Bicon Dental Implants
Friday, November 21st 2008 11:49AM EDT

Bicon Integrated Abutment Crowns™: Maxillary Ridge Split, Two Stage Placements of Four Anterior Implants, Implant Level Transfer Impression, and their Restoration with Integrated Abutment Crowns™
This case demonstrates a maxillary ridge split, two stage placements of four anterior implants, implant level transfer impression and their routine restoration with Integrated Abutment Crowns™ despite the extreme trajectories of the implants.

 

    


1. Pre-operative radiograph.


2. Pre-operative smile.


3. Pre-operative site.


4. Flap being reflected.


5. Alveolar ridge initially being marked with a #15 blade prior to being split with osteotomes.


6. High speed #171 bur being used to create a starting point for the osteotomes.


7. Ridge being split by the use of successively larger osteotomes.


8. Ridge being split by the use of successively larger osteotomes.


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


10. Parallel pins confirming appropriate trajectories and acting as guides for subsequent osteotomies.


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


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


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


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


15. Osteotomy being enlarged with a blue 3.5mm hand reamer while the surgeon's finger is monitoring the buccal bone.


16. Osteotomy being enlarged with a red 4.0mm hand reamer while the surgeon's finger is monitoring the buccal bone.


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


18. Depth gauge seated in the osteotomy facilitates the selection of an implant with an appropriate length.


19. A 4.0mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


20. A 4.0mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


21. A 4.5mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


22. A 4.5mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.


23. View of the wells of the seated implants.


24. Black polyethylene healing plug being trimmed with a healing plug cutter.


25. View of the wells of the implants with trimmed polyethylene healing plugs in place.


26. Harvested autogenous bone placed over the implants.


27. Harvested bone being packed with a cotton tipped applicator.


28. Post-operative radiograph.


29. View of operative site prior to the uncovering of the implants ten months after the ridge split and implant placements.


30. Initial incision.


31. Trimmed polyethylene healing plug being removed with a #110 reamer.


32. Trimmed polyethylene healing plug removed from the uncovered implant well with a healing plug removal instrument.


33. Trimmed polyethylene healing plug removed from the uncovered implant well with a #110 reamer.


34. Red 2.0mm impression reamer being inserted onto guide pin to remove any tissue which might inhibit the complete seating of an impression post.


35. View of trimmed healing plug removed from the implant well with healing plug removal instrument.


36. Red 2.0mm plastic impression post being inserted into the 2.0mm well of an integrated implant for the making of an implant level transfer impression prior to floss being used to confirm the lack of contact between the red and green plastic impression posts.


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


38. Sutured site with two white plastic healing abutments, modified green 3.0mm plastic impression and red 2.0mm plastic impression post.


39. Red 2.0mm plastic impression post being trimmed for clearance prior to insertion of patient's prosthesis.


40. Patient's prosthesis being reinserted.


41. Integrated Abutment Crowns™ on stone model.


42. Palatal view of Integrated Abutment Crowns™ on stone model.


43. Yellow thermoplastic seating jig being fabricated on a crown alignment device to facilitate directing the seating forces in the long axis of the implant well and abutment post.


44. Yellow thermoplastic seating jig being fabricated on a crown alignment device to facilitate directing the seating forces in the long axis of the implant well and abutment post.


45. Yellow thermoplastic seating jig being fabricated on a crown alignment device to facilitate directing the seating forces in the long axis of the implant well and abutment post.


46. View of maxillary right central incisor Integrated Abutment Crown™. Note the angle of the abutment post.


47. Operative site prior to the removal of the healing abutments and modified plastic impression posts one month after the full arch implant level transfer impression was taken.


48. Healing abutment being removed in preparation for the insertion of Integrated Abutment Crowns™.


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


50. Integrated Abutment Crown™ being inserted.


51. 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.


52. 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.


53. Healing abutment being removed in preparation for the insertion of Integrated Abutment Crown™.


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


55. Integrated Abutment Crown™ being inserted.


56. 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.


57. Blue markings indicate excessive interproximal contacts which must be adjusted to assure passive contact for the engagement of the locking taper connection.


58. Interproximal contacts being adjusted.


59. View of seated maxillary right central and lateral incisor Integrated Abutment Crowns™.


60. Modified green plastic impression post being removed in preparation for the insertion of Integrated Abutment Crown™.


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


62. View of maxillary left lateral incisor Integrated Abutment Crown™. Note the extreme angle of the abutment post.


63. Integrated Abutment Crown™ being inserted.


64. 360° universal positioning demonstrates the severe angulation of the Integrated Abutment Crown™.


65. 360°universal positioning demonstrates the severe angulation of the Integrated Abutment Crown™.


66. 360°universal positioning demonstrates the severe angulation of the Integrated Abutment Crown™.


67. 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.


68. An acrylic orientation jig being used to initially position the Integrated Abutment Crown™.


69. Modified red plastic impression post being removed in preparation for the insertion of an Integrated Abutment Crown™.


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


71. Maxillary left central incisor Integrated Abutment Crown™ being inserted.


72. Blue markings indicate excessive interproximal contacts which must be adjusted to assure passive contact for the engagement of the locking taper connection.


73. Interproximal contacts being adjusted.


74. Diamond finishing strip being used to lighten the interproximal contact area eliminating the possibility that the contact may prevent the engagement of the locking taper connection.


75. 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.


76. Articulating paper being used to confirm incisal contacts in all extreme excursions while the patient is clenching.


77. Articulating paper being used to confirm incisal contacts in all extreme excursions while the patient is clenching.


78. Incisal view of Integrated Abutment Crowns™.


79. View of seated Integrated Abutment Crowns™ immediately after their insertion.


80. Post-operative radiograph revealing the relative trajectories of the implants and crowns.


81. Right side profile of patient's smile one year post-insertion.


82. Left side profile of patient's smile one year post-insertion.


83. Close-up of facial view one year post-insertion.


84. View of patient’s smile one year post-insertion.


85. Radiograph one year post-insertion.
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