Restoration of an Edentulous Maxillary Arch in Three Clinical Visits

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1.

Pre-operative facial view.

2.

Pre-operative occlusal view.

3.

Pre-operative radiograph.

4.

Tooth being extracted.

5.

2.0mm pilot bur preparing initial osteotomy.

6.

Paralleling pin facilitates achieving appropriate trajectory of pilot bur.

7.

View of three paralleling pins.

8.

Osteotomy being prepared with blue 3.5mm reamer bur.

9.

Osteotomy being prepared with red 4.0mm reamer bur.

10.

Osteotomy being prepared with 5.0mm reamer bur rotating at 50rpm without water irrigation.

11.

Harvested bone being removed from reamer bur.

12.

Implant being inserted into osteotomy.

13.

Second implant being inserted into osteotomy.

14.

Occlusal view of 8 seated implants.

15.

Shouldered depth guage seated in implant well indicating relative height of soft tissue crest.

16.

5.0mm x 2.0mm shouldered abutment being inserted into 2.0mm implant well.

17.

5.0mm x 2.0mm shouldered abutment being inserted into 3.0mm implant well.

18.

Fourth shouldered abutment being inserted into implant well.

19.

5.0mm x 4.0mm shouldered abutment being inserted into 3.0mm implant well.

20.

View of eight shouldered abutments seated with only finger pressure.

21.

Vacuum-formed template being confirmed for appropriateness of fit over shouldered abutments.

22.

View of three short one-piece acrylic sleeves and a 4.0mm diameter shouldered abutment.

23.

A tall one-piece acrylic sleeve being seated on 4.0mm diameter shouldered abutment.

24.

Occlusal view of eight seated one-piece acrylic sleeves.

25.

Transitional composite material "Integrity" by Dentsply being injected around one-piece acrylic sleeves to form a strut.

26.

Transitional strut being modified to accommodate vacuum-formed template.

27.

Perforations being made in vacuum-formed template to facilitate the seating of the composite-filled template onto the strut.

28.

Transitional composite material being injected into the occlusal half of the template.

29.

Composite filled template seated over the hardened strut.

30.

Vacuum-formed template being removed.

31.

Blue markings indicating need for adjustment.

32.

Facial view of transitional prosthesis.

33.

Additional transitional material being added to voids in prosthesis.

34.

Transitional prosthesis being removed for contouring and polishing.

35.

Polished prosthesis prior to being reinserted.

36.

Reinserted polished prosthesis.

37.

Patient's smile at the conclusion of her first clinical visit.

38.

Radiograph of eight immediately placed and stabilized implants.

39.

Patient's smile seventy-nine days after implant placement at the beginning of her second clinical visit.

40.

View of transitional prosthesis on the second clinical visit.

41.

Radiograph at the beginning of the second clinical visit.

42.

Radiograph at the beginning of the second clinical visit.

43.

View of shouldered abutments at the second clinical visit.

44.

View of shouldered abutments prior to their removal.

45.

White impression post being inserted into 3.0mm implant well for the recording of an occlusal registration.

46.

Black impression post being tapped into 2.0mm implant well.

47.

Red acrylic being injected around impression posts for an occlusal registration while the patient occludes on right side transitional prosthesis.

48.

Confirmation of occlusal clearance of right side impression posts.

49.

View of occlusally adjusted central incisor impression post.

50.

View of bilateral occlusal registration.

51.

Removal of right side occlusal registration.

52.

White impression post being inserted into 3.0mm implant well prior to being tapped for definitive seating.

53.

White impression post being inserted into 3.0mm implant well prior to being tapped for definitive seating.

54.

Impression material being injected around definitively seated impression posts.

55.

Impression material being injected around definitively seated impression posts.

56.

Digital photo being taken of shade guide against a black background for transmission to the dental technician.

57.

Occlusal view of implant wells and soft tissue sulci.

58.

View of reinserted shouldered abutment at the conclusion of the second clinical visit.

59.

View of reinserted transitional prosthesis.

60.

Patient's smile at the conclusion of her second clinical visit.

61.

Mirror view of eight Integrated Abutment Crowns™.

62.

View of Integrated Abutment Crowns™ and clear acrylic occlusal orientation seating jig.

63.

Clear acrylic jig.

64.

Mirror view of modified white temporary abutment seated in straight driver and aligned in the long axis of the shaft of the Integrated Abutment Crown™.

65.

Transitional prosthesis prior to its removal at the beginning of the patient's third clinical visit.

66.

Shouldered abutments prior to their removal.

67.

Occlusal view of the implant wells and sulci.

68.

An oblique crestal relieving incision being made between the soft tissue sulci.

69.

Occlusal view of ridge after the completion of the oblique crestal relieving incisions.

70.

Integrated Abutment Crown™ being inserted.

71.

Second Integrated Abutment Crown™ being inserted.

72.

Second Integrated Abutment Crown™ seated into its implant well.

73.

Third Integrated Abutment Crown™ being inserted.

74.

Fourth Integrated Abutment Crown™ being inserted.

75.

Clear acrylic orientation jig facilitating the initial seating of four Integrated Abutment Crowns™.

76.

Tapping on the clear acrylic jig facilitates the seating of the Integrated Abutment Crowns™.

77.

Clear acrylic jig directs seating force in the long axis of abutment shaft.

78.

Dental floss indicating interproximal contact that is too tight.

79.

Lateral incisor being removed for interproximal contact adjustment.

80.

Blue articulating paper being used to indicate contact area.

81.

Lateral incisor being reseated with a modified white temporary abutment in a straight driver.

82.

Left lateral Integrated Abutment Crown™ being seated.

83.

Clear acrylic jig facilitates the seating in the long axis of the abutment shaft.

84.

Dental floss confirming the appropriate interproximal contact.

85.

Seated Integrated Abutment Crowns™ at the conclusion of third clinical visit.

86.

Insertion of a hard acrylic mouth-guard which will stabilize the patient's occlusion initially especially during sleep. It will also facilitate the re-insertion of an Integrated Abutment Crown™ by the patient, if one were to loosen.

87.

Post-operative radiograph of seated Integrated Abutment Crowns™ ninety-six days after the placement of the implants.

88.

Post-operative radiograph of seated Integrated Abutment Crowns™ ninety-six days after the placement of the implants.

89.

Patient's smile at the beginning of fourth clinical visit indicating uneven lengths of central incisors.

90.

Facial view of Integrated Abutment Crowns™ four days after their being seated.

91.

Facial view of Integrated Abutment Crowns™ revealing need to shorten length of right central incisor.

92.

Radiograph reveals potential bony interference with mesial cantilever of right central incisor Integrated Abutment Crown™.

93.

Adjustment of mesial cantilever to facilitate further seating of the right central incisor Integrated Abutment Crown™.

94.

Polishing of the adjusted Integrated Abutment Crown™.

95.

Reseating of the maxillary right central incisor.

96.

Right profile view of Integrated Abutment Crowns™ four days after their initial insertion.

97.

Left profile view of Integrated Abutment Crowns™ four days after their initial insertion.

98.

Facial view of Integrated Abutment Crowns™ four days after their initial insertion and hundred days after the placement and initial stabilization of the implants.