Placement of Two Immediately Functioning Implants and their Restoration with Two Polyceramic to Metal Crowns and the Restoration of Two Natural Teeth with All-Ceramic Crowns

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1.

Pre-operative smile.

2.

Pre-operative prosthesis.

3.

Pre-operative radiograph.

4.

Pre-operative site.

5.

Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation and the aid of a blue acrylic surgical template.

6.

Osteotomy being enlarged with a 3.5mm latch reamer bur rotating at 50RPM without water irrigation.

7.

Hand reamer being rotated to enlarge the osteotomy.

8.

A 5.0mm x 8.0mm HA coated implant being inserted into osteotomy with an implant seating tip threaded on a straight driver.

9.

A 5.0mm x 8.0mm HA coated implant being inserted into osteotomy with an implant seating tip threaded on a straight driver.

10.

View of wells of seated implants.

11.

Acrylic sleeve being adjusted for occlusal clearance.

12.

Modified acrylic sleeve on a 4.0mm x1.5mm shouldered abutment being inserted into well of implant.

13.

Modified acrylic sleeve on a 4.0mm x1.5mm shouldered abutment being inserted into well of implant.

14.

Vacuum formed template confirming appropriateness of modified sleeves.

15.

Transitional composite material being injected into vacuum formed template.

16.

Transitional composite material being added to acrylic sleeves to form a transitional prosthesis.

17.

Vacuum formed template seated over acrylic sleeves and prepared lateral incisor teeth.

18.

Transitional composite prosthesis being removed for polishing.

19.

Additional composite material being light cured onto the prosthesis.

20.

Cement being applied to lateral incisors.

21.

View of seated transitional stabilizing prosthesis.

22.

Patient’s smile.

23.

Radiograph of integrated implants with transitional prosthesis nine weeks after their placement.

24.

Transitional prosthesis prior to the removal of the transitional prosthesis and abutments for the making of an implant level transfer impression fourteen weeks after the placement.

25.

View of implant wells and soft tissue sulci.

26.

Green 3.0mm metal impression post being inserted into the 3mm implant well.

27.

Green 3.0mm metal impression post being inserted into the 3mm implant well.

28.

Green 3.0mm metal impression post receiving its mandatory seating tap.

29.

Impression material being injected around impression posts for the making of an implant level transfer impression.

30.

Milled abutments on dental model.

31.

Castings on milled abutments.

32.

Mirror view of the castings.

33.

Transitional stabilization prosthesis in place.

34.

View of implant wells and soft tissue sulci.

35.

Milled abutments initially seated in implant wells.

36.

Castings placed on abutments to confirm orientation.

37.

Milled abutment being definitively seated.

38.

Individual castings seated on abutments.

39.

Castings being luted together with red acrylic.

40.

Impression material being injected around prepared teeth and luted castings.

41.

Full arch impression being made.

42.

Castings withdrawn in full arch impression.

43.

Digital image being taken of shade guide against a black metal background to facilitate the fabrication of aesthetic crowns.

44.

Crowns on dental model.

45.

Mirror view of two polyceramic to metal and two all ceramic crowns.

46.

Mirror view of two polyceramic to metal and two all ceramic crowns.

47.

Transitional prosthesis prior to its removal.

48.

View of prepared teeth and milled abutments.

49.

View of cemented left lateral all ceramic crown.

50.

Minimal cement being injected into polyceramic to metal crown.

51.

View of two cemented crowns.

52.

View of four cemented crowns.

53.

Post-insertion radiograph.

54.

Facial view two weeks post insertion.

55.

Left profile two weeks post insertion.

56.

Right profile two weeks post insertion.

57.

Facial view ten weeks post insertion.

58.

Patient’s smile.