Extraction, Placement and Restoration of Immediately Placed and Functioning Maxillary Central Incisor Implants with Integrated Abutment Crowns™

Posted on November 4, 2004 by Bicon

This case demonstrates the extraction of a failed endodontically treated maxillary right central incisor and of the adjacent central incisor and their replacement with immediately placed and functioning implants as well as their restoration with Integrated Abutment Crowns™.

SURGICAL: Extraction Immediate Placement Immediate Stabilization and Function
RESTORATIVE: Integrated Abutment Crowns™
TOPICS: Crown Insertion

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1.

Pre-operative smile.

2.

Pre-operative site.

3.

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

4.

Bonding agent being applied.

5.

Light curing of bonding agent.

6.

Extraction of failed endodontically treated tooth.

7.

View of cracked root.

8.

Curette removing soft tissue remnants of periodontal ligament.

9.

Pilot bur initiating osteotomy by having a trajectory that is more perpendicular to the palatal wall of the socket which will allow for its engagement. Immediately upon its engagement, the pilot bur will be uprighted to a trajectory parallel to the adjacent teeth.

10.

Parallel pins inserted into pilot osteotomies confirming their trajectories.

11.

Template being used to confirm appropriate trajectories.

12.

Clinician’s fingers monitoring the buccal bone during the preparation of the osteotomy and the harvesting of bone with an olive green 2.5mm latch reamer rotating at 50RPM.

13.

Clinician’s fingers monitoring the buccal and palatal bone during the preparation of the osteotomy and the harvesting of bone with a teal 3.0mm latch reamer rotating at 50RPM.

14.

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 latch reamer rotating at 50RPM.

15.

Clinician’s fingers monitoring the buccal and palatal bone during the preparation of the osteotomy and the harvesting of bone with a silver 4.5mm reamer rotating at 50RPM.

16.

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 reamer rotating at 50RPM.

17.

Curette removing residual bone while confirming the integrity of the five bony walls of the osteotomy.

18.

A 5.0mm x 8.0mm HA coated implant with a 3.0mm implant well is being inserted with the black polyethylene healing plug.

19.

A 5.0mm x 8.0mm HA coated implant with a 3.0mm implant well is being inserted with the black polyethylene healing plug.

20.

Healing plug is being removed from the well of the implant.

21.

Shoulder depth gauge indicates the need for additional seating of the implant

22.

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

23.

Shoulder depth gauge indicates the additional seating of the implant.

24.

View of a 5.0mm x 4.0mm and a 5.0mm x 6.0mm stealth abutment revealing how they are identical except for the fact that the 5.0mm x 6.0mm stealth abutment has a 2.0mm longer post.

25.

A 5.0mm wide stealth shouldered abutment with a shoulder height of 4.0mm is being inserted into the implant well with only finger pressure to assure the appropriateness of its shoulder height.

26.

A 5.0mm wide stealth shouldered abutment 5.0 mm wide with a shoulder height of 6.0mm is being inserted into the implant well with only finger pressure since its shoulder height is more appropriate than the shoulder height of the previously placed abutment.

27.

Vacuum formed template seated over abutments to confirm the appropriateness of their placement.

28.

Short acrylic sleeve being inserted onto stealth abutment.

29.

Acrylic sleeve being modified.

30.

Bonding agent being applied.

31.

Light curing of bonding agent.

32.

Transitional composite material being added to acrylic sleeves to form a transitional prosthesis.

33.

Transitional composite material being added to acrylic sleeves to form a transitional prosthesis.

34.

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

35.

Polyceramic material is being added to the labial aspect of the vacuum formed template.

36.

Vacuum formed template is being placed over the strut material prior to its being light cured.

37.

Light curing of additional material.

38.

Transitional prosthesis being contoured.

39.

Harvested bone being placed around abutment.

40.

Transitional stabilizing prosthesis being light cured.

41.

Additional material being added to prosthesis.

42.

Light curing of additional material.

43.

Prosthesis prior to final polishing.

44.

Radiograph of immediately placed and functioning implants at the completion of the first clinical visit.

45.

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

46.

Radiograph of integrated implants eleven weeks after implant placements.

47.

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

48.

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

49.

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

50.

Green plastic impression post receiving its mandatory seating tap.

51.

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

52.

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

53.

Integrated Abutment Crowns™ on stone model.

54.

View of Integrated Abutment Crowns™.

55.

View of implant wells and soft tissue sulci.

56.

Cotton tipped applicator being used to clean and dry the well of the implant.

57.

Abutment post being cleaned with alcohol wipe to remove any debris which could diminish the effectiveness of the locking taper connection.

58.

Initial seating of Integrated Abutment Crown™.

59.

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

60.

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

61.

Clear orientation jig is being tapped to initially engage the locking taper connection of the Integrated Abutment Crown™.

62.

A 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.

63.

Cotton tipped applicator being used to clean and dry the well of the implant.

64.

Abutment post being cleaned with alcohol wipe to remove any debris which could diminish the effectiveness of the locking taper connection.

65.

Clear orientation jig is being tapped to initially engage the locking taper connection of the Integrated Abutment Crown™.

66.

A 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 of the tapping forces in the long axis of the abutment post and implant well.