Extraction, Placement and Restoration of Immediately Placed and Functioning Maxillary Right Central Incisor Implant with Integrated Abutment Crown™

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1.

Pre-operative smile.

2.

Pre-operative radiograph.

3.

Pre-operative site.

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.

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

9.

Paralleling pin seated in pilot osteotomy indicating its trajectory.

10.

Clinician’s finger 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.

11.

Osteotomy being enlarged with a teal 3.0mm latch reamer bur rotating at 50RPM without water irrigation.

12.

Clinician’s finger monitoring the buccal bone during the preparation of the osteotomy and the harvesting of bone with a red 4.0mm latch reamer rotating at 50RPM.

13.

A 4.5mm hand reamer attached to a straight handle is being rotated to enlarge the osteotomy.

14.

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

15.

A 4.5mm x 8.0mm HA coated implant being inserted into the osteotomy with the implant inserter/retriever device.

16.

4.5mm x 8.0mm HA coated implant being definitively seated into osteotomy with an implant seating tip threaded on a straight driver.

17.

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

18.

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

19.

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

20.

Tall acrylic sleeve is being placed onto stealth abutment.

21.

Tall acrylic sleeve is being modified.

22.

Tall acrylic sleeve is being modified.

23.

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

24.

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

25.

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

26.

Transitional stabilizing prosthesis being light cured.

27.

Prosthesis prior to final polishing.

28.

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

29.

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

30.

View of transitional abutment after removal of splinted prosthesis.

31.

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

32.

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

33.

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.

34.

Green plastic impression post receiving its mandatory seating tap.

35.

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

36.

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

37.

Integrated Abutment Crown™ on dental model with acrylic orientation jig.

38.

Integrated Abutment Crown™ on stone model with yellow thermoplastic seating jigs which were fabricated on a caliper-like device to facilitate directing the seating forces in the long axis of the implant well and abutment post.

39.

View of Integrated Abutment Crown™.

40.

View of transitional prosthesis prior to its removal for the insertion of the Integrated Abutment Crown™.

41.

View of implant well and soft tissue sulcus.

42.

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

43.

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

44.

Palatal oblique incisions are being made to facilitate the seating of the Integrated abutment Crown™.

45.

A gold 5.0mm sulcus reamer being used to remove soft tissue and bone which might inhibit the complete seating of the Integrated Abutment Crown™.

46.

A gold 5.0mm sulcus reamer being used to remove soft tissue and bone.

47.

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.

48.

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

49.

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.

50.

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

51.

Facial view of seated Integrated Abutment Crown™ immediately after being inserted.

52.

Right profile view of seated Integrated Abutment Crown™ immediately after being inserted.

53.

Left profile view of seated Integrated Abutment Crown™ immediately after being inserted.

54.

Post-insertion radiograph of the Integrated Abutment Crown™.

55.

Gingivally aesthetic restoration after dissipation of the initial tissue blanching.

56.

Post insertion smile thirteen weeks after the extraction of the failed root canal treated tooth.

57.

Close-up of the right profile one week after the insertion of the Integrated Abutment Crown™.

58.

Close-up of the left profile one week after the insertion of the Integrated Abutment Crown™.

59.

Facial view one week after the insertion of the Integrated Abutment Crown™.

60.

Patient’s smile one week after the insertion of the Integrated Abutment Crown™.

61.

Seven weeks post-insertion image.