Extraction, Four Implants, and Four Crowns in Two Patient Visits

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1.

First Patient Visit: Pre-operative labial view.

2.

Pre-operative occluso-lingual view.

3.

Labial view after extraction.

4.

Pilot bur being used with lingual template.

5.

Paralleling pins placed into the four pilot osteotomies.

6.

Reamer bur being used with two-handed technique.

7.

Bone being removed from flute of reamer bur.

8.

A 3.5mm x 11.0mm HA coated implant being inserted.

9.

Implant inserted with healing plug prior to healing plug being removed from implant.

10.

Seated shoulder depth gauge indicating the appropriate abutment height for a subgingival margin placement.

11.

Tall one-piece plastic sleeve being seated on one of the four 4.0mm x 3.5mm shouldered stealth abutments.

12.

Temporary composite material being injected around acrylic sleeves prior to being incorporated in a vacuum formed template for the fabrication of a transitional splint prosthesis.

13.

After removal of transitional prosthesis and abutments a black impression post is being inserted into the well of an implant.

14.

Four black impression posts seated in implant wells.

15.

Impression material being injected around impression posts.

16.

Transfer impression being made.

17.

Polished transitional splint prosthesis being bonded to adjacent canine for stabilization of the four immediately loaded implants.

18.

Bonded transitional prosthesis at conclusion of first patient visit.

19.

Radiograph of four immediately loaded implants with 4.0mm x 3.5mm shouldered abutments.

20.

Second Patient Visit: Three all-ceramic crowns on soft-tissue model revealing well of one implant analog.

21.

Four all-ceramic crowns on soft-tissue model.

22.

Acrylic jig or template being formed over incisal edge of crowns to aid in the orientation of the crowns during their intra-oral seating.

23.

Vacuum-formed template or jig on model which will aid in orienting the crowns intra-orally.

24.

Transitional splint prosthesis at second patient visit.

25.

Removal of a 4.0mm x 3.5mm abutment which was used with the transitional prosthesis.

26.

Labial view of healed tissue after removal of abutments.

27.

Occlusal view of healed tissue prior to clinically trying three 4.0mm x 1.5mm abutments and one 3.5x 1.5mm abutment along with their all-ceramic crowns into the implant wells. Mirror view of all-ceramic crowns revealing the internal aspect of the aluminum oxide sleeves on which the alpha porcelain was directly applied during the fabrication of the crowns.

28.

Mirror view of all-ceramic crowns revealing the internal aspect of the aluminum oxide sleeves on which the alpha porcelain was directly applied during the fabrication of the crowns.

29.

Four all-ceramic crowns, three 4.0mm x 1.5mm abutments, and one 3.5mm x 1.5mm abutment.

30.

All-ceramic crown being tried on a 4.0mm x 1.5mm shouldered stealth abutment.

31.

All-ceramic crown seated on abutment.

32.

Abutment and crown being tried into implant well.

33.

Abutment and crown inserted in implant.

34.

Third abutment and crown being inserted.

35.

Four crowns inserted for confirmation of aesthetics and clinical fit.

36.

Vacuum-formed template confirms orientation of crowns prior to their removal for extra-oral cementation.

37.

Metallic coupler being applied to abutments.

38.

Ceramic coupler being applied to crowns.

39.

Bonding agent being applied to crowns.

40.

Bonding agent being applied to abutments.

41.

Resin cement being applied to abutments.

42.

Fourth crown being extra-orally cemented.

43.

Extra-orally cemented crown.

44.

Mirror view of four extra-orally cemented abutments and crowns.

45.

Cemented all-ceramic crowns being held in vacuum-formed template.

46.

Four extra-orally cemented abutments and crowns being inserted with the aid of the template for proper orientation within the implants.

47.

Since Bicon abutments have the possibility of 360 degrees of universal positioning, they are being tapped into the implant only after their proper positioning has been established with the aid of the template and confirmed by the opposing occlusion.

48.

Radiograph of four implants and their extra-orally cemented all-ceramic crowns.

49.

Labial view of four extra-orally cemented all-ceramic crowns built directly on aluminum oxide sleeves. The entire treatment from the extraction and implant placements to the final crown insertions was accomplished in only two patient visits.