Extraction, Placement and Immediate stabilization and Restoration of a Mandibular Left Lateral Incisor with Integrated Abutment Crown™

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1.

Pre-operative radiograph.

2.

Pre-operative view of failed root canal treated tooth with a fistula.

3.

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

4.

Bonding primer agent being applied.

5.

Bonding agent being applied.

6.

Light curing of bonding agent.

7.

Extraction of failed endodontically treated tooth.

8.

Etchant being applied to the crown of the extracted tooth prior to bonding.

9.

Extracted crown being bonded to adjacent teeth.

10.

Transitional prosthesis in place.

11.

Post-operative radiograph.

12.

Flap reflected in preparation for the osteotomy nine months after the extraction.

13.

A 4.5mm x 11.0mm HA coated implant with a 3.0mm implant well is being inserted with the black polyethylene healing plug.

14.

View of the well of initially seated implant.

15.

A straight handle with an implant seating tip attached is being tapped to seat implant farther into the osteotomy.

16.

Thickness of the flap is being reduced.

17.

Thickness of the flap is being reduced.

18.

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

19.

Stealth shouldered abutment 4.0mm wide with a shoulder height of 3.5mm is being inserted into the implant well with only finger pressure.

20.

Tall acrylic sleeve being snapped onto stealth abutment.

21.

Tall acrylic sleeve being adjusted.

22.

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

23.

Bonding primer agent being applied.

24.

Bonding agent being applied.

25.

Light curing of bonding agent.

26.

Polyceramic material being added to acrylic sleeve to form a bonded strut between adjacent teeth.

27.

Light curing of polyceramic material that was applied over the acrylic sleeve.

28.

Transitional stabilization prosthesis being contoured.

29.

Polishing of bonded prosthesis with a soft white silicone disc.

30.

Polishing of bonded prosthesis with a nylon bristle brush.

31.

Transitional stabilization prosthesis in place.

32.

Radiograph twelve weeks after implant placement prior to the making of a full arch implant level transfer impression.

33.

Bonded stabilizing prosthesis prior to its being removed.

34.

1. View of stealth abutment after the removal of stabilizing prosthesis.

35.

View of implant well after the removal of the transitional prosthesis and the stealth abutment.

36.

A 3.0mm guide pin being inserted into the well of the implant.

37.

Green 3.0mm impression reamer being inserted onto guide pin to remove any tissue which might inhibit the complete seating of an impression post.

38.

Green 3.0mm plastic impression post being inserted into the well of an integrated implant for the making of an implant level transfer impression.

39.

Green 3.0mm plastic impression post receiving its mandatory seating tap.

40.

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

41.

Digital image being taken of shade guide against a black plastic background to facilitate the fabrication of aesthetic Integrated Abutment Crowns™.

42.

Transitional prosthesis being reinserted.

43.

Integrated Abutment Crown™ on stone model.

44.

View of Integrated Abutment Crown™.

45.

View of transitional prosthesis prior to its removal for the insertion of the Integrated Abutment Crown™ two weeks after the implant level transfer impression was taken.

46.

View of implant well and soft tissue sulcus.

47.

Abutment post receiving its mandatory alcohol wipe to remove any contaminants that would reduce the effectiveness of its locking taper engagement.

48.

Integrated Abutment Crown™ being inserted initially to evaluate its appropriateness.

49.

Crestal relieving incision being made to facilitate the seating of the Integrated Abutment Crown™.

50.

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

51.

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.

52.

A clear acrylic orientation jig is being used to initially position the Integrated Abutment Crown™.

53.

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.

54.

Blue markings indicate appropriate occlusal contacts in all extreme excursions while the patient is clenching.

55.

Seated Integrated Abutment Crown™ immediately after the insertion.

56.

Post-insertion radiograph.

57.

Integrated Abutment Crown™ twelve days after insertion.

58.

One-year post-insertion radiograph.

59.

One-year post-insertion image.