This case demonstrates the extraction of a failed endodontically treated mandible incisors and their replacement with two immediately placed and functioning implants and their restoration with a four unit polyceramic material to metal fixed prosthesis with two laboratory milled abutments.
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Initial osteotomy being prepared with a 2.0 mm pilot bur rotating at 1,000RPM with external water irrigation.
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Paralleling pins placed into the pilot osteotomies to confirm that their trajectories are parallel and that they bisect the mesial surface of their adjacent tooth.
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Osteotomy being widened with a red 4.0 mm latch reamer bur rotating at 50RPM without water irrigation.
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Harvested bone being collected in a flexible dappen dish.
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A depth gauge being inserted into prepared osteotomy to confirm its depth.
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A 4.0mm x 11.0mm HA coated implant is being inserted with an implant inserter/retriever instrument.
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Final seating of the implant is being achieved prior to the removal of the inserter/retriever instrument.
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A 4.5 x 8.0mm HA coated implant is inserted with an implant inserter/retriever instrument.
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Final seating of the implant is being achieved prior to the removal of the inserter/retriever instrument.
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Shoulder depth gauge being inserted.
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A 4.0 mm x 3.5 mm stealth shouldered abutment with a 2.0 mm diameter post is being inserted with finger pressure only into the well of its implant.
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Shoulder depth gauge being inserted.
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A 4.0 mm x 3.5 mm stealth shouldered abutment with a 3.0 mm diameter post is being inserted with finger pressure only into the well of its implant.
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A short 4.0 mm wide acrylic sleeve is being placed onto a 4.0 mm wide stealth shouldered abutment.
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Two short 4.0 mm wide acrylic sleeves snapped onto 4.0 mm diameter stealth abutments.
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Vacuum formed template inserted over snapped on acrylic sleeves to confirm its appropriateness.
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Transitional prosthesis being removed for polishing.
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Etchant being applied to adjacent tooth surfaces.
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Bonding agent being applied.
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Light curing of bonding agent.
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Polished prosthesis being re-inserted.
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Light curing of splinted transitional stabilization prosthesis.
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Splinted prosthesis.
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Splinted transitional prosthesis providing stabilization and functional loading of the immediately placed implants.
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Radiograph of immediately placed and functioning implants.
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Transitional stabilizing prosthesis being removed from 4.0 mm stealth abutments.
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View of implant wells and sulci.
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Black impression post being inserted into the 2.0 mm implant well.
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White impression post being inserted into the 3.0mm implant well.
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Impression post receiving its mandatory seating taps.
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Impression material being inserted around impression post for the making of an implant level transfer impression.
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Red acrylic around impression post for the recording of an occlusal relationship.
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Occlusal registration being removed from the implant wells.
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A 4.0mm x 3.5mm stealth abutment with a 3.0mm post being re-inserted into the implant well.
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A 4.0 x 1.5mm stealth abutment with a 2.0mm post being inserted into the implant well for the making of a new transitional prosthesis.
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Two 4.0mm wide stealth abutments seated with only finger pressure.
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Short 4.0mm acrylic sleeve being inserted onto stealth abutment.
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Two 4.0mm short acrylic sleeves snapped onto stealth abutments.
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Transitional composite material “Integrity” by Dentsply being injected around sleeves to form an initial strut prior to the application of additional material with a vacuumed formed template.
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Additional material being applied.
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Clear template being removed.
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Transitional prosthesis being removed for polishing.
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Transitional prosthesis snapped onto abutments without cement.
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Digital Image being taken of shade guide against a black metallic background.
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White impression post with metal implant analog attached is being seated into transfer impression.
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Plastic impression posts with metal implant analogs seated in transfer impression.
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Separating medium being applied to impression.
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Soft tissue material being injected around implant analogs and impression posts.
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Pouring of the soft tissue model.
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Plastic impression posts in the soft tissue model.
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Two piece four unit metal frame on two milled abutments on stone model.
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Transitional prosthesis prior to its removal for the try in of the two piece metal frame and milled abutments.
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Transitional prosthesis being removed.
56.
View of implant wells and sulci after the removal of the stealth abutments which were only seated with finger pressure.
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Milled abutment with metal prosthesis is being inserted into the 3.0mm implant well.
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Initial positioning of the abutment is being facilitated by the appropriate positioning of the metal prosthesis.
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Milled abutment is being inserted into the metal prosthesis.
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Milled abutment with metal prosthesis is being inserted into the 2.0mm implant well.
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After appropriate alignment of the two metal prostheses an initial seating tap to the 3.0mm abutment is being applied through the metal frame.
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After appropriate alignment of the two metal prostheses an initial seating tap to the 2.0mm abutment is being applied through the metal frame.
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After the removal of the metal frame a definitive seating tap is being delivered to the 3.0mm diameter abutment post.
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After the removal of the metal frame a definitive seating tap is being delivered to the 2.0mm abutment.
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The metal frames have been inserted onto the seated abutments to confirm their alignment prior to their being seated together.
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Red acrylic is being used to unite the two pieces of the framework together.
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An incisal relationship is also being recorded in the splinting red acrylic.
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Impression material is being injected around the metal framework for the making of a withdrawal impression.
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After the withdrawal impression the milled abutments were replaced with the previously used stealth abutments and the transitional prosthesis is being re-inserted.
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Four unit polyceramic to metal fixed prosthesis on model.
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Mirror view of prosthesis.
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Transitional prosthesis being removed.
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View of implant wells and sulci.
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Milled abutment being inserted into prosthesis.
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After appropriate alignment with the prosthesis an initial seating tap of the abutment is being delivered through the prosthesis.
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Prosthesis is being removed.
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Milled abutment being inserted into prosthesis.
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Prosthesis is being used to confirm the passive interproximal contacts which would not interfere with the complete seating of the prosthesis.
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Floss is being used to confirm passive interproximal contacts which would not interfere with the complete seating of the prosthesis.
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After removal of the prosthesis the abutment is being definitively seated.
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After removal of the prosthesis the abutment is being definitively seated.
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View of seated abutments prior to the re-insertion of the prosthesis for radiographic confirmation of its complete seating.
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Re-inserted prosthesis for radiographic confirmation of the seating.
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Radiograph confirms complete seating of the prosthesis.
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Cement is being applied only to the cervical margins.
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Prosthesis 11 months after being permanently cemented.
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Radiograph 11 months after cementation of the prosthesis.
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