Maxillary Ridge Split, Two Stage Placement, and Restoration of Four Congenitally Missing Teeth with Bicon Integrated Abutment Crowns™

Posted on January 18, 2005 by Bicon

This case demonstrates the restoration of four congenitally missing teeth with a maxillary ridge split for the placement of four Bicon implants using the two stage surgical technique and their restoration with Bicon Integrated Abutment Crowns™.

SURGICAL: Ridge Splits Two Stage
RESTORATIVE: Integrated Abutment Crowns™
TOPICS: Congenitally Missing Laterals Crown Insertion Impression

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1.

Pre-operative smile.

2.

Pre-operative site.

3.

Pre-operative radiograph.

4.

View of removable transitional prosthesis.

5.

Extraction site.

6.

Pre-operative radiograph.

7.

Pre-operative site.

8.

View of broad base flap.

9.

View of broad base flap.

10.

Scalpel blade being used to score crest of ridge to establish a point of purchase for subsequent use of chisels.

11.

Ridge being initially split by the gentle tapping of a ridge splitting chisel.

12.

Ridge being split by the use of successively larger chisels.

13.

Ridge being split by the use of successively larger chisels.

14.

Ridge being split by the use of successively larger chisels.

15.

View of split ridge prior to the use of a pilot bur.

16.

Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.

17.

Parallel pin confirming appropriate trajectory and acting as a guide for subsequent osteotomy.

18.

Parallel pins confirming appropriate trajectories and acting as guides for subsequent osteotomy.

19.

Parallel pins seated in pilot osteotomies indicating their trajectories.

20.

Osteotomy being enlarged while the surgeon’s finger is monitoring the buccal bone.

21.

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

22.

Harvested bone within the red 4.0mm hand reamer.

23.

Silver 4.5mm hand reamer attached to a straight handle is being rotated to enlarge the osteotomy.

24.

Harvested bone within the 4.5mm hand reamer.

25.

4.5mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.

26.

View of wells of seated implants.

27.

Implant seating tip attached to a straight handle is being tapped to seat implant farther into the osteotomy.

28.

Guide pins seated in the implant wells indicating the trajectory of the implants.

29.

Guide pin being removed prior to the placement of the cut black polyethylene healing plug.

30.

Black polyethylene healing plugs placed into the well of implants .

31.

View of seated implants with their cut black polyethylene healing plugs being covered with harvested autogenous bone.

32.

View of seated implants with their cut black polyethylene healing plugs being covered with harvested autogenous bone.

33.

Sutured operative site immediately after the placement of four implants into split alveolar ridge.

34.

Radiograph of four implants immediately after placement.

35.

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

36.

View of operative site twenty weeks after implant placement.

37.

View of widened ridge prior to the removal of the implants’ black healing plugs.

38.

View of widened ridge prior to the removal of the implants’ black healing plugs.

39.

Healing plug is being removed from the well of the implant.

40.

Healing plug is being removed from the well of the implant.

41.

Healing plug is being removed from the well of the implant.

42.

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.

43.

Impression post being tapped into place to assure its proper seating.

44.

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

45.

View of four green plastic impression posts after the removal of the full arch implant level transfer impression.

46.

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

47.

Stealth shouldered abutment 4.0mm wide with a shoulder height of 3.5mm is being inserted into the implant well with only finger pressure.

48.

Stealth shouldered abutment 4.0mm wide with a shoulder height of 3.5mm is being inserted into the implant well with only finger pressure.

49.

Short acrylic sleeve being snapped onto stealth abutment.

50.

Vacuum formed template seated over acrylic sleeves to confirm the appropriateness of their placement.

51.

Transitional composite material being added to vacuum formed template.

52.

Material is being added to facilitate the aesthetic contouring of the strut.

53.

Vacuum formed template being used to aesthetically form composite material over the strut.

54.

Transitional prosthesis being removed for polishing.

55.

Polished transitional prosthesis being inserted.

56.

View of transitional prosthesis.

57.

View of transitional prosthesis.

58.

Integrated Abutment Crowns™ on stone model.

59.

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

60.

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

61.

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™.

62.

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

63.

A clear acrylic orientation jig is being used to initially position the Integrated Abutment Crown™.

64.

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

65.

Yellow thermoplastic custom seating jig, which was formed in a crown alignment device, is seated in a crown seating tip attached to a straight handle to facilitate directing the tapping forces in the long axis of the abutment post and implant well.