This case demonstrates the immediate placement and loading or stabilization of two mandibular lateral incisor implants as well as their implant level transfer impression and restoration with a four unit polyceramic to metal fixed bridge.
SURGICAL: Immediate Placement Immediate Stabilization and Function
RESTORATIVE: Bridges Polyceramic Material Fused to Metal
TOPICS: Crestal Relieving Incision Crown Insertion
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View of incisor teeth prior to their extraction.
Pilot bur initiating left osteotomy.
Pilot bur initiating right osteotomy.
4.0mm reamer being removed from left osteotomy.
4.0mm x 11.0mm HA coated implant being transported to the prepared osteotomy.
4.0mm x 11.0mm HA coated implant being inserted into right osteotomy.
Shoulder depth gauge inserted into well of implant to indicate the appropriate abutment shoulder height relative to the height of the soft tissue.
Shoulder depth gauge seated in well of right implant.
A 4.0mm x 3.5mm shouldered stealth abutment being inserted with only finger pressure into the well of right implant.
A 4.0mm x 3.5mm shouldered abutment being inserted into left implant well with flat surface being positioned buccally by convention to facilitate further placement issues.
Two temporarily seated 4.0mm shouldered abutments.
One piece tall acrylic sleeve being snapped onto shouldered abutment.
Two one piece acrylic sleeves with flat side of top facing buccally to correspond with the placement by convention of the flat side of the underlying abutment.
Height of tall one piece acrylic sleeve being reduced.
Seated sleeves.
Second sleeve being reduced.
Mesial surface of adjacent teeth being acid etched for the bonding of the transitional stabilization prosthesis.
Bonding agent being applied to etched surface.
Vacuum formed template being confirmed for fit over prepared acrylic sleeves.
A strut of the transitional composite material, Integrity by Dentsply, is being made between the two acrylic sleeves.
The composite strut is allowed to harden and its size is confirmed prior to the additional material being added.
Composite material is being added only to the incisal portion of the vacuum formed template.
Vacuumed formed template inserted over the hardened composite strut.
Transitional stabilization prosthesis being removed for polishing.
4.0mm x 3.5mm shouldered abutment being removed for insertion into polished transitional prosthesis.
Shouldered abutments seated into transitional stabilization prosthesis.
Transitional prosthesis with lingual wings being used to orientate the seating of the shouldered abutments.
Appropriate seating of abutments and prosthesis is being confirmed prior to its removal for cementation.
Stabilization prosthesis is being snapped onto shouldered abutments and cement bonded to the adjacent canine teeth.
Cemented prosthesis prior to the removal of excess bonding cement.
Stabilization prosthesis at the conclusion of the implant placement procedure.
Radiograph of transitional prosthesis and the immediately placed and stabilized implants.
Prosthesis prior to its removal ten weeks after implant placement.
4.0mm shouldered abutments prior to their removal.
Soft tissue around implant wells after the removal of the shouldered abutments.
Two black 2.0mm impression posts after being tapped for definitive seating into the well of the implants.
Impression material being injected around impression posts for the making of an implant level transfer impression.
Lingual view of four unit polyceramic to metal fixed bridge on stone model.
Labial view of prosthesis on titanium implant analogs.
Prosthesis with two laboratory milled abutments prior to being seated into implants.
Prosthesis being used to orientate the seating of the abutments.
An oblique crestal relieving incision is being made to facilitate the seating of the prosthesis with an ideal emergence profile.
Prosthesis being used to orientate abutments into the well of the implants prior to their being tapped for their final seating into the implant.
Labial view of intra-orally cemented polyceramic to metal prosthesis.
Radiograph of two 4.0mm x 11.0mm HA coated implants with intra-orally cemented four unit fixed bridge on two laboratory milled non-shouldered abutments.
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