This case demonstrates the placement and immediate loading of two implants one after an extraction and the other after a ridge split. It also demonstrates the temporization, transfer impression, laboratory fabrication and clinical insertion of two Bicon Integrated Abutment Crowns™.
SURGICAL: Extraction Immediate Placement Ridge Splits
RESTORATIVE: Integrated Abutment Crowns™
TOPICS: Crestal Relieving Incision Crown Insertion Impression
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Preoperative smile.
Preoperative site.
Preoperative radiograph.
Extraction site.
Extracted tooth.
Operative site.
Fissure bur initiating ridge split.
Fissure bur preparing ridge split.
Chisel splitting ridge.
Chisel being removed from split ridge.
Pilot bur in extraction site.
Pilot bur in ridge split.
Pilot bur in ridge split.
Latch reamer preparing osteotomy.
Hand reamer preparing osteotomy.
Hand dilator preparing osteotomy.
Insertion of a 4.0mm x 8.0mm HA coated implant into ridge split site.
Insertion of a 5.0mm x 8.0mm TPS coated implant into extraction site.
Final seating of implant with implant inserter/retriever instrument.
View of seated implants.
Shoulder depth gauge indicating gingival level above implant.
Shoulder depth gauge indicating gingival level above implant.
Insertion of a 5.0mm x 4.0mm shouldered abutment into a 2.0mm implant well.
Insertion of a 5.0mm x 4.0mm shouldered abutment into a 3.0mm implant well.
Insertion of a short one-piece acrylic sleeve.
Insertion of a short one-piece acrylic sleeve.
Two short one-piece acrylic sleeves prior to their being incorporated into a temporary splint prosthesis.
Initial splinting of the two one-piece acrylic sleeves.
After their initial splinting vacuum formed template is used to provide anatomical contours for the previously splinted one-piece acrylic sleeves.
Vacuum formed template being removed.
Temporary prosthesis being removed.
Temporary prosthesis being removed for polishing. Note extraneous temporization material in midline.
Adjacent teeth being acid etched for bonding.
Bonding agent being applied.
Light curing of bonding agent.
Cement being applied to prosthesis.
Light curing of cement.
Splinted prosthesis.
Radiograph of immediately loaded implants. Note extraneous temporization material on mesial aspect of the left central incisor.
Temporary prosthesis fourteen weeks post implant insertion.
Shouldered abutments fourteen weeks after they were placed with only finger pressure.
Removal of the 5.0mm x 4.0mm shouldered abutment from the 3.0mm implant well.
Removal of the 5.0mm x 4.0mm shouldered abutment from the 2.0mm implant well.
View of the 2.0mm and 3.0mm implant wells and soft tissue sulci.
Insertion of the black 2.0mm impression post.
Insertion of the white 3.0mm impression post.
The mandatory tapping of the impression post achieving proper axial seating.
The mandatory tapping of the impression post achieving proper axial seating.
View of the fully seated impression posts.
Impression being taken of the fully seated impression posts.
Removal of the black 2.0mm post after the making of the impression.
Insertion of the impression post into the corresponding impression analogs.
Insertion of the white impression post and implant analog as a unit into the impression.
Impression posts and analogs seated in impression.
Soft tissue material being injected minimally around the implant analogs.
Dental stone being poured into the transfer impression.
Impression posts in soft tissue model.
A 6.5mm x 5.0mm 0° and a 6.5mm x 6.5mm 15° non shouldered abutments in a soft tissue model.
Palatal view of selected abutments.
Gingival height of contour being marked with red felt pen on the abutment.
A wider black marking being placed cervical to the red marking which indicated the gingival height of contour.
Marked abutments indicating the proper level for an aesthetic subgingival interface.
Abutment being reduced while being held in an abutment prep holder.
Entire black marking will be removed during the reduction of the abutment which will ensure 360° of subgingival margin placement of polyceramic material.
All sharp line angles are being removed.
Labial view of one partially prepared and one unprepared abutment.
Palatal view of one partially prepared and one unprepared abutment.
Labial view of two partially prepared abutments.
Final reduction to provide an abutment with no sharp line angles and with aesthetic subgingival margins.
Final reduction to provide an abutment with no sharp line angles and with aesthetic subgingival margins.
Abutment being seated into a piece of wax prior to its being blasted with 50-micron alumina.
Abutment being blasted with 50-micron alumina.
Abutment being blasted with 50-micron alumina.
Abutment after having been blasted with 50-micron alumina.
Removal of the abutment from wax block.
95% ethyl alcohol being poured for the ultrasonic cleaning of the abutments.
Abutments being ultrasonically cleaned in 95% ethyl alcohol for 5 minutes.
Cleaned abutments seated in titanium implant analogs within an acrylic block.
Several applications of metal coupler being applied to ensure the complete wetting of the prepared abutment surface.
Coated abutments being placed in oven at 250°F for 5 minutes.
Abutments after their removal from oven.
Preparation of the neutral opaque powder prior to its mixing.
Preparation of the neutral opaque powder prior to its mixing.
The mixing of neutral opaque powder and liquid.
The mixing of neutral opaque powder and liquid.
The mixing of neutral opaque powder and liquid.
The mixing of neutral opaque powder and liquid.
The first of two mandatory applications of neutral opaque powder.
Abutments with first coating of neutral opaque material prior to their insertion into an over for 5 minutes under vacuum at 250°F.
Cervical area of abutment being cleaned after the second application of neutral opaque powder.
Opaqued abutments in model prior to the application of a ceramo-coupler.
Preparation of the dentin opaque material on a glass slab.
Modeling liquid facilitates the handling of the polyceramic material.
Application of dentin opaque material.
Abutments with initial build up of dentin opaque material.
Initial application of dentin opaque material is being cured in a halogen light booth for 4 minutes.
Dentin chroma modifier being prepared on glass slab.
Dentin chroma modifier being applied.
Light curing of dentin chroma layer.
Dentin material on glass slab.
Application of dentin material.
Light curing of dentin material.
Preparation of enamel material on glass slab.
Application of enamel material.
Application of enamel material.
Application of enamel material.
Integrated Abutment Crown™ after application of enamel material.
Light curing of enamel material.
White dentin intensifier on glass slab.
White dentin intensifier being applied.
Integrated Abutment Crowns™ after dentin intensifier application.
Light curing of dentin intensifier.
Application of translucent material.
Removal of Integrated Abutment Crown™ from implant analog.
Light curing of translucent material.
Insertion of Integrated Abutment Crown™ into abutment prep holder.
Further applications being applied.
Insertion of Integrated Abutment Crown™ into the implant analog for insertion into light booth.
Final light curing in halogen light booth.
Removal of superficial layer with spatula.
Integrated Abutment Crown™ being polished with HF-Diamond fine carbide bur (double blue band).
Integrated Abutment Crown™ being polished with HF-Diamond fine carbide bur (double blue band).
Initial polishing with a soft white silicone wheel.
Contacts being checked with articulating paper.
Adjusting contact with a diamond fine carbide.
Integrated Abutment Crown™ being polished with HF-Diamond fine carbide bur (double blue band).
Anatomical contours being marked with a pencil.
Incisal contacts being checked with articulating paper.
Labial surface being polished with a soft white silicone wheel.
Integrated Abutment Crowns™ on model.
Application of powder to assist in the visualization of contours.
Integrated Abutment Crowns™ with powder applied.
Anatomical contours being marked with pencil.
Morphology being shaped with soft white silicone wheel.
Initial polishing with a soft pink silicone wheel.
Steam cleaning of Integrated Abutment Crown™ prior to final polishing.
Temporary prosthesis on the day of the insertion of the Integrated Abutment Crowns™.
Removal of finger pressured seated shouldered abutment.
View of the 2.0mm and 3.0mm implant wells and soft tissue sulci.
Arrows indicate the necessity for the blue acrylic seating jig in order to have the tapping force in the long axis of the abutment shaft.
Labial view of one sulcus and initially seated Integrated Abutment Crown™.
Interproximal crestal relieving incision being made to accommodate the ideal gingival contour of the Integrated Abutment Crown™.
Integrated abutment Crown™ with 2.0mm post being inserted into the well of the implant.
Blue incisal jig being used to orientate the Integrated Abutment Crowns™.
Palatal view of Integrated Abutment Crowns™.
Piece of wooden tongue depressor to dampen the seating tap of the Integrated Abutment Crown™.
Labial view of two Integrated Abutment Crowns™.
Right profile view of fully seated Integrated Abutment Crowns™.
Left profile view of fully seated Integrated Abutment Crowns™.
Smile of satisfied patient.
Radiograph of Integrated Abutment Crowns™.
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