Mixed pink polyceramic material being held up against the soft tissue to match the gingival color.


61. Laboratory bur being used to prepare the cervical portion of a Bicon abutment by cutting a groove into the surgical grade titanium alloy.


62. Pink acrylic wheel being used to further prepare the abutment.


63. Sandblasting of the Integrated Abutment Crown™ with 50 micron alumina.


64. Prepared groove being coated with a metallic coupling agent.


65. A layer of neutral metal opaque powder being applied onto the prepared groove.


66. Applied metal opaque powder being light cured.


67. Pink polyceramic material being applied to the groove.


68. Polyceramic material being light cured.


69. A spatula being used to contour the added polyceramic material while the Integrated Abutment Crown™ is seated in stone model.


70. Integrated Abutment Crown™ being re-inserted.


71. A spatula being used to contour the added polyceramic material.


72. Added polyceramic material being light cured.


73. View of re-inserted Integrated Abutment Crown™.


74. Added polyceramic material being polished with a super-fine grade carbide bur.


75. Added polyceramic material being polished with a pink acrylic wheel.


76. Crown being light cured.


77. Added polyceramic material being polished.


78. Added polyceramic material being polished.


79. Added polyceramic material being polished.


80. Added polyceramic material being polished.


81. Added polyceramic material being polished.


82. Added polyceramic material being polished.


83. Abutment post being cleaned with alcohol wipe to remove any debris which would diminish the effectiveness of the locking taper connection.


84. Polished Integrated Abutment Crown™ being inserted.


85. 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.


86. View of seated Integrated Abutment Crown™.


87. Right side profile.


88. Post-operative radiograph.


89. Patient’s smile.


90. Facial view seven-months post insertion.


91. Profile view seven-months post insertion.
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