This case demonstrates the extraction of a failed endodontically treated maxillary central incisor and its replacement with an immediately placed and functioning implant as well as its restoration with an Integrated Abutment Crown™ showing a prosthetic technique for masking the metallic graying of thin gingival tissues from the underlying abutment.
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Pre-operative view of discolored maxillary central incisor.
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Pre-operative radiograph of a failed endodontically treated maxillary central incisor.
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Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.
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Parallel pin seated in pilot osteotomy indicating its trajectory.
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Template being used to confirm appropriate trajectory.
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Clinician’s fingers monitoring the buccal and palatal bone during the preparation of the osteotomy and the harvesting of bone with a blue 3.5mm latch reamer bur rotating at 50RPM without water irrigation.
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Clinician’s fingers monitoring the buccal and palatal bone during the preparation of the osteotomy and the harvesting of bone with a red 4.0mm hand reamer.
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Clinician’s fingers monitoring the buccal and palatal bone during the preparation of the osteotomy and the harvesting of bone with a gold 5.0mm hand reamer.
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A 5.0mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.
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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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Short acrylic sleeve is being snapped on to stealth abutment.
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Vacuum formed template seated over acrylic sleeve to confirm the appropriateness of its height.
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Polyceramic material is being added to the labial aspect of the vacuum formed template.
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Transitional stabilizing prosthesis being light cured.
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Additional material being added to the prothesis.
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Transitional crown in place showing gingival discrepancy in length between central incisors.
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Gingival discrepancy has been corrected by adding composite material to cervical area of the crown to obtain proper gingival contours.
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Etchant being applied in preparation for the bonding of the transitional stabilizing crown to adjacent teeth.
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Bonding primer being applied.
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Bonding agent being applied.
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Additional composite material being applied to lingual surface to splint crown to adjacent teeth.
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Composite material is light-cured.
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Occlusion being adjusted with carbide finishing bur.
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Radiograph of immediately placed and functioning implant at the completion of the first clinical visit.
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Bonded stabilizing prosthesis prior to its being removed at the patient’s second clinical visit twelve weeks after the implant placement.
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View of graying of gingival tissues due to lack of buccal bone and thin gingival tissues.
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View of implant well after the removal of the transitional prosthesis and the stealth abutment.
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Green 3.0mm impression reamer being inserted onto guide pin to remove any tissue which might inhibit the complete seating of an impression post.
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Green 3.0mm plastic impression post being inserted into the 3.0mm well of the integrated implant for the making of an implant level transfer impression.
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Green plastic impression post receiving its mandatory seating tap.
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Impression material being injected around the impression post for the making of a full arch implant level transfer impression.
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Digital image being taken of shade guide against a black plastic background to facilitate the fabrication of an aesthetic Integrated Abutment Crown™.
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Implant well being washed with chlorhexidine prior to placing transitional prosthesis.
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Transitional Prosthesis in place after impression appointment revealing graying of gingival tissue due to underlying metal abutment.
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Right profile view revealing lack of facial bone and darkening gingival tissue.
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Left profile view revealing lack of facial bone and darkening of gingival tissue.
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Radiograph of integrated implant twelve weeks after implant placement.
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Integrated Abutment Crown™ on stone model.
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Integrated Abutment Crown™ on dental model with acrylic orientation jig.
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Integrated Abutment Crown™ on stone model with yellow thermoplastic seating jig which was 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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View of transitional prosthesis prior to its removal for the insertion of the Integrated Abutment Crown™.
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View of implant well and soft tissue sulcus.
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Initial seating of Integrated Abutment Crown™.
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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™ with pink material added to mask the graying of the gingival tissue is being inserted.
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Clear orientation jig facilitates the orientation of Integrated Abutment Crown™.
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Interproximal contacts being adjusted to achieve passive contacts since too tight interproximal contacts may prevent the engagement of the locking taper and possibly result in subsequent loosening of the restoration.
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Pink polyceramic material has been replaced with white opaque material to mask the graying of gingival tissues.
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Integrated Abutment Crown™ being inserted with newly applied opaqued material.
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Yellow thermoplastic custom seating jig which was formed in a caliper-like device is seated in a crown seating tip attached to a straight handle to facilitate directing the tapping forces in the long axis of the abutment post and implant well.
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Integrated Abutment Crown™ immediately after insertion.
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Post-insertion radiograph of Integrated Abutment Crown™.
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Patient’s smile.
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Integrated Abutment Crown™ five days after insertion revealing gingival health, and complete masking of metallic graying of gingival tissue.
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Left profile view.
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Right profile view.
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Seven weeks post-insertion image.
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Three year post-insertion view of left central incisor.
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