Bilateral Sinus Floor Augmentation Grafts, the Placement and Removal of Three Immediately Placed and Functioning Implants, the Placement of Eleven Maxillary Implants and their Restoration with Nine Integrated Abutment Crowns™ and a Three-Unit Polyceramic to Metal Fixed Prosthesis
This case demonstrates the sequencing and execution of treatments for the restoration of an edentulous maxilla with bilateral sinus floor augmentation grafts, the placement and removal of three immediately placed and functioning implants, the placement of eleven maxillary implants and their restoration with nine Integrated Abutment Crowns™ and one three-unit polyceramic to metal fixed prosthesis.
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Radiograph revealing four restored and two unrestored implants.
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Template placed over two recently uncovered maxillary bilateral implants and four extraction sites.
4.
The osteotomy being prepared with a 2.0mm pilot bur rotating at 1100RPM with external irrigation, using the parallel pin in the adjacent osteotomy as a guide.
5.
Vacuum formed template seated over paralleling pins confirming the appropriateness of their trajectory.
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Clinician’s finger monitoring the buccal bone during the preparation of the osteotomy and the harvesting of bone with a 4.5mm latch reamer rotating at 50RPM.
7.
Harvested bone within the flute of the latch reamer.
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Harvested bone being collected in a silicone dappin dish.
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Hand reamer being rotated to enlarge the osteotomy.
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Implant being held for the removal of its polyethylene handle.
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Implant inserter/retriever instrument on a straight handle being inserted into the well of the implant for transport to the osteotomy site.
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A 5.0mm x 8.0mm HA coated implant being inserted into the osteotomy with the implant inserter/retriever device.
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A 5.0mm x 8.0mm HA coated implant being inserted into the osteotomy with the implant inserter/retriever device.
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A 5.0mm x 8.0mm HA coated implant being inserted into the osteotomy with the implant inserter/retriever device.
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Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth shouldered abutment.
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Vacuum formed template seated over abutments to confirm the appropriateness of their placement.
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Modified acrylic sleeves prior to their being incorporated into a transitional stabilizing prosthesis.
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Vacuum formed template confirming appropriateness of the modified acrylic sleeves.
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Transitional composite material, Integrity by Dentsply, being injected around the acrylic sleeves to form a strut.
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Transitional composite material, Integrity by Dentsply, being injected around the acrylic sleeves to form a strut.
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Bonding agent being applied to the strut.
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Transitional composite material being injected into the vacuum formed template.
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Transitional stabilizing prosthesis being removed for polishing.
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Transitional stabilizing prosthesis being removed for polishing.
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Polished transitional stabilizing prosthesis being re-inserted.
Radiograph after insertion of three maxillary anterior and two left mandibular implants.
28.
Sinus lift bur (260-201-029) being used to prepare osteotomy for maxillary right sinus floor augmentation graft.
29.
View of operative site.
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Sinus lift curette being used to elevate sinus membrane.
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Allograft material being transported to site in a glass syringe.
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Allograft material being packed with a curette.
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View of allograft prior to closure of the flap.
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Retraction suture being removed for the repositioning and closure of the flap.
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Flap being closed by initially suturing at its corner.
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Sutured closure of flap.
37.
Post operative radiograph revealing bilateral sinus floor augmentation.
38.
Radiograph revealing placement of three additional implants in the right posterior maxilla six months after sinus graft.
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Radiograph revealing loss of an anterior implant ten months after its placement and the placement of three additional implants in the right posterior maxilla six months after sinus graft.
40.
Radiograph revealing placement of two additional implants in the left posterior maxilla.
41.
Patient’s smile with transitional prosthesis.
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Transitional prosthesis in place.
43.
Impression posts inserted into posterior implants. Red acrylic applied to anterior teeth to record occlusal relationship.
44.
Left posterior prosthesis removed for the insertion of impression posts to recording an occlusal relationship.
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Anterior occlusal registration with posterior impression posts.
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Red acrylic resin being injected around posterior impression posts.
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Posterior registration being made.
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Posterior registration being made.
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Anterior prosthesis removed for the making of an anterior occlusal registration and soft tissue relationship.
50.
View of seated 3.0mm green plastic impression posts prior to taking an implant level transfer impression.
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Impression material being injected around impression posts.
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Digital image being taken of shade guide against a black metal background to facilitate the fabrication of an aesthetic Integrated Abutment Crown™.
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Pink acrylic being molded around two green plastic impression posts.
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Pink acrylic registration retained on impression posts.
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Pink acrylic registration being modified.
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Midline of face being recorded.
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Recording of smile line and midline of face.
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Green plastic impression posts with pink acrylic registration being removed from implant wells.
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Integrated Abutment Crowns™ on dental model with acrylic orientation jig.
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Mirror view of Integrated Abutment Crowns™.
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Transitional prosthesis being removed.
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Abutments being removed.
63.
View of implant wells and soft tissue sulci.
64.
Relieving incisions being made to facilitate the seating of the Integrated Abutment Crown™.
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Relieving incisions being made to facilitate the seating of the Integrated Abutment Crown™.
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Clear acrylic orientation jig facilitating the positioning of an Integrated Abutment Crown™.
67.
Orientation jig being used for the initial tapping of the Integrated Abutment Crown™.
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Integrated Abutment Crown™ being inserted into the well of the implant.
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Integrated Abutment Crown™ being removed for adjustment of its interproximal contacts.
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Interproximal contact being adjusted.
71.
Three unit polyceramic to metal prosthesis being used to orientate the distal milled abutment in the well of the distal implant.
72.
Three unit polyceramic to metal prosthesis being used to orientate the mesial milled abutment in the well of the mesial implant.
73.
Three unit prosthesis being removed to adjust interproximal contact area.
74.
Facial view immediately after the insertion of eight Integrated Abutment Crowns™ and a three unit polyceramic to metal prosthesis.
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