Bicon Dental Implants
Friday, November 21st 2008 4:15PM EDT
 

Congenitally Missing Laterals / Bicon Integrated Abutment Crowns™: Two Stage Placement of Two Implants and their Restoration with Integrated Abutment Crowns™ for Two Congenitally Missing Lateral Incisors
This case demonstrates a maxillary ridge split, two stage placement, uncovering, implant level transfer impression, and restoration with Bicon Integrated Abutment Crowns™ of two implants replacing congenitally missing lateral incisors.
     
First Clinical Visit:    


1. Pre-operative radiograph.


2. Pre-operative view.


3. Preoperative radiograph of the congenitally missing right lateral incisor.


4. Preoperative radiograph of the congenitally missing left lateral incisor.


5. View of right preoperative site.


6. View of left preoperative site.


7. Preoperative smile.


8. View of preoperative sites after the removal of orthodontic braces.


9. View of maxillary preoperative sites.


10. Initial incision.


11. Osteotomy being prepared for the right lateral incisor implant with 2.0mm pilot bur rotating at 1100RPM with external irrigation.


12. Osteotomy being prepared for the left lateral incisor implant with 2.0mm pilot bur rotating at 1100RPM with external irrigation.


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


14. Osteotomy being enlarged with an olive green 2.5mm hand reamer.


15. Harvested bone within the flute of an olive green 2.5mm hand reamer.


16. Ridge being split by the use of blue 3.0mm Expanding Chisel.


17. Ridge being split by the use of blue 3.0mm Expanding Chisel.


18. Ridge being split by the use of sliver 4.5mm Expanding Chisel.


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


20. Osteotomy being enlarged with a red 4.0mm hand reamer.


21. Osteotomy being enlarged with a red 4.0mm hand reamer.


22. Curette harvesting residual bone while confirming the integrity of the five bony walls of the osteotomy.


23. Curette harvesting residual bone while confirming the integrity of the five bony walls of the osteotomy.


24. Osteotomy being prepared with a silver 4.5mm bone expander.


25. A 4.5mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant inserter/retriever.


26. A 4.5mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant inserter/retriever.


27. Cut polyethylene healing plug being inserted into the well of the implant.


28. Harvested bone being placed over the shoulder of the implant.


29. Post operative radiograph.


30. Post operative radiograph.
Second Clinical Visit:    


31. View of operative site prior to the two stage uncovering four months after the implant placement.


32. View of the trimmed black polyethylene plug seated in the well of the implant.


33. Healing plug being removed with a healing plug removal instrument.


34. Green 3.0mm impression reamer being rotated on guide pin to remove any tissue which might inhibit the complete seating of an impression post.


35. 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.


36. Green 3.0mm plastic impression post receiving its mandatory seating tap.


37. Healing plug being removed with a healing plug removal instrument.


38. Green 3.0mm impression reamer being rotated on guide pin to remove any tissue which might inhibit the complete seating of an impression post.


39. View of green 3.0mm plastic impression posts seated in the well of the implants.


40. Impression material being injected around impression posts for the making of a full arch implant level transfer impression.
Third Clinical Visit:    


41. Integrated Abutment Crowns™ on stone model with acrylic orientation jig.


42. Facial view of Integrated Abutment Crowns™ on stone model.


43. View of Integrated Abutment Crowns™.


44. View of transitional prostheses prior to their removal for the insertion of Integrated Abutment Crowns™


45. View of green 3.0mm plastic impression posts which were used as temporary abutments after the removal of transitional prostheses.


46. Well of implant being cleaned with alcohol on a cotton tipped applicator.


47. Integrated Abutment Crown™ being inserted.


48. View immediately after the insertion of right maxillary lateral Integrated Abutment Crown™.


49. Right maxillary lateral Integrated Abutment Crown™ being adjusted.


50. 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.


51. Green 3.0mm plastic impression post which was used as a temporary abutment is being removed.


52. Well of implant being cleaned with alcohol on a cotton tipped applicator.


53. Integrated Abutment Crown™ being inserted.


54. Floss being used to confirm the fact that the interproximal contacts are passive and will not interfere with the engagement of the locking taper.


55. Diamond finishing strip being used to lighten the interproximal contact area eliminating the possibility that the contact may prevent the engagement of the locking taper connection.


56. 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.


57. 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.


58. Facial view immediately after the insertion of two Integrated Abutment Crowns™.


59. Post operative radiograph after the insertion of the right maxillary lateral Integrated Abutment Crown™.


60. Post operative radiograph after the insertion of the left maxillary lateral Integrated Abutment Crown™.


61. View of Integrated Abutment Crown™ two weeks after being inserted.


62. View of Integrated Abutment Crown™ two weeks after being inserted.


63. View of Integrated Abutment Crowns™ two weeks after being inserted.


64. Left profile two weeks post insertion of Integrated Abutment Crowns™.


65. Right profile two weeks post insertion of Integrated Abutment Crowns™.


66. Patient’s smile two weeks post insertion of Integrated Abutment Crowns™.
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