This case demonstrates the surgical placement, laboratory and clinical restoration with porcelain fused to metal crowns using the indirect abutment transfer technique for an immediately placed, stabilized and functioning implant, as well as two maxillary molar implants placed after a lateral sinus floor augmentation with two stage surgical technique.
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Extraction of failed endodontically treated tooth.
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Removal of granuloma
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Clinician’s finger monitoring buccal bone during the initial osteotomy preparation with a 2.0mm diameter pilot bur rotating at 1,100RPM with external water irrigation.
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Paralleling pin indicating the trajectory of the pilot osteotomy.
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Clinician’s finger monitoring the buccal bone while the osteotomy is enlarged with a 3.5mm latch reamer rotating without irrigation at 50RPM.
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Clinician’s finger monitoring bone as the osteotomy is enlarged with a 4.0mm latch reamer rotating at 50RPM without irrigation.
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Clinician’s finger monitoring bone as the osteotomy is enlarged with a 4.5mm latch reamer rotating at 50RPM without irrigation.
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A 5.0mm x 8.0mm TPS coated implant being inserted into osteotomy with implant inserter/retriever instrument threaded on a straight driver.
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Implant being definitively seated by being tapped with an implant seating tip threaded on a straight driver.
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Radiograph of seated 5.0mm x 8.0mm TPS coated implant.
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Etchant being applied to adjacent tooth surfaces.
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Adjacent tooth surfaces being prepared for the bonding of the transitional stabilizing prosthesis.
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Adjacent tooth surfaces being prepared for the bonding of the transitional stabilizing prosthesis.
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Light curing of bonded surface.
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Shoulder depth guage in the well of the implant to facilitate the selection of a stealth abutment with an appropriate shoulder height.
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A 5.0mm x 4.0mm stealth abutment with a short acrylic sleeve is being inserted with only finger pressure into the well of the implant.
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Polyceramic material is being adapted over the acrylic sleeve and onto the surface of the adjacent tooth to form the bonded transitional stabilization prosthesis.
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Light curing of the transitional prosthesis.
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Initial polishing with a soft white silicone disc.
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Additional polishing with nylon bristle brush.
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Post-insertion radiograph of transitional stabilizing prosthesis.
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Facial view of transitional prosthesis.
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Radiograph prior to augmentation of sinus floor eight weeks after the implant placement.
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View of lateral wall of sinus. Note the middle superior alveolar artery.
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Radiograph revealing two 5.0mm x 8.0mm HA coated implants in grafted bone.
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Black polyethylene plug being removed from the well of the osseointegrated implant.
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A 7.5mm sulcus reamer threaded on a straight driver and placed onto a guide pin in the implant is being turned to contour the bone over the implant to be compatible with the contour of the abutment.
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A 5.0mm x 6.5mm non-shouldered abutment is being inserted into well of the implant.
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Abutment is being definitively seated to engage its locking taper connection.
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A 6.5mm x 6.5mm non-shouldered abutment is being inserted into well of the implant.
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A 7.5mm x 8.0mm non-shouldered abutment is being inserted into well of the implant.
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The 7.5mm x 8.0mm abutment is being trimmed for occlusal clearance with a carbide bur.
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A purple acrylic sleeve is being inserted onto a 7.5mm x 8.0mm abutment in an abutment prep holder.
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Purple acrylic sleeve is being cut to the level of the prepared abutment.
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The prepared abutment and sleeve are being polished.
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The modified 7.5mm x 8.0mm abutment is being tapped into the implant well with an offset driver to engage its locking taper connection.
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The 6.5mm x 6.5mm abutment is being tapped to engage its locking taper connection.
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A yellow acrylic transfer impression sleeve is being inserted onto the 5.0mm x 6.5mm non-shouldered abutment.
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The yellow acrylic sleeve is being reduced to fit interproximally.
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The green acrylic sleeve is being reduced to fit interproximally.
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The modified green acrylic sleeve is being inserted onto the 6.5mm x 6.5mm non-shouldered abutment.
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The modified purple acrylic sleeve is being inserted onto the 7.5mm x 8.0mm non-shouldered abutment.
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Yellow sleeve is being definitively seated.
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Green sleeve is being definitively seated.
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Impression material is being injected around the acrylic sleeves for the making of an abutment level transfer impression.
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Acrylic transfer sleeves withdrawn in impression material prior to its being sent to the laboratory.
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Digital image of a shade guide against a black background is being made to facilitate aesthetically the fabrication of a porcelain fused to metal restoration.
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A 5.0mm tooth colored sleeve is being snapped onto the 5.0mm diameter non-shouldered abutment for the fabrication of a transitional prosthesis.
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A 5.0mm tooth colored sleeve is being modified.
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A 6.5mm tooth colored sleeve is being removed to be modified.
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A 6.5mm tooth colored sleeve is being modified.
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A 6.5mm tooth colored sleeve is being modified occlusally.
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Three modified acrylic sleeves snapped onto non-shouldered abutments.
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Transitional composite material being injected onto acrylic sleeves.
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Transitional prosthesis being removed for polishing.
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Additional composite material being added to voids in the prosthesis prior to polishing.
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Polished transitional prosthesis.
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Polished transitional prosthesis being inserted without cement.
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Polished transitional prosthesis snapped in place.
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Three acrylic transfer sleeves within abutment level transfer impression.
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A 5.0mm yellow, a 6.5mm green and a 7.5mm purple abutment analog.
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A 7.5mm diameter purple abutment analog with a modified purple acrylic sleeve being cut in order to be seated into abutment level transfer impression.
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5.0mm diameter yellow abutment analog being inserted into 5.0mm acrylic sleeve in abutment level transfer impression.
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Soft tissue material being injected around acrylic sleeves and abutment analogs in abutment level transfer impression.
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Soft tissue model with two acrylic sleeves on their abutment analogs.
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Abutment analog and acrylic sleeve being reduced for occlusal clearance.
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Acrylic sleeves incorporated in wax patterns on stone model.
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Acrylic sleeves and wax patterns sprued for investing.
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Acrylic sleeves and wax patterns sprued for investing.
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Internal aspect of casting sprayed with pink pressure indicator material.
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Metal castings on the green 6.5mm analog and metal casting with indicator material on 7.5mm purple abutment analog.
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Marking of indicator material revealing areas of contact with abutment analog.
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View of palatal side of castings on abutment analogs.
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View of buccal side of castings.
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A 5.0mm(yellow), 6.5mm(green) and a 7.5mm(purple) occlusally modified abutment analogs in a stone model.
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Acrylic sleeves reduced to the height of the adjusted analogs for use as corrective copings intra-orally.
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Adjusted acrylic sleeves with red acrylic dot to indicate buccal side for use intra-orally as a corrective coping.
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A modified 5.0mm yellow acrylic sleeve with a red acrylic dot to indicate its buccal side is being placed onto titanium abutment.
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A modified 6.5mm green acrylic sleeve with a red acrylic dot to indicate its buccal side is being placed onto titanium abutment.
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A modified 7.5mm purple acrylic sleeve with a red acrylic dot to indicate its buccal side is being placed onto titanium abutment.
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Acrylic sleeves snapped onto non-shouldered abutments indicating the extent to width the titanium abutments must be reduced.
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Occlusal aspect of non-shouldered abutment being reduced with a carbide bur to the level of the modified 5.0mm yellow acrylic sleeve.
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Occlusal aspect of non-shouldered abutment being reduced with a carbide bur to the level of the modified 6.5mm green acrylic sleeve.
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Occlusal aspect of non-shouldered abutment being reduced with a carbide bur to the level of the modified 7.5mm purple acrylic sleeve.
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Occlusal view revealing titanium abutments reduced to the level of the adjusted acrylic sleeves.
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Casting being placed onto modified non-shouldered abutment.
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Casting being placed onto modified non-shouldered abutment.
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Casting being placed onto modified non-shouldered abutment.
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Catings being inserted with white pressure indicator paste.
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Internal aspect of castings with white indicator material.
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Radiograph of seated castings.
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Occlusal registration being taken with red acrylic on castings.
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Castings on re-articulated models.
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Buccal view of porcelain fused to metal crowns on model.
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Occlusal view of porcelain fused to metal crowns on model.
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Mirror view of three porcelain fused to metal crowns.
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Transitional prosthesis before it is removed for the placement of three porcelain fused to metal crown.
100.
Modified non-shouldered abutments.
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Porcelain fused to metal crown on 7.5mm non-shouldered abutment.
102.
Three porcelain fused to metal crowns on non-shouldered abutments for confirmation of their aesthetics and functional morphology.
103.
Cement being applied only to the cervical portion of the crown.
104.
Porcelain fused to metal crown prior to being cemented intra-orally onto non-shouldered abutment.
105.
Facial view of three cemented porcelain fused to metal crowns immediately after cementation prior to maturation of soft tissue.
106.
Post-insertion radiograph of three individual porcelain fused to metal crowns.
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