Extraction and Immediate Placement of four Maxillary Anterior Short Implants and their Restoration with Integrated Abutment Crowns™

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1.

First Clinical Visit: Pre-operative radiograph.

2.

Pre-operative site.

3.

View of extracted right lateral incisor.

4.

View of extracted left central incisor.

5.

View of extracted failed endodontically treated tooth.

6.

View of extracted right central incisor.

7.

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

8.

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

9.

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

10.

Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation and view of parallel pins confirming appropriate trajectory and acting as a guide for subsequent osteotomy.

11.

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

12.

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

13.

Harvested bone within dark blue 3.5 mm latch reamer.

14.

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

15.

Osteotomy being enlarged with silver 4.5 mm hand reamer.

16.

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

17.

Depth gauge seated in the osteotomy to facilitate the selection of an implant with an appropriate length.

18.

4.5mm x 6.0mm HA coated implant being inserted into the osteotomy with an implant-seating tip threaded on a straight driver.

19.

4.5mm x 6.0mm HA coated implant being inserted into the osteotomy with an implant-seating tip threaded on a straight driver.

20.

4.5mm x 6.0mm HA coated implant being inserted into the osteotomy with an implant-seating tip threaded on a straight driver.

21.

4.5mm x 6.0mm HA coated implant being inserted into the osteotomy with an implant-seating tip threaded on a straight driver.

22.

Implant seating tip attached to a straight handle being tapped to seat implant farther into the osteotomy.

23.

View of seated implants with polyethylene healing plugs.

24.

Cut polyethylene healing plug being inserted into the well of the implant.

25.

Autogenous bone graft harvested during osteotomy being placed over the seated implants.

26.

View of Bicon Resorbable Collagen Plug being inserted.

27.

Sutured implant site.

28.

Post-operative radiograph.

29.

Second Clinical Visit: (Five months after previous visit) View of operative site prior to the two stage uncovering and the making of an implant level transfer impression on the patient’s second clinical visit.

30.

Polyethylene healing plug being removed with a healing plug removal instrument.

31.

Polyethylene healing plug being removed with a healing plug removal instrument.

32.

Polyethylene healing plug being removed with a healing plug removal instrument.

33.

Polyethylene healing plug being removed with a healing plug removal instrument.

34.

View of four green 3.0mm guide pins seated in the wells of the implants.

35.

View of 3.0 mm green plastic sleeve snapped onto 3.0 mm titanium impression post being inserted into the well of the implant.

36.

Third Clinical Visit: (One month after previous visit)

37.

View of Integrated Abutment Crowns™ on stone model.

38.

Integrated Abutment Crowns™ on stone model with orientation jig.

39.

Integrated Abutment Crowns™ on stone model with yellow thermoplastic seating jigs, which were fabricated on a crown alignment device to facilitate directing the seating forces in the long axis of the implant well and abutment post.

40.

View of four maxillary anterior Integrated Abutment Crowns™.

41.

Trimmed white temporary abutment being removed.

42.

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

43.

Integrated Abutment Crown™ being inserted.

44.

Trimmed white temporary abutment being removed.

45.

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

46.

Integrated Abutment Crown™ being inserted.

47.

Trimmed white temporary abutment being removed.

48.

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

49.

Integrated Abutment Crown™ being inserted.

50.

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.

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.

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.

54.

Seated Integrated Abutment Crowns™ immediately after insertion.

55.

Seated Integrated Abutment Crowns™ immediately after insertion.

56.

Post-insertion radiograph immediately after insertions.

57.

Post-insertion radiograph immediately after insertions.

58.

Facial view three weeks post insertion.

59.

Left profile view three weeks post insertion.

60.

Patient’s smile three weeks post insertion.