A Two Stage Placement of Mandibular Central Incisor Implant and its Restoration with an Integrated Abutment Crown™

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1.

First clinical visit: Pre-operative radiograph.

2.

Pre-operative site.

3.

Periotome being used to initiate the extraction.

4.

Periotome being used to initiate the extraction.

5.

Forceps being used to extract the fractured root.

6.

Luxator being used to further elevate the root from the socket.

7.

Luxator being used to further elevate the root from the socket.

8.

Forceps being used to extract the fractured root.

9.

View of extracted root.

10.

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

11.

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

12.

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

13.

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

14.

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

15.

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

16.

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

17.

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

18.

Curetted autogenous bone being placed into a dappen dish.

19.

A 4.0mm x 8.0mm HA coated implant with a 2.0mm implant well being inserted with the black polyethylene healing plug.

20.

View of the well of the seated implant.

21.

Trimmed polyethylene healing plug being inserted into the well of the seated implant for two stage placement.

22.

Harvested bone being placed over implant.

23.

Sutured site.

24.

Post-operative radiograph.

25.

Second Clinical Visit: View of transitional prosthesis four months after the immediate two stage placement.

26.

View after the removal of transitional prostheses in preparation for two stage uncovering and an implant level transfer impression.

27.

View of trimmed polyethylene healing plug in the well of the integrated implant.

28.

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

29.

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

30.

View of 2.0mm guide pin seated in the well of the implant.

31.

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

32.

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.

33.

Red 2.0mm plastic impression post receiving its mandatory seating tap.

34.

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

35.

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

36.

Integrated Abutment Crown™ on stone model.

37.

View of Integrated Abutment Crown™.

38.

Third Clinical Visit: Transitional prosthesis being removed for the insertion of Integrated Abutment Crown™.

39.

Integrated Abutment crown™ being inserted initially to evaluate its appropriateness.

40.

Crestal relieving incision being made to facilitate the seating of the Integrated Abutment Crown™.

41.

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

42.

Integrated Abutment Crown™ being reinserted.

43.

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.

44.

Post insertion radiograph.

45.

Height of buccal gingiva being marked to facilitate the adjustment of the cervical aspect of the Integrated Abutment Crown™.

46.

Buccal aspect of Integrated Abutment Crown™ being reduced with #7404 bur.

47.

Buccal aspect of Integrated Abutment Crown™ being polished with pink silicone polishing wheel.

48.

Integrated Abutment Crown™ being inserted.

49.

Incisal contact being adjusted with pink silicone polishing wheel.

50.

Mesial composite veneer on stone model fabricated to close the diastema between the two central incisors.

51.

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

52.

Bonding agent being applied.

53.

Bonding agent being light cured.

54.

Surface of the veneer being roughened for bonding.

55.

Bonding agent being applied.

56.

Bonding agent being light cured.

57.

Composite material being applied to the veneer for bonding.

58.

Veneer being bonded.

59.

Composite material being light cured.

60.

Composite material being polished with pink silicone polishing wheel.

61.

Composite material being polished with white silicone polishing wheel.

62.

Articulating paper being used to confirm interproximal contacts.

63.

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

64.

Interproximal contact being adjusted.

65.

Integrated Abutment Crown™ being reinserted.

66.

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.

67.

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

68.

Integrated Abutment Crown™ three months after insertion.

69.

Radiograph three months after insertion.

70.

Integrated Abutment Crown™ one year after insertion.

71.

Radiograph one year after insertion.