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

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1.

First Clinical Visit: Pre-operative smile.

2.

Pre-operative site.

3.

Pre-operative radiograph.

4.

View of extracted tooth.

5.

View of extracted tooth.

6.

View of extracted root.

7.

Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.

8.

Osteotomy being enlarged with an olive green 2.5mm latch reamer rotating at RPM without water irrigation.

9.

Osteotomy being enlarged with a teal 3.0mm latch reamer rotating at 50 RPM without water irrigation.

10.

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

11.

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

12.

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

13.

Osteotomy being enlarged with a gold 5.0mm hand reamer.

14.

A 5.0mm x 6.0mm Nanotite implant being inserted into the osteotomy with an implant inserter/retriever.

15.

A 5.0mm x 6.0mm Nanotite implant being inserted into the osteotomy with an implant inserter/retriever.

16.

View of seated implants in the osteotomy.

17.

An implant being tapped into place.

18.

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

19.

A 5.0mm x 6.0mm 10° stealth shouldered abutment being inserted into the implant well with only finger pressure.

20.

A 5.0mm x 6.0mm 10° stealth shouldered abutment being inserted into the implant well with only finger pressure.

21.

Vacuum formed template seated over the abutments to confirm the appropriateness of their placement.

22.

A stealth shouldered abutment being modified.

23.

Tall acrylic sleeve being modified.

24.

A modified acrylic sleeve snapped onto a shouldered abutment being inserted into the implant well.

25.

A modified acrylic sleeve snapped onto a shouldered abutment being inserted into the implant well.

26.

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

27.

"Composite material, ""Integrity"" by Dentsply, being added to vacuum formed template to form a transitional stabilizing prosthesis."

28.

Transitional composite material in vacuum-formed template being formed around acrylic strut.

29.

Transitional prosthesis incorporating modified acrylic sleeves being removed for polishing.

30.

Transitional prosthesis being polished.

31.

View of transitional stabilizing prosthesis.

32.

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

33.

Bonding material being applied.

34.

Light curing of bonding material.

35.

Composite material being added.

36.

Light curing of composite material.

37.

Transitional prosthesis being polished.

38.

View of finished transitional stabilizing prosthesis.

39.

Post operative radiograph.

40.

Second Clinical Visit: View of transitional prosthesis prior to its removal.

41.

View of implant wells after the removal of the transitional prosthesis and the stealth abutments.

42.

A 3.0mm titanium impression post being seated into the well of an integrated implant for the making of an implant level transfer impression.

43.

A 3.0mm titanium impression post being seated into the well of an integrated implant for the making of an implant level transfer impression.

44.

View of titanium impression posts seated in the wells of integrated implants.

45.

A green 3.0mm plastic sleeve being snapped onto the 3.0mm titanium impression post.

46.

View of seated green 3.0mm plastic sleeves which were snapped onto the impression posts.

47.

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

48.

View of metal opaque layer on top of prepared non-shoulder abutments.

49.

View of the restoration after an application and light curing of polyceramic opaque dentin.

50.

View of the restoration after an application and light curing of enamel dentin.

51.

View of unpolished Integrated Abutment Crowns™.

52.

View of marked unpolished Integrated Abutment Crowns™.

53.

View of marked unpolished Integrated Abutment Crowns™.

54.

Finished Maxillary Integrated Abutment Crowns™ on stone model.

55.

View of Integrated Abutment Crowns™.

56.

Integrated Abutment Crowns™ on stone model with yellow thermoplastic seating jigs, which were fabricated on a caliper like device to facilitate directing the seating forces in the long axis of the implant well and abutment post.

57.

Third Clinical Visit: View of transitional prosthesis prior to its removal.

58.

Patient's smile after removal of transitional prosthesis.

59.

View of implant wells and soft tissue sulci.

60.

Integrated Abutment Crown™ being inserted.

61.

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

62.

Integrated Abutment Crown™ being inserted.

63.

Floss being used to confirm the fact that the interproximal contacts are passive and will not interfere with the engagement of the locking taper.

64.

Floss being used to confirm the fact that the interproximal contacts are passive and will not interfere with the engagement of the locking taper.

65.

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.

66.

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.

67.

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.

68.

Articulating paper being used to confirm incisal contacts in all extreme excursions while the patient is clenching.

69.

Incisal contacts being adjusted.

70.

Post-insertion radiograph.

71.

Right profile view one month post insertion.

72.

Left profile view one month post insertion.

73.

Facial view one month post insertion.