Surgically, this case demonstrates a two stage nine tooth mandibular alveolar ridge split and the subsequent placement and uncovering of five implants. Prosthetically, this case demonstrates the temporization, occlusal registration, implant level transfer impression and insertion of three Bicon Integrated Abutment Crowns™ and a five unit fixed bridge.
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View of bony ridge after extraction of three teeth and the reflection of a full thickness mucoperiosteal flap.
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Periodontal probe demonstrates the thinness of the alveolar ridge.
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Thinness of ridge is being demonstrated by the placement of the periodontal probe along the ridge.
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Crestal bony cut is being made with a thin fissure bur at high speed.
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Occlusal view of crestal cut.
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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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View of the mandibular ridge prior to the placement of the implants twenty-one days after the initial surgery.
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Crestal incision.
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Crestal incision.
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Minimal reflection of the labial mucosa.
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Pilot bur preparing initial osteotomy.
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Paralleling pin in initial osteotomy site acts as a guide for the second osteotomy.
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Second paralleling pin acts as a guide for third osteotomy.
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Five paralleling pins demonstrate positioning of the osteotomies.
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Vacuum-formed template confirms the appropriateness of the positioning of the osteotomies.
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Two handed drilling technique facilitates the preparation of the osteotomies.
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Hand reamer is being inserted into the osteotomy.
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Final preparation of the osteotomy is being accomplished with hand instrumentation.
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A 3.5mm x 11.0mm is being placed with an implant inserter/retriever instrument.
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Final seating of the implant into the osteotomy.
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Removal of the implant inserter from the seated implant.
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Implant prior to final seating.
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Two implants prior to insertion of black polyethylene healing plugs.
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Alveolar ridge prior to suturing.
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Suturing of alveolar ridge.
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Sutured alveolar ridge.
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View of alveolar ridge three weeks after implant placement revealing less than ideal axial positioning of two implants.
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Two guide pins confirming integration and positioning of implants.
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Five guide pins seated in implant wells: Note the relatively high positioning of two implants.
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Two 5.0mm x 2.0mm and one 4.0mm x 1.5mm shouldered abutment seated with only finger pressure in their implant wells.
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Three 5.0mm tall one-piece acrylic sleeves snapped onto the 5.0mm wide shouldered abutments.
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Sulcus reamer being positioned onto guide pin.
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Sulcus reamer prior to its being rotated for the removal of excess bone over the implant.
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Five one-piece sleeves snapped onto abutments prior to being incorporated into transitional prosthesis.
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Transitional composite material “Integrity” by Dentsply being injected around one-piece acrylic sleeves.
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Initial application of the composite material is allowed to set forming a strut.
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After appropriate trimming of the strut for seating clearance of the vacuum-formed template, the occlusal portion only of the template is filled with composite material, “Integrity” by Dentsply.
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Template forming transitional prosthesis over the one-piece sleeves and composite strut.
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Removal of transitional prosthesis for polishing.
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Black 2.0mm impression post being inserted into implant well.
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Five 2.0mm impression posts after having been tapped into an implant well.
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Impression material being injected around impression posts.
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Impression posts remaining in implants after the removal of the impression tray.
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Red acrylic being injected around seated impression posts for the recording of an occlusal registration.
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Occlusal registration being made.
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Insertion of the transitional prosthesis with five shouldered abutments.
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Lingual view of permanent restorations.
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Mirror view of three Bicon Integrated Abutment Crown™ restorations and one five unit polyceramic material fused to metal fixed bridge.
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Labial view of permanent polyceramic restorations with yellow thermo plastic incisal orientation jig.
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Transitional prosthesis prior to being removed for insertion of the permanent Bicon Integrated Abutment Crown™ restorations.
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Mandibular ridge with one Bicon Integrated Abutment Crown™ in place and view of two supra gingival implants.
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A two unit Bicon Integrated Abutment Crown™ being seated into a relatively high positioned implant.
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Yellow thermo plastic incisal jig being used to facilitate the orientation of the two Bicon Integrated Abutment Crowns™.
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Crestal relieving incision being made to facilitate the seating of the prosthesis.
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Initial seating of the laboratory milled bridge abutments is being achieved by tapping on the polyceramic prosthesis through the wood of a cotton Q-tip.
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The third Bicon Integrated Abutment Crown™ is being inserted into the implant.
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Facial view of the seated permanent restorations.
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Facial and mirror view of the seated restorations.
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Radiograph of the permanent restorations and implants.
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