This case demonstrates the extraction, immediate placement, transitional stabilization, implant level transfer impression, and insertion of six immediately stabilized or loaded maxillary anterior and posterior implants as well as the insertion of six Bicon Integrated Abutment Crowns™ with a seating jig.
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Pre-operative radiograph revealing three Bicon implants ten years after being inserted.
2.
View of bicuspid prior to being extracted.
3.
Extraction of a maxillary first bicuspid.
4.
Extraction of a maxillary lateral incisor.
5.
Five walls of extraction socket being evaluated.
6.
Paralleling pins inserted into pilot osteotomies confirming appropriate trajectories.
7.
Reamer preparing right central incisor osteotomy at 50RPM without water irrigation.
8.
Reamer preparing left lateral incisor osteotomy.
9.
Index finger monitoring buccal bone during the preparation of second bicuspid osteotomy.
10.
Finger monitoring of buccal bone as first bicuspid osteotomy is being enlarged.
11.
Reamer being inserted into left lateral osteotomy.
12.
Finger monitoring of labial bone as left central incisor osteotomy is being enlarged.
13.
Reamer being inserted into left second bicuspid osteotomy.
14.
Harvested bone in flutes of reamer being removed from left lateral incisor osteotomy.
15.
Bone is being harvested from the osteotomy while the five walls of the osteotomy are evaluated with a curette.
16.
A 4.0mm x 11.0mm HA coated implant is being transported to the first bicuspid osteotomy with its black polyethylene inserter / healing plug.
17.
A 4.5mm x 8.0mm HA coated implant is being transported to left lateral osteotomy with the implant inserter / retrieval instrument.
18.
View of four seated implants in the left maxilla.
19.
A 4.5 x 8.0mm HA coated implant being inserted with the implant inserter / retriever instrument into the right central incisor osteotomy.
20.
Shoulder depth gauge seated in the well of the implant to facilitate the selection of the appropriate abutment shoulder height relative to the crest of the soft tissue.
21.
A 5.0mm x 2.0mm shouldered abutment being inserted into implant with only finger pressure.
22.
Three 5.0mm wide and one 4.0mm wide shouldered abutments seated with only finger pressure prior to their being used to support the transitional stabilization prosthesis.
23.
A short 5.0mm one piece acrylic sleeve snapped onto the left central incisor shouldered abutment.
24.
A tall 5.0mm one piece acrylic sleeve being reduced.
25.
A bonding agent being applied to shortened one piece acrylic sleeve.
26.
A composite strut is being fabricated with the transitional composite, ñIntegrityî by Dentsply.
27.
After the strut hardened it was incorporated into additional ñIntegrityî composite material within the incisal portion a vacuum formed template.
28.
Transitional prosthesis being removed for polishing.
29.
View of one piece acrylic sleeves within transitional stabilization prosthesis prior to being polished.
30.
Acid-etching of canine prior to its bonding to the transitional stabilization prosthesis.
31.
Bonding agent being applied to etched canine.
32.
Light curing of the bonding cement for the fixation of the polished transitional stabilization prosthesis to the canine tooth.
33.
View of bonded transitional prosthesis ten weeks after its placement and prior to its removal for the making of an implant level transfer impression
34.
Closer view of bonded transitional stabilization prosthesis.
35.
View of four white 3.0mm and one black 2.0mm seated impression posts prior to impression material being injected around them.
36.
Digital photograph being taken of shade guide against a black background for transmission to a technician.
37.
Five Integrated Abutment Crowns™ on stone model with yellow acrylic orientation jig.
38.
Mirror view of six Integrated Abutment Crowns™.
39.
View of transitional prosthesis snapped onto shouldered abutments prior to their removal for the insertion of the six Integrated Abutment Crowns™.
40.
View of shouldered abutments prior to their removal.
41.
Finger pressure seated shouldered abutments prior to their removal.
42.
Occlusal view of six implant wells and their soft tissue sulci.
43.
Guide pin with sulcus reamer on straight driver being inserted into implant well to remove bone preventing the seating of the Integrated Abutment Crown™.
44.
Sulcus reamer being rotated to remove bone that prevented the seating of the Integrated Abutment Crown™.
45.
Removal of sulcus reamer revealing bone chips which were preventing the seating of the Integrated Abutment Crown™.
46.
Oblique crestal relieving incision being made to facilitate the seating of the Integrated Abutment Crowns™ with ideal emergence profiles.
47.
Oblique crestal relieving incision being made.
48.
A 6.5mm sulcus reamer on a straight driver with a 3.0mm guide pin is being inserted into the 3.0mm implant well to remove and widen the bony orifice over the implant.
49.
Sulcus reamer being removed with bone chips on its blade.
50.
Sulcus reamer with harvested bone on gauze.
51.
Right central incisor Integrated Abutment Crown™ being inserted into the well of implant to confirm its appropriateness.
52.
Left central incisor being inserted.
53.
Left lateral incisor being inserted.
54.
Blue articulating paper being used to indicate inter-proximal contact area preventing the proper seating of the Integrated Abutment Crown™.
55.
Oblique crestal relieving incision being made to facilitate the seating of the first bicuspid Integrated Abutment Crown™.
56.
Oblique crestal relieving incision being made to facilitate the seating of the second bicuspid Integrated Abutment Crown™.
57.
First bicuspid Integrated Abutment Crown™ with a 2.0mm shaft diameter is being inserted into the 2.0mm wide implant well to initially confirm its appropriateness.
58.
Second bicuspid Integrated Abutment Crown™ with a 3.0mm shaft diameter is being seated into the 3.0mm wide implant well to initially confirm its appropriateness.
59.
Seating jig being fabricated after the removal of the initially placed Integrated Abutment Crowns™.
60.
Integrated Abutment Crown™ in hard acrylic seating jig.
61.
White temporary healing abutment seated in an abutment prep holder is being aligned with the shaft of the Integrated Abutment Crown™for modification to facilitate the tapping of the crown in the long axis of its shaft.
62.
White temporary abutment being modified.
63.
White temporary abutment modified to facilitate the seating force to be directed in the long axis of the abutment shaft.
64.
Hard acrylic occlusal template being inserted to initially act as an orientation and seating jig. Subsequently it will be used as a mouth guard until the patient is comfortable with his new occlusion.
65.
Hard acrylic incisal seating jig or mouth guard in place.
66.
Hard acrylic seating jig facilitating the tapping of the Integrated Abutment Crown™ into the well of the implant in the long axis of its shaft.
67.
Definitive seating is being accomplished by the use of a modified white temporary healing abutment seated in an abutment prep holder.
68.
Right profile view of a ten year porcelain fused to metal crown on a Bicon implant and three recently seated incisor Integrated Abutment Crowns™
69.
Left profile view of a veneered natural canine and four Integrated Abutment Crowns™ revealing excellent gingival aesthetics.
70.
View of three ten year old porcelain fused to metal crowns and six recently placed Integrated Abutment Crowns™on nine Bicon implants and two veneered natural canines.
71.
Radiograph of two ten- year- old porcelain fused to metal implant crowns and one recently placed Integrated Abutment Crown™.
72.
Radiograph of ten year old porcelain fused to metal lateral incisor implant crown and one recently placed central incisor Integrated Abutment Crown™.
73.
Radiograph of three recently placed incisor Integrated Abutment Crowns™.
74.
Radiograph of two recently placed bicuspid Integrated Abutment Crowns™.
75.
Facial view of maxillary arch restored with nine Bicon implant restorations and three natural teeth.
76.
Radiograph of three ten year old porcelain fused to metal crowns and six recently placed Integrated Abutment Crowns™ on nine Bicon implants and three natural teeth.
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