Extraction, Grafting with Bicon Resorbable Collagen Membrane, Placement of Maxillary Left Central Incisor, its Restoration with a Bicon Integrated Abutment Crown™ with the subsequent intra-oral addition to the incisal edge
This case demonstrates the extraction of a failed endodontically treated maxillary left central incisor, site preparation by grafting with Bicon Resorbable Collagen Membrane, placement of an immediately stabilized and functioning implant, implant level transfer impression, insertion of a Bicon Integrated Abutment Crown™ and adding to the incisal edge.
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Full thickness flap elevated on facial with mesial and distal vertical incisions. If possible, these incisions are placed to avoid trauma to the interproximal aspect of the papillae.
6.
The graft site has been carefully curetted to remove granulation tissue and soft tissue tags.
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Bicon resorbable 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. 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 can be made.
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Bone graft material placed filling defect to the width of the buccal cortical plate, and to the height of the interproximal bone.
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Bone graft material positioned filling defect to the width of the buccal cortical plate, and to the height of the interproximal bone.
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Additional bone graft material added.
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Bicon resorbable membrane being placed to cover the graft.
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Flap closure with 4.0 chromic gut sutures.
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The transitional composite material in vacuum formed template seated over the sutured site to form an aesthetic transitional prosthesis. A piece of clear plastic strip is used to protect the sutures.
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View of transitional prosthesis after being polished.
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Articulating paper being used to adjust incisal contacts.
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Additional polishing.
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View of finished temporary prosthesis.
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Post-operative radiograph of graft site.
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Patient’s smile after the removal of the transitional prosthesis eleven weeks after the bone graft.
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Close-up of the site.
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Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.
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Parallel pin seated in pilot osteotomy indicating its trajectory.
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Osteotomy being enlarged with an olive green 2.5mm hand reamer attached to a straight handle.
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Harvested bone within the blue 3.5mm hand reamer.
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Osteotomy is being widened with a blue 3.5mm bone dilator attached to a threaded straight handle.
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Harvested bone within the red 4.0mm hand reamer.
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Silver 4.5mm hand reamer attached to a straight handle is being inserted into the osteotomy.
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Osteotomy is being widened with a silver 4.5mm bone dilator attached to a threaded straight handle.
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A 4.5mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.
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View of well of seated implant.
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Implant seating tip attached to a straight handle is being tapped to seat implant farther into the osteotomy.
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View of seated implant with polyethylene healing plug.
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Etchant being applied in preparation for the bonding of the transitional stabilizing prosthesis.
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Bonding primer agent being applied.
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Bonding agent being applied.
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Light curing of bonding agent.
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Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height.
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Implant seating tip attached to a straight handle is being tapped to seat implant farther into the osteotomy.
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Shouldered depth gauge indicating that a stealth shouldered abutment 4.0mm wide and with a shoulder height of 1.5mm would be appropriately positioned below the gingival crest.
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Stealth abutment being inserted.
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Polyceramic material being added to acrylic sleeve to form a bonded strut between adjacent teeth.
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Polyceramic material being added to acrylic sleeve to form a bonded strut between adjacent teeth.
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Light curing of polyceramic material that was applied over the acrylic sleeve.
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Transitional stabilizing prosthesis being contoured.
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Polishing of bonded prosthesis with a soft white silicone disc.
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Polishing of bonded prosthesis with a nylon bristle brush.
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View of polished stabilizing transitional prosthesis.
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Post-operative radiograph.
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View of transitional stabilizing prosthesis thirteen weeks after the insertion of the implant.
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View of transitional abutment after removal of transitional stabilizing prosthesis.
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Transitional abutment being removed for the making of a full arch implant level transfer impression.
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A 3.0mm guide pin being inserted into the well of the implant.
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Green 3.0mm impression reamer being inserted onto guide pin to remove any tissue which might inhibit the complete seating of an impression post.
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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.
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Green 3.0mm plastic impression post receiving its mandatory seating tap.
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Impression material being injected around the impression post for the making of a full arch implant level transfer impression.
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Digital image being taken of shade guide against a black plastic background to facilitate the fabrication of aesthetic Integrated Abutment Crowns™.
58.
View of transitional prosthesis prior to its removal for the insertion of the Integrated Abutment Crown™ three weeks after the implant level transfer impression.
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Initial seating of Integrated Abutment Crown™.
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Blanching of soft tissues with the initial seating of the Integrated Abutment Crown™ indicates the need for either relieving incisions of the soft tissue or re-contouring of the cervical aspect of the integrated abutment crown™.
61.
Crestal relieving incision being made to facilitate the seating of the Integrated Abutment Crown™.
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A clear acrylic orientation jig is being used to initially position the Integrated Abutment Crowns™.
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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.
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Patient’s smile with the seated Integrated Abutment Crown™.
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Close-up view of Integrated Abutment Crown™ revealing the fact that the length of the left anterior incisor Integrated Abutment Crown™ is shorter than the right anterior incisor after definitive seating.
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Blue markings indicate that there is no incisal contact on the left anterior incisor Integrated Abutment Crown™.
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Post insertion radiograph.
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Incisal edge being roughened with a fine micro-diamond bur two weeks after the insertion of the Integrated Abutment Crown™.
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Bonding material being applied.
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Polyceramic material being added to incisal edge.
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Polyceramic material being added to incisal edge.
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Added polyceramic material being light cured.
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View of Integrated Abutment Crown™ with added polyceramic material.
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Polishing of the Integrated Abutment Crown™.
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Polishing of the Integrated Abutment Crown™ with a white acrylic polishing wheel.
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Polishing of the Integrated Abutment Crown™ with a pink acrylic polishing wheel.
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Polishing of the Integrated Abutment Crown™ with a soft bristle brush and a polishing paste.
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Final buffing of the Integrated Abutment Crown™ with a cloth wheel.
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Facial view of Integrated Abutment Crown™ sixteen months after insertion.
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Right profile view.
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Left profile view.
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Close-up view.
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Post-operative radiograph twenty-three months after bone graft, twenty months after implant placement and sixteen months after insertion.
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