Extraction, Grafting, and Full Mouth Placement of Twenty-Three Two Stage, Immediately Stabilized and Functioning Implants, and their Restoration with Twenty-One Integrated Abutment Crowns™ and a Three Unit Polyceramic Material Fused to Metal Fixed Prosthesis (Part One)
This case demonstrates the sequencing of tooth extractions, bone grafting and two stage and immediately stabilized and functioning implant placement techniques for twenty-three implants as well as their restoration with twenty-one Integrated Abutment Crowns™ (IACs) and a three unit polyceramic to metal fixed prosthesis.
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Facial view after the removal of patient's upper fixed prosthesis.
8.
Initial incision prior to extractions.
9.
Failed endodontically treated teeth.
10.
Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.
11.
Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.
12.
Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external 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 blue 3.5mm latch reamer bur rotating at 50RPM without water irrigation.
15.
Harvested bone within the latch reamer being transferred to a silicon dappin dish.
16.
Osteotomy being enlarged with a silver 4.5mm latch reamer bur rotating at 50RPM without water irrigation.
17.
ClinicianÕs fingers monitoring the buccal bone during the preparation of the osteotomy and the harvesting of bone with a silver 4.5mm hand reamer.
18.
Allograft material being placed into extraction site.
19.
A 4.5mm x 8.0mm HA coated implant being inserted into the osteotomy with the implant's black polyethylene healing plug.
20.
A 4.5mm x 8.0mm HA coated implant being inserted into the osteotomy with the implant's black polyethylene healing plug.
21.
View of seated implant with polyethylene healing plug.
22.
A 4.5mm x 8.0mm HA coated implant being inserted into the osteotomy with the implant inserter/retriever device.
23.
Harvested bone being placed over implant.
24.
Harvested bone being placed over implant.
25.
Post-operative radiograph after first surgical visit.
26.
Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation six weeks after first visit.
27.
Osteotomy being enlarged with an olive green 2.5mm latch reamer bur rotating at 50RPM without water irrigation.
28.
Osteotomy being enlarged with an olive green 2.5mm latch reamer bur rotating at 50RPM without water irrigation.
29.
Osteotomy being enlarged with a blue 3.5mm latch reamer bur rotating at 50RPM without water irrigation.
30.
Osteotomy being enlarged with a red 4.0mm latch reamer bur rotating at 50RPM without water irrigation.
31.
A silver 4.5mm hand reamer attached to a straight handle is being rotated to enlarge the osteotomy.
32.
A 4.5mm x 8.0mm HA coated implant being inserted into the osteotomy with the implant inserter/retriever device.
33.
A 4.5mm x 8.0mm HA coated implant being inserted into the osteotomy with the implant inserter/retriever device.
34.
Implant seating tip attached to a straight handle is being tapped to seat implant farther into the osteotomy.
35.
Post-operative radiograph after second surgical visit.
36.
Initial incision eight weeks after first clinical visit.
37.
Osteotomy being enlarged with an olive green 2.5mm latch reamer bur rotating at 50RPM without water irrigation.
38.
Osteotomy being enlarged with a teal 3.0mm latch reamer bur rotating at 50RPM without water irrigation.
39.
Osteotomy being enlarged with a silver 4.5mm latch reamer bur rotating at 50RPM without water irrigation.
40.
A 5.0mm x 8.0mm HA coated implant being inserted into the osteotomy with the implant's black polyethylene healing plug.
41.
A 5.0mm x 8.0mm HA coated implant being inserted into the osteotomy with the implant's black polyethylene healing plug.
42.
View of sutured operative site immediately after the implant placement.
43.
Post-operative radiograph after third surgical visit.
44.
View of prosthesis prior to its removal for additional uncovering of the integrated implants and additional implant placement seventeen weeks after first visit.
45.
Stealth shouldered abutment 5.0 mm wide with a shoulder height of 4.0mm is being inserted into the implant well with only finger pressure.
46.
Stealth shouldered abutment 5.0 mm wide with a shoulder height of 6.0mm is being inserted into the implant well with only finger pressure.
47.
Short acrylic sleeve being snapped onto stealth abutment.
48.
Vacuum formed template seated over acrylic sleeves to confirm the appropriateness of their placement.
49.
Transitional composite material being added to acrylic sleeves to initially form a strut.
50.
View of the initial strut.
51.
Bonding agent being applied to strut.
52.
Strut being light cured.
53.
Transitional composite material being added to vacuum formed template.
54.
Vacuum formed template being used to aesthetically form composite material over the strut.
55.
Transitional stabilizing prosthesis being removed for polishing.
56.
Polished transitional stabilizing prosthesis being inserted.
57.
Radiograph eighteen weeks after first clinical visit.
58.
View of transitional restoration on integrated implants eighteen weeks after first clinical visit.
59.
Extraction of failed endodontically treated tooth.
60.
Extraction of failed endodontically treated tooth.
61.
Extraction of failed endodontically treated tooth.
62.
Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.
63.
Parallel pins seated in pilot osteotomies indicating their trajectories.
64.
Parallel pins confirming appropriate trajectories and acting as guides for subsequent osteotomies.
65.
Osteotomy being enlarged with an olive green 2.5mm latch reamer bur rotating at 50RPM without water irrigation.
66.
Osteotomy being enlarged with a. teal 3.0mm latch reamer bur rotating at 50RPM without water irrigation.
67.
Osteotomy being enlarged with a red 4.0mm latch reamer bur rotating at 50RPM without water irrigation.
68.
Osteotomy being enlarged with a gold 5.0mm latch reamer bur rotating at 50RPM without water irrigation.
69.
Harvested bone in a silicon dappen dish prior to its being placed over the seated implants.
70.
A 5.0mm x 8.0mm HA coated implant being inserted into the osteotomy with the implant inserter/retriever device.
71.
A 5.0mm x 8.0mm HA coated implant being inserted into the osteotomy with the implant inserter/retriever device.
72.
A 4.5mm x 8.0mm HA coated implant being inserted into the osteotomy with the implant inserter/retriever device.
73.
A 4.5mm x 8.0mm HA coated implant being inserted into the osteotomy with the implant inserter/retriever device.
74.
A 3.5mm x 11.0mm HA coated implant being inserted into the osteotomy with the implant inserter/retriever device.
75.
Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.
76.
Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.
77.
Parallel pins seated in pilot osteotomies indicating their trajectories.
78.
Osteotomy being enlarged with an olive green 2.5mm latch reamer bur rotating at 50RPM without water irrigation.
79.
Osteotomy being enlarged with a blue 3.5mm latch reamer bur rotating at 50RPM without water irrigation.
80.
A 3.5mm x 11.0mm HA coated implant being inserted into the osteotomy with the implant inserter/retriever device.
81.
A 3.5mm x 11.0mm HA coated implant being inserted into the osteotomy with the implant inserter/retriever device.
82.
View of seated implants with their polyethylene healing plugs.
83.
Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height.
84.
Stealth shouldered abutment 5.0 mm wide with a shoulder height of 4.0mm is being inserted into the implant well with only finger pressure.
85.
Shouldered depth gauge indicating that an abutment with a 6.0mm shoulder height would be appropriately positioned below the gingival crest.
86.
Stealth shouldered abutment 5.0 mm wide with a shoulder height of 6.0mm is being inserted into the implant well with only finger pressure.
87.
Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height.
88.
A cut black polyethylene healing plug is being inserted into the well of the seated implant for the two stage technique.
89.
Posterior transitional crown and integrated implants facilitate establishing a new occlusion.
90.
Tall acrylic sleeve being modified.
91.
Modified acrylic sleeve.
92.
Short acrylic sleeve snapped on to stealth abutment.
93.
Light curing of initial strut material.
94.
Bonding agent being applied to the strut.
95.
Strut being light cured.
96.
Transitional composite material being added to vacuum formed template prior to its placement over the hardened strut.
97.
Vacuum formed template being used to form transitional stabilizing prosthesis.
98.
Transitional prosthesis being removed for polishing.
99.
Polished transitional stabilizing prosthesis.
100.
Polished transitional stabilizing prostheses which will be periodically modified to establish a new occlusal relationship.
101.
Post-operative radiograph after fifth surgical visit.
102.
Post-operative radiograph after extraction of two maxillary molars eight months after first clinical visit.
103.
View of transitional stabilizing prostheses nine months after first clinical visit.
104.
Bonded transitional stabilizing prosthesis prior to its being removed.
105.
View of stealth abutments after removal of transitional stabilizing prosthesis.
106.
View of implant wells and soft tissue sulci prior to insertion of impression posts.
107.
Guide pins being inserted to check the stability of the implants.
108.
Red 2.0mm impression reamer being inserted onto guide pin to remove any tissue which might inhibit the complete seating of an impression post.
109.
Red 2.0mm impression reamer inserted onto guide pin to remove any tissue which might inhibit the complete seating of an impression post.
110.
Green 3.0mm impression reamer inserted onto guide pin to remove any tissue which might inhibit the complete seating of an impression post.
111.
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.
112.
Green 3.0mm plastic impression post receiving its mandatory seating tap.
113.
Red 2.0mm plastic impression post receiving its mandatory seating tap.
114.
Impression material being injected around the impression posts for the making of a full arch implant level transfer impression.
115.
Transitional stabilizing prosthesis being re-inserted after the making of an implant level impression.
116.
View of stealth abutments after removal of transitional stabilizing prosthesis.
117.
Stealth abutments being removed.
118.
View of implant wells and soft tissue sulci.
119.
Guide pins being inserted to check the stability of the implants.
120.
Green 3.0mm impression reamer being inserted onto guide pin to remove any tissue which might inhibit the complete seating of an impression post.
121.
View of implant wells and soft tissue sulci prior to insertion of impression posts.
122.
Green 3.0mm plastic impression post being inserted into the 3.0mm well of an integrated implant for the making of an implant level transfer impression.
123.
Green 3.0mm plastic impression post receiving its mandatory seating tap.
124.
Impression material being injected around the impression posts for the making of a full arch implant level transfer impression.
125.
View of implant wells and soft tissue sulci.
126.
Transitional stabilizing prosthesis being re-inserted to allow additional time for establishing a comfortable occlusion.
127.
Bonded stabilizing prostheses prior to their right side being removed for the recording of an occlusal registration one week after the impression was taken.
128.
View prior to removal of right side abutments.
129.
Vertical dimension being recorded.
130.
View of implant wells and soft tissue sulci.
131.
Green 3.0mm plastic impression post being inserted.
132.
Green 3.0mm plastic impression post receiving its mandatory seating tap.
133.
View of implant wells and soft tissue sulci.
134.
Green 3.0mm plastic impression post being inserted.
135.
Red 2.0mm plastic impression post receiving its mandatory seating tap.
136.
Green 3.0mm plastic impression post receiving its mandatory seating tap
137.
Red acrylic being injected onto the impression posts for occlusal registration.
138.
Red acrylic on impression posts recording an occlusal registration.
139.
Left side prosthesis being removed.
140.
Green 3.0mm plastic impression post being inserted.
141.
Red 2.0mm plastic impression post being inserted.
142.
Green 3.0mm plastic impression post receiving its mandatory seating tap
143.
Red acrylic on impression posts recording an occlusal registration.
144.
Red acrylic being injected onto the impression posts for occlusal registration.
145.
Red acrylic being injected onto the impression posts.
146.
Occlusal registration being marked to record the midline of the face, lip line and incisal length of anterior teeth.
147.
Occlusal registration being marked to record the midline of the face, lip line and incisal length of anterior teeth.
148.
Occlusal registration being marked to record the midline of the face, lip line and incisal length of anterior teeth.
149.
Occlusal registration being marked to record the midline of the face, lip line and incisal length of anterior teeth.
150.
Occlusal registration being marked to record the midline of the face, lip line and incisal length of anterior teeth.
151.
Transitional stabilizing prosthesis being re-inserted.
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