Extraction, Grafting with Bicon Resorbable Collagen Membrane, Placement and Restoration of immediately functioning Maxillary Right Central Incisor Implant with an Integrated Abutment Crown™

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1.

Pre-operative smile.

2.

Pre-operative view. Note sinus tract over maxillary right central incisor.

3.

Pre-operative radiograph.

4.

View of extracted tooth.

5.

Post extraction radiograph.

6.

The extraction site being carefully curetted to remove granulation tissue and soft tissue tags.

7.

Vertical incision being made lateral to osseous defect in the buccal cortical plate.

8.

Full thickness flap elevated on facial with mesial and distal vertical incisions placed so as to provide a margin of sound bone for placement of the membrane. If possible, incisions are placed to avoid trauma to the interproximal aspect of the papillae.

9.

A large defect is evident in the buccal cortical plate.

10.

Allograft filling defect to the width of the buccal cortical plate, and to the height of the interproximal bone. Graft material can be bovine, porcine, human or inorganic.

11.

Bicon Resorbable Collagen Membrane cut to size and placed so that its margins extend onto surrounding bone on its mesial, distal, and apical borders. On the palatal aspect the membrane is tucked under the palatal tissue in direct contact with the palatal bone.

12.

The palatal tissue can usually be elevated with a periosteal elevator without using additional vertical incisions on the palatal aspect. However, if there is difficulty tucking the membrane under these tissues, small mesial and distal incisions may be helpful.

13.

Closure of the tension free flap with vicryl sutures. In order to achieve primary closure, the facial flap was apically undermined by creating a split thickness flap and advancing the flap coronally.

14.

Etchant being applied in preparation for the bonding of the transitional stabilizing prosthesis.

15.

Bonding agent being applied.

16.

Bonding agent being applied.

17.

Light curing of bonding agent.

18.

Polyceramic material being added to form a bonded strut between adjacent teeth.

19.

Polyceramic material being added to form a bonded strut between adjacent teeth.

20.

Strut is being light cured.

21.

Additional polyceramic material in vacuum formed template being added to the hardened strut for aesthetic contouring.

22.

Polyceramic material within vacuum formed template is being light cured.

23.

Additional polyceramic material is being added to facilitate the aesthetic contouring of the strut.

24.

Transitional prosthesis being light cured.

25.

Transitional prosthesis being contoured.

26.

Polishing of transitional prosthesis.

27.

Polishing of transitional prosthesis.

28.

View of finished transitional prosthesis.

29.

Six month post-operative view of the grafted site after the removal of the transitional prosthesis prior to the implant placement.

30.

Black polyethylene healing plug protruding from the well of the seated 4.5 mm x 8.0mm HA coated implant.

31.

View of well of seated implant with healing plug removed.

32.

A 5.0 mm x 6.0mm stealth abutment with a 3.0mm post is being inserted into the implant.

33.

View of abutment seated with only finger pressure.

34.

Patient’s bone, harvested during osteotomy.

35.

View of seated abutment with autogenous graft placed over the post of the abutment.

36.

Radiograph of the implant immediately after the finger pressure seating of the abutment.

37.

Etchant being applied in preparation for the bonding of the transitional stabilizing prosthesis.

38.

Bonding primer agent being applied.

39.

Bonding agent being applied.

40.

Light curing of bonding agent.

41.

Polyceramic material being added to acrylic sleeve to form a strut.

42.

Polyceramic material being light cured.

43.

Transitional stabilizing prosthesis in place.

44.

Transitional stabilizing prosthesis three months after implant placement.

45.

View of transitional abutment after removal of prosthesis.

46.

View of implant well after the removal of the transitional prosthesis and the stealth abutment.

47.

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

48.

Guide pin being placed into implant well to check the integration of the implant.

49.

A 3.0mm green metal impression post being inserted into the well of the implant.

50.

Impression post being fully seated into the well of the implant with multiple gentle taps.

51.

Impression material being injected around metal impression post for the making of an implant level transfer impression.

52.

Mirror view of cementless Integrated Abutment Crown™.

53.

Stealth shouldered abutment after removal of transitional prosthesis.

54.

View of implant well and soft tissue sulcus.

55.

Patient’s smile prior to the insertion of Integrated Abutment Crown™.

56.

Integrated Abutment Crown™ being placed. If tissue sulcus is too tight, a small relieving incisions may be placed mesially and distally in the interproximal aspect of the sulcus without cutting through the papillae.

57.

A clear acrylic orientation jig is being used to initially position the Integrated Abutment Crown™.

58.

Radiograph of implant and Integrated Abutment Crown™.

59.

Integrated Abutment Crown™ immediately after being inserted.

60.

Patient’s smile with Integrated Abutment Crown™ in place.