Extraction, Placement and Restoration of Four Mandibular Incisors with Two Immediately Functioning Implants and a four-unit polyceramic material to metal fixed prosthesis

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1.

Pre-operative radiograph.

2.

Pre-operative site.

3.

Extraction of failed endodontically treated tooth.

4.

Extraction of failed endodontically treated tooth.

5.

Soft tissue being removed from the five walls of the extraction sockets.

6.

Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.

7.

Parallel pin confirming appropriate trajectory and acting as a guide for subsequent osteotomy.

8.

Latch reamer extension being used to facilitate the use of the pilot bur close to the adjacent canine tooth.

9.

Parallel pins seated in their pilot osteotomies indicating their trajectories.

10.

A 2.0mm guidepin being inserted into the pilot osteotomy to accommodate using a sulcus reamer as a planisher to level the crestal bone around the pilot osteotomy.

11.

Sulcus reamer being inserted onto the guide pin.

12.

Sulcus reamer being used to level the bone heights around the pilot osteotomy, since uneven levels may cause inadvertent displacement of the reamer burs.

13.

Osteotomy being enlarged with an olive green 2.5mm latch reamer bur rotating at 50RPM without water irrigation.

14.

Depth gauge confirming the appropriateness of the prepared osteotomy

15.

3.5mm x 11.0mm HA coated implant with a 2.0mm implant well is being inserted with the black polyethylene healing plug.

16.

3.5mm x 11.0mm HA coated implant being inserted into the osteotomy with the implant inserter/retriever device.

17.

Implant seating tip attached to a straight handle is being tapped to seat implant farther into the osteotomy.

18.

Post-insertion radiograph.

19.

Primer agent being applied.

20.

A 4.0mm x 3.5mm Stealth Shouldered Abutment with a 2.0mm Post being inserted into the well of the implant.

21.

. Short acrylic sleeve being snapped on to stealth abutment.

22.

Bonding primer agent being applied.

23.

Bonding agent being applied.

24.

Light curing of bonding agent.

25.

Polyceramic material being added to an acrylic sleeve to form a strut.

26.

Vacuum-formed template placed over the strut material is being light cured.

27.

Vacuum-formed template placed over the strut material is being light cured.

28.

Material is being added to facilitate the aesthetic contouring of the strut.

29.

Material is being added to facilitate the aesthetic contouring of the strut.

30.

Prosthesis prior to final polishing.

31.

Transitional prosthesis being removed for polishing.

32.

Bonding agent being applied.

33.

Additional Light curing of bonding agent.

34.

Polyceramic material is being contoured around the acrylic sleeve.

35.

Transitional prosthesis being snapped onto non-shouldered abutments.

36.

Light curing of additional material.

37.

View of bonded transitional prosthesis.

38.

Radiograph of integrated implants sixteen weeks after implant placement.

39.

View of transitional prosthesis prior to its removal sixteen weeks after implant placement.

40.

View of transitional abutments after removal of splinted prosthesis.

41.

View of implant wells after the removal of the transitional prosthesis and the stealth abutments.

42.

Red 2.0mm impression reamer being inserted onto guide pin to remove any tissue which might inhibit the complete seating of an impression post.

43.

Red 2.0mm plastic impression post being inserted into the 2.0mm well of an integrated implant for the making of an implant level transfer impression.

44.

Red plastic impression post receiving its mandatory seating tap.

45.

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

46.

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

47.

Transitional prosthesis re-inserted after the making of an implant level impression.

48.

Two milled abutments in red plastic implant analogs in stone model.

49.

Two piece cast metal framework joined with red acrylic resin prior to an intra-oral confirmation of its appropriateness.

50.

View of two transitional abutments prior to their being removed during patient’s third clinical visit.

51.

View of implant wells after the removal of the transitional prosthesis and the stealth abutments.

52.

Metal framework being used to orient milled abutments into the wells of their implants.

53.

Metal framework being removed from the initially seated milled abutments.

54.

Milled abutment being tapped into its implant well.

55.

Milled abutment being tapped into its implant well.

56.

Separated metal framework being tapped onto milled abutments.

57.

Separated framework being reattached with red acrylic.

58.

Impression material being injected around metal framework for the making of a transfer impression.

59.

New master model with the removed milled abutments and metal implant analogs to facilitate the soldering of the framework.

60.

Prosthesis on stone model.

61.

View of four-unit poly-ceramic material to metal prosthesis.

62.

View of transitional prosthesis on patient’s fourth clinical visit.

63.

View of two transitional abutments prior to their being removed during patient’s fourth clinical visit.

64.

Stealth abutment being removed.

65.

View of implant wells after the removal of the transitional prosthesis and the stealth abutments.

66.

Milled abutment being inserted into prosthesis.

67.

Prosthesis being used to orient the milled abutment into its implant well.

68.

Prosthesis being tapped to initially engage the first milled abutment into its implant well.

69.

Prosthesis being removed.

70.

Post of milled abutment being cleaned with an alcohol wipe to remove any contaminants.

71.

Second milled abutment being inserted into the well of its implant.

72.

Prosthesis being tapped to initially engage the second milled abutment into its implant well.

73.

Prosthesis being removed.

74.

Milled abutment being definitively tapped to engage its locking taper connection.

75.

Milled abutment being definitively tapped to engage its locking taper connection.

76.

Prosthesis being reseated.

77.

Reseated prosthesis.

78.

Separating medium being applied to facilitate removal of extraneous cement.

79.

Minimal cement being added only to the cervical area of casting.

80.

Prosthesis being cemented onto laboratory milled abutments.

81.

View of cemented prosthesis.

82.

View of prosthesis four-weeks post-insertion.