Extraction of Four Maxillary Incisors, Placement of Four Immediately Placed and Functioning Implants with an Acellular Dermal Graft and their Restoration with Four Integrated Abutment Crowns™
This case demonstrates the extraction of three failed endodontically treated maxillary incisors and the placement of four immediately placed and functioning implants and their restoration with four Integrated Abutment Crowns™ along with the placement of an acellular dermal graft.
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Extraction of failed endodontically treated tooth.
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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 a 3.5mm latch reamer bur rotating at 50rpm without water irrigation.
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Hand reamer being rotated to enlarge the osteotomy.
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Harvested bone within the flute of hand reamer fastened to a straight driver.
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A 5.0mm x 8.0mm HA coated implant being inserted into the osteotomy with the implant inserter/retriever device.
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Etchant being applied in preparation for the bonding of the transitional stabilizing prosthesis while a black polyethylene healing plug is seated in the well of the implant.
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Bonding agent being applied.
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Light curing of bonding agent.
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Black polyethylene plug being removed from the well of the implant.
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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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Stealth shouldered abutment 4.0mm wide with a shoulder height of 3.5mm is being inserted into the implant well with only finger pressure with a snapped on short acrylic sleeve attached.
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Polyceramic material being added to acrylic sleeve to form a bonded strut between adjacent teeth.
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Light curing of polyceramic material that was applied over the acrylic sleeve.
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Transitional stabilizing prosthesis bonded to adjacent teeth.
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Radiograph of immediately functioning implant at the completion of first clinical visit.
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Pre-operative site three months after the placement of the right lateral incisor implant.
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Pre-operative radiograph.
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Removal of loose crown with post and core restoration.
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Extraction of failed endodontically treated tooth.
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Extraction of left lateral incisor.
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Extraction of failed endodontically treated tooth.
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Remnants of soft tissue being curetted from teeth sockets.
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Probe being used to evaluate operative site.
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Depth gauge being used to evaluate extraction site.
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Osteotomy being prepared with 2.0mm pilot bur rotating at 1100rpm with external irrigation.
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Osteotomy being prepared with 2.5mm latch reamer rotating at 1100rpm with external irrigation.
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Osteotomy being prepared with 2.5mm latch reamer rotating at 1100rpm with external irrigation.
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Osteotomy being enlarged with a 3.5mm latch reamer bur rotating at 50RPM without water irrigation.
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Osteotomy being enlarged with a 3.5mm latch reamer bur rotating at 50RPM without water irrigation.
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Osteotomy being enlarged with a 4.0mm latch reamer bur rotating at 50 RPM without water irrigation.
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Harvested bone within the latch reamer.
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Curette removing residual bone while confirming the integrity of the five bony walls of the osteotomy.
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A 5.0mm x 8.0mm HA coated implant being inserted into the osteotomy with the implant inserter/retriever device.
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A 5.0mm x 8.0mm HA coated implant being inserted into the osteotomy with the implant inserter/retriever device.
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A 5.0mm x 8.0mm HA coated implant being inserted into the osteotomy with the implant inserter/retriever device.
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View of wells of seated implants.
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Implant being definitively seated into the osteotomy with an implant seating tip threaded onto a straight handle.
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Periodontal probe being used to evaluate site prior to placement of an acellular dermal graft to eliminate the tissue concavity with its metallic hue.
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Vertical incision being made to evaluate site prior to placement of an acellular dermal graft to eliminate the tissue concavity with its metallic hue.
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Reflected flap reveals that the facially coronal aspect of the implant is not covered with bone.
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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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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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Stealth shouldered abutment 4.0mm wide with a shoulder height of 3.5mm is being inserted into the implant well with only finger pressure.
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Stealth shouldered abutment 5.0mm wide with a shoulder height of 4.0mm is being inserted into the implant well with only finger pressure.
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Stealth shouldered abutment 5.0mm wide with a shoulder height of 4.0mm is being inserted into the implant well with only finger pressure.
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As the acellular dermal graft is removed from the saline its clear backing is removed.
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The acellular dermal graft is sized for an appropriate piece to cover the implant in order to provide for a better connective tissue zone to eliminate the concavity of the overlying tissue with its metallic hue.
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Acellular dermal graft material being transported to the surgical site.
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Acellular dermal graft material in place over the previously placed osseointegrated implant.
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Acellular dermal graft material being sutured in place prior to the removal of the transitional crown for the fabrication of a four unit transitional stabilizing prosthesis.
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Four shouldered abutments only seated with finger pressure into the well of their implants.
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Tall acrylic sleeve being snapped on to stealth abutment.
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Short acrylic sleeve being snapped onto stealth abutment.
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Acrylic sleeve being adjusted to provide space for an interdental papilla.
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Etchant being applied in preparation for the bonding of the transitional stabilizing prosthesis.
63.
Bonding agent being applied.
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Light curing of bonding agent.
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Polyceramic material being added to acrylic sleeves to form a bonded strut between adjacent teeth.
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Light curing of polyceramic material that was applied over the acrylic sleeves.
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Light curing of polyceramic material in vacuum-formed template that was applied over the acrylic sleeve.
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Holes are being placed into template to facilitate the escape of air and movement of polyceramic material.
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Polyceramic material is being added to the labial aspect of the vacuum formed template.
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Additional material is being added to facilitate the aesthetic contouring of the strut.
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Transitional stabilizing prosthesis being light cured.
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Transitional prosthesis prior to being polished.
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Transitional prosthesis being contoured.
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Bonding agent being applied to transitional prosthesis.
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Bonding agent being applied to transitional prosthesis.
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Additional material being added to prosthesis.
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Light curing of additional material.
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Transitional stabilizing prosthesis being inserted.
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Polishing of bonded prosthesis with a soft white silicon disc.
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Transitional stabilizing prosthesis immediately after being placed.
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Radiograph of immediately placed and functioning implants at the completion of the first clinical visit.
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Smile at completion of second clinical visit.
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Six day post operative view.
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Six day post operative view.
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Two week post operative view.
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One month post operative view.
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Transitional prosthesis ten weeks after being placed and just prior to its being removed for the making of an implant level impression.
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Four shouldered abutments only seated with finger pressure into the well of their implants.
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Residual bonding material of the stabilizing prosthesis is being removed prior to the making of an implant level transfer impression.
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View of implant wells after the removal of the transitional prosthesis and the stealth abutments.
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Green 3.0mm plastic impression post being inserted into the 3.0mm implant well.
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Green 3.0mm plastic impression post being inserted into the 3.0mm implant well.
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Impression material being injected around impression posts for the making of a full arch implant level transfer impression.
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Impression post being removed from implant by tapping on the handle of the grasping forceps.
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Digital image being taken of shade guide against a black metal background to facilitate the fabrication of an aesthetic Integrated Abutment Crown™.
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Transitional prosthesis being reinserted.
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Integrated Abutment Crowns™ on dental model with acrylic orientation jig.
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Integrated Abutment Crowns™ on stone model.
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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.
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Mirror view of Integrated Abutment Crowns™.
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View of transitional prosthesis prior to its removal for the insertion of the Integrated Abutment Crowns™. Note the labial sinus tract which is most likely caused by a loose abutment connection.
102.
View of implant wells and sulci.
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Implant well and sulcus is being irrigated with chlorhexadine.
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Sinus tract is being incised.
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Labial view three months after placement of acellular dermal graft.
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View of implant wells and sulci.
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Incision being made to excise palatal tissue to facilitate the seating of the Integrated Abutment Crowns™.
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Integrated Abutment Crown™ being inserted.
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A clear acrylic orientation jig is being used to initially position the Integrated Abutment Crown™.
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Floss being used to confirm the fact that the interproximal contacts are passive and will not interfere with the engagement of the locking taper.
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Yellow thermoplastic custom seating jig in a crown seating tip threaded onto a straight handle to facilitate directing the seating forces in the long axis of the implant well and abutment post.
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Integrated Abutment Crown™ being inserted.
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Floss being used to confirm the fact that the interproximal contacts are passive and will not interfere with the engagement of the locking taper.
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Polishing strip being used to lighten the interproximal contact area to eliminate the possibility that the contact may prevent the engagement of the locking taper connection.
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Clear acrylic orientation jig being tapped to initially engage the locking taper connection.
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Yellow thermoplastic custom seating jig in a crown seating tip threaded onto a straight handle to facilitate the seating forces in the long axis of the implant well and abutment post.
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Crestal relieving incision being made to facilitate the seating of the Integrated Abutment Crown™.
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Integrated Abutment Crown™ being inserted.
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Floss being used to confirm the fact that the interproximal contacts are passive and will not interfere with the engagement of the locking taper.
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Acrylic polishing wheel being used to lighten the interproximal contact area to eliminate the possibility that the contact may prevent the engagement of the locking taper connection.
121.
Clear acrylic orientation jig being tapped to initially engage the locking taper connection.
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Yellow thermoplastic custom seating jig in a crown seating tip threaded onto a straight handle to facilitate the seating forces in the long axis of the implant well and abutment post.
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Blue markings indicate excessive contact on left incisor.
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Palatal contact is being reduced with acrylic polishing wheel.
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Integrated Abutment Crown™ being inserted.
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Acrylic polishing wheel being used to lighten the interproximal contact area to eliminate the possibility that the contact may prevent the engagement of the locking taper connection.
127.
Integrated Abutment Crown™ being inserted.
128.
Clear acrylic orientation jig being tapped to initially engage the locking taper connection.
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Yellow thermoplastic custom seating jig in a crown seating tip threaded onto a straight handle to facilitate directing the seating forces in the long axis of the implant well and abutment post.
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Blue markings indicate excessive contact on left incisor.
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Close-up of the patient’s smile immediately after insertion of Integrated Abutment Crowns™.
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Post-operative radiograph of seated Integrated Abutment Crowns™.
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Patient’s smile one day after insertion of Integrated Abutment Crowns™.
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Right profile of patient’s smile one day after insertion of Integrated Abutment Crowns™.
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Left profile of patient’s smile one day after insertion of Integrated Abutment Crowns™.
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View of Integrated Abutment Crowns™ one day after being inserted.
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View of Integrated Abutment Crowns™ ten days after being inserted.
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Black markings against a black plastic background facilitates determining the appropriateness and intra-oral modification of the form of the Integrated Abutment Crowns™.
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Black markings against a black plastic background facilitates determining the appropriateness and intra-oral modification of the form of the Integrated Abutment Crowns™.
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White silicone polishing wheel reducing the incisal length of the Integrated Abutment Crown™.
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White silicone polishing wheel reducing the incisal length of the Integrated Abutment Crown™.
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White silicone polishing wheel reducing the facial contour of the Integrated Abutment Crown™.
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Pink silicone polishing wheel reducing the facial contour of the Integrated Abutment Crown™.
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Pink silicone polishing wheel reducing the incisal length of the Integrated Abutment Crown™.
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White silicone polishing wheel reducing the facial contour of the Integrated Abutment Crown™.
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