Simultaneous Two Stage Placement of Two maxillary Implants and Grafting with Bicon Resorbable Collagen Membrane, Subsequent Third Implant Placement and Restoration with Integrated Abutment Crowns™

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1.

Pre-operative radiograph.

2.

Reflected flaps revealing deep concavity in the alveolar ridge and the maxillary right canine extraction site.

3.

Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM.

4.

Parallel pin seated in pilot osteotomy.

5.

Adjacent osteotomy being prepared with parallel pin as a guide for the trajectory of the pilot bur

6.

Two paralleling pins confirming trajectories of osteotomies and graft site being decorticated.

7.

Harvested bone within the flute of hand reamer fastened to a straight driver.

8.

Harvested bone in flute of hand reamer will be mixed with allograft material to enhance the osteogenic potential of the graft.

9.

Bicon resorbable collagen membrane after being modified to fit the graft site.

10.

Osteotomy is being widened with a bone dilator attached to a threaded straight handle.

11.

View of wells of seated implants.

12.

Flap is being relieved apically to make room for the Bicon resorbable collagen membrane.

13.

Bicon resorbable collagen membrane is being electively tacked in place. Tacking is not always necessary but its use can be determined by the operator.

14.

A second Bicon resorbable collagen membrane tack is being placed.

15.

Sutures being placed prior to the graft placement, since they will provide additional stabilization of the membrane.

16.

Suture placed to provide additional support for the Bicon resorbable collagen membrane and graft material.

17.

A mixture of allograft material and harvested bone taken from the implant osteotomies is being placed into the alveolar concavity.

18.

An additional suture is being placed so as to further stabilize the Bicon resorbable collagen membrane over the graft material.

19.

Flap being closed over the Bicon resorbable collagen membrane.

20.

Flap closed with a combination of interrupted and continuous sutures.

21.

Post-operative radiograph.

22.

View of site two weeks post-operatively after removal of the sutures.

23.

Nine months after implant and graft placement, the site is opened using a scalloped incision which encourages the formation of papillae.

24.

Elevated flaps revealing enhanced ridge and two black polyethylene healing plugs within the implant wells.

25.

Guide pins in place to determine the stability and trajectory of the implants.

26.

Pilot drill being used to prepare an osteotomy in the grafted site for another implant.

27.

Parallel pin confirming trajectory of pilot osteotomy.

28.

Harvested bone within the flute of hand reamer fastened to a straight driver.

29.

A 5.0mm x 8.0mm HA coated implant being inserted into the osteotomy with the implant.

30.

Seated guide pins indicating the trajectories of the three implants.

31.

Flap sutured.

32.

Post-operative radiograph.

33.

Incision is being made to uncover the implants ten months after the placement of the third implant.

34.

Healing plug is being removed from the well of the maxillary right canine implant.

35.

Sulcus reamer being placed onto a guide pin to remove any excess bone over the implant.

36.

A 3.0mm green metal Impression post being placed in well of an integrated implant for the making of an implant level transfer impression.

37.

Impression post being tapped into place to assure its proper seating.

38.

Impression material being injected around impression posts.

39.

Digital image being taken of shade guide against a black metal background to facilitate the fabrication of an aesthetic Integrated Abutment Crown™.

40.

View of the patient’s original removable prosthesis which is acting as a transitional prosthesis.

41.

Digital image of custom pink polyceramic shade guide is being taken to facilitate the fabrication of an aesthetic gingival color.

42.

Integrated Abutment Crowns™ on dental model with acrylic orientation jig.

43.

Custom seating jig for canine Integrated Abutment Crown™.

44.

Seating jig for the lateral incisor.

45.

Seating jig for the central incisor.

46.

Mirror view of Integrated Abutment Crown™.

47.

Mirror view of Integrated Abutment Crown™.

48.

Mirror view of Integrated Abutment Crown™.

49.

Plastic healing abutments in place prior to placement of the Integrated Abutment Crowns™.

50.

View of implant wells and soft tissue sulci after removal of plastic healing abutments.

51.

Integrated Abutment Crown™ being inserted into the well of the central incisor implant.

52.

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.

53.

Integrated Abutment Crown™ being inserted into the well of the lateral incisor implant.

54.

Integrated Abutment Crown™ being inserted into the well of the right canine implant.

55.

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.

56.

View of three Integrated Abutment Crowns™ in place.

57.

Post-operative radiograph of seated Integrated Abutment Crowns™.

58.

Patient’s smile with Integrated Abutment Crowns™ in place.