Two Congenitally Missing Maxillary Lateral Incisors

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1.

Preoperative radiograph.

2.

Right profile view.

3.

Left profile view.

4.

Palatal view of two flaps with retraction sutures.

5.

Pilot bur bisecting edentulous ridge and the inter-proximal surface of the adjacent teeth.

6.

Pilot bur initiating the left osteotomy.

7.

Two paralleling pins confirming the trajectory of the pilot osteotomies.

8.

Right osteotomy being prepared with finger monitoring of buccal bone.

9.

Left osteotomy being prepared with finger monitoring of buccal bone.

10.

Right osteotomy being enlarged while a needle holder and gravity maintains retraction of the palatal flaps.

11.

Left osteotomy is enlarged with a reamer bur rotating at 50RPM.

12.

Preparation of right osteotomy with finger monitoring of the buccal bone.

13.

Preparation of left osteotomy

14.

Reamer filled with harvested bone.

15.

Reamer filled with harvested bone.

16.

Bone being harvested from prepared osteotomy.

17.

A 3.5 mm X 11.0mm HA coated implant being inserted into prepared osteotomy.

18.

View of implant in osteotomy.

19.

Final seating of implant in osteotomy.

20.

Radiograph of seated implant.

21.

Implant being inserted into left osteotomy with an implant inserter / retriever instrument.

22.

View of implant in osteotomy.

23.

Radiograph of implant in left osteotomy.

24.

Shoulder depth gauge indicating gingival height for the selection of abutment shoulder height.

25.

Shoulder depth gauge seated in well of implant indicating a shoulder height of 4.0mm.

26.

A 3.5mm X 1.5mm shouldered abutment being inserted into well of implant.

27.

The 3.5mm X 1.5mm abutment being was chosen so that it would support but not encroach upon the interdental papillae.

28.

Two shouldered abutments seated with only finger pressure in implant wells.

29.

Adjacent teeth being acid etched for the bonding of transitional crowns for the stabilization of the integrating implants.

30.

Bonding agent being applied to adjacent teeth.

31.

Bonding agent being applied to adjacent teeth.

32.

Light curing of bonding agent.

33.

Tall 4.0mm one piece acrylic sleeve being inserted onto abutment.

34.

Seated tall one piece acrylic sleeve seated on 4.0mm shouldered abutment.

35.

Acrylic sleeve being seated onto left shouldered abutment.

36.

Seated tall one piece acrylic sleeve seated on left shouldered abutment.

37.

Acrylic sleeves prior to being reduced in height.

38.

Height of sleeve being reduced.

39.

Bonding agent being applied to cut acrylic sleeve.

40.

Bonding agent being applied to left acrylic sleeve.

41.

Light curing of bonding agent.

42.

Polyceramic material being applied onto sleeves to form a transitional crown splint.

43.

Left transitional splinted crown being formed.

44.

Light curing of newly formed transitional crown.

45.

Polished transitional crown being inserted onto abutment to confirm appropriateness.

46.

Left crown being inserted onto abutment.

47.

Polyceramic material being applied to surface of transitional crown to bond or splint restoration to the adjacent natural teeth.

48.

Polyceramic material being applied to adjacent teeth.

49.

Light curing of the splinted transitional restoration.

50.

Radiograph of right lateral incisor implant splinted to adjacent natural teeth.

51.

Insertion of left lateral incisor for splinting to adjacent natural teeth.

52.

Radiograph of left lateral incisor implant splinted to adjacent natural teeth.

53.

View immediately after the placement and prosthetic stabilization of two maxillary lateral incisors.

54.

View ten weeks after implant placement and just prior to the making of an implant level transfer impression.

55.

Closer view of the splinted transitional crown.

56.

View of 3.5mm shouldered abutment after removal of splinted transitional crown.

57.

View of 3.5mm shouldered abutment prior to its removal.

58.

Insertion of black 2.0mm impression post prior to its being tapped into the implant well.

59.

Impression post being inserted prior to its receiving mandatory seating taps.

60.

Impression material being injected around black impression post.

61.

Impression material being injected around seated left impression post.

62.

Digital photo being taken of shade guide against a black background for transmission to a technician for fabrication of Integrated Abutment Crowns™.

63.

Two Integrated Abutment Crowns™ on stone model

64.

Alignment of seating instrument in notched hard acrylic occlusal mouthguard.

65.

Alignment of seating instrument in long axis of abutment shaft with notched hard acrylic mouthguard.

66.

View of transitional crowns prior to their removal for insertion of permanent Integrated Abutment Crowns™.

67.

Smile prior to insertion of Integrated Abutment Crowns™.

68.

Right implant sulcus.

69.

Left implant sulcus.

70.

Occlusal view of implant sulci.

71.

Integrated Abutment Crown being held in a cotton roll within a forceps

72.

Initial seating of right lateral incisor Integrated Abutment Crown™.

73.

Oblique crestal relieving incision being made to facilitate seating of Integrated Abutment Crown™.

74.

Integrated Abutment Crown™ in hard acrylic seating jig.

75.

Hard acrylic seating jig facilitating the insertion of Integrated Abutment Crown™.

76.

Right lateral incisor being inserted with seating jig.

77.

Seated hard acrylic jig prior to the tapping and seating of the Integrated Abutment Crowns™.

78.

Notched hard acrylic jig facilitating the tapping in the long axis of the abutment shaft.

79.

Left Integrated Abutment Crown™ being tapped in the long axis of its abutment shaft.

80.

Right lateral incisor immediately after being tapped into the implant well

81.

Radiograph of right lateral incisor Integrated Abutment Crown™.

82.

Left lateral incisor immediately after being tapped into the implant well.

83.

Radiograph of left lateral incisor Integrated Abutment Crown™.

84.

Right Integrated Abutment Crown™ four weeks after insertion.

85.

Left Integrated Abutment Crown™ four weeks after insertion.

86.

Right profile four weeks after insertion.

87.

Left profile four weeks after insertion.

88.

Radiograph of two Bicon Integrated Abutment Crowns™.

89.

Patient's smile.