This case demonstrates the extraction of maxillary incisors and the surgical placement of four immediately functioning implants and their permanent restoration with Bicon Integrated Abutment Crowns™ in three clinical visits in a time period of 97 days. This case also demonstrates the use of a caliper device for the fabrication of custom seating jigs.
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2.0mm pilot bur preparing initial osteotomy at 1100RPM.
8.
Parallel pin inserted into initial osteotomy to act as a guide for second osteotomy.
9.
Second osteotomy being prepared with parallel pin as a guide.
10.
Second parallel pin positioned to act as a guide for third osteotomy.
11.
Pilot bur preparing third osteotomy parallel to the inserted parallel pins.
12.
Parallel pins seated in initial osteotomies.
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Pilot bur preparing initial osteotomy of maxillary left lateral incisor.
14.
Four seated parallel pins prior to their being replaced with four actual abutments.
15.
Four actual abutments in the pilot osteotomies being used to confirm the appropriateness of the pilot osteotomies.
16.
Vacuum formed template seated over abutments to confirm the appropriateness of their placement.
17.
Right maxillary central incisor osteotomy being enlarged with a 2.5mm latch reamer bur rotating at 50RPM without water irrigation.
18.
Right maxillary lateral incisor osteotomy being enlarged while the surgeon's finger is monitoring the buccal bone.
19.
Harvested bone within the flute of hand reamer fastened to a straight driver.
20.
Hand reamer being inserted into right maxillary central incisor osteotomy.
21.
Hand reamer being rotated to enlarge the right central incisor osteotomy.
22.
5.0mm x 11mm HA coated implant being inserted into the osteotomy with implant inserter/retriever device.
23.
Second 5.0mm x 11mm HA coated implant with a 3.0mm implant well is being inserted.
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5.0mm x 8.0mm HA coated implant with a 3.0mm implant well is being inserted.
25.
4.0mm x 11mm implant with a 2.0mm well being inserted into the right lateral incisor osteotomy.
26.
View of wells of four seated implants.
27.
Acid applied to the adjacent canines prior to their being bonded to the transitional prosthesis.
28.
Bonding agent being applied.
29.
Light curing of bonding agent.
30.
Shoulder depth gauge inserted into the well of the left central incisor implant facilitating the selection of an appropriate shouldered abutment.
31.
Shoulder depth gauge indicating that an abutment with a 4.0mm shoulder height would be appropriately placed below the gingival crest.
32.
5.0mm wide stealth shouldered abutment with a shoulder height of 4.0mm is being inserted into the implant well with only finger pressure.
33.
4.0mm x 3.5mm stealth abutment with a 2.0mm post being inserted into the right lateral incisor implant.
34.
5.0mm x 4.0mm stealth abutment with a 3.0mm post being inserted into the right central incisor implant.
35.
Short 5.0mm wide acrylic sleeve being inserted onto the 5.0mm wide stealth abutment.
36.
Two short 5.0mm wide acrylic sleeves and two tall 4.0mm wide acrylic sleeves snapped onto stealth abutments.
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Tall acrylic sleeve being modified.
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Seated sleeves prior to their being incorporated into a transitional stabilizing prosthesis.
39.
Holes being placed into vacuum formed template to facilitate fabrication of transitional prosthesis.
40.
Short acrylic sleeve being modified to accommodate vacuum formed template.
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4.0mm wide sleeve being modified to accommodate vacuum formed template.
42.
Polyceramic material being added to acrylic sleeves to form a strut.
43.
Polyceramic material is being contoured around the acrylic sleeves.
44.
Vacuum formed template is being placed over the strut material prior to its being light cured.
45.
Strut is being light cured.
46.
Polyceramic material is being added to the labial aspect of the vacuum formed template.
47.
Material is being added to facilitate the aesthetic contouring of the strut.
48.
Template seated over strut.
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Transitional stabilizing prosthesis being light cured.
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Prosthesis being contoured.
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Additional material being added to prosthesis.
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Light curing of additional material.
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Polishing of transitional stabilizing prosthesis.
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Prosthesis prior to final polishing.
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Buffing of prosthesis with a cotton wheel.
56.
Smile at completion of first clinical visit.
57.
Radiograph of four immediately functioning implants at the completion of first clinical visit.
58.
Smile 69 days later at the beginning of patient's second clinical visit.
59.
Bonded stabilizing prosthesis prior to its being removed at the patient's second clinical visit.
60.
View of implant wells after the removal of the transitional prosthesis and stealth abutments.
61.
Black 2.0mm plastic impression post being inserted into the 2.0mm well of right lateral incisor.
62.
White 3.0mm plastic impression post being inserted into the 3.0mm well of right central incisor.
63.
White impression post receiving its mandatory seating tap.
64.
Impression material being injected around seated impression posts.
65.
Full arch implant level impression being taken of the four maxillary incisor implants.
66.
Digital photograph is being taken to record the appropriate shade.
67.
Polishing of Integrated Abutment Crown™ at the laboratory.
68.
Further polishing of the Integrated Abutment Crown™.
69.
Final polishing of the Integrated Abutment Crown™.
70.
Mirror view of four Integrated Abutment Crowns™.
71.
Integrated Abutment Crowns™ on model.
72.
Model prepared for the application of acrylic for the fabrication of an incisal orientation jig.
73.
Caliper seating jig orientation device holding an Integrated Abutment Crown™ prior to red acrylic being added to the white temporary abutment.
74.
Four seating jigs which were fabricated with the aid of the caliper device assure proper alignment of the seating force.
75.
Seating jigs on their appropriate Integrated Abutment Crowns™.
76.
Left lateral incisor Integrated Abutment Crown™ being seated with the incisal orientation jig.
77.
Left lateral incisor prior to confirmation of an appropriately passive inter-proximal contact.
78.
Seating jig being used to facilitate the seating of the Integrated Abutment Crown™ in the long axis of both the post and implant well.
79.
Cotton being used on an endodontic file to clean the well of the implant prior to inserting the Integrated Abutment Crown™.
80.
Orientation jig being used to seat the maxillary left central incisor Integrated Abutment Crown™.
81.
Fully seated orientation jig.
82.
Confirmation of an appropriately passive inter-proximal contact.
83.
It is essential that there be a passive contact to allow for the application of seating forces in the long axis of both the implant well and abutment post.
84.
Seating jig being used to facilitate the application of forces in the long axis of both the implant and abutment post.
85.
Cotton being used to clean the well of the implant.
86.
Cotton being removed from well of the implant prior to the insertion of the Integrated Abutment Crown™.
87.
Floss being used to confirm the fact that the inter-proximal contacts are passive and will not interfere with the engagement of the locking taper.
88.
Incisal seating jig being seated onto Integrated Abutment Crown™ to facilitate seating in the long axis of abutment post and implant well.
89.
Inter-proximal contact being confirmed after seating.
90.
Seating jig facilitating the seating of the Integrated Abutment Crown™.
91.
Cotton being inserted to clean and dry the well of the implant.
92.
Cotton being removed from the implant well.
93.
Integrated Abutment Crown™ being inserted into the cleaned and dried well of implant.
94.
Orientation jig being inserted onto the Integrated Abutment Crowns™.
95.
Orientation jig being tapped to initially seat the Integrated Abutment Crown™.
96.
Acrylic seating jig facilitating the seating forces to be directed in the long axis of the abutment post and implant well.
97.
Articulating paper being used to confirm occlusal contacts.
98.
Marking of initial contacts.
99.
Adjustment of premature contacts.
100.
Marking of excursive contacts.
101.
Insertion of hard acrylic mouthguard.
102.
Inserted hard acrylic mouthguard which will initially protect the newly seated crowns especially during sleep.
103.
Premature contact markings prior to their being adjusted.
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