This case demonstrates the surgical placement, immediate stabilization, and permanent restoration with Integrated Abutment Crowns™ of an edentulous maxillary arch in three clinical visits in a time period of one hundred days.
SURGICAL: Immediate Stabilization and Function
RESTORATIVE: Integrated Abutment Crowns™
TOPICS: Crown Insertion Impression
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Pre-operative radiograph.
Stone cast of edentulous ridge.
Acrylic surgical template on stone model.
Incision being made with surgical template as a guide.
Initial 2.0mm pilot osteotomy being made at 1,000RPM with external water irrigation.
Second pilot osteotomy being made parallel to pin inserted into the first pilot osteotomy and mesio-distally positioned according to surgical template.
Fourth pilot osteotomy being prepared.
Positioning of first four pilot osteotomies being confirmed with surgical template.
Paralleling pins indicating positioning and trajectory of pilot osteotomies.
Diameter of osteotomy being enlarged with reamer bur rotating at 50RPM without water irrigation.
Second osteotomy being prepared.
Third osteotomy being prepared.
Finger applying apical pressure during the preparation of the osteotomy.
A 4.5mm x 8.0mm HA coated implant being inserted into osteotomy with an implant inserter / retriever instrument.
Fourth implant being inserted into its osteotomy.
Sixth implant being inserted into its osteotomy.
Occlusal view of eight seated implants.
Shoulder depth gauge seated into maxillary right central incisor implant facilitating the selection of a stealth shouldered abutment with the appropriate height of its shoulder relative to the soft tissue height.
A 5.0mm x 2.0mm shouldered abutment being inserted with only finger pressure into the well of the left central incisor implant.
A short one-piece acrylic sleeve is being snapped onto the right central incisor shouldered abutment.
Transitional composite material "Integrity" by Dentsply is being injected onto acrylic sleeves to form a stabilization strut.
Mandibular teeth facilitate the contouring of the stabilization strut.
Hardened strut prior to its being shaped to accommodate the anatomical vacuum-formed template.
Holes are being made in vacuum-formed template to facilitate the seating of the composite-filled template onto the strut.
Transitional composite material being injected into the occlusal half of the template.
Composite filled template seated over the hardened strut.
Transitional stabilization prosthesis within the vacuum formed template being removed from the mouth for polishing.
View of eight one-piece acrylic sleeves within polished transitional stabilization prosthesis.
Since the implants are not necessarily rigid in their osteotomies, seating of the transitional stabilization prosthesis is easily achieved.
Facial view of seated transitional stabilization prosthesis.
Occlusal view of transitional stabilization seated immediately after the placement of the eight implants.
Facial view of transitional stabilization prosthesis in occlusion.
Blue markings facilitate occlusal adjustment.
Patient's smile after the first clinical treatment following the placement and immediate stabilization of eight maxillary implants.
Radiograph of eight immediately stabilized implants on the day of their insertion.
Transitional stabilization prosthesis prior to its removal ninety days after its insertion.
Occlusal view of transitional stabilization prosthesis prior to its removal.
Occlusal view of eight shouldered abutments ninety days after their placement and prior to their being removed for the making of an implant level transfer impression.
Facial view of shouldered abutments with the right side prosthesis replaced to facilitate the recording of an occlusal registration.
Occlusal view with five abutments removed from their implant wells.
A white impression post is being inserted into 3.0mm implant well for the recording of an occlusal registration.
A second impression post is being inserted into the left central implant well.
A third white impression is being inserted.
A black impression post is being inserted into the 2.0mm implant well of the left canine.
White impression post is receiving the mandatory axial tap to assure definitive seating in the well of the implant.
Occlusal clearance of the five impression posts is being confirmed prior to the addition of red acrylic for the occlusal registration.
Red acrylic resin being injected around left impression posts while patient is occluding on right transitional crowns.
Additional red acrylic being injected around impression posts.
Patient is occluding on right transitional crowns while the red acrylic is polymerizing.
After removal of the transitional prosthesis an impression post is being tapped into the implant well to record the right side occlusal registration.
Acrylic resin being injected on right side while patient occludes on left side.
Patient occludes while right side acrylic is polymerizing.
Right side registration is being removed.
Left side registration is being removed.
A new set of impression posts are being inserted into the well of the implants for the making of an implant level transfer impression.
Impression material is being injected around impression posts.
Transitional prosthesis is being used to facilitate the re-seating of the shouldered abutments into the implant wells.
Shouldered abutments seated with only finger pressure in their implant wells.
Transitional prosthesis seated in three pieces.
Intra-oral bonding of the transitional prosthesis.
Light curing of the intra-oral bonding material.
Digital photo being taken of shade guide against a black background for transmission to the dental technician.
White impression post and implant analog being seated into impression material as a single unit.
Pink soft tissue material being injected around implant analogs in a full arch impression.
Dental stone being poured around implant analogs in a soft-tissue model.
Facial view of eight Integrated Abutment Crowns™ on a stone model.
Palatal view of eight Integrated Abutment Crowns™.
Clear acrylic orientation jig seated on eight Integrated Abutment Crowns™.
Mirror view of eight Integrated Abutment Crowns™.
Occlusal view of eight implant wells and sulci after the removal of the transitional prosthesis and the eight shouldered abutments.
Oblique crestal relieving incision being made to facilitate the seating of the Integrated Abutment Crowns™ by allowing them to displace the soft tissue.
Mirror view of how a white temporary abutment has been modified and inserted into straight driver to facilitate the tapping of the Integrated Abutment Crown™ in the long axis of the abutment shaft.
Note the angle of the abutment shaft relative to the incisal edge of the Integrated Abutment Crown™ as it is being inserted into the its implant well.
A second integrated Abutment Crown™ is being inserted.
Initial stabilization of the Integrated Abutment Crowns™ is achieved by tapping on the orientation jig.
Definitve seating is achieved by using a modified white temporary healing abutment in a straight driver to direct the seating force onto the labial surface of the crown which is in line with the long axis of the shaft of the abutment.
Clear acrylic orientation jig is being used to facilitate the seating of two additional Integrated Abutment Crowns™.
Initial stabilization is achieved by tapping on the orientation jig.
Four seated Integrated abutment Crowns™.
Fifth Integrated Abutment Crown™ is being initially seated.
Right lateral incisor is being inserted into implant well.
Orientation jig facilitates the alignment of the right lateral incisor.
Initial seating is being achieved by tapping on the orientation jig.
Dental floss is being used to confirm the appropriate interproximal contact. It is essential to have minimal contact that does not preclude the seating of the abutment shaft in the well of the implant.
Definitive seating is achieved with the use of a white temporary healing abutment inserted into a straight driver.
Right canine being inserted.
Right canine being definitively seated.
Right bicuspid being inserted.
Occulsal view of eight seated Integrated Abutment Crowns™.
Labial view of eight Integrated Abutment Crowns™ immediately after being seated into their implant wells.
Insertion of a hard acrylic mouth-guard which will initially stabilize the patient's occlusion, especially during sleep. It will also facilitate the re-insertion of an Integrated Abutment Crown™ by the patient, if one were to loosen initially until final adjustments have been made.
Seated hard acrylic mouth-guard prior to its being adjusted occlusally.
Post insertion radiograph of eight Integrated Abutment Crowns™ and their immediately stabilized or loaded implants.
Patient's smile on the one hundredth day after the placement of his immediately loaded implants and on the day of his third clinical visit when eight Integrated Abutment Crowns™ were seated.
Radiograph taken on day of third clinical visit
Radiograph taken on day of third clinical visit.
Radiograph taken on day of third clinical visit.
Facial view five days after insertion of Integrated Abutment Crowns™. Note superior gingival aesthetics.
Facial view five days after insertion of Integrated Abutment Crowns™. Note superior gingival aesthetics.
Patient's smile.
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