This case demonstrates the extraction of six anterior teeth, insertion of four maxillary and two mandibular immediately placed, stabilized, and functioning implants, implant level transfer impression, metal try-in, and their restoration with Integrated Abutment Crowns™, a PFM bridge, as well as two Procera crowns cemented on natural teeth.
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Pre-operative site prior to the extraction of the three mandibular anterior teeth.
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A mandibular anterior tooth being extracted.
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Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.
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Parallel pin confirming appropriate trajectory and acting as a guide for subsequent osteotomy.
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Osteotomy being enlarged with an olive green 2.5mm latch reamer rotating at 50RPM without water irrigation.
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Osteotomy being enlarged with a teal 3.0mm latch reamer rotating at 50 RPM without water irrigation.
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Osteotomy being enlarged with a blue 3.5mm latch reamer rotating at 50 RPM without water irrigation.
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Harvested bone within the blue 3.5mm hand reamer.
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View of harvested bone being placed into dappen dish.
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A 3.5mm x 11.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threADOed on a straight driver.
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A 3.5mm x 11.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threADOed on a straight driver.
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Implant seating tip attached to a straight handle being tapped to seat implant farther into the osteotomy.
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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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A 5.0mm wide with a shoulder height of 4.0mm stealth shouldered abutment is being inserted into the implant well with only finger pressure.
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A 5.0mm wide with a shoulder height of 4.0mm stealth shouldered abutment is being inserted into the implant well with only finger pressure.
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Shoulder of the stealth shouldered abutment being ADOjusted.
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The abutment being re-seated after modification.
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Autogenous bone graft being placed around the shoulder of the stealth abutment with sterile cotton applicator.
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Suture being placed over the bone graft.
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Sutured site.
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Tall acrylic sleeve being snapped on to stealth abutment.
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Tall acrylic sleeve being modified.
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Vacuum formed template seated over modified tall acrylic sleeves and abutments to confirm the appropriateness of their placement.
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Etchant being applied for the bonding of the transitional stabilizing prosthesis.
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Bonding primer agent being applied.
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Light curing of bonding agent.
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Vaseline being applied to protect the sutures.
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Transitional composite material in vacuum-formed template being formed around acrylic sleeves.
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Transitional composite prosthesis incorporating modified acrylic sleeves being removed for polishing.
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Bonding material being light cured.
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Composite material being ADOded to transitional prosthesis.
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Transitional prosthesis being seated.
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ADOded composite material being light cured.
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Incisal contacts being ADOjusted.
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Incisal contacts being polished.
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Finished transitional prosthesis.
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Post operative rADOiograph immediately after implant placement.
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Pre-operative view prior to the maxillary implant placement.
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Second clinical visit: Pre-operative site prior to the extraction of the maxillary anterior teeth.
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Extracted maxillary tooth.
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Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.
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Parallel pins confirming appropriate trajectories and acting as guides for subsequent osteotomy.
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Parallel pins seated in pilot osteotomies indicating their trajectories.
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Osteotomy being enlarged with a red 4.0 mm latch reamer rotating at 50 RPM without water irrigation.
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A 4.5mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threADOed on a straight driver.
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A 4.5mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threADOed on a straight driver.
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A 4.5mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threADOed on a straight driver.
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View of the wells of the seated implants.
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View of initial incision.
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Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.
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Osteotomy being enlarged with an olive green 2.5mm latch reamer rotating at 50RPM without water irrigation.
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Osteotomy being enlarged with a teal 3.0mm latch reamer rotating at 50 RPM without water irrigation.
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Osteotomy being enlarged with a blue 3.5mm hand reamer
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Harvested bone within the silver 4.5mm hand reamer.
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A 4.5mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threADOed on a straight driver.
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View of seated implants with polyethylene healing plugs.
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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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A 5.0mm x 2.0mm, 10º Stealth shouldered abutment with 3.0mm post being inserted into the implant well with only finger pressure.
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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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Seated stealth shouldered abutment.
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A 4.0mm wide, 0° stealth shouldered abutment with a shoulder height of 1.5mm is being inserted into the implant well with only finger pressure.
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Vacuum formed template seated over the abutments to confirm the appropriateness of their placement.
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Tall acrylic sleeve being modified for clearance.
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Tall acrylic sleeve being modified.
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Vacuum formed template seated over the modified acrylic sleeves and abutments to confirm the appropriateness of their placement.
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Transitional composite material, “Integrity by Dentsply”, being ADOded to vacuum formed template to form a transitional prosthesis.
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Transitional composite material being ADOded to the modified acrylic sleeves snapped onto abutments.
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Transitional composite material in vacuum-formed template being formed around acrylic sleeves.
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Transitional composite prosthesis incorporating modified acrylic sleeves being removed for polishing.
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Transitional composite prosthesis incorporating modified acrylic sleeves and a stealth shouldered abutment.
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View of immediately stabilizing transitional prosthesis in place.
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Post-operative rADOiograph.
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Post-operative rADOiograph.
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Post-operative rADOiograph.
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Third clinical visit: Facial view prior to the removal of the lower anterior transitional prosthesis for metal try-in, thirteen weeks after the implant placements.
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Red 2.0mm plastic impression post receiving its mandatory seating tap for the making of an implant level transfer impression.
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Digital image being taken of shADOe guide against a black plastic background to facilitate the fabrication of aesthetic Integrated Abutment Crowns&trADOe;.
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Two milled abutments in red plastic implant analogs in stone model.
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Two-piece cast metal framework joined with red acrylic resin seated on two milled abutments in stone model.
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Two-piece cast metal framework joined with red acrylic resin seated on two milled abutments prior to an intra-oral confirmation of its appropriateness.
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View of cast metal framework and two milled abutments.
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The close-up view of the two-piece cast metal framework.
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Transitional stabilizing prosthesis eight months after the immediate placement and stabilization.
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Transitional stabilizing prosthesis being removed for metal try-in.
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Metal framework being used to orient milled abutments into the wells of their implants.
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Milled abutment being tapped into its implant well.
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Milled abutment being tapped into its implant well.
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Metal casting being seated to reconfirm a passive fit after the definitive seating of the two milled abutments.
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Separated metal framework being removed from the initially seated milled abutments.
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Transitional composite material in vacuum-formed template being formed around acrylic sleeves.
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Transitional prosthesis being removed for polishing.
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Cement being applied.
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View of finished transitional prosthesis.
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Fourth clinical visit: Confirmation of try in prosthesis.
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Try in
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Post operative rADOiograph immediately before the cementation of four-unit porcelain fused to metal crown.
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Separating medium being applied to the four-unit porcelain fused to metal crown to facilitate removal of extraneous cement.
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Minimal cement being ADOded only to the cervical area of casting.
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Four-unit porcelain fused to metal crown bridge being cemented.
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View of cemented four-unit porcelain fused to metal crown.
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Green 3.0mm plastic impression posts seated in the wells of integrated maxillary implants for the making of an implant level transfer impression.
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Polyvinylsiloxane material injected for the recording of an occlusal registration.
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Occlusal registration being recorded.
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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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View of maxillary full arch implant level transfer impression.
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Digital image being taken of shADOe guide against a black plastic background to facilitate the fabrication of aesthetic Integrated Abutment Crowns&trADOe;.
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Four Integrated Abutment Crowns&trADOe; and two procera crowns on stone model.
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Fifth clinical visit: Facial view of mandibular four-unit porcelain fused to metal crown and maxillary transitional prosthesis five weeks after the maxillary full arch implant level impression.
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View of temporary healing abutments after the removal of the transitional prosthesis for the insertion of the Integrated Abutment Crowns&trADOe;.
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View of implant wells and soft tissue sulci.
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Integrated Abutment Crown&trADOe; being inserted. Note the angulation of the abutment post.
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Integrated Abutment Crown&trADOe; being inserted.
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Crestal relieving incision being mADOe to facilitate the seating of the Integrated Abutment Crown&trADOe;.
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Integrated Abutment Crown&trADOe; being inserted.
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Crestal relieving incision being mADOe to facilitate the seating of the Integrated Abutment Crown&trADOe;.
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An acrylic orientation jig being used to initially position the Integrated Abutment Crowns&trADOe;.
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A green 6.5mm sulcus reamer being used to remove soft tissue and bone which might inhibit the complete seating of the Integrated Abutment Crown&trADOe;.
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Cervical aspect of the Integrated Abutment Crown&trADOe; being reduced with #7404 bur.
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White healing abutment in a straight handle is being used to tap the Integrated Abutment Crown&trADOe; into the well of the implant.
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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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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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Cement being applied to the procera crown.
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Cement being applied to the procera crown.
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Procera crown being cemented.
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View of seated Integrated Abutment Crowns&trADOe; and two procera crowns immediately after being inserted.
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Postoperative rADOiograph.
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View of seated Integrated Abutment Crowns&trADOe; and two procera crowns three months post insertion.
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