Extraction of Two Maxillary Canines, Placement of Three Immediately Functioning Implants, Restoration of Twelve Maxillary Implants with Integrated Abutment Crowns™, and the Removal of Right Canine Implant and its Two Stage Replacement (Part One)
This case demonstrates the extraction of two maxillary canines and the placement of three maxillary immediately functioning implants as well as the restoration of twelve maxillary implants with Integrated Abutment Crowns™ and the subsequent removal of the non-integrated right canine implant and its two stage surgical replacement.
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Pre-operative radiograph with three mandibular right posterior implants.
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Radiograph of transitional prosthesis on the three posterior implants.
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Pre-operative radiograph with three additional anterior implants.
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Pre-operative site.
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Extraction being initiated with a periotome.
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Extraction of canine tooth.
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Crestal incision for the uncovering and the placement of implants.
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Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.
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Guide pins inserted into integrated implants.
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Osteotomy being enlarged while the surgeon’s finger is monitoring the buccal bone.
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Curette removing residual bone while confirming the integrity of the five bony walls of the osteotomy.
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Harvested bone within the flute of hand reamer fastened to a straight driver.
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Osteotomy being enlarged with a 4.5mm latch reamer bur rotating at 50RPM without water irrigation.
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Osteotomy being enlarged with a 5.0mm latch reamer bur rotating at 50RPM without water irrigation.
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6.5mm x 8.0mm HA coated implant being inserted into the osteotomy with the implant inserter/retriever device.
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6.5mm x 8.0mm HA coated implant being inserted into the osteotomy with the implant inserter/retriever device.
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6.5mm x 8.0mm HA coated implant being inserted into the osteotomy with the implant inserter/retriever device.
19.
Radiograph prior to the fabrication of a transitional prosthesis incorporating the newly uncovered and placed anterior implants.
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Acrylic sleeves snapped onto shouldered abutments prior to their being incorporated into a transitional prosthesis.
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Acrylic sleeves snapped onto shouldered abutments prior to their being incorporated into a transitional prosthesis.
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Acrylic sleeves snapped onto shouldered abutments prior to their being incorporated into a transitional prosthesis.
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Acrylic sleeves snapped onto shouldered abutments prior to their being incorporated into a transitional prosthesis.
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Acrylic sleeves snapped onto shouldered abutments prior to their being incorporated into a transitional prosthesis.
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Relined lab prosthesis prior to being inserted over acrylic sleeves.
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Relined prosthesis on acrylic sleeves.
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View of transitional prosthesis with a left side cantilever.
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Patient’s smile prior to the making of occlusal registration and an implant level transfer impression.
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Green 3.0mm impression post being inserted into implant well for the making of an occlusal registration.
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Green 3.0mm impression post being inserted into implant well for the making of an occlusal registration.
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Green 3.0mm impression post being inserted into implant well for the making of an occlusal registration.
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Occlusal registration being taken of anterior and left posterior while the transitional prosthesis on the right side is in occlusion.
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Occlusal registration being taken of anterior and left posterior while the transitional prosthesis on the right side is in occlusion.
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Green 3.0mm impression post being tapped into implant well for the making of an occlusal registration.
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Red acrylic on impression posts recording an occlusal registration.
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Occlusal registration being marked to record the midline of the face, lip line and incisal length of anterior teeth.
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Occlusal registration being marked to record the midline of the face, lip line and incisal length of anterior teeth.
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Occlusal registration being marked to record the midline of the face, lip line and incisal length of anterior teeth.
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Occlusal registration being removed from implant well.
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Cut black polyethylene healing plug being removed from well of uncovered two stage left posterior implant.
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Cut black polyethylene healing plug being removed from well of uncovered two stage left posterior implant.
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5.0mm sulcus reamer being inserted onto seated guide pin to prepare soft tissue sulcus.
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5.0mm sulcus reamer being inserted onto seated guide pin to prepare soft tissue sulcus.
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Green 3.0mm impression post being inserted into implant well.
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5.0mm sulcus reamer being inserted onto seated guide pin to prepare soft tissue sulcus.
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Green 3.0mm impression post receiving its mandatory seating tap.
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Impression material being injected around seated impression posts.
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Digital image being taken of shade guide against a black metal background to facilitate the fabrication of aesthetic Integrated Abutment Crowns™.
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Transitional composite material being added to acrylic sleeves to form a transitional prosthesis.
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Transitional composite material in vacuum-formed template being formed around acrylic sleeves.
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Patient’s smile with transitional prosthesis in place.
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Integrated Abutment Crowns™ on stone model.
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Integrated Abutment Crowns™ on stone model.
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Integrated Abutment Crowns™ on stone model with acrylic orientation jig.
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Mirror view of twelve Integrated Abutment Crowns™.
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View of transitional prosthesis prior to its removal for the insertion of twelve Integrated Abutment Crowns™.
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View of implant wells and soft tissue sulci.
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Integrated Abutment Crown™ being inserted.
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Integrated Abutment Crown™ being inserted.
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Floss being used to confirm the fact that the inter-proximal contacts are passive and will not interfere with the engagement of the locking taper.
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Yellow thermoplastic acrylic orientation jig being used to facilitate positioning of Integrated Abutment Crowns™.
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Articulating paper being used to confirm interproximal contacts.
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Adjustment of interproximal contact. A too tight interproximal contact will prevent the engagement of the locking taper and possibly result in subsequent loosening 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 interproximal contacts are passive and will not interfere with the engagement of the locking taper.
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Articulating paper being used to confirm interproximal contacts.
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Adjustment of interproximal contact. A too tight interproximal contact will prevent the engagement of the locking taper and possibly result in subsequent loosening of the Integrated Abutment Crown™.
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Incision being made to excise palatal tissue to facilitate the seating of the Integrated Abutment Crown™.
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Yellow thermoplastic acrylic orientation jig being used to facilitate positioning of Integrated Abutment Crowns™.
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Integrated Abutment Crown™ being inserted.
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A 5.0mm sulcus reamer being inserted onto guide pin seated in the well of the implant to facilitate the seating of Integrated Abutment Crown™ by removing interfering tissue.
72.
Sulcus reamer being removed with tissue.
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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.
74.
Yellow thermoplastic orientation jig is being tapped to initially engage the locking taper connection of the Integrated Abutment Crown™.
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Custom yellow thermoplastic jig in a crown seating tip is being used to insure that the seating forces are directed in the long axis of the implant well and abutment post.
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Blue markings confirming occlusal contacts after each Integrated Abutment Crown™ insertion.
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Relieving incision being made to facilitate the insertion of the Integrated Abutment Crown™.
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Integrated Abutment Crown™ being inserted.
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Abutment post is being wiped with alcohol to remove any microscopic debris which would reduce the effectiveness of the locking taper connection.
80.
Integrated Abutment Crown™ in custom seating jig reveals how the jig facilitates directing seating forces in the long axis of the abutment post.
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Custom yellow thermoplastic seating jig in a crown seating tip is being used to insure that the seating forces are directed in the long axis of the implant well and the abutment post.
82.
A 5.0mm sulcus reamer being inserted onto guide pin seated in the well of the implant to facilitate the seating of Integrated Abutment Crown™ by removing interfering tissue.
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Sulcus reamer being removed with tissue.
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Integrated Abutment Crown™ being inserted.
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Custom yellow thermoplastic seating jig in a crown seating tip is being used to insure that the seating forces are directed in the long axis of the implant well and the abutment post.
86.
View of six definitively seated Integrated Abutment Crowns™.
87.
Integrated Abutment Crown™ being inserted.
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A 5.0mm sulcus reamer being inserted onto guide pin seated in the well of the implant to facilitate the seating of Integrated Abutment Crown™ by removing interfering tissue.
89.
Custom yellow thermoplastic jig in a crown seating tip is being used to insure that the seating forces are directed in the long axis of the implant well and abutment post.
90.
Relieving incision being made to facilitate the insertion of the Integrated Abutment Crown™.
91.
Custom yellow thermoplastic jig in a crown seating tip is being used to insure that the seating forces are directed in the long axis of the implant well and abutment post.
92.
Integrated Abutment Crown™ being inserted.
93.
A 5.0mm sulcus reamer being inserted onto guide pin seated in the well of the implant to facilitate the seating of Integrated Abutment Crown™ by removing interfering tissue.
94.
Sulcus reamer being removed with tissue.
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Integrated Abutment Crown™ being inserted.
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Integrated Abutment Crown™ being inserted.
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Plastic temporary abutment mounted in a straight driver to seat the Integrated Abutment Crown™ in the long axis of the abutment shaft and implant well to engage the locking taper.
98.
Integrated Abutment Crown™ being inserted.
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Patient’s smile immediately after the definitive seating of twelve Integrated Abutment Crowns™.
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View of Integrated Abutment Crowns™ immediately after their being definitively seated.
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View of Integrated Abutment Crowns™ immediately after their being definitively seated.
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View of Integrated Abutment Crowns™ immediately after their being definitively seated.
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Occlusal view of Integrated Abutment Crowns™ immediately after their being definitively seated.
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Post-insertion radiograph of Integrated Abutment Crowns™.
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Post-insertion radiograph of Integrated Abutment Crowns™.
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Post-insertion radiograph of Integrated Abutment Crowns™.
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Post-insertion radiograph of Integrated Abutment Crowns™.
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Post-insertion radiograph of Integrated Abutment Crowns™.
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Post-insertion radiograph of Integrated Abutment Crowns™.
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Post-insertion radiograph of Integrated Abutment Crowns™.
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Post-insertion radiograph of Integrated Abutment Crowns™.
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Right lateral Integrated Abutment Crown™ has been removed prior to the removal of the right canine implant.
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Right canine implant being removed three days after the insertion of its Integrated Abutment Crown™ because of its mobility and non-integration.
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Depth guage being used in the socket of removed implant.
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Osteotomy being enlarged with a 3.5mm latch reamer bur rotating at 50RPM without water irrigation.
116.
6.0 x 5.7mm HA coated implant being inserted into osteotomy with the black polyethylene healing plug.
117.
Harvested bone being placed over the seated implant and cut polyethylene healing plug.
118.
Sutured closure of the two stage surgical implant placement.
119.
Light curing of transitional crown.
120.
Radiograph of integrated implant six weeks after implant placement.
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