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™.
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Scalpel blade being used to score crest of ridge to establish a point of purchase for subsequent use of chisels.
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Ridge being initially split by the gentle tapping of a ridge splitting chisel.
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Ridge being split by the use of successively larger chisels.
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Ridge being split by the use of successively larger chisels.
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Ridge being split by the use of successively larger chisels.
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View of split ridge prior to the use of a pilot bur.
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Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.
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Parallel pin confirming appropriate trajectory and acting as a guide for subsequent osteotomy.
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Parallel pins confirming appropriate trajectories and acting as guides for subsequent osteotomy.
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Parallel pins seated in pilot osteotomies indicating their trajectories.
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Osteotomy being enlarged while the surgeon’s finger is monitoring the buccal bone.
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Osteotomy being enlarged with a teal 3.0mm latch reamer bur rotating at 50RPM without water irrigation.
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Harvested bone within the red 4.0mm hand reamer.
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Silver 4.5mm hand reamer attached to a straight handle is being rotated to enlarge the osteotomy.
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Harvested bone within the 4.5mm hand reamer.
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4.5mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.
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View of wells of seated implants.
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Implant seating tip attached to a straight handle is being tapped to seat implant farther into the osteotomy.
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Guide pins seated in the implant wells indicating the trajectory of the implants.
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Guide pin being removed prior to the placement of the cut black polyethylene healing plug.
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Black polyethylene healing plugs placed into the well of implants .
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View of seated implants with their cut black polyethylene healing plugs being covered with harvested autogenous bone.
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View of seated implants with their cut black polyethylene healing plugs being covered with harvested autogenous bone.
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Sutured operative site immediately after the placement of four implants into split alveolar ridge.
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Radiograph of four implants immediately after placement.
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Digital image being taken of shade guide against a black plastic background to facilitate the fabrication of an aesthetic Integrated Abutment Crown™.
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View of operative site twenty weeks after implant placement.
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View of widened ridge prior to the removal of the implants’ black healing plugs.
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View of widened ridge prior to the removal of the implants’ black healing plugs.
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Healing plug is being removed from the well of the implant.
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Healing plug is being removed from the well of the implant.
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Healing plug is being removed from the well of the implant.
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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 posts for the making of a full arch implant level transfer impression.
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View of four green plastic impression posts after the removal of the full arch implant level transfer impression.
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Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height.
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Stealth shouldered abutment 4.0mm wide with a shoulder height of 3.5mm is being inserted into the implant well with only finger pressure.
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Stealth shouldered abutment 4.0mm wide with a shoulder height of 3.5mm is being inserted into the implant well with only finger pressure.
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Short acrylic sleeve being snapped onto stealth abutment.
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Vacuum formed template seated over acrylic sleeves to confirm the appropriateness of their placement.
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Transitional composite material being added to vacuum formed template.
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Material is being added to facilitate the aesthetic contouring of the strut.
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Vacuum formed template being used to aesthetically form composite material over the strut.
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Transitional prosthesis being removed for polishing.
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Polished transitional prosthesis being inserted.
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View of transitional prosthesis.
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View of transitional prosthesis.
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Integrated Abutment Crowns™ on stone model.
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Crestal relieving incision being made to facilitate the seating of the Integrated Abutment Crown™.
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Integrated Abutment crown™ being inserted initially to evaluate its appropriateness.
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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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Integrated Abutment crown™ being inserted initially to evaluate its appropriateness.
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A clear acrylic orientation jig is being used to initially position the Integrated Abutment Crown™.
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Integrated Abutment crown™ being inserted initially to evaluate its appropriateness.
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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.
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A gold 5.0mm sulcus reamer being used to remove soft tissue and bone which might inhibit the complete seating of the Integrated Abutment Crown™.
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Integrated Abutment crown™ being inserted initially to evaluate its appropriateness.
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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.
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A gold 5.0mm sulcus reamer being used to remove soft tissue and bone which might inhibit the complete seating of the Integrated Abutment Crown™.
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Integrated Abutment crown™ being inserted initially to evaluate its appropriateness.
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Integrated Abutment crown™ being inserted initially to evaluate its appropriateness.
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A gold 5.0mm sulcus reamer being used to remove soft tissue and bone which might inhibit the complete seating of the Integrated Abutment Crown™.
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Integrated Abutment crown™ being inserted initially to evaluate its appropriateness.
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View of seated Integrated Abutment Crowns™ immediately after insertion.
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View of seated Integrated Abutment Crowns™ immediately after insertion.
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View of seated Integrated Abutment Crowns™ immediately after insertion.
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Post-insertion radiograph of Integrated Abutment Crowns™.
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View of seated Integrated Abutment Crowns™ five weeks after being inserted.
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View of seated Integrated Abutment Crowns™ five weeks after being inserted.
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