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

Immediate Stabilization and Function / Polyceramic Material Fused to Metal : Placement and Restoration of Immediately Functioning Mandibular Incisor Implants with a Four Unit Polyceramic to Metal Fixed Prosthesis
This case demonstrates the extraction of a failed endodontically treated mandible incisors and their replacement with two immediately placed and functioning implants and their restoration with a four unit polyceramic material to metal fixed prosthesis with two laboratory milled abutments.

 

    


1. Pre- operative radiograph.


2. Removal of failed endodontically treated tooth.


3. Initial osteotomy being prepared with a 2.0 mm pilot bur rotating at 1,000RPM with external water irrigation.


4. Paralleling pins placed into the pilot osteotomies to confirm that their trajectories are parallel and that they bisect the mesial surface of their adjacent tooth.


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


6. Harvested bone being collected in a flexible dappen dish.


7. A depth gauge being inserted into prepared osteotomy to confirm its depth.


8. A 4.0mm x 11.0mm HA coated implant is being inserted with an implant inserter/retriever instrument.


9. Final seating of the implant is being achieved prior to the removal of the inserter/retriever instrument.


10. A 4.5 x 8.0mm HA coated implant is inserted with an implant inserter/retriever instrument.


11. Final seating of the implant is being achieved prior to the removal of the inserter/retriever instrument.


12. Shoulder depth gauge being inserted.


13. A 4.0 mm x 3.5 mm stealth shouldered abutment with a 2.0 mm diameter post is being inserted with finger pressure only into the well of its implant.


14. Shoulder depth gauge being inserted.


15. A 4.0 mm x 3.5 mm stealth shouldered abutment with a 3.0 mm diameter post is being inserted with finger pressure only into the well of its implant.


16. A short 4.0 mm wide acrylic sleeve is being placed onto a 4.0 mm wide stealth shouldered abutment.


17. Two short 4.0 mm wide acrylic sleeves snapped onto 4.0 mm diameter stealth abutments.


18. Vacuum formed template inserted over snapped on acrylic sleeves to confirm its appropriateness.


19. Transitional prosthesis being removed for polishing.


20. Etchant being applied to adjacent tooth surfaces.


21. Bonding agent being applied.


22. Light curing of bonding agent.


23. Polished prosthesis being re-inserted.


24. Light curing of splinted transitional stabilization prosthesis.


25. Splinted prosthesis.


26. Splinted transitional prosthesis providing stabilization and functional loading of the immediately placed implants.


27. Radiograph of immediately placed and functioning implants.


28. Transitional stabilizing prosthesis being removed from 4.0 mm stealth abutments.


29. View of implant wells and sulci.


30. Black impression post being inserted into the 2.0 mm implant well.


31. White impression post being inserted into the 3.0mm implant well.


32. Impression post receiving its mandatory seating taps.


33. Impression material being inserted around impression post for the making of an implant level transfer impression.


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34. Red acrylic around impression post for the recording of an occlusal relationship.


35. Occlusal registration being removed from the implant wells.


36. A 4.0mm x 3.5mm stealth abutment with a 3.0mm post being re-inserted into the implant well.


37. A 4.0 x 1.5mm stealth abutment with a 2.0mm post being inserted into the implant well for the making of a new transitional prosthesis.


38. Two 4.0mm wide stealth abutments seated with only finger pressure.


39. Short 4.0mm acrylic sleeve being inserted onto stealth abutment.


40. Two 4.0mm short acrylic sleeves snapped onto stealth abutments.


41. Transitional composite material “Integrity” by Dentsply being injected around sleeves to form an initial strut prior to the application of additional material with a vacuumed formed template.


42. Additional material being applied.


43. Clear template being removed.


44. Transitional prosthesis being removed for polishing.


45. Transitional prosthesis snapped onto abutments without cement.


46. Digital Image being taken of shade guide against a black metallic background.


47. White impression post with metal implant analog attached is being seated into transfer impression.


48. Plastic impression posts with metal implant analogs seated in transfer impression.


49. Separating medium being applied to impression.


50. Soft tissue material being injected around implant analogs and impression posts.


51. Pouring of the soft tissue model.


52. Plastic impression posts in the soft tissue model.


53. Two piece four unit metal frame on two milled abutments on stone model.


54. Transitional prosthesis prior to its removal for the try in of the two piece metal frame and milled abutments.


55. Transitional prosthesis being removed.


56. View of implant wells and sulci after the removal of the stealth abutments which were only seated with finger pressure.


57. Milled abutment with metal prosthesis is being inserted into the 3.0mm implant well.


58. Initial positioning of the abutment is being facilitated by the appropriate positioning of the metal prosthesis.


59. Milled abutment is being inserted into the metal prosthesis.


60. Milled abutment with metal prosthesis is being inserted into the 2.0mm implant well.


61. After appropriate alignment of the two metal prostheses an initial seating tap to the 3.0mm abutment is being applied through the metal frame.


62. After appropriate alignment of the two metal prostheses an initial seating tap to the 2.0mm abutment is being applied through the metal frame.


63. After the removal of the metal frame a definitive seating tap is being delivered to the 3.0mm diameter abutment post.


64. After the removal of the metal frame a definitive seating tap is being delivered to the 2.0mm abutment.


65. The metal frames have been inserted onto the seated abutments to confirm their alignment prior to their being seated together.


66. Red acrylic is being used to unite the two pieces of the framework together.


67. An incisal relationship is also being recorded in the splinting red acrylic.


68. Impression material is being injected around the metal framework for the making of a withdrawal impression.


68a. After the withdrawal impression the milled abutments were replaced with the previously used stealth abutments and the transitional prosthesis is being re-inserted.


69. Four unit polyceramic to metal fixed prosthesis on model.


70. Mirror view of prosthesis.


71. Transitional prosthesis being removed.


72. View of implant wells and sulci.


73. Milled abutment being inserted into prosthesis.


74. After appropriate alignment with the prosthesis an initial seating tap of the abutment is being delivered through the prosthesis.


75. Prosthesis is being removed.


76. Milled abutment being inserted into prosthesis.


77. Prosthesis is being used to confirm the passive interproximal contacts which would not interfere with the complete seating of the prosthesis.


78. Floss is being used to confirm passive interproximal contacts which would not interfere with the complete seating of the prosthesis.


79. After removal of the prosthesis the abutment is being definitively seated.


80. After removal of the prosthesis the abutment is being definitively seated.


81. View of seated abutments prior to the re-insertion of the prosthesis for radiographic confirmation of its complete seating.


82. Re-inserted prosthesis for radiographic confirmation of the seating.


83. Radiograph confirms complete seating of the prosthesis.


84. Cement is being applied only to the cervical margins.


85. Prosthesis 11 months after being permanently cemented.


86. Radiograph 11 months after cementation of the prosthesis.
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