Extraction of Mandibular First Premolar, Two Stage Placement and Restoration of Three Mandibular implants with Bicon Integrated Abutment Crowns™

Click on an image to view it larger. Click on the right half of the large image to view the next image, click on the left half to view the previous image. You may also use the left and right arrow keys on your keyboard to navigate through the images. Click the ESC key to exit the slideshow.

Click "Switch View" below to change to a layout optimized for printing the case.

Switch Thumb

1.

A periotome is being used with apical pressure to facilitate the removal of the failed endodontically treated root by sufficiently loosening it prior to any removal attempt.

2.

Apical pressure is being applied on the periotome in a rocking motion to sever the root’s periodontal ligament.

3.

Use of the periotome is discontinued once it has been sufficiently inserted around the circumference of the root.

4.

A straight elevator is gently luxating the root prior to any removal attempt which may cause fracture of the bone.Use of the straight elevator is discontinued once the root is freely moveable.

5.

A straight elevator is gently luxating the root prior to any removal attempt which may cause fracture of the bone.Use of the straight elevator is discontinued once the root is freely moveable.

6.

Root is being removed.

7.

Root is being removed.

8.

A curette is being used to remove any soft tissue from the five walls of the socket.

9.

A retraction suture is maintaining reflection of the lingual flap.

10.

A 2.0mm pilot bur is being used to prepare the initial osteotomy in the socket of the extracted root while its trajectory is parallel to and bisecting the distal surface of the adjacent canine.

11.

A paralleling pin has been placed into the initial pilot osteotomy to facilitate the positioning of the pilot bur for the second osteotomy in the same trajectory.

12.

Pilot bur initiating the third osteotomy in the same trajectory as the first two osteotomies

13.

Three paralleling pins confirming the appropriateness of the pilot osteotomies.

14.

A 2.5mm gold colored latch reamer preparing the osteotomy at 50RPM.

15.

A 3.5mm blue latch reamer widening the osteotomy while rotating at 50RPM.

16.

A 4.5mm latch reamer being removed from osteotomy with harvested bone.

17.

Harvested bone being collected in flexible dappen dish.

18.

A 4.5mm x 8.0mm HA coated implant being carried to osteotomy site with its black polyethylene healing plug handle.

19.

A 4.5mm x 8.0mm HA coated implant being inserted into the osteotomy.

20.

Cut black polyethylene healing plug being inserted into the well of the implant with a periodontal probe.

21.

Harvested autogenous bone being placed over the implants.

22.

Resorbable cellulose being placed over the grafted bone to facilitate its stabilization.

23.

Sutured surgical site.

24.

View of three healing abutments that were placed at the time of the stage two uncovering of the implants.

25.

View of three implant wells and soft tissue sulci after the removal of the healing abutments.

26.

A 3.0mm impression post is being inserted into the well of the implant.

27.

Second impression post being inserted.

28.

Impression post receiving its mandatory seating tap.

29.

Impression material being injected around the white impression posts for the making of an implant level transfer impression.

30.

View of implant level transfer impression immediately after its removal from the mouth.

31.

Impression posts are being reduced for the recording of an occlusal relationship.

32.

Red acrylic being injected around impression posts.

33.

Occlusal relationship being recorded in red acrylic.

34.

Occlusal registration being removed from the implant wells.

35.

Healing abutment being re-inserted into the well of the implant.

36.

Digital image being taken of shade guide against a black metallic background which will facilitate the fabrication of an aesthetic restoration.

37.

Facial view of three Integrated Abutment Crowns™ on stone model.

38.

Integrated Abutment Crowns™ on model with clear acrylic occlusal orientation jig.

39.

Mirror view of three Integrated Abutment Crowns™.

40.

View of healing abutments prior to their removal for the insertion of the Integrated Abutment Crowns™.

41.

View of implant wells and soft tissue sulci.

42.

Integrated Abutment Crown™ being inserted.

43.

Clear acrylic orientation jig facilitating the appropriate positioning of the Integrated Abutment Crown™.

44.

Second Integrated Abutment Crown™ being inserted.

45.

Insertion of third Integrated Abutment Crown™.

46.

Post insertion radiograph.

47.

View of seated Integrated Abutment Crowns™.