Bicon Dental Implants
Friday, November 21st 2008 5:57PM EDT

Immediate Stabilization and Function / Bicon Integrated Abutment Crowns™ : Extraction, Immediate Placement and Stabilization of Sixteen Bicon Implants and their Restoration with Integrated Abutment Crowns™
This case demonstrates the extraction of fourteen teeth, insertion of sixteen immediately placed, stabilized, and functioning implants, implant level transfer impression, and their restoration with Sixteen Integrated Abutment Crowns™.
 
First Clinical Visit:


1.
Pre-operative radiograph.


2.
 Pre-operative site.


3.
 Pre-operative smile.


4.
 View of extracted tooth.


5.
 View of extracted tooth.


6.
 View of extracted tooth.


7.
 Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.


8.
 Parallel pins seated in pilot osteotomies indicating their trajectories.


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


10.
 Osteotomy being enlarged with a teal 3.0mm latch reamer rotating at 50 RPM without water irrigation


11.
 Osteotomy being enlarged with a blue 3.5mm latch reamer rotating at 50 RPM without water irrigation.


12.
 Osteotomy being enlarged with a red 4.0mm latch reamer rotating at 50 RPM without water irrigation.


13.
 Osteotomy being enlarged with a blue 3.5mm latch reamer rotating at 50 RPM without water irrigation.


14.
 Osteotomy being enlarged with a silver 4.5mm latch reamer rotating at 50 RPM without water irrigation.


15.
 Harvested bone within the flute of gold 5.0mm hand reamer being placed into dappen dish.


16.
 A 5.0mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


17.
 A 5.0mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


18.
 A 5.0mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


19.
 Parallel pins confirming appropriate trajectories and acting as guides for subsequent osteotomy.


20.
 Parallel pins seated in pilot osteotomies indicating their trajectories.


21.
 Osteotomy being enlarged with an olive green 2.5mm latch reamer rotating at 50 RPM without water irrigation.


22.
 Osteotomy being enlarged with a teal 3.0mm latch reamer rotating at 50 RPM without water irrigation.


23.
 Osteotomy being enlarged with a blue 3.5mm latch reamer rotating at 50 RPM without water irrigation.


24.
 Osteotomy being enlarged with a red 4.0mm latch reamer rotating at 50 RPM without water irrigation.


25.
 Osteotomy being enlarged with a gold 5.0mm hand reamer.


26.
 Curette removing residual bone while confirming the integrity of the five bony walls of the osteotomy.


27.
 A 5.0mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


28.
 A 5.0mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


29.
 View of seated implants with their polyethylene healing plugs.


30.
 View of extracted maxillary tooth.


31.
 Osteotomy being enlarged with an olive green 2.5mm latch reamer rotating at 50 RPM without water irrigation.


32.
 Osteotomy being enlarged with a blue 3.5mm latch reamer rotating at 50 RPM without water irrigation.


33.
 A 5.0mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


34.
 View of extracted tooth.


35.
 View of extracted tooth.


36.
 Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.


37.
 Osteotomy being enlarged with a blue 3.5mm latch reamer bur rotating at 50 RPM without water irrigation.


38.
 Osteotomy being enlarged with a gold 5.0mm latch reamer bur rotating at 50 RPM without water irrigation.


39.
 A 5.0mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


40.
 A 5.0mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


41.
 A 5.0mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


42.
 View of seated implants with their polyethylene healing plugs.


43.
 Post-operative radiograph.


44.
 Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height.


45.
 A modified acrylic sleeve snapped onto a shouldered abutment being inserted into the implant well.


46.
 A modified acrylic sleeve snapped onto a shouldered abutment being inserted into the implant well.


47.
 View of vacuum formed template seated on the stone model.


48.
 Vacuum formed template seated over acrylic sleeves and abutments to confirm the appropriateness of their placement.


49.
 Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height.


50.
 Stealth shouldered abutment 4.0mm wide with a shoulder height of 3.5mm being inserted into the implant well with only finger pressure.


51.
 Tall acrylic sleeve being modified.


52.
 Transitional composite material, “Integrity”, by Dentsply, being added to acrylic sleeves to form a bonded strut between adjacent teeth.


53.
 Transitional composite material, “Integrity”, by Dentsply, being added to vacuum formed template to form a transitional stabilizing prosthesis.


54.
 Vacuum formed template seated over modified stealth acrylic sleeves and abutments to confirm the appropriateness of their placement on the mandible while the additional transitional composite material, "Integrity" by Dentsply, in vacuum formed template is added to the hardened strut on the mandible for aesthetic contouring.


55.
 Transitional composite material, “Integrity” by Dentsply, being added to acrylic sleeves to form a bonded strut between adjacent teeth.


56.
 Transitional composite material, “Integrity” by Dentsply, being added to vacuum formed template to form a transitional stabilizing prosthesis.


57.
 Additional transitional composite material, “Integrity” by Dentsply, in vacuum formed template added to the hardened strut on the maxilla for aesthetic contouring.


58.
 Light curing of the bonding material of polished transitional stabilizing prosthesis.


59.
 View of finished transitional stabilizing prostheses.


60.
 Post-operative radiograph after the patient’s first clinical visit.
Second Clinical Visit:    


61.
 Mandibular prostheses prior to their removal for the making of implant level transfer impression.


62.
 Healing plug being removed with a healing plug removal instrument.


63.
 A 4.0mm x3.5mm stealth shouldered abutment being removed for the making of a mandibular implant level transfer impression.


64.
 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.


65.
 Green 3.0mm plastic impression post receiving its mandatory seating tap.


66.
 A 5.0mm x6.0mm stealth shouldered abutment being removed for the making of a mandibular implant level transfer impression.


67.
 View of implant wells and soft tissue sulci.


68.
 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.


69.
 Green 3.0mm plastic impression post receiving its mandatory seating tap with an offset driver.


70.
 Impression material being injected around impression posts for the making of a full arch implant level transfer impression.


71.
 Facial view with green 3.0mm plastic impression posts and white healing abutment prior to the making of an occlusal registration.


72.
 Polyvinylsiloxane material injected for the recording of an occlusal registration.


73.
 Post operative radiograph after second clinical visit.
Third Clinical Visit:    


74.
 Right mandibular Integrated Abutment Crowns™ on stone model.


75.
 View of right mandibular Integrated Abutment Crowns™.


76.
 Left mandibular Integrated Abutment Crowns™ on stone model.


77.
 View of left mandibular Integrated Abutment Crowns™.


78.
 View of transitional prosthesis and white healing abutment prior to their removal for the insertion of Integrated Abutment Crowns™ four months after the uncovering of the implants and mandibular implant level transfer impression.


79.
 Integrated Abutment Crown™ being inserted.


80.
 Integrated Abutment Crown™ being inserted.


81.
 View of seated Integrated Abutment Crowns™ immediately after their insertion.


82.
 White healing abutment in a straight handle is being used to definitively seat the Integrated     Abutment Crown™ into the well of the implant.


83.
 White healing abutment in a straight handle is being used to definitively seat the Integrated Abutment Crown™ into the well of the implant.
Fourth Clinical Visit:    


84.
 Green 3.0mm plastic impression post being inserted into the 3.0mm well of an integrated implant for the making of an occlusal registration.


85.
 Impression post being tapped into place to assure its proper seating.


86.
 View of seated impression posts prior to its making of an occlusal registration.


87.
 View of the impression posts on the left side.


88.
 Red acrylic being injected onto the impression posts.


89.
 Red acrylic on impression posts for the recording of an occlusal registration on the left side.


90.
 Impression post being tapped into place to assure its proper seating.


91.
 Green 3.0mm plastic impression post being modified for the making of an occlusal registration.


92.
 View of impression posts on the right side prior to its making of an occlusal registration.


93.
 Red acrylic being injected onto the impression posts.


94.
 Red acrylic on impression posts for the making of an occlusal registration on the right side.


95.
 Occlusal registration being made.


96.
 Transitional abutment being removed.


97.
 Green 3.0mm plastic impression post being inserted into the 3.0mm well of an integrated implant for the making of a full arch implant level transfer impression.


98.
 Impression post receiving its mandatory seating tap.


99.
 Impression material being injected around the impression post for the making of a full arch implant level transfer impression.


100.
 Transitional prosthesis re-cemented after the making of an implant level transfer impression.
Fifth Clinical Visit:    


101.
 Integrated Abutment Crowns™ on a stone model with acrylic orientation jig.


102.
 Integrated Abutment Crowns™ on a stone model.


103.
 Palatal view of Integrated Abutment Crowns™ on a stone model.


104.
 View of ten Integrated Abutment Crowns™.


105.
 View of transitional prostheses prior to its removal for the insertion of the Integrated Abutment Crowns™.


106.
 View of implant wells and soft tissue sulci.


107.
 Well of implant being cleaned with alcohol on a cotton tipped applicator. Note soft tissue contours.


108.
 IAbutment post being cleaned with alcohol wipe to remove any debris which would diminish the effectiveness of the locking taper connection.


109.
 Integrated Abutment Crown™ being inserted.


110.
 Well of implant being cleaned with alcohol on a cotton tipped applicator.


111.
 Integrated Abutment Crown™ being inserted.


112.
 Floss being used to confirm the fact that the interproximal contacts are passive and will not interfere with the engagement of the locking taper.


113.
 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.


114.
 Well of implant being cleaned with alcohol on a cotton tipped applicator.


115.
 Integrated Abutment Crown™ being inserted.


116.
 Integrated Abutment Crown™ being inserted.


117.
 Integrated Abutment Crown™ being inserted.


118.
 Articulating paper being used to confirm appropriateness of interproximal contacts.


119.
 Blue markings indicate excessive interproximal contact which must be adjusted to assure passive contact for the engagement of the locking taper connection.


120.
 Interproximal contact being adjusted.


121.
 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.


122.
 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.


123.
 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.


124.
 Blue markings confirming appropriate occlusal contacts in all extreme excursions while the patient was clenching.


125.
 Facial view immediately after the insertion of ten Integrated Abutment Crowns™.


126.
 Patient’s smile.


127.
 Post-insertion radiograph.


128.
 Facial view one-week after the insertion of ten maxillary Integrated Abutment Crowns™.
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