Bicon Dental Implants
Friday, November 21st 2008 6:15PM EDT

Immediate Stabilization and Function / Polyceramic Material Fused to Metal / Bicon Integrated Abutment Crowns™:

Placement of Seven Immediately Functioning Mandibular Implants and their Restoration with six Integrated Abutment Crowns™ and a Three Unit Fixed Polyceramic to Metal Bridge
 This case demonstrates a patient’s attempt to solve his frustration with failed root canal and conventional restorative treatments by using plumber’s cement to rescue his mandibular fixed prosthesis as well as the insertion of seven implants and their restoration with six Integrated Abutment Crowns™ and a three unit fixed polyceramic to metal bridge.

 

    


1. Pre-operative radiograph of failed endodontically treated teeth.


2. Pre-operative site revealing black plumber's cement attempting to secure failed prosthesis.


3. Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM.


4. Pilot bur preparing osteotomy parallel to the inserted parallel pins


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


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


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


8. Osteotomy being enlarged with a 4.5mm latch reamer bur rotating at 50RPM without water irrigation.


9. Harvested bone collected in silicone dappen dish.


10. A 4.5mm x 8.0mm HA coated implant being inserted into osteotomy with an inserter retriever instrument on a threaded knob.


11. A 4.5mm x 8.0mm HA coated implant being inserted into osteotomy with an inserter retriever instrument on a threaded knob.


12. A 4.5mm x 8.0mm HA coated implant being inserted into osteotomy with an inserter retriever instrument on a threaded knob.


13. A 4.5mm x 8.0mm HA coated implant being inserted into osteotomy with an inserter retriever instrument on a threaded knob.


14. A 4.5mm x 8.0mm HA coated implant being inserted into osteotomy with an inserter retriever instrument on a threaded knob.


15. A 4.5mm x 8.0mm HA coated implant being inserted into osteotomy with an inserter retriever instrument on a threaded knob.


16. Implant being definitively seated into its osteotomy by tapping on an offset driver attached to an implant seating tip.


17. Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM.


18. Pilot bur preparing osteotomy parallel to the inserted parallel pin.


19. Pilot bur preparing osteotomy parallel to the inserted parallel pins.


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


21. Osteotomy being enlarged with a 4.5mm latch reamer bur rotating at 50RPM without water irrigation.


22. A 4.5mm x 8.0mm HA coated implant being inserted into osteotomy with an inserter retriever instrument on a threaded knob.


23. A 4.5mm x 8.0mm HA coated implant being inserted into osteotomy with an inserter retriever instrument on a threaded knob.


24. Implant being definitively seated into its osteotomy by tapping on an offset driver attached to an implant seating.


25. Black polyethylene healing plugs in implant wells prior to their replacement with titanium stealth abutments.


26. A 5.0mm tall acrylic sleeve on stealth abutment being inserted into the well of the implant.


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


28. A 5.0mm short acrylic sleeve on stealth abutment being inserted into the well of the implant.


29. Seated stealth shouldered abutments with acrylic sleeves.


30. Acrylic sleeves being adjusted for occlusal clearance.


31. Modified acrylic sleeve.


32. Vacuum formed template seated over modified acrylic sleeves to confirm the occlusal clearance.


33. Bonding agent being applied to acrylic sleeves.


34. Light curing of bonding agent.


35. Polyceramic material being added to acrylic sleeve to form a bonded strut between adjacent implants.


36. Light curing of vacuum formed template placed over the strut material


37. Bonding agent being applied to strut.


38. Transitional composite material being injected into vacuum formed template.


39. Additional polyceramic material in vacuum formed template being added to the hardened strut for aesthetic contouring.


40. Transitional composite prosthesis incorporating modified acrylic sleeves snapped onto abutments.


41. View of transitional stabilizing prosthesis in place.


42. Radiograph of immediately placed and functioning implants with transitional stabilizing prosthesis.


43. View of transitional prosthesis six months after implant placement and the removal of the most posterior right implant.


44. View of transitional abutments after removal of splinted prosthesis.


45. View of red acrylic resin on a green impression post recording the occlusal relationship while the transitional prosthesis is in place.


46. Green 3.0 mm plastic impression post being inserted into the 3.0 mm implant well.


47. Red acrylic on impression posts recording an occlusal registration.


48. Occlusal registration being removed from implant wells.


49. View of implant wells after the removal of the transitional prosthesis and the stealth abutments.


50. Green 3.0 mm plastic impression post being inserted into the 3.0 mm implant well.


51. Green 3.0 mm plastic impression post being inserted into the 3.0 mm implant well.


52. View of seated impression posts after being tapped into the well of their implant.


53. Impression material being injected around impression posts for the making of an implant level transfer impression.


54. Impression post being tapped out of implant well.


55. Transitional prosthesis being re-inserted.


56. Milled abutments and occlusal registration rims on dental models.


57. View of transitional abutments after removal of splinted prosthesis one month after the patient’s second visit.


58. Milled posterior abutment being inserted into metal prosthesis.


59. Prosthesis being used to position milled posterior abutment.


60. Milled anterior abutment being inserted into metal prosthesis.


61. Prosthesis being used to insert milled abutments into the well of their implants.


62. Transitional stealth abutment being removed.


63. An abutment prepared for an Integrated Abutment Crown™ being inserted into the well of an implant.


64. An abutment prepared for an Integrated Abutment Crown™ being inserted into the well of an implant.


65. Sulcus reamer being inserted into a seated guide pin to remove soft tissue and bony interference for the seating of a prepared Integrated Abutment Crown™ abutment.


66. An abutment prepared for an Integrated Abutment Crown™ being inserted into the well of an implant.


67. Occlusal registration rim being used to position cantilevered Integrated Abutment Crown™ abutment into the well of its implant.


68. Occlusal registration and anterior aesthetic being established.


69. Transitional prosthesis being re-inserted.


70. Orientation jig on Integrated Abutment Crowns™ and three unit fixed prosthesis.


71. Mirror view of Integrated Abutment Crowns™ and three unit fixed prosthesis.


72. View of implant wells after the removal of the transitional prosthesis and the stealth abutments.


73. Posterior milled abutment being inserted into prosthesis.


74. Prosthesis being used to position milled abutment into the well of its implant.


75. Three unit prosthesis preliminarily positioned with only posterior abutment.


76. Integrated Abutment Crown™ being inserted to facilitate the positioning of adjacent three unit prosthesis.


77. Anterior milled abutment being inserted into prosthesis.


78. Prosthesis being used to position anterior abutment into the well of its implant.


79. Dental floss indicates an inappropriately too tight interproximal contact.


80. Prosthesis is being re-inserted with only the anterior abutment to facilitate establishing an appropriate interproximal relationship.


81. Posterior abutment is being re-inserted after an appropriate anterior interproximal relationship was established.


82. View of preliminarily positioned prosthesis prior to radiographic confirmation of its adaptation.


83. Posterior abutment receiving a preliminary seating tap.


84. Anterior abutment receiving a preliminary seating tap with the aid of an orientation jig.


85. Anterior abutment receiving a definitive seating tap in the long axis of its implant well and abutment post.


86. Re-inserted prosthesis reveals blanching of soft tissue beneath pontic.


87. Crestal relieving incision being made to accommodate pontic.


88. Integrated Abutment Crown™ being re-inserted after definitive seating of fixed posterior prosthesis.


89. Orientation jig being used to facilitate positioning of Integrated Abutment Crown™.


90. Polishing strip being used to adjust an inappropriately tight interproximal contact.


91. A custom yellow seating jig is being used to direct the seating forces in the long axis of the implant well and abutment post.


92. Integrated Abutment Crown™ being inserted.


93. A custom yellow seating jig is being used to direct the seating forces in the long axis of the implant well and abutment post.


94. Integrated Abutment Crown™ being inserted.


95. Integrated Abutment Crown™ receiving a preliminary seating tap with the aid of an orientation jig.


96. Integrated Abutment Crown™ being inserted.


97. View of prostheses immediately after being seated.


98. Post-operative radiograph of seated Integrated Abutment Crowns™ and three unit fixed prosthesis.


99. View of prostheses one month after insertion.
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