Ridge Split with Two-Stage Implant Placement and their Restoration with Integrated Abutment Crowns™

Posted on January 7, 2009 by Bicon

This case demonstrates the two stage placement of two implants, implant level transfer impression, and their restoration with Bicon Integrated Abutment Crowns™ for two lateral incisors.

SURGICAL: Ridge Splits Two Stage
RESTORATIVE: Integrated Abutment Crowns™
TOPICS: Congenitally Missing Laterals Crown Insertion

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1.

First Clinical Visit: View of the pre-operative site with two Maryland bridges.

2.

Pre-operative site without Maryland bridges.

3.

Pre-operative smile.

4.

Pre-operative radiograph.

5.

View of two palatal flaps with retraction sutures.

6.

Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation in the area of the maxillary right lateral incisor.

7.

Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation in the area of the maxillary right lateral incisor.

8.

Two paralleling pins demonstrating position and trajectory of the osteotomies.

9.

Harvested bone in the flute of an olive green 2.5mm latch reamer bur rotating at 50RPM without external irrigation.

10.

Osteotomy being enlarged with a teal 3.0mm latch reamer bur rotating at 50RPM without irrigation.

11.

Harvested bone in the flute of a teal 3.0mm latch reamer bur.

12.

A 5.5 mm expanding chisel being used to perform a ridge split in the area of the maxillary left lateral incisor.

13.

Osteotomy being enlarged with a blue 3.5mm hand reamer attached to a straight driver.

14.

Harvested bone in the flute of a blue 3.5mm hand reamer attached to a straight driver.

15.

Osteotomy being enlarged with a red 4.0mm hand reamer attached to a straight driver.

16.

Curette being used to remove residual bone while confirming the integrity of the five bony walls of the osteotomy.

17.

Harvested bone in the flute of a silver 4.5mm hand reamer.

18.

A 4.5mm x 8.0mm implant being inserted into the osteotomy with an implant inserter/retriever.

19.

A 4.5mm x 8.0mm implant being inserted into the osteotomy with an implant inserter/retriever.

20.

Implant being tapped into place with an implant seating tip attached to a straight handle.

21.

View of 3.0mm guide pins seated into the wells of the implants.

22.

Trimmed polyethylene healing plug being inserted into the seated implant.

23.

Harvested bone being placed over the implant.

24.

Post-operative radiograph.

25.

Second Visit: Fourteen weeks after previous visit Site after the removal of transitional prosthesis.

26.

Incision being made for the uncovering of the maxillary right lateral incisor implant.

27.

Healing plug being removed from the well of the implant with a healing plug removal instrument.

28.

Healing plug being removed from the well of the implant with a healing plug instrument.

29.

Green 3.0mm impression reamer being rotated onto guide pin to remove any tissue which may inhibit the complete seating of an impression post.

30.

View of crown being cemented on the maxillary right canine.

31.

Green 3.0mm plastic impression post being modified to prevent contact with adjacent teeth which would distort the trajectory of the impression analog.

32.

Plastic impression post being placed into the implant well.

33.

Plastic impression post is receiving its mandatory tapping after cementation of the crown of the maxillary left canine.

34.

Impression material being injected around the impression posts for the making of a full arch implant-level transfer impression.

35.

Third Visit: One month after previous visit Facial view of Integrated Abutment Crowns™ on stone model prior to their insertion.

36.

View of two lateral incisor Integrated Abutment Crowns™. Note the fact the the hemisphical base of the abutment is not covered by composite material.

37.

Bonded transitional prostheses prior to their removal for the insertion of two Integrated Abutment Crowns™.

38.

Transitional prosthesis being removed.

39.

Transitional prosthesis being removed.

40.

Integrated Abutment Crown™ being inserted after the well of the implant was cleaned with alcohol on a cotton-tipped applicator.

41.

Integrated Abutment Crown™ being inserted after the well of the implant was cleaned with alcohol on a cotton tipped applicator.

42.

Diamond finishing strip being used to establish passive interproximal contact to facilitate the complete seating of the locking taper connection.

43.

Modeling liquid prior to its application to the Integrated Abutment Crowns™.

44.

Light curing of newly applied modeling liquid.

45.

Ceramage composite prior to its being added to the Integrated Abutment Crowns™.

46.

Application of Ceramage composite to the interproximal surfaces of the Integrated Abutment Crown™.

47.

Light curing of bonding material.

48.

Well of implant being cleaned with alcohol on cotton-tipped applicator.

49.

Well of implant being cleaned with alcohol on cotton-tipped applicator.

50.

Integrated Abutment Crown™ being inserted.

51.

Integrated Abutment Crown™ being inserted.

52.

Ceramage composite is being applied to the cervical area of Integrated Abutment Crown™.

53.

Ceramage composite being applied to the cervical area of Integrated Abutment Crown™.

54.

Light curing of newly applied material.

55.

Polishing of the Integrated Abutment Crown™ with a small pink acrylic wheel.

56.

View of Integrated Abutment Crown™ in a crown alignment device during fabrication of the yellow thermoplastic custom seating jig.

57.

Newly contoured Integrated Abutment Crown™ being inserted.

58.

Integrated Abutment Crown™ being inserted.

59.

Floss being used to confirm passive interproximal contacts.

60.

Facial view immediately after the insertion of the Integrated Abutment Crown™.

61.

Yellow thermoplastic custom seating jig (which was formed with a crown alignment device) in a crown seating tip attached to a straight handle facilitates directing the tapping forces in the long axis of the abutment post and implant well.