Extraction, Two Stage Placement of Three Mandibular Implants, and their Restoration with Integrated Abutment Crowns™

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1.

Pre-operative radiograph.

2.

Extraction of a failed endodontically treated tooth.

3.

View of cracked root.

4.

Post-extraction site.

5.

The 2.5mm latch reamer bur being removed from the distal osteotomy. The parallel pin adjacent was used to confirm the appropriate trajectory for the subsequent osteotomy.

6.

Osteotomy being prepared with 2.0mm pilot bur rotating at 1100rpm.

7.

Guide Pins seated in pilot osteotomies indicating their trajectories.

8.

Osteotomy being enlarged with a 5.0mm latch reamer bur rotating at 50rpm without water irrigation.

9.

Harvested bone within flute of latch reamer.

10.

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

11.

A short 6.0mm x 5.7mm HA coated is being inserted with a black polyethylene healing plug.

12.

View of healing plugs in the inserted implants.

13.

View of healing plugs in the inserted implants.

14.

Implant being seated into the osteotomy by the tapping of the black healing plug with an implant seating tip attached to a straight handle.

15.

Implant being seated into the osteotomy by the tapping of the black healing plug with an implant seating tip attached to a straight handle.

16.

View of seated implant with cut polyethylene healing plug.

17.

Harvested bone in a silicon dappen dish prior to its being placed over the seated implants.

18.

Harvested bone placed over implant.

19.

Resorbable cellulose material being placed to stabilize a blood clot.

20.

Cellulose material being sutured in place.

21.

Cellulose material being sutured in place.

22.

Additional harvested bone being placed over implant.

23.

Flap closed with a combination of interrupted and continuous sutures.

24.

Radiograph immediately after implant placement.

25.

View of operative site fourteen weeks after implant placement with marks from infiltration anesthesia.

26.

Another view of the site prior to the uncovering of the implants.

27.

Crestal incision being made.

28.

View of integrated implants prior to the removal of the cut black polyethylene healing plugs.

29.

Guide pins seated in the well of the implants confirming their trajectory and stability.

30.

Plastic healing abutments seated in implant wells.

31.

Mucosa closed with sutures around healing abutments.

32.

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

33.

Healing abutments seated in implant wells five weeks after their insertion and prior to their removal for the making of an implant level impression.

34.

View of implant wells and soft tissue sulci.

35.

White 3.0mm plastic impression post being inserted into the 2.0mm implant well.

36.

White 3.0mm plastic impression post being inserted into the 2.0mm implant well.

37.

White 3.0mm plastic impression post being inserted into the 2.0mm implant well.

38.

White plastic impression post receiving its mandatory seating tap.

39.

White plastic impression post receiving its mandatory seating tap.

40.

Impression material being injected around seated impression posts.

41.

View of implant level transfer impression immediately after its removal from the mouth.

42.

Red acrylic being injected around impression posts for the making of an occlusal registration.

43.

Red acrylic on impression posts recording an occlusal registration.

44.

Occlusal registration being removed from implant wells.

45.

White healing abutment being re-inserted.

46.

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

47.

Buccal view of Integrated Abutment Crowns™ on dental model.

48.

Lingual view of Integrated Abutment Crowns™ on dental model.

49.

Mirror view of Integrated Abutment Crowns™.

50.

White healing abutments prior to their removal for the insertion of the Integrated Abutment Crowns™.

51.

View of implant wells and soft tissue sulci.

52.

Integrated Abutment Crown™ being inserted.

53.

Integrated Abutment Crown™ being inserted.

54.

Integrated Abutment Crown™ being inserted.

55.

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

56.

Plastic temporary abutment mounted in a straight driver to seat the Integrated Abutment Crown™ in the long axis of the abutment shaft and implant well to engage the locking taper.

57.

Plastic temporary abutment mounted in a straight driver to seat the Integrated Abutment Crown™ in the long axis of the abutment shaft and implant well to engage the locking taper.

58.

Blue marking of occlusal contact.

59.

Seated Integrated Abutment Crowns™ after adjustment.

60.

View of seated Integrated Abutment Crowns™ in occlusion immediately after insertion.

61.

Seventeen months post-operative radiograph.