Bicon Dental Implants
Friday, November 21st 2008 4:13PM EDT

Full Arch / Short Implants / Immediate Stabilization and Function / Bicon Integrated Abutment Crowns™: 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.
Before
Before
Before

After

After

After



 

(NOTE: This is Part One of a two-part case. Click here to view Part Two.)

 

    


1.
 Pre-operative radiograph.


2.
 Pre-operative smile.


3.
 Facial view of pre-operative site with patient’s original prostheses.


4.
 Pre-operative smile without patient’s original prostheses.


5.
 Facial view of pre-operative site.


6.
 Left side view of pre-operative site.


7.
 Right side view of pre-operative site.


8.
 Template being used to confirm appropriate trajectories.


9.
 Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.


10.
 Osteotomy being enlarged with a teal 3.0mm latch reamer rotating at 50 RPM.


11.
 Osteotomy being enlarged with a dark blue 3.5mm latch reamer rotating at 50 RPM.


12.
 Osteotomy being enlarged with a red 4.0mm latch reamer rotating at 50 RPM.


13.
 Osteotomy being enlarged with a silver 4.5mm latch reamer rotating at 50 RPM.


14.
 Osteotomy being enlarged with a gold 5.0mm latch reamer rotating at 50 RPM.


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.


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.


17.
 Implant seating tip attached to an offset handle is being tapped to seat implant farther into the osteotomy.


18.
 Cut polyethylene healing plug being inserted into the implant well for two stage placement.


19.
 Cut polyethylene healing plug being inserted into the implant well for two stage placement.


20.
 Flap being elevated.


21.
 Template being used to confirm appropriate trajectories.


22.
 Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.


23.
 Parallel pins confirming appropriate trajectories and acting as guides for subsequent osteotomy.


24.
 Parallel pins seated in pilot osteotomies indicating their trajectories.


25.
 Osteotomy being enlarged with a olive green 2.5mm latch reamer rotating at 50 RPM.


26.
 Dark blue 3.5mm hand reamer attached to a straight handle is being rotated to enlarge the osteotomy.


27.
 Harvested bone within the flute of dark blue 3.5mm hand reamer.


28.
 Red 4.0mm hand reamer attached to a straight handle is being rotated to enlarge the osteotomy.


29.
 Harvested bone within the flute of red 4.0mm hand reamer.


30.
 Harvested bone within the flute of red 4.0mm hand reamer being placed into a dappin dish.


31.
 Silver 4.5mm hand reamer attached to a straight handle is being rotated to enlarge the osteotomy.


32.
 Harvested bone within the flute of the silver 4.5mm hand reamer.


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


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.


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.


37.
 View of wells of seated implants.


38.
 Implant seating tip attached to a straight handle is being tapped to seat implant farther into the osteotomy.


39.
 Cut polyethylene healing plug being inserted into the implant well for two stage placement.


40.
 Cut polyethylene healing plug being inserted into the implant well for two stage placement.


41.
 Parallel pins seated in pilot osteotomies indicating their trajectories.


42.
 Osteotomy being enlarged with a dark blue 3.5mm latch reamer rotating at 50 RPM.


43.
 Harvested bone within the gold 5.0mm latch reamer.


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.


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.


46.
 Cut polyethylene healing plug being inserted into the implant well for two stage placement.


47.
 Parallel pin confirming appropriate trajectory and acting as a guide for subsequent osteotomy.


48.
 Parallel pins seated in pilot osteotomies indicating their trajectories.


49.
 Osteotomy being enlarged with a red 4.0mm latch reamer rotating at 50 RPM.


50.
 Osteotomy being enlarged with a silver 4.5mm latch reamer rotating at 50 RPM.


51.
 Osteotomy being enlarged with a gold 5.0mm latch reamer rotating at 50 RPM.


52.
 Harvested bone within the flute of gold 5.0mm latch reamer being placed into dappin dish.


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.


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.


55.
 Initial incision.


56.
 Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.


57.
 Parallel pin confirming appropriate trajectory and acting as a guide for subsequent osteotomy.


58.
 Parallel pin confirming appropriate trajectory and acting as a guide for subsequent osteotomy.


59.
 Parallel pin confirming appropriate trajectory and acting as a guide for subsequent osteotomy.


60.
 Parallel pins seated in pilot osteotomies indicating their trajectories.


61.
 Osteotomy being enlarged with a olive green 2.5mm latch reamer rotating at 50 RPM.


62.
 Osteotomy being enlarged with a teal 3.0mm latch reamer rotating at 50 RPM.


63.
 Osteotomy being enlarged with a dark blue 3.5mm latch reamer rotating at 50 RPM.


64.
 Harvested bone within the flute of dark blue 3.5mm latch reamer.


65.
 Harvested bone being placed over implant.


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.


67.
 Implant seating tip attached to a straight handle is being tapped to seat implant farther into the osteotomy.


68.
 Implant seating tip attached to a straight handle is being tapped to seat implant farther into the osteotomy.


69.
 View of wells of seated implants.


70.
 Harvested bone being placed over implant.


71.
 View of sutured site.


72.
 Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.


73.
 Parallel pins seated in pilot osteotomies indicating their trajectories.


74.
 Osteotomy being enlarged with a dark blue 3.5mm latch reamer rotating at 50 RPM.


75.
 Osteotomy being enlarged with a red 4.0mm latch reamer rotating at 50 RPM.


76.
 Osteotomy being enlarged with a silver 4.5mm latch reamer rotating at 50 RPM.


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.


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.


79.
 View of sutured site.


80.
 Post-operative radiograph of seated implants.


81.
 Inter-arch measurements being recorded nine weeks after the initial implant placements.


82.
 Cut healing plug is being removed from the well of the implant.


83.
 Cut healing plug is being removed from the well of the implant.


84.
 Cut healing plug is being removed from the well of the implant.


85.
 A 2.0mm guide pin inserted into the well of the implant.


86.
 Extraction of mandibular premolar.


87.
 Extraction of mandibular molar.


88.
 Osteotomy being enlarged with a gold 5.0mm latch reamer rotating at 50 RPM.


89.
 View of seated implant with polyethylene healing plug.


90.
 Healing plug being removed from the well of the 5.0mm x 6.0mm HA coated implant.


91.
 Healing plug being removed from the well of the 5.0mm x 6.0mm HA coated implant.


92.
 Healing plug being removed from the well of the 5.0mm x 6.0mm HA coated implant.


93.
 Healing plug being removed from the well of the 5.0mm x 6.0mm HA coated implant.


94.
 Healing plug being removed from the well of the 5.0mm x 6.0mm HA coated implant.


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.


96.
 View of 3.0mm guide pins seated in the wells of 5.0mm x 6.0mm HA coated implants.


97.
 Healing plug being removed from the well of the 5.0mm x 6.0mm HA coated implant.


98.
 Healing plug being removed from the well of the 5.0mm x 6.0mm HA coated implant.


99.
 View of 3.0mm guide pins seated in the wells of the implants.


100.
 Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height.


101.
 Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height.


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.


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.


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.


105.
 Black healing plug being re-inserted for the continued two stage integration of the previously placed implant.


106.
 Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height.


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.


108.
 Short acrylic sleeve snapped on to stealth abutment.


109.
 Short acrylic sleeve snapped on to stealth abutment.


110.
 Short acrylic sleeve snapped on to stealth abutment.


111.
 Short acrylic sleeve snapped on to stealth abutment.


112.
 Short acrylic sleeve snapped on to stealth abutment.


113.
 Short acrylic sleeve snapped on to stealth abutment.


114.
 Vacuum formed template seated over abutments and modified sleeves to confirm the appropriateness of their modifications.


115.
 Vacuum formed template seated over abutments and modified sleeves to confirm the appropriateness of their modifications.


116.
 Transitional composite material, “Integrity” by Dentsply is being injected into vacuum formed template.


117.
 Transitional composite material, “Integrity” by Dentsply is being injected into vacuum formed template.


118.
 Transitional composite material being added to acrylic sleeves to form a transitional prosthesis.


119.
 Transitional prostheses being formed.


120.
 Transitional prostheses being formed.


121.
 Transitional prostheses being formed.


122.
 Transitional prostheses being formed.


123.
 Transitional prosthesis being removed for polishing.


124.
 Polished transitional prostheses being inserted.


125.
 Polished transitional prostheses being inserted.


126.
 Polished transitional prostheses being inserted.


127.
 Polished transitional prostheses being inserted.


128.
 Etchant being applied in preparation for the bonding of the transitional stabilizing prosthesis.


129.
 Bonding agent being applied.


130.
 Bonding agent being applied.


131.
 Bonding agent being applied.


132.
 Bonding agent being applied.


133.
 Bonding agent being applied.


134.
 Light curing of bonding agent.


135.
 Additional material being added to prosthesis.


136.
 Light curing of additional material.


137.
 Transitional prosthesis being cemented.


138.
 Transitional prosthesis being cemented.


139.
 Transitional prosthesis being cemented.


140.
 Extracted maxillary premolar.


141.
 Extracted maxillary premolar.


142.
 Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.


143.
 Osteotomy being enlarged with a teal 3.0mm latch reamer bur rotating at 50RPM without water irrigation.


144.
 Harvested bone within the 3.0mm latch reamer.


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.


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.


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.


148.
 Extracted maxillary cuspid.


149.
 Extracted maxillary premolar.


150.
 Extracted maxillary cuspid.


151.
 Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.


152.
 Osteotomy being enlarged with a olive green 2.5mm latch reamer bur rotating at 50RPM without water irrigation.


153.
 Osteotomy being enlarged with a teal 3.0mm latch reamer bur rotating at 50RPM without water irrigation.


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


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.


156. Harvested bone within the silver 4.5mm hand reamer.


157. Harvested bone within the gold 5.0mm hand reamer.


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.


159. View of seated implants with polyethylene healing plugs.


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


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.


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.


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.


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


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.


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


167. Healing plug being removed from the well of the 5.0mm x 6.0mm HA coated implant.


168. Healing plug being removed from the well of the 5.0mm x 6.0mm HA coated implant.


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.


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.


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.


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


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.


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


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.


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.


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


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


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.


180. Vacuum formed template seated over abutments to confirm the appropriateness of their placement.


181. Tall acrylic sleeve being modified.


182. Modified tall acrylic sleeve being snapped on to stealth abutment.


183. Modified tall acrylic sleeve being snapped on to stealth abutment.


184. Modified tall acrylic sleeve being snapped on to stealth abutment.


185. Transitional composite material, “Integrity” by Dentsply is being injected into vacuum formed template.


186. Transitional composite material being added to acrylic sleeves to form a transitional prosthesis.


187. Vacuum formed template placed over the strut material.


188. Vacuum formed template being removed.


189. Transitional prosthesis being inserted.


190. Transitional prosthesis being inserted.


191. Transitional prosthesis being inserted.


192. Transitional prosthesis being contoured.


193. Transitional prosthesis being inserted.


194. Bonding agent being applied.


195. Light curing of bonding agent.


196. Occlusal contacts being adjusted.


197. Patient’s smile.


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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