Extraction, Immediate Placement and Immediate stabilization and Restoration of Maxillary Central Incisor Implants with Integrated Abutment Crowns™

Click on an image to view it larger. Click on the right half of the large image to view the next image, click on the left half to view the previous image. You may also use the left and right arrow keys on your keyboard to navigate through the images. Click the ESC key to exit the slideshow.

Click "Switch View" below to change to a layout optimized for printing the case.

Switch Thumb

1.

Pre-operative view.

2.

Pre-operative radiograph.

3.

Extraction of failed endodontically treated tooth.

4.

Extraction of failed endodontically treated tooth.

5.

Subsequent to having achieved the appropriate depth and trajectory with a 2.0mm pilot bur, osteotomy is enlarged with an olive green 2.5mm latch bur rotating at 50 RPM without water irrigation.

6.

Harvested bone in a teal 3.0mm latch reamer bur rotating at 50 RPM without water irrigation.

7.

Osteotomy being enlarged with a blue 3.5mm latch reamer bur rotating at 50 RPM without water irrigation.

8.

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

9.

Osteotomy being enlarged with a silver 4.5mm latch reamer bur rotating at 50 RPM without water irrigation.

10.

Osteotomy being enlarged with a gold 5.0mm hand reamer bur.

11.

A 5.0mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight handle.

12.

A 5.0mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight handle.

13.

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

14.

Post-operative radiograph showing two 5.0x8.0mm HA coated implants.

15.

Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height.

16.

Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height.

17.

Tall stealth acrylic sleeve being modified.

18.

Close-up of the modified tall stealth acrylic sleeve.

19.

Modified stealth acrylic sleeve snapped onto a 4.0 x 3.5mm stealth shouldered abutment are being inserted into the implant well with only finger pressure.

20.

Modified stealth acrylic sleeve snapped onto a 4.0 x 1.5mm stealth shouldered abutment are being inserted into the implant well with only finger pressure.

21.

Vacuum formed template seated over modified stealth acrylic sleeves and abutments to confirm the appropriateness of their placement.

22.

Transitional composite material, “Integrity, by Dentsply”, being added to vacuum formed template to form a transitional stabilizing prosthesis.

23.

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

24.

Transitional composite transitional stabilizing prosthesis incorporating stealth acrylic sleeves prior to being polished.

25.

Transitional stabilizing prosthesis being polished.

26.

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

27.

Bonding agent being applied.

28.

Light curing of bonding agent.

29.

Polyceramic material being added to the adjacent teeth.

30.

Polyceramic material being added to the transitional stabilizing prosthesis.

31.

View of transitional stabilizing prosthesis with additional material.

32.

Light curing of additional material.

33.

View of bonded transitional stabilizing prosthesis.

34.

Post-operative radiograph three weeks after implant placement.

35.

View of bonded transitional stabilizing prosthesis three weeks after implant placement.

36.

Post-operative radiograph twelve weeks after implant placement..

37.

Transitional stabilizing prosthesis being removed prior to the making of an implant level transfer impression twelve weeks after implant placement.

38.

View of transitional abutments after removal of splinted transitional stabilizing prosthesis.

39.

View of implant wells and soft tissue sulci.

40.

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.

41.

Green 3.0mm plastic impression post receiving its mandatory seating tap.

42.

Impression material being injected around the impression post for the making of a full arch implant level transfer impression.

43.

Integrated Abutment Crowns™ on stone model.

44.

View of transitional prosthesis four months after the implant placement and one month after the implant level transfer impression.

45.

View of implant wells and soft tissue sulci.

46.

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

47.

Abutment post receiving its mandatory alcohol wipe to remove any contaminants that would reduce the effectiveness of its locking taper engagement.

48.

Integrated Abutment Crown™ being inserted.

49.

Blue markings indicate excessive interproximal contacts which must be adjusted to assure passive contact for the engagement of the locking taper connection.

50.

Interproximal contacts being reduced with a pink acrylic polishing wheel.

51.

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 IAC.

52.

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

53.

Integrated Abutment Crown™ being reinserted.

54.

Acrylic orientation jig is being used to initially position the Integrated Abutment Crowns™.

55.

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.

56.

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.

57.

View of Integrated Abutment Crowns™ immediately after thier insertion.

58.

Patient’s smile.

59.

Post-insertion radiograph of Integrated Abutment Crowns™ four months after implant placement.

60.

View of Integrated Abutment Crowns™ twenty-two weeks after implant placement and six weeks after the insertion.

61.

View of Integrated Abutment Crowns™ twenty-two weeks after implant placement and six weeks after the insertion.

62.

Post-operative radiograph of Integrated Abutment Crowns™ twenty-two weeks after the implant placement and six weeks after the insertion.