Bicon Dental Implants
Sunday, March 14th 2010 4:45AM EDT

Bicon Integrated Abutment Crowns™: Extraction Site Preparation with Bicon Resorbable Collagen Membrane, Amalgam Stain Removal and Placement of Alloderm Connective Tissue Graft, Placement, Temporization and Restoration of Two Maxillary Anterior Implants with a Veneer and Two Integrated Abutment Crowns™
This case demonstrates the treatment sequencing of extraction site preparation with Bicon Resorbable Collagen Membrane, removal of amalgam stain and placement of Alloderm connective tissue graft, implant placements, temporizations and restoration of two maxillary anterior implants with Integrated Abutment Crowns™ as well as the cementing of polyceramic veneer to the left lateral incisor.

Before
Before

After

After



     


1. Pre-operative radiograph,


2. Post-operative radiograph of maxillary left canine implant.


3. Surgical site receiving graft to restore missing buccal plate in preparation for implant placement.


4. Graft in place and extraneous amalgam tattoo evident over adjacent teeth.


5. Bicon resorbable membrane in place covering the graft.


6. Closure of the flap.


7. Site four months later prior to implant placement.


8. Exposed graft.


9. Paralleling pin in osteotomy confirming appropriate trajectory of osteotomy.


10. Bicon Resorbable Collagen Membrane being placed over buccal
shoulder of the implant with harvested bone from osteotomy.


11. View of Bicon Resorbable Collagen Membrane and polyethylene
healing plug.


12. Membrane in place over implant.


13. Sutured flap.


14. Site prior to the surgical removal of amalgam tattoo seven months
after the placement of the graft.


15. The entire area of amalgam tattoo is outlined with the initial incision.


16. Deeply stained tissue beneath raised flap.


17. Excised stained tissue.


18. View of stained apical bone.


19. Stain in bone being removed with a surgical bur.


20. Surgical site being measured for AlloDerm graft.


21. A strip of AlloDerm in place to determine appropriate size.


22. Connective tissue graft in place.


23. Initial 5.0 gut suture in place.


24. Peripheral gut sutures in place.


25. Final sutures including stabilizing cross vicryl sutures.


26. Post-operative radiograph prior to uncovering implant and insertion of transitional crown.


27. One-week post operative view.


28. Two-week post operative view.


29. One-month post operative view.


30. Transitional prosthesis prior to its being removed for a full arch implant level transfer impression ten-months after implant placement.


31. View of implant well and soft tissue sulci after the removal of the transitional prosthesis and the stealth abutment.


32. View of implant well and soft tissue sulci.


33. 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.


34. 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.


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


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


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


38. Post-operative radiograph.


39. View of transitional prosthesis prior to its removal for the insertion of the Integrated Abutment Crowns™ nine months after the implant level transfer impression.


40. Integrated Abutment Crowns™ on stone model.


41. Integrated Abutment Crowns™ on stone model with yellow thermoplastic seating jigs which were fabricated on a crown alignment device to facilitate directing the seating forces in the long axis of the implant well and abutment post.


42 View of temporary prosthesis being removed for the insertion of the Integrated Abutment Crowns™.


43. View of implant wells and soft tissue sulci.


44. Polyceramic veneer initially being seated on the left lateral incisor.


45. A clear acrylic orientation jig is being used to initially position the Integrated Abutment Crown™.


46. Articulating paper being used to confirm interproximal contacts.


47. View of left central incisor Integrated Abutment Crown™. Note the prominent facial contour which will subsequently be reduced.


48. Pink silicone polishing wheel adjusting the interproximal contacts and reducing the facial contour of the Integrated Abutment Crown™.


49. Polishing with soft white bristle brush.


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


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


52. Yellow thermoplastic custom seating jig which was formed with a crown alignment 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. Well of implant being cleaned with alcohol on a cotton tipped applicator.


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


55. Integrated Abutment Crown™ being inserted.


56. Articulating paper being used to confirm interproximal contacts.


57. Adjustment of interproximal contact. Since a too tight interproximal contact will prevent the engagement of the locking taper and possibly result in subsequent loosening of the Integrated Abutment Crown™.


58. Floss being used to confirm the fact that the inter-proximal contacts are passive and will not interfere with the engagement of the locking taper.


59. Yellow thermoplastic custom seating jig which was formed with a crown alignment 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.


60. Patient’s smile with initially seated Integrated Abutment Crowns™ and a polyceramic veneer.


61. Close-up view.


62. Facial view.


63. Facial view.


64. Vaseline being applied to the left lateral incisor prior to cementing the polyceramic veneer.


65. The surface of the veneer being roughened with a bur in preparation for the bonding.


66. Bonding primer agent being applied.


67. Bonding agent being applied.


68. Bonding agent being applied.


69. Light curing of bonding agent.


70. Polyceramic material being added.


71. Clear plastic strip used to preserve interproximal contacts.


72. Light curing of the added polyceramic material.


73. The interior of the veneer being etched.


74. Bonding agent being applied.


75. Etchant being applied in preparation for the bonding of the veneer.


76. Bonding agent being applied to the left lateral incisor.


77. Bonding agent being applied.


78. Cement being applied.


79. Veneer being cemented.


80. Post-operative radiograph.


81. View of seated Integrated Abutment Crowns™ and a polyceramic veneer three days post insertion.


82. Incisal view.


83. Right profile view.


84. Left profile view.


85. Facial View.


86. Right profile view.


87. Left profile view.
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