This case demonstrates the full mouth restoration of nineteen implants with the placement of twelve two stage and seven immediately placed and stabilized implants using transitional implants, implant level transfer impressions, occlusal registration, and insertion of nineteen Integrated Abutment Crowns™ including three two-unit Integrated Abutment Crowns™ for the intraoral fabrication of two fixed bridges.
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Pre-operative facial view after the removal of the maxillary denture.
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Patient’s smile.
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Right profile view.
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Left profile view.
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Extracted mandibular tooth.
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Mandibular osteotomy being prepared with 2.0mm pilot bur rotating at 1100 RPM with external irrigation.
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Parallel pins seated in pilot osteotomies indicating their trajectories.
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Osteotomy being enlarged with an olive green 2.5mm latch reamer rotating at 50 RPM without irrigation.
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Osteotomy being enlarged with a teal 3.0mm latch reamer rotating at 50 RPM without irrigation.
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Osteotomy being enlarged with a dark blue 3.5mm latch reamer rotating at 50 RPM without irrigation.
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Osteotomy being enlarged with a red 4.0mm latch reamer rotating at 50 RPM without irrigation.
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Osteotomy being enlarged with a gold 5.0mm latch reamer rotating at 50 RPM without irrigation.
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Harvested bone within the flute of gold 5.0mm latch reamer.
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Harvested bone within the flute of gold 5.0mm latch reamer being placed into dappin dish.
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Curette removing harvested bone from osteotomy.
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A 5.0mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant inserter/retriever.
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Cut polyethylene healing plug being inserted into the implant well for two stage placement.
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O-ring transitional implant being placed.
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View of two o-ring transitional implants immediately after their placement.
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The top of the o-ring transitional implant being marked with a pencil to indicate its location on the denture.
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Denture being marked with a pencil.
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Denture being relieved to accommodate the housings.
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Rubber dam aprons being placed over o-ring transitional implants to prevent extraneous acrylic from locking around the implant.
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Vaseline being injected around the o-ring transitional implants.
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Brevis housing being placed onto the o-ring transitional implants.
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View of seated Brevis housings.
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View of relieved mandibular denture.
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Acrylic being injected into denture for the retention of the housings.
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Patient clenching on two cotton rolls until the acrylic around the housings is completely polymerized to assure that the denture will be EVENLY TISSUE BORNE.
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View of the denture after being removed from the mouth.
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Excess acrylic being removed.
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Pressure-indicating paste (PIP) placed in the denture.
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Denture with pressure-indicating paste (PIP) being seated.
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View of the denture removed from patient’s mouth to check for pressure areas.
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Incisal contacts of patient’s denture being adjusted.
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Patient’s smile.
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Right profile view.
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Left profile view.
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Second clinical visit: Maxillary osteotomy being prepared with 2.0mm pilot bur rotating at 1100 RPM with external irrigation.
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Parallel pins confirming appropriate trajectories and acting as guides for subsequent osteotomies.
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Osteotomy being enlarged with an olive green 2.5mm latch reamer rotating at 50 RPM without water irrigation.
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Osteotomy being enlarged with a blue 3.5mm latch reamer rotating at 50 RPM without water irrigation.
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Osteotomy being enlarged with a red 4.0mm latch reamer rotating at 50 RPM without water irrigation.
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A 4.5mm x 8.0mm HA coated Implant being inserted into the osteotomy with an implant inserter/retriever.
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Parallel pin seated in pilot osteotomy indicating its trajectory.
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Osteotomy being enlarged with an olive green 2.5mm latch reamer rotating at 50 RPM without water irrigation.
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Osteotomy being enlarged with a red 4.0mm latch reamer rotating at 50 RPM without water irrigation.
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Osteotomy being enlarged with a silver 4.5mm hand reamer.
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View of seated implants with their polyethylene healing plugs prior to being cut.
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Sutured site.
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Mandibular osteotomy being prepared with 2.0mm pilot bur rotating at 1100 RPM with external irrigation.
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Osteotomy being enlarged with a blue 3.5mm latch reamer rotating at 50 RPM without water irrigation.
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Osteotomy being enlarged with a teal 3.0mm latch reamer rotating at 50 RPM without water irrigation.
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A 4.5mm x 8.0mm HA coated Implant being inserted into the osteotomy with an implant inserter/retriever.
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Osteotomy being enlarged with an olive green 2.5mm latch reamer rotating at 50 RPM without water irrigation.
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View of short acrylic sleeves and modified tall acrylic sleeves snapped on to stealth abutments for fabrication of transitional stabilizing prosthesis.
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Vacuum formed template seated over acrylic sleeves snapped onto abutments to confirm the appropriateness of their placement.
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Transitional composite material in vacuum-formed template being formed around acrylic sleeves.
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Transitional composite prosthesis incorporating modified acrylic sleeves and a transitional o-ring implant that was inadvertently removed.
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View of transitional stabilizing prosthesis snapped onto stealth abutments.
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Post-operative radiograph.
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Patient’s smile four months after the implant placement.
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Third clinical visit: Flap being reflected.
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Osteotomy being enlarged with a blue 3.5mm latch reamer rotating at 50 RPM without water irrigation.
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Osteotomy being prepared with 2.0mm pilot bur rotating at 1100 RPM with external irrigation.
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Osteotomy being enlarged with a teal 3.0mm latch reamer rotating at 50 RPM without water irrigation.
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Osteotomy being enlarged with a red 4.0mm latch reamer rotating at 50 RPM without water irrigation.
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Osteotomy being enlarged with a silver 4.5mm hand reamer.
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Harvested bone within the flute of gold 5.0mm hand reamer.
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A 5.0mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant inserter/retriever.
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A 5.0mm x 2.0mm stealth abutment being inserted into the implant well with only finger pressure.
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Occlusal view of seated stealth abutments.
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Vacuum formed template seated over abutments to confirm the appropriateness of their placement.
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View of seated modified acrylic sleeves.
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Transitional composite material in vacuum-formed template being formed around acrylic sleeves.
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Transitional composite prosthesis being removed for polishing.
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View of polished transitional prosthesis in place.
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Fourth clinical visit: Occlusal view of transitional abutments.
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Healing plug being removed from the well of the implant with a healing plug removal instrument.
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Green 3.0mm impression reamer threaded onto the knob being inserted onto guide pin to remove any tissue which might inhibit the complete seating of an impression post.
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Transitional abutment being removed.
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View of impression posts seated in the implant wells. Note the trajectories of implants.
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Impression material being injected around the impression posts for the making of a full arch implant level transfer impression.
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Maxillary implant level transfer impression. Note the inadvertent removal of an impression post necessitating the need to retake the impression.
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Healing plug being removed from the well of the implant with a healing plug removal instrument.
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Green 3.0mm impression reamer threaded on a knob being inserted onto guide pin to remove any tissue which might inhibit the complete seating of an impression post.
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Green 3.0mm impression reamer threaded on a knob being inserted onto guide pin to remove any tissue which might inhibit the complete seating of an impression post.
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Green 3.0mm plastic impression post being inserted into the 3.0mm well of the implant for a full arch implant level transfer impression.
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Green 3.0mm plastic impression post receiving its mandatory seating tap.
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Mandibular implant level transfer impression.
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Stealth abutment being inserted for the fabrication of transitional prosthesis.
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View of modified acrylic sleeves snapped onto transitional abutments and modified impression post acting as a temporary abutment along with two white temporary abutments.
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Vacuum formed template seated over acrylic sleeves and snapped onto abutments to check for occlusal clearance.
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Transitional composite prosthesis being removed for polishing.
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Polished transitional prosthesis being snapped onto the transitional shouldered abutments.
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Polished transitional prosthesis in place.
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Fifth clinical visit: View of transitional shouldered abutments, modified impression posts and healing abutments after the removal of the left side of the transitional prostheses for the recording of an occlusal registration eight months after the initial implant placement and one week after the implant level transfer impression.
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Green 3.0mm plastic impression post being inserted into the 3.0mm well of an integrated implant for the recording an occlusal registration.
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Red acrylic being injected around the impression posts.
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Red acrylic on impression posts for the recording of an occlusal registration on the left side.
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View after the removal of the transitional prostheses on the right side.
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Green 3.0mm plastic impression post being inserted into the 3.0mm well of an integrated implant for the recording an occlusal registration.
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Red acrylic being injected around the transitional abutments.
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Occlusal registration being made.
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Occlusal registration being removed from implant wells.
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Face-bow recording.
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Face-bow recording.
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Dentatus articulator with face-bow mounting.
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Mandibular occlusal rim with white speckled abrasive plaster.
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Occlusal rim with abrasive plaster on the model with a few impression posts.
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Green 3.0mm plastic impression post receiving its mandatory seating tap.
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Mandibular occlusal rim with abrasive plaster being seated with a few impression posts.
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Mandibular occlusal rim with abrasive plaster being stabilized with acrylic resin prior to the functionally-derived occlusal registration.
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Mandibular occlusal rim with abrasive plaster stabilized with acrylic resin.
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Green 3.0mm plastic impression post receiving its mandatory seating tap.
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Maxillary occlusal rim with abrasive plaster being seated with selective impression posts.
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Maxillary base plate stabilized with acrylic resin.
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Confirming vertical dimension after the functionally-derived occlusal registration.
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Removal of the joined occlusal rims after the functionally derived registration. Note the reduction of abrasive plaster.
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Fabrication of a single central incisor crown to act as a guide for the labial and midline positioning.
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View of single central incisor guide crown.
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Light curing the single central incisor guide crown.
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Removal of single central incisor guide crown.
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View of maxillary and mandibular Integrated Abutment Crowns™ on stone models mounted on Dentatus articulator.
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Facial view of maxillary and mandibular Integrated Abutment Crowns™ on stone models.
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Right profile view of maxillary and mandibular Integrated Abutment Crowns™ on stone models.
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Left profile view of maxillary and mandibular Integrated Abutment Crowns™ on stone models.
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Occlusal view of maxillary Integrated Abutment Crowns™ on stone model.
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Occlusal view of mandibular Integrated Abutment Crowns™ on stone model.
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Nine maxillary Integrated Abutment Crowns™ including one cantilever crown which will be bonded intraorally for the fabrication of a three-unit fixed prosthesis.
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Ten mandibular Integrated Abutment Crowns™ including two cantilever crowns which will be bonded intraorally for the fabrication of a four-unit fixed prosthesis.
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Integrated Abutment Crown™ being inserted.
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Close-up view of the transitional prostheses prior to their removal for the insertion of the Integrated Abutment Crowns™.
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Sixth clinical visit: Occlusal view of maxillary arch after the removal of the transitional prosthesis.
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Integrated Abutment Crown™ being inserted.
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An orientation jig being used to initially position the Integrated Abutment Crowns™.
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Diamond finishing strip being used to lighten the interproximal contact area thus eliminating the possibility that the contact may prevent the engagement of the locking taper connection.
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An orientation jig being used to initially position the Integrated Abutment Crowns™.
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Integrated Abutment Crown™ being inserted.
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Blue markings indicate excessive interproximal contact which must be adjusted to assure passive contact for the engagement of the locking taper connection. Interproximal contact being adjusted.
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Articulating paper being used to confirm interproximal contacts.
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Integrated Abutment Crown™ being inserted.
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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.
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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.
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View of mandibular arch after the removal of the transitional prosthesis.
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Trimmed red 2.0mm plastic impression post being removed for the insertion of Integrated Abutment Crown™.
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Integrated Abutment Crown™ being inserted.
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Integrated Abutment Crown™ being inserted.
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Straight stealth latch driver being used to remove the stealth transitional implant.
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Stealth transitional implant being removed.
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A two-unit Integrated Abutment Crown™ being inserted.
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A two-unit Integrated Abutment Crown™ being inserted.
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Crestal relieving incision being made to facilitate the seating of the Integrated Abutment Crown™.
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White healing abutment in a straight handle is being used to tap the Integrated Abutment Crown™ into the well of the implant.
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White healing abutment in a straight handle is being used to tap the Integrated Abutment Crown™ into the well of the implant.
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A two-unit Integrated Abutment Crown™ being removed for intraoral bonding.
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Modeling liquid being applied to the roughened interproximal surface for intraoral bonding.
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Light curing of the modeling liquid for intraoral bonding.
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Composite material which will be used for intraoral bonding for the fabrication of a four-unit prosthesis.
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Composite being added to interproximal surface for intraoral bonding.
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3.0mm and 2.0mm wells of implants being cleaned with alcohol and cotton tipped applicators.
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The two cantilevered Integrated Abutment Crowns™ being bonded intraorally for the fabrication of a four-unit fixed prosthesis.
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Excess composite material being removed.
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Light curing of the added composite material.
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Facial view immediately after insertion of twenty-two Integrated Abutment Crowns™.
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Right side profile view immediately after insertion of twenty-two Integrated Abutment Crowns™.
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Left side profile view immediately after insertion of twenty-two Integrated Abutment Crowns™.
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