This case demonstrates the placement and restoration of twenty-seven immediately placed, stabilized and functioning implants with Integrated Abutment Crowns™.
SURGICAL: Immediate Placement Immediate Stabilization and Function
RESTORATIVE: Integrated Abutment Crowns™
TOPICS: Crestal Relieving Incision Crown Insertion Impression
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Pre-operative radiograph.
View of maxillary teeth revealing extensive cervical caries.
View of maxilla after initial extractions.
View of pink plastic surgical template in place.
View of vacuum formed template in place.
A 2.5mm pilot bur preparing initial pilot osteotomy at 1,100RPM with external water irrigation.
A 2.5mm pilot bur being removed from initial osteotomy.
Seven paralleling pins in place indicating the trajectory of the pilot osteotomies.
Osteotomy being enlarged with a latch reamer bur rotating at 50RPMs with a two-handed technique where apical pressure is being applied by a finger of the hand not holding the handpiece.
Implant held in cut plastic bag is being placed onto the implant/inserter instrument on a straight driver.
Implant on the end of an implant/inserter instrument is being inserted into the prepared osteotomy.
Implant on the end of an implant/inserter instrument is being inserted into the prepared osteotomy.
Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height.
Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height.
Occlusal view of seated implants.
A 5.0mm x 4.0mm stealth shouldered abutment being inserted with only finger pressure into the well of a seated implant.
A 4.0mm x 1.5mm stealth shouldered abutment being inserted with only finger pressure into the well of an implant. An abutment should have sufficient width to support the interdental papillae without encroaching upon them.
View of shouldered abutments seated in their implants with only finger pressure.
Snap-on acrylic sleeves being modified to allow room for the interdental papilla.
Acrylic sleeve being inserted onto shouldered abutment which has its flats by convention oriented to the buccal.
A tall 4.0mm acrylic sleeve being inserted onto a 4.0mm stealth abutment.
A laboratory processed transitional prosthesis is being fitted onto acrylic sleeves.
The occlusion of the transitional prosthesis is being confirmed.
Laboratory processed transitional prosthesis is being relined with cold cure acrylic for the incorporation of the acrylic sleeves.
Relined prosthesis seated onto acrylic sleeves.
Occlusal view of transitional prosthesis.
Facial view of transitional prosthesis.
Transitional stabilizing prosthesis being removed for polishing.
Transitional stabilizing prosthesis being removed for polishing.
Polished transitional stabilizing prosthesis being snapped onto stealth abutments.
Polished transitional stabilizing prosthesis snapped onto stealth abutments.
View of mandibular arch after the extraction of extensively carious teeth.
A 2.5mm pilot bur rotating at 1,100RPM is preparing the initial osteotomy.
Apical pressure is being applied by the finger of the hand not holding the handpiece.
Seven paralleling pins positioned in the initial pilot osteotomies indicating their trajectories.
A 3.5mm x 11.0mm HA coated implant is being inserted with an implant inserter/retriever instrument on a threaded knob.
A 4.5mm x 11.0mm HA coated implant is being inserted with an implant inserter/retriever instrument on a threaded knob.
Shouldered depth gauge seated in well of implant to facilitate the selection of a stealth abutment with an appropriate shoulder height.
Shouldered depth gauge seated in well of implant to facilitate the selection of a stealth abutment with an appropriate shoulder height.
A 4.0mm x 3.5mm stealth abutment being inserted into well of implant.
A 4.0mm x 3.5mm stealth abutment being inserted into well of implant.
Ten stealth abutments seated with only finger pressure into the well of their implants.
A tall 4.0mm diameter acrylic sleeve being cut to accommodate vacuum formed template.
Four modified acrylic sleeves on stealth abutments.
Ten acrylic sleeves on stealth abutments.
Occlusion being confirmed with vacuum formed template in place.
Vacuum formed template over acrylic sleeves.
Transitional composite material being injected around acrylic sleeves to initially form a strut.
Additional composite material being added to hardened strut.
Composite material being added to vacuum formed template.
Vacuum formed template being used to form transitional stabilizing prosthesis.
Template being removed.
Transitional stabilizing prosthesis being removed for polishing.
Transitional stabilizing prosthesis being removed for polishing.
Polished transitional stabilizing prosthesis.
Facial view of stealth abutments.
Polished transitional stabilizing prosthesis being snapped onto stealth abutments.
Polished transitional stabilizing prosthesis snapped onto stealth abutments.
Prosthesis prior to the removal of mandibular prosthesis for the immediate placement of molar implants.
Removal of mandibular prosthesis.
Removal of mandibular prosthesis.
Facial view of arches.
Mandibular arch prior to the placement of additional implants.
View of prostheses after the placement of additional implants.
Radiograph revealing twenty-seven immediately functioning implants.
View of twenty-seven finger pressured seated stealth abutments.
Occlusal view of maxillary stealth abutments.
Occlusal view of wells of maxillary integrated implants.
View of 3.0mm white impression posts and 2.0mm black impression posts after they have been tapped into their implant wells.
Impression material being injected around impression posts for the making of an implant level transfer impression.
Occlusal view of mandibular stealth abutments.
Removed stealth abutments appropriately identified for re-insertion into their implants after the making of an implant level transfer impression.
View of fourteen mandibular implant wells and soft-tissue sulci.
Facial view of maxillary arch with 2.0mm black and 3.0mm white impression posts.
A 2.0mm black plastic impression post being inserted into well of an implant.
A 2.0mm black plastic impression post receiving a mandatory seating tap.
A 3.0mm white plastic impression post receiving a mandatory seating tap.
Occlusal view of seated mandibular impression posts.
Impression material being injected around impression posts for the making of an implant level transfer impression.
Mandibular implant level transfer impression.
Maxillary arch with partial complement of stealth abutments in order to accommodate occlusal registration rims.
Mandibular arch with partial complement of stealth abutments in order to accommodate occlusal registration rims.
Occlusal registration rims in place.
Occlusal registration rims in place.
Occlusal registration rims removed from mouth.
Remaining stealth abutments re-inserted into implant wells for the re-insertion of the transitional prostheses.
Occlusal registration rims being used to re-articulate dental models.
Facial view of finished Integrated Abutment Crowns™.
Right profile view of finished Integrated Abutment Crowns™.
Left profile view of finished Integrated Abutment Crowns™.
Palatal view of maxillary Integrated Abutment Crowns™.
Mirror view of finished Integrated Abutment Crowns™.
Lingual view of mandibular Integrated Abutment Crowns™.
Mirror view of mandibular Integrated Abutment Crowns™.
Maxillary transitional prosthesis prior to its final removal.
Occlusal view of maxillary stealth abutments prior to their final removal.
Occlusal view of maxillary implant wells and their soft tissue sulci.
Facial view of maxillary implant wells and their soft tissue sulci.
Insertion of initial Integrated Abutment Crown™.
Insertion of fourth Integrated Abutment Crown™.
Yellow occlusal orientation jig being used to facilitate the initial positioning of the Integrated Abutment Crowns™.
Left central incisor is being inserted.
Yellow orientation jig facilitating the orientation and seating of anterior Integrated Abutment Crowns™. It is essential to evaluate and eliminate any soft tissue, bony or interproximal interferences to the seating and full engagement of the locking taper abutment to implant connection.
Orientation jig being used to seat the maxillary left lateral incisor. Note how the soft tissue blanching is being dissipated.
Yellow seating jig being used to facilitate the seating Integrated Abutment Crowns™.
Occlusal view of initially placed Integrated Abutment Crowns™.
After checking interproximal contacts with dental floss, any contact that was deemed too tight was removed for adjustment.
Gray silicone wheel being used to reduce excessive interproximal contacts.
Blue articulating paper is being used to identify excessive interproximal contacts.
Blue articulating paper is being used to identify excessive interproximal contacts.
Blue articulating paper is being used to identify excessive interproximal contacts.
Blue articulating paper is being used to identify excessive interproximal contacts.
An oblique crestal relieving incision is being made to facilitate the seating of the ideally contoured Integrated Abutment Crowns™.
An oblique crestal relieving incision is being made to facilitate the seating of the ideally contoured Integrated Abutment Crowns™.
An oblique crestal relieving incision is being made to facilitate the seating of the ideally contoured Integrated Abutment Crowns™.
Hard clear acrylic jig being used to facilitate the seating of the Integrated Abutment Crowns™.
Periosteal elevator being used to reflect soft tissue prior to the use of a sulcus reamer.
A sulcus reamer threaded to a straight driver and placed onto a guide pin is being inserted into the well of the implant.
The sulcus reamer with bone that was removed from around the crestal aspect of the implant while it was being rotated on the guide pin that was inserted in the well of the implant.
View of Integrated Abutment Crowns™ that were placed after the sulcus reamer removed the interfering soft tissue and bone.
Integrated Abutment Crowns™ being definitively seated by the tapping of a white plastic temporary abutment inserted into a straight driver.
Integrated Abutment Crowns™ being definitively seated by the tapping of a white plastic temporary abutment inserted into a straight driver.
Occlusal view of mandibular arch with stealth shouldered abutments after the removal of the transitional prosthesis.
View of implant wells and soft tissue sulci after the removal of the stealth abutments that were only seated with finger pressure.
Insertion of the initial mandibular Integrated Abutment Crown™.
Crestal relieving incision is being made to facilitate the seating of the Integrated Abutment Crown™.
View of ridge after crestal incision.
Re-insertion of Integrated Abutment Crown™.
Insertion of another Integrated Abutment Crown™.
Yellow orientation jig being used to facilitate the seating of the Integrated Abutment Crown™.
A sulcus reamer with a threaded knob is being inserted on a guide pin into an implant well to remove any infringing tissue.
The sulcus reamer is being rotated to remove any infringing tissue.
A clear, hard plastic template is being tapped to facilitate the seating of the Integrated Abutment Crowns™.
Integrated Abutment Crown™ with clear plastic template.
A clear, hard plastic template is being tapped to facilitate the seating of the Integrated Abutment Crown™.
Integrated Abutment Crown™ being inserted.
A clear, hard plastic template is being tapped to facilitate the seating of the Integrated Abutment Crown™.
View of initially seated Integrated Abutment Crowns™.
Definitive seating to engage the 1.5 degree locking taper connection is being accomplished by the tapping of a white plastic temporary abutment in a straight driver.
View of seated Integrated Abutment Crowns™.
View of seated Integrated Abutment Crowns™ and stealth abutments.
Occlusal view of stealth abutments, implant wells and Integrated Abutment Crowns™.
Integrated Abutment Crown™ being inserted.
144. Oblique relieving incision being made to facilitate the seating of the ideally contoured Integrated Abutment Crown™.
Oblique relieving incision being made to facilitate the seating of the ideally contoured Integrated Abutment Crown™.
Integrated Abutment Crown™ being inserted.
Labial view of initially seated mandibular incisor Integrated Abutment Crowns™ revealing ideal gingival aesthetics.
View of two stealth abutments prior to their removal and two recently seated Integrated Abutment Crowns™.
Occlusal view of implant well and lingual view of Integrated Abutment Crowns™.
Oblique relieving incision being made to facilitate the seating of the ideally contoured Integrated Abutment Crown™.
Sulcus reamer with a threaded knob on a guide pin being inserted into the well of an implant for the removal of any tissue preventing the proper seating of the Integrated Abutment Crown™.
A hard, clear acrylic jig is being tapped to initially seat the Integrated Abutment Crown™.
Definitive seating of the Integrated Abutment Crown™ is achieved by the tapping of a white plastic temporary abutment in a straight driver.
Integrated Abutment Crown™ being inserted.
Sulcus reamer on a threaded knob is being inserted onto a guide pin seated in the well of an implant.
A premature occlusal contact is being adjusted.
Patient’s smile after the insertion of twenty-seven Integrated Abutment Crowns™.
Protrusive and lateral excursive contacts are being checked and adjusted alternatingly with articulating paper as the patient is instructed to move their mandible in all extreme positions while they are clenching their teeth.
Protrusive and lateral excursive contacts are being checked and adjusted alternatingly with articulating paper as the patient is instructed to move their mandible in all extreme positions while they are clenching their teeth.
Protrusive and lateral excursive contacts are being checked and adjusted alternatingly with articulating paper as the patient is instructed to move their mandible in all extreme positions while they are clenching their teeth.
Protrusive and lateral excursive contacts are being checked and adjusted alternatingly with articulating paper as the patient is instructed to move their mandible in all extreme positions while they are clenching their teeth.
Protrusive and lateral excursive contacts are being checked and adjusted alternatingly with articulating paper as the patient is instructed to move their mandible in all extreme positions while they are clenching their teeth.
Protrusive and lateral excursive contacts are being checked and adjusted alternatingly with articulating paper as the patient is instructed to move their mandible in all extreme positions while they are clenching their teeth.
Protrusive and lateral excursive contacts are being checked and adjusted alternatingly with articulating paper as the patient is instructed to move their mandible in all extreme positions while they are clenching their teeth.
Protrusive and lateral excursive contacts are being checked and adjusted alternatingly with articulating paper as the patient is instructed to move their mandible in all extreme positions while they are clenching their teeth.
Radiograph of twenty-seven implants restored with Integrated Abutment Crowns™.
Facial view of Integrated Abutment Crowns™.
Right profile of Integrated Abutment Crowns™.
Left profile of Integrated Abutment Crowns™.
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