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Extraction, Two-Stage & Immediate Placement and Loading of Twenty-One Implants and their Restoration with Integrated Abutment Crowns™ (Part One)
This case demonstrates the two stage, immediate placement and loading of twenty one implants as well as their restoration with Integrated Abutment Crowns™ in four clinical visits during a period of twenty-two weeks.
Categories: Full ArchShort ImplantsImmediate Stabilization and FunctionBicon Integrated Abutment Crowns™
Before |
Before |
Before |
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After |
After |
After |
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(NOTE: This is Part One of a two-part case. Click here to view Part Two.)
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1. | Pre-operative radiograph. |
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2. | Pre-operative smile. |
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3. | Facial view of pre-operative site with patient’s original prostheses. |
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4. | Pre-operative smile without patient’s original prostheses. |
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5. | Facial view of pre-operative site. |
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6. | Left side view of pre-operative site. |
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7. | Right side view of pre-operative site. |
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8. | Template being used to confirm appropriate trajectories. |
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9. | Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation. |
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10. | Osteotomy being enlarged with a teal 3.0mm latch reamer rotating at 50 RPM. |
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11. | Osteotomy being enlarged with a dark blue 3.5mm latch reamer rotating at 50 RPM. |
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12. | Osteotomy being enlarged with a red 4.0mm latch reamer rotating at 50 RPM. |
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13. | Osteotomy being enlarged with a silver 4.5mm latch reamer rotating at 50 RPM. |
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14. | Osteotomy being enlarged with a gold 5.0mm latch reamer rotating at 50 RPM. |
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15. | A 5.0mm x 6.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver. |
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16. | A 5.0mm x 6.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver. |
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17. | Implant seating tip attached to an offset handle is being tapped to seat implant farther into the osteotomy. |
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18. | Cut polyethylene healing plug being inserted into the implant well for two stage placement. |
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19. | Cut polyethylene healing plug being inserted into the implant well for two stage placement. |
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20. | Flap being elevated. |
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21. | Template being used to confirm appropriate trajectories. |
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22. | Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation. |
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23. | Parallel pins confirming appropriate trajectories and acting as guides for subsequent osteotomy. |
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24. | Parallel pins seated in pilot osteotomies indicating their trajectories. |
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25. | Osteotomy being enlarged with a olive green 2.5mm latch reamer rotating at 50 RPM. |
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26. | Dark blue 3.5mm hand reamer attached to a straight handle is being rotated to enlarge the osteotomy. |
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27. | Harvested bone within the flute of dark blue 3.5mm hand reamer. |
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28. | Red 4.0mm hand reamer attached to a straight handle is being rotated to enlarge the osteotomy. |
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29. | Harvested bone within the flute of red 4.0mm hand reamer. |
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30. | Harvested bone within the flute of red 4.0mm hand reamer being placed into a dappin dish. |
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31. | Silver 4.5mm hand reamer attached to a straight handle is being rotated to enlarge the osteotomy. |
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32. | Harvested bone within the flute of the silver 4.5mm hand reamer. |
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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. |
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34. | A 5.0mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver. |
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35. | A 5.0mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver. |
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36. | A 5.0mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver. |
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37. | View of wells of seated implants. |
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38. | Implant seating tip attached to a straight handle is being tapped to seat implant farther into the osteotomy. |
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39. | Cut polyethylene healing plug being inserted into the implant well for two stage placement. |
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40. | Cut polyethylene healing plug being inserted into the implant well for two stage placement. |
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41. | Parallel pins seated in pilot osteotomies indicating their trajectories. |
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42. | Osteotomy being enlarged with a dark blue 3.5mm latch reamer rotating at 50 RPM. |
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43. | Harvested bone within the gold 5.0mm latch reamer. |
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44. | A 5.0mm x 6.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver. |
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45. | A 5.0mm x 6.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver. |
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46. | Cut polyethylene healing plug being inserted into the implant well for two stage placement. |
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47. | Parallel pin confirming appropriate trajectory and acting as a guide for subsequent osteotomy. |
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48. | Parallel pins seated in pilot osteotomies indicating their trajectories. |
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49. | Osteotomy being enlarged with a red 4.0mm latch reamer rotating at 50 RPM. |
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50. | Osteotomy being enlarged with a silver 4.5mm latch reamer rotating at 50 RPM. |
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51. | Osteotomy being enlarged with a gold 5.0mm latch reamer rotating at 50 RPM. |
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52. | Harvested bone within the flute of gold 5.0mm latch reamer being placed into dappin dish. |
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53. | A 5.0mm x 6.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on an implant inserter/retriever. |
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54. | A 5.0mm x 6.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on an implant inserter/retriever. |
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55. | Initial incision. |
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56. | Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation. |
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57. | Parallel pin confirming appropriate trajectory and acting as a guide for subsequent osteotomy. |
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58. | Parallel pin confirming appropriate trajectory and acting as a guide for subsequent osteotomy. |
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59. | Parallel pin confirming appropriate trajectory and acting as a guide for subsequent osteotomy. |
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60. | Parallel pins seated in pilot osteotomies indicating their trajectories. |
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61. | Osteotomy being enlarged with a olive green 2.5mm latch reamer rotating at 50 RPM. |
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62. | Osteotomy being enlarged with a teal 3.0mm latch reamer rotating at 50 RPM. |
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63. | Osteotomy being enlarged with a dark blue 3.5mm latch reamer rotating at 50 RPM. |
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64. | Harvested bone within the flute of dark blue 3.5mm latch reamer. |
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65. | Harvested bone being placed over implant. |
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66. | A 4.5mm x 11.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on an implant inserter/retriever. |
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67. | Implant seating tip attached to a straight handle is being tapped to seat implant farther into the osteotomy. |
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68. | Implant seating tip attached to a straight handle is being tapped to seat implant farther into the osteotomy. |
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69. | View of wells of seated implants. |
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70. | Harvested bone being placed over implant. |
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71. | View of sutured site. |
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72. | Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation. |
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73. | Parallel pins seated in pilot osteotomies indicating their trajectories. |
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74. | Osteotomy being enlarged with a dark blue 3.5mm latch reamer rotating at 50 RPM. |
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75. | Osteotomy being enlarged with a red 4.0mm latch reamer rotating at 50 RPM. |
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76. | Osteotomy being enlarged with a silver 4.5mm latch reamer rotating at 50 RPM. |
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77. | A 5.0mm x 6.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on an implant inserter/retriever. |
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78. | A 5.0mm x 6.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on an implant inserter/retriever. |
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79. | View of sutured site. |
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80. | Post-operative radiograph of seated implants. |
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81. | Inter-arch measurements being recorded nine weeks after the initial implant placements. |
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82. | Cut healing plug is being removed from the well of the implant. |
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83. | Cut healing plug is being removed from the well of the implant. |
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84. | Cut healing plug is being removed from the well of the implant. |
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85. | A 2.0mm guide pin inserted into the well of the implant. |
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86. | Extraction of mandibular premolar. |
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87. | Extraction of mandibular molar. |
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88. | Osteotomy being enlarged with a gold 5.0mm latch reamer rotating at 50 RPM. |
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89. | View of seated implant with polyethylene healing plug. |
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90. | Healing plug being removed from the well of the 5.0mm x 6.0mm HA coated implant. |
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91. | Healing plug being removed from the well of the 5.0mm x 6.0mm HA coated implant. |
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92. | Healing plug being removed from the well of the 5.0mm x 6.0mm HA coated implant. |
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93. | Healing plug being removed from the well of the 5.0mm x 6.0mm HA coated implant. |
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94. | Healing plug being removed from the well of the 5.0mm x 6.0mm HA coated implant. |
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95. | View of 3.0mm guide pins and healing plugs in the wells of 5.0mm x 6.0mm HA coated implants prior to their removal for the implant level transfer impression. |
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96. | View of 3.0mm guide pins seated in the wells of 5.0mm x 6.0mm HA coated implants. |
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97. | Healing plug being removed from the well of the 5.0mm x 6.0mm HA coated implant. |
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98. | Healing plug being removed from the well of the 5.0mm x 6.0mm HA coated implant. |
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99. | View of 3.0mm guide pins seated in the wells of the implants. |
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100. | Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height. |
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101. | Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height. |
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102. | Stealth shouldered abutment 4.0mm wide with a shoulder height of 3.5mm is being inserted into the implant well with only finger pressure. |
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103. | Stealth shouldered abutment 4.0mm wide with a shoulder height of 3.5mm is being inserted into the implant well with only finger pressure. |
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104. | Stealth shouldered abutment 4.0mm wide with a shoulder height of 1.5m is being inserted into the implant well with only finger pressure. |
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105. | Black healing plug being re-inserted for the continued two stage integration of the previously placed implant. |
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106. | Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height. |
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107. | Stealth shouldered abutment 4.0mm wide with a shoulder height of 1.5mm is being inserted into the implant well with only finger pressure. |
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108. | Short acrylic sleeve snapped on to stealth abutment. |
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109. | Short acrylic sleeve snapped on to stealth abutment. |
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110. | Short acrylic sleeve snapped on to stealth abutment. |
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111. | Short acrylic sleeve snapped on to stealth abutment. |
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112. | Short acrylic sleeve snapped on to stealth abutment. |
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113. | Short acrylic sleeve snapped on to stealth abutment. |
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114. | Vacuum formed template seated over abutments and modified sleeves to confirm the appropriateness of their modifications. |
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115. | Vacuum formed template seated over abutments and modified sleeves to confirm the appropriateness of their modifications. |
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116. | Transitional composite material, “Integrity” by Dentsply is being injected into vacuum formed template. |
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117. | Transitional composite material, “Integrity” by Dentsply is being injected into vacuum formed template. |
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118. | Transitional composite material being added to acrylic sleeves to form a transitional prosthesis. |
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119. | Transitional prostheses being formed. |
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120. | Transitional prostheses being formed. |
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121. | Transitional prostheses being formed. |
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122. | Transitional prostheses being formed. |
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123. | Transitional prosthesis being removed for polishing. |
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124. | Polished transitional prostheses being inserted. |
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125. | Polished transitional prostheses being inserted. |
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126. | Polished transitional prostheses being inserted. |
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127. | Polished transitional prostheses being inserted. |
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128. | Etchant being applied in preparation for the bonding of the transitional stabilizing prosthesis. |
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129. | Bonding agent being applied. |
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130. | Bonding agent being applied. |
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131. | Bonding agent being applied. |
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132. | Bonding agent being applied. |
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133. | Bonding agent being applied. |
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134. | Light curing of bonding agent. |
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135. | Additional material being added to prosthesis. |
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136. | Light curing of additional material. |
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137. | Transitional prosthesis being cemented. |
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138. | Transitional prosthesis being cemented. |
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139. | Transitional prosthesis being cemented. |
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140. | Extracted maxillary premolar. |
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141. | Extracted maxillary premolar. |
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142. | Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation. |
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143. | Osteotomy being enlarged with a teal 3.0mm latch reamer bur rotating at 50RPM without water irrigation. |
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144. | Harvested bone within the 3.0mm latch reamer. |
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145. | Clinician’s fingers monitoring the buccal and palatal bone during the preparation of the osteotomy and the harvesting of bone with a silver 4.5mm hand reamer. |
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146. | A 5.0mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver. |
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147. | A 5.0mm x 6.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver. |
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148. | Extracted maxillary cuspid. |
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149. | Extracted maxillary premolar. |
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150. | Extracted maxillary cuspid. |
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151. | Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation. |
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152. | Osteotomy being enlarged with a olive green 2.5mm latch reamer bur rotating at 50RPM without water irrigation. |
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153. | Osteotomy being enlarged with a teal 3.0mm latch reamer bur rotating at 50RPM without water irrigation. |
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154. | Osteotomy being enlarged with a red 4.0mm latch reamer bur rotating at 50RPM without water irrigation. |
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155. | Clinician’s fingers monitoring the buccal and palatal bone during the preparation of the osteotomy and the harvesting of bone with a silver 4.5mm hand reamer. |
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156. | Harvested bone within the silver 4.5mm hand reamer. |
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157. | Harvested bone within the gold 5.0mm hand reamer. |
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158. | A 5.0mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver. |
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159. | View of seated implants with polyethylene healing plugs. |
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160. | Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height. |
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161. | Stealth shouldered abutment 5.0mm wide with a shoulder height of 6.0mm is being inserted into the implant well with only finger pressure. |
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162. | Stealth shouldered abutment 5.0mm wide with a shoulder height of 4.0mm is being inserted into the implant well with only finger pressure. |
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163. | Stealth shouldered abutment 5.0mm wide with a shoulder height of 2.0mm is being inserted into the implant well with only finger pressure. |
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164. | Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height. |
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165. | Stealth shouldered abutment 5.0mm wide with a shoulder height of 2.0mm is being inserted into the implant well with only finger pressure. |
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166. | Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height. |
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167. | Healing plug being removed from the well of the 5.0mm x 6.0mm HA coated implant. |
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168. | Healing plug being removed from the well of the 5.0mm x 6.0mm HA coated implant. |
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169. | Stealth shouldered abutment 5.0mm wide with a shoulder height of 2.0mm is being inserted into the implant well with only finger pressure. |
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170. | Stealth shouldered abutment 5.0mm wide with a shoulder height of 2.0mm is being inserted into the implant well with only finger pressure. |
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171. | Stealth shouldered abutment 5.0mm wide with a shoulder height of 2.0mm is being inserted into the implant well with only finger pressure. |
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172. | Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height. |
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173. | Stealth shouldered abutment 5.0mm wide with a shoulder height of 4.0mm is being inserted into the implant well with only finger pressure. |
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174. | Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height. |
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175. | Stealth shouldered abutment 5.0mm wide with a shoulder height of 2.0mm is being inserted into the implant well with only finger pressure. |
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176. | Stealth shouldered abutment 5.0mm wide with a shoulder height of 2.0mm is being inserted into the implant well with only finger pressure. |
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177. | Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height. |
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178. | Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height. |
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179. | Stealth shouldered abutment 5.0mm wide with a shoulder height of 4.0mm is being inserted into the implant well with only finger pressure. |
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180. | Vacuum formed template seated over abutments to confirm the appropriateness of their placement. |
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181. | Tall acrylic sleeve being modified. |
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182. | Modified tall acrylic sleeve being snapped on to stealth abutment. |
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183. | Modified tall acrylic sleeve being snapped on to stealth abutment. |
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184. | Modified tall acrylic sleeve being snapped on to stealth abutment. |
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185. | Transitional composite material, “Integrity” by Dentsply is being injected into vacuum formed template. |
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186. | Transitional composite material being added to acrylic sleeves to form a transitional prosthesis. |
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187. | Vacuum formed template placed over the strut material. |
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188. | Vacuum formed template being removed. |
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189. | Transitional prosthesis being inserted. |
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190. | Transitional prosthesis being inserted. |
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191. | Transitional prosthesis being inserted. |
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192. | Transitional prosthesis being contoured. |
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193. | Transitional prosthesis being inserted. |
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194. | Bonding agent being applied. |
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195. | Light curing of bonding agent. |
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196. | Occlusal contacts being adjusted. |
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197. | Patient’s smile. |
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198. | Radiograph of immediately placed and functioning implants. |
(NOTE: This is Part Two of a two-part case. Click here to view Part Two .) |
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