Bicon Dental Implants
Friday, November 21st 2008 4:05PM EDT

Full Arch /Bicon Integrated Abutment Crowns™: Bilateral Sinus Lifts with SynthoGraft™, Two Stage Full Arch Placement of Twelve Maxillary and Two Mandibular Implants, and their Restoration with Fourteen Bicon Integrated Abutment Crowns™
This case demonstrates the use of SynthoGraft™, pure phase Beta-Tricalcium Phosphate, for bilateral sinus lifts, two stage placement and restoration of fourteen implants, implant level transfer impressions, occlusal registration, and insertion of fourteen Integrated Abutment Crowns™ including one two-unit Integrated Abutment Crown™ for the intraoral fabrication of a three unit prosthesis.

 

     
First Clinical Visit:    


1.
 Pre-operative radiograph.


2.
 Initial incision.


3.
 Window being prepared with Bicon sinus lift bur (260-201-029).


4.
 Sinus lift curette being used to elevate sinus membrane.


5.
 Sinus lift curette being used to elevate sinus membrane.


6.
 Venipuncture in the antecubital region of the arm.


7.
 Mixture of patient’s blood and SynthoGraft™, Beta-Tricalcium Phosphate.


8.
 Bicon resorbable collagen membrane being placed into the sinus floor.


9.
 The mixture of patient’s blood and SynthoGraft™, Beta-Tricalcium Phosphate, being injected.


10.
 Osteotomy being prepared with 2.0mm pilot bur rotating at 1100 RPM with external irrigation.


11.
 Parallel pin seated in pilot osteotomy indicating its trajectory.


12.
 Osteotomy being prepared with 2.0mm pilot bur rotating at 1100 RPM with external irrigation.


13.
 Osteotomy being enlarged with an olive green 2.5mm latch reamer rotating at 50 RPM without irrigation.


14.
 Osteotomy being enlarged with a teal 3.0mm latch reamer rotating at 50 RPM without irrigation.


15.
 Osteotomy being enlarged with a dark blue 3.5mm latch reamer rotating at 50 RPM without irrigation.


16.
 Osteotomy being enlarged with a red 4.0mm latch reamer rotating at 50 RPM without irrigation.


17.
 Harvested bone within the flute of the silver 4.5mm hand reamer.


18.
 Osteotomy being enlarged with a gold 5.0mm hand reamer.


19.
 A 4.5 mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant inserter/retriever.


20.
 A 5.0 mm x 6.0mm HA coated implant being inserted into the osteotomy with an implant inserter/retriever.


21.
 Cut polyethylene healing plug being placed into the implant well for two stage implant placement.


22.
 Cut polyethylene healing plug being placed into the implant well for two stage implant placement.


23.
 View of initial incision.


24.
 Osteotomy being prepared with 2.0mm pilot bur rotating at 1100 RPM with external irrigation.


25.
 Parallel pins confirming appropriate trajectories and acting as guides for subsequent osteotomy.


26.
 Maxillary osteotomy being prepared with 2.0mm pilot bur rotating at 1100 RPM with external irrigation.


27.
 Parallel pins seated in pilot osteotomies indicating their trajectories.


28.
 Osteotomy being enlarged with an olive green 2.5mm latch reamer rotating at 50 RPM without irrigation.


29.
 Harvested bone within the flute of an olive green 2.5mm latch reamer.


30.
 Osteotomy being enlarged with a teal 3.0mm latch reamer rotating at 50 RPM without irrigation.


31.
 Osteotomy being enlarged with a dark blue 3.5mm latch reamer rotating at 50 RPM without irrigation.


32.
 Osteotomy being enlarged with a red 4.0mm latch reamer rotating at 50 RPM without irrigation.


33.
 Harvested bone within the flute of a silver 4.5mm hand reamer.


34.
 Harvested bone within the flute of a silver 4.5mm hand reamer being placed into dappin dish.


35.
 A 4.5 mm x 6.0mm HA coated implant being inserted into the osteotomy with an implant inserter.


36.
 A 4.5 mm x 6.0mm HA coated implant being inserted into the osteotomy with an implant inserter.


37.
 A 4.5 mm x 6.0mm HA coated implant being inserted into the osteotomy with an implant inserter.


38.
 An implant being tapped into place.


39.
 A 3.5 x 8.0mm HA coated implant being inserted into the osteotomy with an implant inserter/retriever.


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


41.
 Osteotomy being prepared with 2.0mm pilot bur rotating at 1100 RPM with external irrigation.


42.
 Parallel pin confirming appropriate trajectory and acting as a guide for subsequent osteotomy .


43.
 Osteotomy being enlarged with an olive green 2.5mm latch reamer rotating at 50 RPM without irrigation.


44.
 Osteotomy being enlarged with a teal 3.0mm latch reamer rotating at 50 RPM without irrigation.


45.
 Osteotomy being enlarged with a dark blue 3.5mm latch reamer rotating at 50 RPM without irrigation.


46.
 Osteotomy being enlarged with a red 4.0mm latch reamer rotating at 50 RPM without irrigation.


47.
 Osteotomy being enlarged with a silver 4.5mm hand reamer.


48.
 A 4.5 mm x 6.0mm HA coated implant being inserted into the osteotomy with an implant inserter


49.
 Post operative radiograph
Second Clinical Visit:    


50.
 View of flap being reflected for the grafting of right mandibular molar area with SynthoGraft™, pure phase Beta-Tricalcium Phosphate (Ca3 (PO4)2).


51.
 Venipuncture in the antecubital region of the arm.


52.
 Mixture of patient’s blood and SynthoGraft™, Beta-Tricalcium Phosphate.


53.
 Bicon collagen membrane being placed over the synthograft™, Beta-Tricalcium Phosphate.


54.
 Bicon collagen membrane covering the synthograft™, Beta-Tricalcium Phosphate.


55.
 Sutured site.


56.
 View of torn sinus membrane.


57.
 Bicon’s resorbable collagen membrane being used to bridge the tear for the containment of the SynthoGraft™, Beta-Tricalcium Phosphate, particles.


58.
 The mixture of patient’s blood and SynthoGraft™, Beta-Tricalcium Phosphate, placed into the sinus floor.


59.
 The mixture of patient’s blood and SynthoGraft™, Beta-Tricalcium Phosphate, being placed.


60.
 View of sinus with SynthoGraft™, Beta-Tricalcium Phosphate, in place.


61.
 Sutured site.


62.
 View of extracted tooth.


63.
 View of initial incision.


64.
 Osteotomy being enlarged with an olive green 2.5mm latch reamer rotating at 50 RPM without irrigation.


65.
 Harvested bone within the flute of dark blue 3.5mm latch reamer.


66.
 Osteotomy being enlarged with a silver 4.5mm hand reamer.


67.
 A 4.5 x 6.0mm HA coated implant being inserted into the osteotomy with an implant inserter.


68.
 A 5.0 x 6.0mm HA coated implant being inserted into the osteotomy with an implant inserter.


69.
 Cut polyethylene healing plug being placed into the implant well for two stage placement.


70.
 Osteotomy being prepared with 2.0mm pilot bur rotating at 1100 RPM with external irrigation.


71.
 Osteotomy being prepared with 2.0mm pilot bur rotating at 1100 RPM with external irrigation.


72.
 Osteotomy being enlarged with an olive green 2.5mm latch reamer rotating at 50 RPM without irrigation.


73.
 Osteotomy being enlarged with a teal 3.0mm latch reamer rotating at 50 RPM without irrigation.


74.
 Osteotomy being enlarged with a dark blue 3.5mm latch reamer rotating at 50 RPM without irrigation.


75.
 Osteotomy being enlarged with a red 4.0mm latch reamer rotating at 50 RPM without irrigation.


76.
 Osteotomy being enlarged with a silver 4.5mm latch reamer rotating at 50 RPM without irrigation.


77.
 Harvested bone within the flute of a silver 4.5mm hand reamer.


78.
 Harvested bone within the flute of a gold 5.0mm hand reamer.


79.
 Curette harvesting residual bone while confirming the integrity of the five bony walls of the osteotomy.


80.
 A 5.0 x 6.0mm HA coated implant being inserted into the osteotomy with an implant inserter/retriever.


81.
 A 5.0 x 6.0mm HA coated implant being inserted into the osteotomy with an implant inserter/retriever.


82.
 An implant being tapped into place.


83.
 View of seated implants with their polyethylene healing plugs.


84.
 Cut polyethylene healing plug being placed into the implant well for two stage placement.


85.
 Harvested bone being placed over the shoulder of the implant.


86.
 A stealth shouldered abutment 5.0mm wide with a shoulder height of 4.0 mm being inserted into the implant well with only finger pressure.


87.
 Flap being reflected for the two stage uncovering of the implants.


88.
 Healing plug being removed with a healing plug removal instrument.


89.
 A 5.0mm x 4.0mm 10°stealth shouldered abutment being inserted into the implant well with only finger pressure.


90.
 A 5.0mm x 4.0mm stealth shouldered abutment being inserted into the implant well with only finger pressure.


91.
 A 5.0mm x 4.0mm stealth shouldered abutment being inserted into the implant well with only finger pressure.


92.
 Post operative radiograph


93.
 Tall acrylic sleeve being modified.


94.
 Modified acrylic sleeve being snapped onto stealth abutment.


95.
 Vacuum-formed template seated over acrylic sleeves to check for occlusal clearance.


96.
 Composite material is being injected into vacuum-formed template.


97.
 Composite material, “Integrity by Dentsply”, being added to acrylic sleeves to form a strut.


98.
 Transitional prosthesis being formed.


99.
 Transitional prosthesis incorporating modified stealth acrylic sleeves.


100.
 View of the transitional prosthesis before polishing.
Third Clinical Visit:    


101.
 Osteotomy being prepared with 2.0mm pilot bur rotating at 1100 RPM with external irrigation.


102.
 Paralleling pin confirming appropriate trajectory and acting as a guide for subsequent osteotomy.


103.
 Paralleling pins seated in pilot osteotomies indicating their trajectories.


104.
 Osteotomy being enlarged with an olive green 2.5mm latch reamer rotating at 50 RPM without irrigation.


105.
 Osteotomy being enlarged with a teal 3.0mm latch reamer rotating at 50 RPM without irrigation.


106.
 Osteotomy being enlarged with a dark blue 3.5mm latch reamer rotating at 50 RPM without irrigation.


107.
 Osteotomy being enlarged with a red 4.0mm latch reamer rotating at 50 RPM without irrigation.


108.
 Harvested bone within the flute of red 4.0mm latch reamer being placed into dappin dish.


109.
 Osteotomy being enlarged with a silver 4.5mm latch reamer rotating at 50 RPM without irrigation.


110.
 Harvested bone within the flute of a gold 5.0mm hand reamer.


111.
 A 5.0 x 6.0mm NanoTite™ implant being inserted into the osteotomy with an implant inserter/ retriever.


112.
 A 5.0 x 6.0mm NanoTite™ implant being inserted into the osteotomy with an implant inserter/ retriever.


113.
 Cut polyethylene healing plug being placed into the implant well for two stage placement.


114.
 Harvested bone being placed over the shoulder of the implant.


115.
 Sutured site.


116.
 A short sleeve being snapped onto stealth abutment.


117.
 Fabrication of a single central incisor crown to act as a guide for the labial and midline positioning.


118.
 Confirming vertical dimension of a central incisor guide crown.


119.
 Light curing the single central incisor guide crown.


120.
 Checking the central incisor guide crown for the labial and midline positioning.


121.
 Checking the central incisor guide crown for the labial and midline positioning.


122.
 View of maxillary arch with transitional stealth shouldered abutments.


123.
 A short sleeve being snapped onto stealth abutment.


124.
 View of seated modified acrylic sleeves.


125.
 Composite material, "Integrity by Dentsply", being added to acrylic sleeves to form a strut.


126.
 Composite material, "Integrity by Dentsply", being added to acrylic sleeves to form a transitional prosthesis.


127.
 Composite material is being injected into vacuum-formed template.


128.
 Transitional prosthesis being formed.


129.
 Transitional prosthesis incorporating modified stealth acrylic sleeves.


130.
 View of the transitional prosthesis.
Fourth Clinical Visit:    


131.
 Red acrylic being injected around the impression posts for the recording of an occlusal registration.


132.
 Red acrylic on impression posts for the recording of an occlusal registration.


133.
 View after the removal of the transitional prostheses on the right side.


134.
 Red acrylic being injected around the impression posts.


135.
 Midline being marked on the red acrylic.


136.
 View of occlusal registration with marked midline.


137.
 High lip line being marked.


138.
 Occlusal registration being removed.


139.
 Scissors reflecting flap revealing black polyethylene healing plug prior to its removal.


140.
 Healing plug removed from the well of the implant with a healing plug remover.


141.
 A 3.0mm titanium impression post being seated into the well of an integrated implant for the making of an implant level transfer impression.


142.
 A green 3.0mm plastic sleeve being snapped onto the 3.0mm titanium impression post.


143.
 Healing plug being removed from the well of the implant with a healing plug remover.


144.
 A 2.0mm titanium impression post being seated into the well of an integrated implant for the making of an implant level transfer impression.


145.
 Healing plug being removed from the well of the implant with a healing plug remover.


146.
 A 3.0mm titanium impression post being seated into the well of an integrated implant for the making of an implant level transfer impression.


147.
 A red 2.0mm plastic sleeve being snapped onto the 2.0mm titanium impression post.


148.
 Incision being made for the uncovering of the implant.


149.
 Healing plug being removed from the well of the implant with a healing plug remover.


150.
 A 4.0mm x 3.5mm stealth shouldered abutment being removed.


151.
 A 3.0mm titanium impression post being seated into the well of an integrated implant for the making of an implant level transfer impression.


152.
 Healing plug being removed from the well of the implant with a healing plug remover.


153.
 Impression material being injected around the impression sleeves for the making of a full arch implant level transfer impression.


154. View of trimmed black polyethylene healing plug seated in the well of the implant.


155. Healing plug being removed from the well of the implant with a healing plug remover.


156. A 2.0mm titanium impression post being seated into the well of an integrated implant for the making of an implant level transfer impression.


157. A red 2.0mm plastic sleeve being snapped onto the 2.0mm titanium impression post.


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


159. Digital image being taken of shade guide to facilitate the fabrication of aesthetic Integrated Abutment Crowns™.
Fifth Clinical Visit:    


160. Mandibular Integrated Abutment Crowns™ on stone model.


161. View of Integrated Abutment Crowns™.


162. Maxillary Integrated Abutment Crowns™ on stone model.


163. View of Integrated Abutment Crowns™.


164. 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.


165. View of implant wells and soft tissue sulci.


166. Integrated Abutment Crown™ being inserted.


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


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


169. Integrated Abutment Crown™ being inserted.


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


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


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


173. Integrated Abutment Crown™ being inserted.


174. Integrated Abutment Crown™ being inserted.


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


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


177. Integrated Abutment Crown™ being inserted.


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


179. Integrated Abutment Crown™ being inserted.


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


181. Integrated Abutment Crown™ being inserted.


182. 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.


183. Interproximal contact being adjusted with metal finishing strip.


184. Interproximal contact being adjusted.


185. 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.


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


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


188. 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.


189. Composite being added to interproximal surface for intraoral bonding.


190. The cantilevered Integrated Abutment Crown™ being seated prior to its being bonded intraorally for the fabrication of a three-unit fixed prosthesis.


191. Light curing of the added composite material for the fabrication of a three-unit fixed prosthesis.


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


193. Facial view immediately after insertion of Integrated Abutment Crowns™.


194. Patient’s smile immediately after insertion of Integrated Abutment Crowns™.


195. Integrated Abutment Crown™ being adjusted.


196. Left profile view.


197. Right profile view.


198. View immediately after adjusting Integrated Abutment Crowns™.


199. Patient’s smile immediately after adjusting Integrated Abutment Crown™.


200. Post operative radiograph after the insertion of Integrated Abutment Crowns™.


201. Left profile view two-months post insertion.


202. Right profile view two-months post insertion.


203. Facial view two-months post insertion.
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