This case demonstrates the extraction of three maxillary anterior teeth, insertion of five maxillary anterior immediately placed, stabilized, and functioning implants, as well as implant level transfer impression, and their restoration with five Integrated Abutment Crowns™.
SURGICAL: Extraction Immediate Placement Immediate Stabilization and Function
RESTORATIVE: Integrated Abutment Crowns™
TOPICS: Crestal Relieving Incision Crown Insertion Impression
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First Clinical Visit: Pre-operative smile.
Pre-operative radiograph.
Pre-operative radiograph.
Pre-operative radiograph.
Pre-operative site.
Prosthesis being removed in preparation for the implant placements.
View of pre-operative site after the removal of the prosthesis.
Extraction of tooth.
Extraction of tooth.
Extraction of tooth.
Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.
Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.
Parallel pin confirming appropriate trajectory and acting as a guide for subsequent osteotomy.
Parallel pins seated in pilot osteotomies indicating their trajectories.
Osteotomy being enlarged with an olive green 2.5mm latch reamer bur rotating at 50 RPM without water irrigation.
Osteotomy being enlarged with a teal 3.0mm latch reamer bur rotating at 50 RPM without water irrigation.
Osteotomy being enlarged with a blue 3.5mm latch reamer bur rotating at 50 RPM without water irrigation.
Osteotomy being enlarged with a red 4.0mm latch reamer bur rotating at 50 RPM without water irrigation.
Osteotomy being enlarged with a silver 4.5mm hand reamer bur attached to a threaded straight handle.
Osteotomy is being widened with a silver 4.5mm bone expander attached to a threaded straight handle.
Osteotomy being enlarged with a gold 5.0mm hand reamer bur attached to a threaded straight handle.
Depth gauge seated in the osteotomy to facilitate the selection of an implant with an appropriate length.
A 4.5mm x 8.0mm HA coated implant with 3.0mm implant well being inserted into the osteotomy with the implant inserter/retriever device.
A 4.5mm x 8.0mm HA coated implant with 3.0mm implant well being inserted into the osteotomy with the implant inserter/retriever device.
A 4.5mm x 8.0mm HA coated implant with 3.0mm implant well being inserted into the osteotomy with the implant inserter/retriever device.
A 5.0mm x 8.0mm HA coated implant with 3.0mm implant well being inserted into the osteotomy with the implant inserter/retriever device.
View of wells of seated implants.
A 5.0mm x 8.0mm HA coated implant with 3.0mm implant well being inserted into the osteotomy with the implant inserter/retriever device.
Implant seating tip attached to a straight handle being tapped to seat implant farther into the osteotomy.
Close-up view of implant seating tip attached to a straight handle being tapped to seat implant farther into the osteotomy.
View of seated implants with polyethylene healing plugs.
Post-operative radiograph.
Post-operative radiograph.
Tall acrylic sleeve being modified.
A modified acrylic sleeve snapped onto a 4.0 x 3.5mm shouldered abutment being inserted into the implant well .
Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height.
A modified acrylic sleeve snapped onto a 4.0 x 3.5mm shouldered abutment being inserted into the implant well.
Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height.
Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height.
A modified acrylic sleeve snapped onto a 4.0 x 3.5mm shouldered abutment being inserted into the implant well.
Acrylic sleeve being adjusted for clearance.
Vacuum formed template seated over acrylic sleeves and abutments to confirm the appropriateness of their placement.
Vaseline being applied around the acrylic sleeves and shouldered abutments.
Transitional composite material, “Integrity” by Dentsply, being added to acrylic sleeves to form a bonded strut between adjacent teeth.
Transitional composite material, “Integrity” by Dentsply, being added to vacuum formed template to form a transitional stabilizing prosthesis.
Additional transitional composite material, “Integrity” by Dentsply, in vacuum formed template added to the hardened strut for aesthetic contouring.
Vacuum formed template being removed.
Transitional composite prosthesis incorporating modified acrylic sleeves being removed for polishing.
Polished transitional composite prosthesis being initially inserted.
Vaseline being applied.
Cement being applied.
Transitional stabilizing prosthesis being cemented.
Incisal contacts being adjusted.
Post-operative radiograph.
Post-operative radiograph.
Second Clinical Visit: Bonded transitional stabilizing prosthesis prior to its being removed at the patient’s second clinical visit.
Transitional stabilizing prosthesis being removed for the making of an implant level transfer impression.
View of implant wells and soft tissue sulci.
Green 3.0mm metal guide pins being inserted.
Green 3.0mm impression reamer being inserted onto guide pin to remove any tissue which might inhibit the complete seating of an impression post.
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.
Green 3.0mm plastic impression post receiving its mandatory seating tap.
Impression material being injected around the impression post for the making of a full arch implant level transfer impression.
Facial view with green 3.0mm plastic impression posts prior to the making of an occlusal registration.
Polyvinylsiloxane material being injected for the recording of an occlusal registration.
Occlusal registration being recorded.
Third Clinical Visit: Integrated Abutment Crowns™ on a stone model.
View of five Integrated Abutment Crowns™.
View of transitional prostheses prior to its removal for the insertion of the Integrated Abutment Crowns™.
Transitional prostheses being removed.
Well of implant being cleaned with alcohol on a cotton tipped applicator.
Integrated Abutment Crown™ being inserted.
Crestal relieving incision being made to facilitate the seating of the Integrated Abutment Crown™.
Integrated Abutment Crown™ being inserted.
Well of implant being cleaned with alcohol on a cotton tipped applicator.
Integrated Abutment Crown™ being inserted.
Crestal relieving incision being made to facilitate the seating of the Integrated Abutment Crown™.
Well of implant being cleaned with alcohol on a cotton tipped applicator.
Integrated Abutment Crown™ being inserted.
Integrated Abutment Crown™ being inserted.
An acrylic orientation jig being used to initially position the Integrated Abutment Crowns™.
Floss being used to confirm the fact that the interproximal contacts are passive and will not interfere with the engagement of the locking taper.
Diamond finishing strip being used to lighten the interproximal contact area eliminating the possibility that the contact may prevent the engagement of the locking taper connection.
Facial view immediately after the insertion of five Integrated Abutment Crowns™.
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.
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.
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.
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.
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.
Incisal contacts being adjusted.
Facial view of the Integrated Abutment Crowns™ after the adjustment. Note how the initial blanching of the tissue is no longer present.
Facial view of the Integrated Abutment Crowns™ in occlusion.
Post-operative radiograph.
Post-operative radiograph.
Post-operative radiograph.
Facial view two-week post insertion.
Smile two-week post-insertion.
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