Mandibular Ridge Split, Extractions, Immediate Placement and Functioning of Implants and their Restoration with Integrated Abutment Crowns™

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1.

View of pre-operative site.

2.

View of pre-operative site.

3.

View of pre-operative site.

4.

Pre-operative radiograph.

5.

Removal of failed endodontically treated tooth.

6.

View of thin alveolar ridge.

7.

View of corticotomy with two vertical cuts and one horizontal and crestal cut.

8.

Post operative site.

9.

Transitional prosthesis four weeks after initial surgery.

10.

Surgical site four weeks after initial surgery.

11.

Surgical site four weeks after initial surgery.

12.

First premolar being removed.

13.

Pilot bur preparing osteotomy at 1,100RPM.

14.

Paralleling pins in each pilot osteotomy.

15.

Prepared osteotomies.

16.

A 4.5mm x 8.0mm HA coated implant being transported to the osteotomy with an implant seating tip threaded onto a straight driver.

17.

A 4.5mm x 8.0mm HA coated implant being inserted into its osteotomy.

18.

View of three seated implants.

19.

Offset driver being tapped to definitively seat a 4.5mm x 8.0mm HA coated implant to its osteotomy.

20.

Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height.

21.

Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height.

22.

Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height.

23.

A 5.0mm x 6.0mm stealth shouldered abutment with its 2.0mm longer shaft is being inserted into the deeply placed mesial implant.

24.

A 5.0mm x 4.0mm stealth shouldered abutment is being inserted into the middle implant.

25.

A 5.0mm x 2.0mm stealth shouldered abutment is being inserted into the distal implant.

26.

View of three 5.0mm wide stealth shouldered abutments seated with only finger pressure.

27.

A short 5.0mm acrylic sleeve is being inserted onto stealth abutment.

28.

A tall 5.0mm acrylic sleeve is being inserted onto stealth abutment.

29.

A tall 5.0mm acrylic sleeve being inserted onto stealth abutment.

30.

Three acrylic sleeves snapped onto stealth abutments. Abutments and sleeves were chosen to support the interdental papillae without encroaching upon them.

31.

Tall acrylic sleeve being adjusted for occlusal clearance.

32.

Adjusted sleeve being re-inserted onto abutment.

33.

Adjusted sleeve being re-inserted onto abutment.

34.

Three sleeves on stealth abutments.

35.

Occlusal clearance being checked.

36.

Bonding agent being applied.

37.

Bonding agent being light cured.

38.

Transitional composite material being applied to sleeves.

39.

Opposing dentition providing occlusal contour for transitional composite material.

40.

Polished transitional stabilizing prosthesis being re-inserted .

41.

Radiograph immediately after implant placement.

42.

Transitional prosthesis six months after implant placement.

43.

Radiograph six months after implant placement.

44.

View of implant wells and sulci six months after placement.

45.

A white 3.0mm impression post being inserted into the well of the implant.

46.

A white 3.0mm impression post being inserted into the well of the implant.

47.

A white 3.0mm impression post being inserted into the well of the implant.

48.

White 3.0mm impression post receiving mandatory seating tap.

49.

Impression material being injected around impression posts for the making of an implant level impression.

50.

Red acrylic on white impression posts recording an occlusal registration.

51.

Occlusal registration being removed from implant wells.

52.

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

53.

Integrated Abutment Crowns™ on stone model.

54.

Occlusal view of Integrated Abutment Crowns™ on stone model.

55.

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

56.

Mirror view of Integrated Abutment Crowns™.

57.

Occlusal view of implant analogs in the stone model.

58.

View of transitional crown prior to its removal for the insertion of the Integrated Abutment Crowns™.

59.

View of three 5.0mm wide stealth shouldered abutments after the removal of transitional crown.

60.

Abutment being removed by gently tapping on the handle of the carbide tipped forceps.

61.

View of implant wells and soft tissue sulci.

62.

Integrated Abutment Crown™ being inserted.

63.

Crestal relieving incision being made to facilitate the seating of the Integrated Abutment Crown™.

64.

Guide pin being inserted.

65.

A 5.0mm sulcus reamer being used to remove soft tissue and bone to accommodate the Integrated Abutment Crown™.

66.

Guide pin being removed revealing excess bone.

67.

Re-insertion of Integrated Abutment Crown™.

68.

Clear orientation jig being used to facilitate the seating of the Integrated Abutment Crown™.

69.

Second Integrated Abutment Crown™ being inserted.

70.

Third Integrated Abutment Crown™ being inserted.

71.

Radiograph of Integrated Abutment Crowns™ immediately after the insertion.

72.

Integrated Abutment Crowns™ three weeks after insertion.