Full Mouth Placement of Immediately Functioning Implants and their Restoration with Three Fixed Polyceramic to Metal Bridges and Six Integrated Abutment Crowns™
This case demonstrates the removal of eight failed previously placed screw-type implants and the full mouth fixed restoration of sixteen Bicon implants with three polyceramic to metal fixed bridges and six Integrated Abutment Crowns™ after the surgical techniques of sinus floor grafting, ridge splitting and immediately functioning implant placements.
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Pre-operative radiograph of eight failed screw-type implants.
2.
Patient’s pre-treatment smile.
3.
Mandibular alveolar arch prior to treatment.
4.
Mandibular arch with surgical template guide.
5.
Preparation of mandibular osteotomy with latch reamer.
6.
Prepared osteotomies.
7.
Occlusal view of seven paralleling pins in osteotomies.
8.
Labial view of seven paralleling pins in osteotomies.
9.
Implant being placed into osteotomy with an implant inserter/retriever instrument.
10.
View of six implants prior to the insertion of shouldered abutments for their immediate functioning and the autogenous bone graft over a seventh implant which was placed in the site of the removed failed implant.
11.
View of six shouldered abutments placed into their implants with only finger pressure and of a size to facilitate the formation of interdental papillae.
12.
A short acrylic sleeve being placed onto a 4.0mm stealth shouldered abutment.
13.
An acrylic sleeve being placed onto a 3.5mm shouldered abutment.
14.
Transitional composite material “Integrity” by Dentsply being injected around acrylic sleeves to form a strut.
15.
View of hardened strut.
16.
Transitional composite material being injected into vacuum formed template prior to its placement over the hardened strut.
17.
Maxillary denture is being used to stabilize the mandibular transitional prosthesis at a previously recorded vertical dimension of occlusion.
18.
Polished transitional prosthesis is being inserted to confirm its appropriateness.
19.
Prosthesis is being roughened prior to its bonding and incorporation of an acrylic o-ring housing.
20.
Bonding agent being applied to facilitate the pickup of the acrylic housing.
21.
Light curing of bonding agent.
22.
Rubber dam aprons and pink acrylic housings seated on existing implant abutments prior to their being incorporated into the transitional stabilizing prostheses for the immediately functioning implants.
23.
Maxillary denture is stabilizing the transitional prosthesis for the pickup of o-ring housings and the cementation of a few of the acrylic sleeves onto the stealth abutments.
24.
Occlusal view of the transitional stabilizing prostheses.
25.
Articulating paper being used to confirm contacts.
26.
Occlusal contacts being confirmed.
27.
View of patient’s occlusion being maintained by only his right side transitional prostheses.
28.
View of abutments prior to their removal and placement of impression posts for the recording of an occlusal registration.
29.
Black 2.0mm impression post being inserted into the 2.0mm well of an implant.
30.
White 3.0mm impression post being inserted into the 3.0mm well of an implant.
31.
White 3.0mm impression post being definitively tapped into the well of the implant.
32.
Black 2.0mm impression post being definitively tapped into the well of the implant.
33.
White 3.0mm impression post being inserted into the 3.0mm well of a maxillary implant.
34.
View of seated impression posts prior to their being incorporated into red acrylic occlusal registration.
35.
Insertion of a white impression post into an implant on the patient’s right side while the red acrylic on the patient’s left side maintains the appropriate occlusal relationship.
36.
Insertion of a black impression post into an implant on the patient’s right side while the red acrylic on the patient’s left side maintains the appropriate occlusal relationship.
37.
View of occlusal relationship prior to the addition of red acrylic around the impression posts on the patient’s right side.
38.
View of acrylic occlusal registrations prior to their removal.
39.
Insertion of a white impression post for the making of maxillary implant level transfer impression.
40.
Insertion of a white impression post for the making of mandibular implant level transfer impression.
41.
View prior to the making of maxillary and mandibular implant level transfer impressions.
42.
Impression material being injected around maxillary impression posts.
43.
Impression material being injected around mandibular impression posts.
44.
Maxillary impression post being removed after the impression making
45.
Mandibular impression post being removed after the impression making.
View of maxilla after the removal of transitional prosthesis.
51.
Insertion of laboratory milled abutment.
52.
Insertion of laboratory milled abutment.
53.
Alignment of milled abutment with the insertion of the metal casting.
54.
Seating of the milled abutment with the tapping of the appropriately aligned casting.
55.
Red acrylic uniting metal castings prior to their withdrawal for soldering.
56.
Insertion of a laboratory prepared abutment for an Integrated Abutment Crown™.
57.
Prepared abutments for Integrated Abutment Crowns™ and aligned castings on milled abutments prior to their being luted with acrylic for their being soldered as a fixed bridge.
58.
Red acrylic uniting metal castings prior to their withdrawal for soldering.
59.
Definitive seating of Integrated Abutment Crowns™ in the long axis of its abutment shaft.
60.
Wax rim seated over mandibular castings.
61.
Wax rim being used to record occlusal relationships.
62.
Impression material being injected around madibular metal castings for the making of a withdrawal transfer impression.
63.
Re-insertion of the transitional prosthesis.
64.
Soldered castings and occlusal confirmation wax rim on articulated stone model.
65.
Stealth shouldered abutments after the removal of the transitional prosthesis and prior to their removal for the insertion of the permanent milled abutments.
66.
Initial insertion of a laboratory milled abutment.
67.
Prosthesis being used to align and seat milled abutments interchangeably until appropriate alignment and seating is achieved.
68.
Prosthesis being used to align and seat milled abutments interchangeably until appropriate alignment and seating is achieved.
69.
Prosthesis being used to align and seat milled abutments interchangeably until appropriate alignment and seating is achieved.
70.
Prosthesis being used to align and seat milled abutments interchangeably until appropriate alignment and seating is achieved.
71.
Prosthesis being used to align and seat milled abutments interchangeably until appropriate alignment and seating is achieved.
72.
Sulcus reamer being used to remove soft tissue to facilitate the seating of the milled abutment.
73.
Prosthesis being used to align and seat milled abutments interchangeably until appropriate alignment and seating is achieved.
74.
Prosthesis being used to align and seat milled abutments interchangeably until appropriate alignment and seating is achieved.
75.
Prosthesis being used to align and seat milled abutments interchangeably until appropriate alignment and seating is achieved.
76.
Aesthetic and functional evaluation of the diagnostic prosthetic arrangement.
77.
Aesthetic and functional evaluation of the diagnostic prosthetic arrangement.
78.
Soldered three-unit metal casting being used to align and seat milled abutments.
79.
Soldered three-unit metal casting being used to align and seat milled abutments.
80.
Soldered three-unit metal casting being used to align and seat milled abutments.
81.
Soldered three-unit metal casting being used to align and seat milled abutments.
82.
Soldered three-unit metal casting being used to align and seat milled abutments.
83.
Soldered three-unit metal casting being used to align and seat milled abutments.
84.
Insertion of prepared abutment for Integrated Abutment Crowns™.
85.
Insertion of prepared abutment for Integrated Abutment Crowns™.
86.
View of seated fixed prostheses and abutment for Integrated Abutment Crowns™.
87.
Aesthetic and functional evaluation of diagnostic prosthetic arrangement.
88.
Aesthetic and functional evaluation of diagnostic prosthetic arrangement.
89.
Aesthetic and functional evaluation of diagnostic prosthetic arrangement.
90.
Confirmational recording of occlusal relationships.
91.
Removal of seated abutment by tapping on the handle of the instrument which is grasping the seated abutment.
92.
Re-insertion of the transitional prosthesis.
93.
Eleven unit one-piece maxillary fixed polyceramic to metal restoration and two single Integrated Abutment Crowns™.
94.
Mirror view of thirteen-unit Maxillary prostheses.
95.
Mirror view of a single maxillary molar Integrated Abutment Crown™.
96.
Two mandibular three-unit polyceramic to metal fixed prostheses and five Integrated Abutment Crowns™.
97.
Mirror view of two three-unit polyceramic to metal fixed prostheses and five Integrated Abutment Crowns™.
98.
View of maxilla after the removal of transitional prosthesis.
99.
Finished polyceramic to metal prostheses being used to align and seat milled abutments.
100.
Finished polyceramic to metal prosthesis being used to align and seat milled abutments.
101.
Finished polyceramic to metal prosthesis being used to align and seat milled abutments.
102.
Prosthesis being removed after seating of the milled abutments on the patient’s right side.
103.
Implant well being cleaned with ethyl alcohol to remove any organic film.
104.
Finished polyceramic metal prosthesis being used to align and seat milled abutments.
105.
Finished polyceramic metal prosthesis being used to align and seat milled abutments.
106.
Milled abutment being definitively seated by being tapped in the long axis of the implant well and abutment shaft.
107.
Milled abutment being seated into prosthesis.
108.
Implant well being cleaned with ethyl alcohol to remove any organic film.
109.
Finished polyceramic to metal prosthesis being used to align and seat milled abutments.
110.
Finished polyceramic to metal prosthesis being used to align and seat milled abutments.
111.
Finished polyceramic to metal prosthesis being used to align and seat milled abutments.
112.
Milled abutment being definitively seated by being tapped in the long axis of the implant well and abutment shaft.
113.
Finished polyceramic to metal prosthesis being used to align and seat milled abutments.
114.
Finished polyceramic to metal prosthesis being used to align and seat milled abutments.
115.
Finished polyceramic to metal prosthesis being used to align and seat milled abutments.
116.
Single Integrated Abutment Crown™ being seated.
117.
Evaluation prior to the adjustment of the interproximal contact area to provide for passive contact between the fixed prosthesis and the two Integrated Abutment Crowns™.
118.
Evaluation prior to the adjustment of the interproximal contact area to provide for passive contact between the fixed prosthesis and the two Integrated Abutment Crowns™.
119.
Evaluation prior to the adjustment of the interproximal contact area to provide for passive contact between the fixed prosthesis and the two Integrated Abutment Crowns™.
120.
Adjustment of the polyceramic material prior to its being re-inserted into the well of the implant.
121.
Molar Integrated Abutment Crown™ is being inserted into the well of the implant.
122.
A passive interproximal contact is being confirmed with the use of dental floss.
123.
View of two seated molar Integrated Abutment Crowns™ and five seated milled abutments.
124.
Mirror view of seated milled abutments and Integrated Abutment Crowns™.
125.
Fixed polyceramic to metal prosthesis being inserted.
126.
Initial seating of prosthesis revealing gingival aesthetics and blanching of soft tissue.
127.
Mirror view of seated prosthesis.
128.
View of mandibular arch revealing a shallowly placed implant.
129.
Initial seating of left mandibular three-unit prosthesis with two milled abutments.
130.
Initially seated mandibular prosthesis.
131.
Confirmation of occlusal contacts.
132.
Prosthesis being used to align and seat anterior milled abutment.
133.
Prosthesis being tapped to engage the locking taper of anterior milled abutment.
134.
Prosthesis being used to align and seat posterior milled abutment as it is seated on its anterior abutment.
135.
Three-unit prostheses is being tapped to confirm proper seating.
136.
Dental floss is being used to confirm appropriate passive interproximal contact between the single Integrated Abutment Crown™ and the three-unit fixed bridge.
137.
Integrated Abutment Crown™ being tapped into place.
138.
Implant well being cleaned with ethyl alcohol to remove any organic film.
139.
Canine Integrated Abutment Crown™ being seated.
140.
Canine Integrated Abutment Crown™ being seated with a white temporary abutment in a straight driver.
141.
Bicuspid Integrated Abutment Crown™ being inserted.
142.
Molar Integrated Abutment Crown™ being inserted.
143.
Labial view of initial occlusal contact of restored maxillary and mandibular dental arches.
144.
Initial right side view of restored dental arches.
145.
Initial left side view of restored dental arches.
146.
Occlusal contacts being confirmed with articulating paper.
147.
Labial view of restored mandibular arch revealing a few metallic cervical margins and blanching of the soft tissues.
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