Bicon Dental Implants
Tuesday, January 6th 2009 10:05AM EDT

Bicon Integrated Abutment Crowns™ / Immediate Stabilization and Function : Extraction, Placement and Restoration of Immediately Placed and Functioning Maxillary Central Incisor Implant with an Integrated Abutment Crown™
This case demonstrates the extraction of a failed endodontically treated maxillary central incisor and its replacement with an immediately placed and functioning implant as well as its restoration with an Integrated Abutment Crown™ showing a prosthetic technique for masking the metallic graying of thin gingival tissues from the underlying abutment.
     


1. Pre-operative smile.


2. Pre-operative view of discolored maxillary central incisor.


3. Pre-operative radiograph of a failed endodontically treated maxillary central incisor.


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


5. Parallel pin seated in pilot osteotomy indicating its trajectory.


6. Template being used to confirm appropriate trajectory.


7. Clinician’s fingers monitoring the buccal and palatal bone during the preparation of the osteotomy and the harvesting of bone with a blue 3.5mm latch reamer bur rotating at 50RPM without water irrigation.


8. Clinician’s fingers monitoring the buccal and palatal bone during the preparation of the osteotomy and the harvesting of bone with a red 4.0mm hand reamer.


9. Clinician’s fingers monitoring the buccal and palatal bone during the preparation of the osteotomy and the harvesting of bone with a gold 5.0mm hand reamer.


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


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


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


13. Short acrylic sleeve is being snapped on to stealth abutment.


14. Vacuum formed template seated over acrylic sleeve to confirm the appropriateness of its height.


15. Polyceramic material is being added to the labial aspect of the vacuum formed template.


16. Transitional stabilizing prosthesis being light cured.


17. Additional material being added to the prothesis.


18. Transitional crown in place showing gingival discrepancy in length between central incisors.


19. Gingival discrepancy has been corrected by adding composite material to cervical area of the crown to obtain proper gingival contours.


20. Etchant being applied in preparation for the bonding of the transitional stabilizing crown to adjacent teeth.


21. Bonding primer being applied.


22. Bonding agent being applied.


23. Additional composite material being applied to lingual surface to splint crown to adjacent teeth.


24. Composite material is light-cured.


25. Occlusion being adjusted with carbide finishing bur.


26. Radiograph of immediately placed and functioning implant at the completion of the first clinical visit.


27. Bonded stabilizing prosthesis prior to its being removed at the patient’s second clinical visit twelve weeks after the implant placement.


28. View of graying of gingival tissues due to lack of buccal bone and thin gingival tissues.


29. View of implant well after the removal of the transitional prosthesis and the stealth abutment.


30. Green 3.0mm impression reamer being inserted onto guide pin to remove any tissue which might inhibit the complete seating of an impression post.


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


32. Green plastic impression post receiving its mandatory seating tap.


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


34. Digital image being taken of shade guide against a black plastic background to facilitate the fabrication of an aesthetic Integrated Abutment Crown™.


35. Implant well being washed with chlorhexidine prior to placing transitional prosthesis.


36. Transitional Prosthesis in place after impression appointment revealing graying of gingival tissue due to underlying metal abutment.


37. Right profile view revealing lack of facial bone and darkening gingival tissue.


38. Left profile view revealing lack of facial bone and darkening of gingival tissue.


39. Radiograph of integrated implant twelve weeks after implant placement.


40. Integrated Abutment Crown™ on stone model.


41. Integrated Abutment Crown™ on dental model with acrylic orientation jig.


42. Integrated Abutment Crown™ on stone model with yellow thermoplastic seating jig which was fabricated on a caliper like device to facilitate directing the seating forces in the long axis of the implant well and abutment post.


43. View of transitional prosthesis prior to its removal for the insertion of the Integrated Abutment Crown™.


44.

 View of implant well and soft tissue sulcus.


45. Initial seating of Integrated Abutment Crown™.


46. Crestal relieving incision being made to facilitate the seating of the Integrated Abutment Crown™.


47. Integrated Abutment Crown™ with pink material added to mask the graying of the gingival tissue is being inserted.


48. Clear orientation jig facilitates the orientation of Integrated Abutment Crown™.


49. Interproximal contacts being adjusted to achieve passive contacts since too tight interproximal contacts may prevent the engagement of the locking taper and possibly result in subsequent loosening of the restoration.


50. Pink polyceramic material has been replaced with white opaque material to mask the graying of gingival tissues.


51. Integrated Abutment Crown™ being inserted with newly applied opaqued material.


52. Yellow thermoplastic custom seating jig which was formed in a caliper-like device is seated in a crown seating tip attached to a straight handle to facilitate directing the tapping forces in the long axis of the abutment post and implant well.


53. Integrated Abutment Crown™ immediately after insertion.


54. Post-insertion radiograph of Integrated Abutment Crown™.


55. Patient’s smile.


56. Integrated Abutment Crown™ five days after insertion revealing gingival health, and complete masking of metallic graying of gingival tissue.


57. Left profile view.


58. Right profile view.


59. Seven weeks post-insertion image.


60. Three year post-insertion view of left central incisor.


61. Three year post-insertion view of patient smile.


62. Three year post-insertion radiograph.
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