Mandibular Ridge Split, Uncovering of Two Two Stage 4.5mm x 8.0mm Implants, Immediate Loading and Stabilization of a 5.0mm x 6.0mm Short Implant and their Restoration with Bicon Integrated Abutment Crowns™ as well an Aesthetic Treatment of a Metallic Gingival Margin
This case demonstrates a mandibular alveolar ridge split, two stage placement and uncovering of two implants including an immediate loading and stabilization of a 5.0mm x 6.0mm HA coated short implant, implant level transfer impression, and restoration with three Bicon Integrated Abutment Crowns™ as well as the remedial aesthetic treatment of a metallic gingival margin.
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View of bony ridge after reflection of a full thickness mucoperiosteal flap.
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Labial view of a crestal and two vertical bony cuts.
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Labial view of a crestal, horizontal and two vertical bony cuts prior to soft tissue closure of the surgical site.
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Sutured closure of flap.
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Post-operative radiograph.
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The osteotomy for the mandibular right first bicuspid being prepared fifteen weeks after the mandibular ridge split and twelve weeks after the placement of 4.5mm x 8.0mm mandibular right second bicuspid and 4.5mm x 8.0mm mandibular right first molar implants. After a crestal incision with only lingual reflection and initial preparation of osteotomies with a sequential use of 2.0mm pilot drill, 2.5mm, 3.0mm, 3.5mm, and 4.0mm latch reamers, the osteotomy being enlarged with a silver 4.5mm latch reamer bur rotating at 50 RPM without water irrigation.
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Osteotomy being enlarged with a gold 5.0mm latch reamer bur rotating at 50 RPM without water irrigation.
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A 5.0mm x 6.0mm HA coated short implant being inserted into the osteotomy with an implant seating tip threaded onto a straight driver.
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Post-operative radiograph immediately after the insertion of the maxillary right first bicuspid implant.
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A 3.0mm guide pin being inserted into the well of the implant.
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A 4.0mm sulcus reamer being placed onto a guide pin to remove any excess bone over the implant to allow for the seating of the shouldered abutment.
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Abutment shoulder gauge seated in the well of the implant to facilitate the selection of a stealth abutment with an appropriate shoulder height.
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Abutment shoulder gauge seated in the well of the implant to facilitate the selection of a stealth abutment with an appropriate shoulder height.
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Stealth shouldered abutment 5.0mm wide with a shoulder height of 4.0mm is being inserted into the implant well with only finger pressure.
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Stealth shouldered abutment being modified.
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Tall acrylic sleeve being modified.
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Tall acrylic sleeve snapped onto stealth abutment being inserted into the implant well.
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Modified tall acrylic sleeve being seated onto stealth abutment.
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Vacuum formed template seated over acrylic sleeves and abutments to confirm the appropriateness of their placement.
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Transitional composite material “Integrity", by Dentsply, being added to acrylic sleeves forming a strut.
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Transitional composite material “Integrity", by Dentsply, being added to vacuum formed template to form a transitional prosthesis.
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Additional transitional composite material in vacuum formed template being added to the hardened strut for aesthetic contouring.
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Transitional composite prosthesis incorporating modified acrylic sleeves snapped onto abutments being removed for polishing.
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Post-operative radiograph.
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View of implant wells and soft tissue sulci thirty weeks after the mandibular ridge split, twenty-seven weeks after the initial implant placement and fifteen weeks after the second implant placement.
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3.0mm guide pins inserted into the wells of the implants to be used with impression reamer.
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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.
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Impression post being tapped into place to assure its proper seating.
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Impression material being injected around the impression post for the making of a full arch implant level transfer impression.
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Digital image being taken of shade guide against a black plastic background to facilitate the fabrication of aesthetic Integrated Abutment Crowns™.
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Integrated Abutment Crowns™ on stone model.
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View of Integrated Abutment Crowns™.
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View of shouldered abutments prior to their removal for the insertion of the Integrated Abutment Crowns™ four weeks after implant level transfer impression was taken.
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Initial seating of Integrated Abutment Crown™.
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Integrated Abutment Crown™ being inserted.
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Abutment post receiving its mandatory alcohol wipe to remove any contaminants that would reduce the effectiveness of its locking taper engagement.
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Integrated Abutment Crown™ being inserted.
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Crestal relieving incision being made to facilitate the seating of the Integrated Abutment Crown™.
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Adjustment of interproximal contact since a too tight interproximal contact will prevent the engagement of the locking taper and possibly result in subsequent loosening of the Integrated Abutment Crown™.
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White healing abutment in a straight handle is being used to tap the Integrated Abutment Crown™ into the well of the implant.
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White healing abutment in a straight handle is being used to tap the Integrated Abutment Crown™ into the well of the implant.
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White healing abutment in a straight handle is being used to tap the Integrated Abutment Crown™ into the well of the implant.
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Post-insertion radiograph of Integrated Abutment Crowns™.
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Integrated Abutment Crowns™ eight months after insertion showing exposed metal margin which was most likely caused by the buccally oversized transitional prosthesis.
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Laboratory bur being used to prepare the cervical portion of a Bicon abutment by cutting a groove into the surgical grade titanium alloy.
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Crown being blasted with 50-micron alumina.
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A layer of metal opaque material being applied onto the prepared groove.
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A layer of neutral metal opaque material is applied onto the prepared groove.
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Shade being checked.
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Prepared polyceramic opaque dentin material on a glass slab being applied.
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A layer of polyceramic opaque dentin material being applied to the groove.
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Light curing of polyceramic opaque dentin material.
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Polishing with a pink silicone disc.
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Polishing with a nylon bristle brush.
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Final buffing with cloth wheel.
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View of polished Integrated Abutment Crown™ with an aesthetic gingival margin.
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Integrated Abutment Crown™ being re-inserted.
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Definitive seating of the restoration and engagement of its locking taper connection is being achieved by occlusal pressure on a cotton applicator.
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Seated Integrated Abutment Crown™ with an aesthetically improved gingival margin immediately after its insertion. Note the blanching of soft tissue.
61.
View of Integrated Abutment Crown™ ten minutes after its insertion. Note that the blanching has been dissipated.
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Post-operative radiograph.
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View of aesthetically modified Integrated Abutment Crown™ one week after the insertion.
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