Bicon Dental Implants
Thursday, March 11th 2010 8:16PM EDT
 

Overdenture Restorations: Two Implant-Retained Mandibular Overdenture
This case demonstrates the placement of two implants and bone grafting with Synthograft™, uncovering of the implants, and insertion of two locator abutments with their metal housing caps integrated into the denture.

     

First Visit


1. Pre-operative radiograph.


2. Pre-operative view of anterior mandibular knife edge ridge.


3. View of extremely thin crestal ridge after reflection of full-thickness labial mucoperiosteal flap.


4. Crestal ridge being flattened in the area of the mandibular left canine.


5. Lingual flap is secured with a retraction suture.


6. Crestal bony notch is being made with a # 701 fissure bur at high speed with external irrigation.


7. Crestal bony notch is enlarged with a # 702 fissure bur at high speed with external irrigation.


8. Osteotomy is being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation in the area of the mandibular right canine.


9. Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation in the area of the mandibular left canine.


10. Paralleling pins in each pilot osteotomy indicating their position and trajectory.


11. Osteotomy being enlarged with an olive green 2.5mm latch reamer rotating at 50RPM without water irrigation in the area of the mandibular right canine.


12. Osteotomy being enlarged with an olive green 2.5mm latch reamer rotating at 50RPM without water irrigation in the area of the mandibular left canine.


13. Harvested bone within the flute of an olive green 2.5mm latch reamer.


14. Osteotomy being enlarged with a teal 3.0mm latch reamer rotating at 50RPM without water irrigation in the area of the mandibular left canine.


15. Harvested bone within the flute of the teal 3.0mm latch reamer.


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


17. Harvested bone within the flute of blue 3.5mm latch reamer.


18. Depth gauge being used to measure the osteotomy depth.


19. A 3.5mm x 11.0mm HA coated implant being inserted into the osteotomy in the area of the mandibular left canine.


20. A 3.5mm x 11.0mm HA coated implant being inserted into the osteotomy in the area of the mandibular right canine.


21. View of seated implants with polyethylene healing plugs.


22. Polyethylene healing plug being cut.


23. Polyethylene healing plug being cut.


24. Synthograft™ being mixed with patient’s blood.


25. Mixture of patient’s blood and Synthograft™ pure phase Beta-Tricalcium Phosphate in a dappen dish.


26. Mixture of patient’s blood and Synthograft™ pure phase Beta-Tricalcium Phosphate being placed.


27. Sutures being placed.


28. Flap closed with a combination of interrupted and continuous sutures.


29. Post-insertion radiograph in the area of the mandibular right canine.


30. Post-insertion radiograph in the area of the mandibular left canine.


31. Panoramic radiograph after the insertion of two implants.

Second Visit: Three months after implant placement.


32. View of operative site three months after the implant placements.


33. View of healing plug in mandibular left canine.


34. View of healing plug in mandibular right canine.


35. Healing plug being removed with a straight curette.


36. Guide pin inserted into the well of each implant.


37. A 4.5mm impression reamer is inserted onto a guide pin with the straight driver to remove bone.


38. A 5.0mm sulcus reamer being rotated to remove bone.


39. Depth gauge is being used to measure and select the appropriate Locator® Abutments.


40. View of 2.0mm and 5.0mm post Locator® Abutments with a 2.0mm post.


41. View of Locator® Core Tool that is being used to hold the retention male.


42. Removal of the processing male from the metal housing cap.


43. Locator® Core Tool is being used to hold a pink 1.4 kg (3.0 lb) retention male.


44. Insertion of a pink 1.4 kg (3.0 lb) retention male into the metal housing cap.


45. View of two metal housing caps with their retention males.


46. View of Locator® Abutments and male processing kit.


47. Placement of the Locator® Abutment after the well of implant has been cleaned with alcohol on a cotton-tipped applicator.


48. Placement of the Locator® Abutment after the well of implant has been cleaned with alcohol on a cotton tipped applicator.


49. Straight handle with a seating tip attached is being tapped to seat the Locator® Abutment into the implant well in the area of the mandibular left canine.


50. Straight handle with a seating tip attached is being tapped to seat the Locator® Abutment into the implant well in the area of the mandibular right canine.


51. Crestal relieving incision being made to facilitate the seating of the prosthesis.


52. View of two Locator® Abutments after their placement.


53. Blockout spacer being placed over a Locator® Abutment.


54. View of the metal housing cap over the Locator® Abutment.


55. View of two Locator® Abutments with their metal housing caps and only one blockout spacer used on mandibular left canine.


56. Marker ink being placed on the housing to indicate its location relative to denture.


57. Denture being inserted.


58. Black ink indicating housing position.


59. Acrylic bur being used to provide room for the housing.


60. Vaseline being placed in the area of premolars and molars of the denture.


61. View of Tokuyama resin being used as a rebase material.


62. Tokuyama resin material being injected into the denture.


63. Tokuyama resin material being injected around the housing caps.


64. Denture being inserted.


65. Patient applying occlusal force while metal housing caps are being secured into the denture.


66. View of denture after being removed.


67. View of denture after being cleaned and polished.


68. Insertion of the lower denture.


69. Post-operative view of the patient’s smile.
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