Extraction, Two Stage Placement, Grafting with Bicon Resorbable Collagen Membrane and Restoration of Maxillary right lateral Incisor Implant with an Integrated Abutment Crown™

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1.

First Clinical Visit: Preoperative radiograph of maxillary right lateral incisor.

2.

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

3.

Preoperative smile.

4.

Periotome being used to initiate the extraction.

5.

Extraction of failed endodontically treated tooth.

6.

Fractured half of the root being elevated from the socket.

7.

Maxillary right lateral root being extracted.

8.

Patient’s blood being collected into a syringe to be mixed with SynthoGraft™, Beta-Tricalcium Phosphate, bone grafting material.

9.

Bony defect being measured using a periodontal probe.

10.

Bicon’s resorbable collagen membrane being measured using a periodontal probe.

11.

Bicon’s resorbable collagen membrane being cut to an appropriate size.

12.

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

13.

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

14.

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

15.

Osteotomy being enlarged with a blue 3.5mm latch reamer rotating at 50 RPM without water irrigation.

16.

Osteotomy being enlarged with a red 4.0mm latch reamer rotating at 50 RPM without water irrigation.

17.

Osteotomy being enlarged with a silver 4.5mm latch reamer rotating at 50 RPM without water irrigation.

18.

A 4.5mm x 8.0mm HA coated implant being inserted with the black polyethylene healing plug.

19.

Black polyethylene healing plug being removed to be cut prior to its being reinserted.

20.

Patient’s blood being mixed with SynthoGraft™, Beta-Tricalcium Phosphate, in a dappen dish.

21.

SynthoGraft™, Beta-Tricalcium Phosphate, being placed over the implant.

22.

SynthoGraft™, Beta-Tricalcium Phosphate, filling defect to the width of the buccal cortical plate, and to the height of the interproximal bone.

23.

Bicon resorbable membrane being placed to cover the graft.

24.

Bicon resorbable membrane cut to size and placed, so that its margins extend onto surrounding bone on the mesial, distal, and apical borders. On the palatal aspect, the membrane is tucked under the palatal tissue in direct contact with the palatal bone. The palatal tissue can usually be elevated with a periosteal elevator without using additional vertical incisions on the palatal aspect. However, if there is difficulty tucking the membrane under these tissues, small mesial and distal incisions can be made.

25.

Bicon resorbable membrane in place covering the graft.

26.

Suture being placed.

27.

Sutured site.

28.

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

29.

Bonding material being applied.

30.

Light curing of bonding material.

31.

Composite material being added to form a strut between adjacent teeth.

32.

Light curing of composite material.

33.

Post operative radiograph.

34.

Second Clinical Visit: Incision being made for the uncovering of the implant.

35.

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

36.

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

37.

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

38.

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

39.

Composite material being placed into vacuum formed template.

40.

Composite material in vacuum-formed template being light cured.

41.

Transitional prosthesis being contoured.

42.

Polishing of transitional prosthesis with a pink silicone disc.

43.

Transitional prosthesis being polished with nylon bristle brush.

44.

View of bonded transitional prosthesis.

45.

Third Clinical Visit: View of Integrated Abutment Crown™ on stone model.

46.

View of Integrated Abutment Crown™.

47.

Integrated Abutment Crown™ being inserted.

48.

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

49.

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.

50.

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

51.

View of Integrated Abutment Crown™ immediately after being inserted.

52.

Note the open mesial interproximal contact.

53.

Post insertion radiograph. Note the open mesial interproximal contact.

54.

Integrated Abutment Crown™ being removed to add composite material to its mesial contact.

55.

View of Integrated Abutment Crown™ with appropriate mesial contact.

56.

Post insertion radiograph.

57.

View of Integrated Abutment Crown™ five months post insertion.