Placement of Maxillary Left Lateral Incisor with Bovine Graft and Bicon Resorbable Collagen Membrane and Restoration with a Bicon Integrated Abutment Crown™
This case demonstrates the extraction of a failed endodontically treated maxillary lateral incisor, subsequent bovine bone allograft with a Bicon Resorbable Collagen Membrane, placement of an immediately stabilized and functioning implant, fabrication of three bonded transitional prostheses, implant level impression, and an insertion of a Bicon Integrated Abutment Crown™.
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Pre-operative radiograph of failed root canal treated tooth.
2.
Patient’s pre-operative smile.
3.
View of carious left lateral root.
4.
Post-extraction site.
5.
Removal of granuloma.
6.
Polyceramic material being inserted into vacuum-formed template for the fabrication of a transitional prosthesis.
7.
Light curing of the bonded transitional prosthesis.
8.
View of transitional prosthesis after five weeks post extraction and prior to its removal for bone grafting procedure.
9.
View of extraction site after the removal of transitional prosthesis.
10.
Etchant being applied prior to the bone grafting and bonding of a second transitional prosthesis.
11.
Primer bonding agent being applied.
12.
Modeling liquid or bonding agent being applied.
13.
Light curing of bonding agent.
14.
View of initial incisions.
15.
Flap being elevated to carefully remove granulation tissue and soft tissue tags with a curette.
16.
Flap being elevated to carefully remove granulation tissue and soft tissue tags with a curette.
17.
View of site prior to addition of bovine graft material.
18.
View of site with bovine graft in place.
19.
View of grafted site prior to placement of Bicon Resorbable Collagen Membrane.
20.
Bicon Resorbable Collagen Membrane cut to appropriate size being applied over the graft material.
21.
Initial suturing with Vicryl sutures.
22.
View of sutured site.
23.
Vacuum-formed template being seated prior to the fabrication of the second transitional prosthesis.
24.
Polyceramic material being applied to the adjacent teeth to facilitate the handling of the polyceramic material in the template.
25.
Vaseline being applied to prevent the material from contacting the sutures.
26.
Vacuum formed template being used to apply polyceramic material to facilitate aesthetic contouring.
27.
Template being adapted to teeth.
28.
Light curing of newly applied polyceramic material.
29.
Transitional prosthesis.
30.
Post-operative radiograph.
31.
Initial incisions for placement of an implant twenty-two weeks after bone graft.
32.
Flap being elevated revealing the grafted site.
33.
Preparation of the pilot osteotomy at 1,100RPMs.
34.
Clinician’s finger monitoring the buccal bone during the preparation of the osteotomy and the harvesting of bone with a latch reamer rotating at 50RPMs.
35.
Harvested bone and graft material in the flute of 4.0mm latch reamer bur.
36.
Clinician’s finger monitoring the buccal bone during the preparation of the osteotomy and the harvesting of bone with a latch reamer rotating at 50RPMs.
37.
A 5.0mm x 8.0mm HA coated Implant being inserted into osteotomy with an implant seating tip threaded on a straight driver.
38.
Implant seated in osteotomy.
39.
Shoulder depth gauge seated in the well of the implant to facilitate the selection of a stealth abutment with an appropriate shoulder height.
40.
A 5.0mm x 4.0mm stealth shouldered abutment being seated with only finger pressure.
41.
Acrylic sleeve being placed onto stealth abutment.
42.
Acrylic sleeve snapped onto abutment.
43.
Adjacent teeth surfaces being prepared for bonding for the transitional stabilizing prosthesis.
44.
Adjacent teeth surfaces being prepared for bonding for the transitional stabilizing prosthesis.
45.
Adjacent teeth surfaces being prepared for bonding for the transitional stabilizing prosthesis.
46.
Adjacent teeth surfaces being prepared for bonding for the transitional stabilizing prosthesis.
47.
Polyceramic material being applied to the acrylic sleeve and teeth to initially form a strut.
48.
Light curing of newly applied material.
49.
View of transitional stabilizing prosthesis.
50.
Radiograph of transitional prosthesis twenty-eight weeks after the extraction.
51.
Labial view of transitional prosthesis prior to its removal for the making of implant level transfer impression eleven weeks after placement of the implant.
52.
Shouldered abutment after the removal of the transitional stabilizing prosthesis.
53.
Labial view of implant sulcus.
54.
View of implant well and sulcus.
55.
White 3.0mm impression post being inserted into the well of the implant for the making of an implant level transfer impression.
56.
White impression post being definitively tapped into the well of the implant.
57.
Impression material being injected around the white impression post for the making of an implant level transfer impression.
58.
Digital image being taken of shade guide for the recording of the desired shade against a black metallic background.
59.
Integrated Abutment Crown™ on dental model.
60.
View of clear acrylic orientation jig on dental model.
61.
Mirror view of cementless and screwless Integrated Abutment Crown™.
62.
View of transitional crown prior to its removal for the insertion of the Integrated Abutment Crown™.
63.
View of implant well and sulcus.
64.
Incision being made to excise palatal tissue to facilitate the seating of the Integrated Abutment Crown™.
65.
Excess palatal tissue being removed.
66.
A 5.0mm sulcus reamer being used to remove soft tissue and bone to accommodate the Integrated Abutment Crown™.
67.
A 6.5mm sulcus reamer being used to remove soft tissue and bone to accommodate the Integrated Abutment Crown™.
68.
A 6.5mm sulcus reamer being removed.
69.
Guide pin being removed revealing excess bone.
70.
Integrated Abutment Crown™ being inserted.
71.
Initial seating of Integrated Abutment Crown™.
72.
Custom seating jig on a straight driver facilitating the application of the engagement of the locking taper by directing the seating forces in the long axis of the implant well and abutment shaft.
73.
Articulating paper being used to confirm incisal contacts in all extreme excursions while the patient is clenching.
74.
Adjustment of incisal contacts.
75.
Post-Insertion radiograph of Integrated Abutment Crown™.
76.
View of seated Integrated Abutment Crown™ immediately after its insertion.
77.
Facial view of seated Integrated Abutment Crown™ immediately after being inserted.
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