Extraction, Implant, and Crown in Two Patient Visits

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1.

First Patient Visit: Maxillary right central incisor prior to being extracted because of root resorption.

2.

Extraction site.

3.

A 5.0mm x 8.0mm implant being inserted into the osteotomy.

4.

View of 3.0mm well of immediately inserted implant.

5.

Shoulder depth gauge seated in well of implant indicating which abutment height will provide for a subgingival margin placement.

6.

A 5.0mm x 4.0mm stealth shouldered abutment being gently inserted into the implant well.

7.

Gently seated stealth shouldered abutment.

8.

One piece short acrylic sleeve being snapped onto stealth shouldered abutment.

9.

The flats on the top of the one piece acrylic sleeves correspond to their internal flats which in turn correspond to the flats on the abutments.

10.

Vacuum formed template being tried for adaptation prior to the fabrication of a transitional crown.

11.

Kevlar® ribbon being placed into the template for incorporation into a bonded acrylic splint.

12.

Newly formed acrylic splint incorporating one piece sleeve and reinforcing ribbon being removed for polishing.

13.

Transitional acrylic splint bonded to adjacent porcelain fused to metal crowns.

14.

Impression being taken of post.

15.

Radiograph of immediately loaded 5.0mm x 8.0mm implant and a 5.0mm x 4.0mm stealth shouldered abutment with a transitional splint bonded to adjacent crowns.

16.

Well of implant analog in soft tissue model.

17.

Stealth shouldered abutment in implant analog of soft tissue model.

18.

10.0mm aluminum oxide sleeve on the abutment in a soft tissue model.

19.

Aluminum oxide sleeve being adjusted easily by the rotating diamond wheel of a model trimmer while the sleeve is held by an abutment prep holder.

20.

Porcelain separator being applied to the abutment.

21.

Alpha porcelain being applied directly to the aluminum oxide sleeve.

22.

Porcelain being built onto an aluminum oxide sleeve in the conventional manner.

23.

Completed all-ceramic crown on the soft tissue model.

24.

Second Patient Visit: Healed implant site with bonded transitional splint incorporating one piece acrylic sleeve snapped onto shouldered abutment along with reinforcing ribbon bonded to adjacent porcelain fused to metal crowns.

25.

Palatal view of bonded splint.

26.

Removal of transitional splint.

27.

View of 5.0mm wide shouldered abutment which was gently seated at the time of implant placement.

28.

View of sulcus and 3.0mm well of implant after the removal of the abutment.

29.

Mirror view of the all-ceramic crown with internal view of aluminum oxide sleeve on which the crown was made.

30.

Metallic coupler bonding system being applied to the abutment.

31.

Ceramic coupler being applied to internal aspect of the crown.

32.

Bonding agent being applied to both the abutment and the crown.

33.

Cement being applied into the crown for its extra-oral cementation to the abutment.

34.

Mirror view of the extra-orally cemented abutment and crown.

35.

Extra-orally cemented abutment and all-ceramic crown being inserted into the implant during the patient's second clinical visit.

36.

After confirming proper orientation, occlusion and inter-proximal contacts the crown and the abutment are being tapped into the implant well with a healing plug inserted into the straight driver.

37.

View of the all-ceramic crown immediately after being tapped into the implant.

38.

Patient's smile with new all-ceramic crown at the end of her second clinical visit.