Mandibular Ridge Split, Two Stage Implant Placement, and their Restoration with Integrated Abutment Crown™

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1.

First Visit: Pre-operative radiograph.

2.

Pre-operative site.

3.

View of thin alveolar ridge.

4.

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

5.

View of horizontal bony cut being made with a fissure bur.

6.

View of corticotomy site.

7.

Post-operative site – to be closed for three weeks.

8.

Post-operative radiograph.

9.

Second Visit: View of operative site prior to the implant placement, three weeks after ridge split.

10.

A chisel being applied onto the crest without reflecting the buccal periosteum.

11.

Pilot bur preparing osteotomy at 1,100 RPM with water irrigation.

12.

Paralleling pins in each pilot osteotomy.

13.

Osteotomy being enlarged with an olive green 2.5mm latch reamer bur rotating at 50RPM without water irrigation.

14.

Osteotomy being enlarged with a teal 3.0mm latch reamer bur rotating at 50RPM without water irrigation.

15.

Osteotomy being enlarged with a blue 3.5mm latch reamer bur rotating at 50RPM without water irrigation.

16.

Harvested bone within the flute of a blue 3.5mm latch reamer bur.

17.

Harvested bone within the flute of a red 4.0mm hand reamer bur with hand reamer extension.

18.

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

19.

Osteotomy being enlarged with a silver 4.5mm hand reamer bur with hand reamer extension without water irrigation.

20.

Harvested bone within the flute of a silver 4.5mm latch reamer bur.

21.

Depth gauge seated in the osteotomy to facilitate the selection of an implant with an appropriate length.

22.

A 5.0mm x 8.0mm implant being inserted into the osteotomy.

23.

A 4.5mmx 8.0mm implant being inserted into the osteotomy.

24.

Offset driver being tapped to definitively seat a 5.0mm x 8.0mm implant into its osteotomy.

25.

Trimmed polyethylene healing plug being inserted into the seated implant.

26.

View of harvested bone in dappen dish.

27.

Harvested bone being placed over implants.

28.

View of Bicon Resorbable Collagen Plug being inserted.

29.

Sutured site.

30.

Post-operative radiograph.

31.

Third Visit: View of operative site prior to the making of an implant level transfer impression.

32.

A crestal incision being made.

33.

Polyethylene healing plug being removed with a #110 reamer bur.

34.

View of two 3.0mm guide pins seated in the wells of the implants.

35.

Impression reamer being used to remove soft tissue and bone prior to seating impression posts.

36.

Green 3.0mm plastic impression post being inserted into the 3.0mm well of an integrated implant for the making of an implant level transfer impression.

37.

Green 3.0mm plastic impression post receiving its mandatory seating tap.

38.

Impression material being injected around the impression posts for the making of a full arch implant level transfer impression.

39.

White healing abutments inserted into implant wells.

40.

Fourth Visit: Post of Integrated Abutment Crown™ receiving its mandatory alcohol wipe for the removal of any contaminants that may interfere with the engagement of its locking taper connection.

41.

Integrated Abutment Crown™ being inserted initially to evaluate its appropriateness.

42.

Integrated Abutment Crown™ being inserted initially to evaluate its appropriateness.

43.

Floss being used to confirm the fact that the interproximal contacts are passive and will not interfere with the engagement of the locking taper.

44.

White healing abutment in a straight handle is being used to tap the Integrated Abutment Crown™ into the well of the implant.

45.

White healing abutment in a straight handle is being used to tap the Integrated Abutment Crown™ into the well of the implant.

46.

Definitive seating of the restoration and engagement of its locking taper connection is being achieved by occlusal pressure on a cotton applicator.

47.

Articulating paper being used to check interproximal contacts between Integrated Abutment Crowns™ .

48.

Interproximal contacts being adjusted.

49.

View of seated Integrated Abutment Crowns™ immediately after their insertion.

50.

Post-operative radiograph after the insertion of Integrated Abutment Crowns™

51.

View of Integrated Abutment Crowns™ two weeks post insertion.