Two Stage and Immediate Full Mouth Placement of Sixteen Bicon Implants and their Restoration with Integrated Abutment Crowns™ as well as the Restoration of Five Non-Bicon Implants with PFMs
This case demonstrates the full mouth restoration of twenty-one implants with the placement of twelve two stage and four immediately placed and stabilized implants including 5.0mm x 6.0mm short implants, implant level transfer impressions, occlusal registration, and insertion of twelve Integrated Abutment Crowns™ including three two-unit Integrated Abutment Crowns™, as well as the cementation of five PFM crowns on five non-Bicon implants.
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Pre-operative radiograph of five maxillary non-Bicon implants.
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Pre-operative smile.
3.
Close-up of facial view.
4.
Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.
5.
Parallel pins confirming appropriate trajectories and acting as guides for subsequent osteotomy.
6.
Parallel pins seated in pilot osteotomies indicating their trajectories.
7.
Osteotomy being enlarged with a olive green 2.5mm latch reamer bur rotating at 50 RPM without water irrigation.
8.
Osteotomy being enlarged with a blue 3.5mm latch reamer bur rotating at 50 RPM without water irrigation.
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Osteotomy being enlarged with a silver 4.5mm latch reamer bur rotating at 50 RPM without water irrigation.
10.
Osteotomy being enlarged with a gold 5.0mm latch reamer bur rotating at 50 RPM without water irrigation.
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A 4.5mm x 8.0mm HA coated implant with a 3.0mm implant well being inserted with the black polyethylene healing plug.
12.
A 5.0mm x 6.0mm HA coated implant with a 3.0mm implant well being inserted with the black polyethylene healing plug.
13.
A 5.0mm x 6.0mm HA coated implant with a 3.0mm implant well being inserted with the black polyethylene healing plug.
14.
View of Bicon’s Collaplug being carried to the site.
15.
View of Bicon’s Collaplug prior to being sutured to stabilize the clot after the two stage placement.
16.
Bicon’s Collaplug sutured in place after the two stage placement on the right mandibular posterior.
17.
Sutured operative site after the two stage placement of a 4.5mm x 8.0mm HA coated implant, a 5.0mm x 6.0mm HA coated short implant, and a 5.0mm x 8.0mm HA coated implant on the left mandibular posterior.
18.
Post-operative radiograph of six mandibular implants.
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Patient’s smile ten days after the mandibular posterior implant placements.
20.
Healing abutment being unscrewed.
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Transitional abutment being screwed in place.
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Transitional abutment being screwed in place.
23.
View of five seated transitional abutments prior to their being adjusted.
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Abutment being modified for clearance.
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Abutment being modified for clearance.
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Vaseline being applied to cover the head of the screw.
27.
Transitional composite material being applied to opaque the modified abutments.
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Light curing of the transitional composite material.
29.
Vacuum formed template seated over modified abutments to confirm the appropriateness of their placement.
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Blue wax placed inside the vacuum formed template to prevent the template from being overseated.
31.
Transitional composite material being added to vacuum formed template to form a transitional prosthesis.
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View of transitional material filled vacuum formed template being inserted.
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View of transitional material filled vacuum formed template forming a transitional prosthesis.
34.
Transitional composite prosthesis being removed for polishing.
35.
Post-operative radiograph.
36.
Facial view ten weeks after mandibular posterior implant placement.
37.
Pre-operative site prior to the extraction and placement of the anterior implants.
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Extraction being initiated with a periotome.
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Extraction being initiated with a periotome.
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View of extracted tooth.
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View of extracted tooth.
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View of extracted tooth.
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Curette removing soft tissue remnants of periodontal ligament.
44.
Incision being made to facilitate the osteotomy.
45.
View of the extraction site.
46.
Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.
47.
Parallel pin confirming appropriate trajectory and acting as a guide for subsequent osteotomy.
48.
Osteotomy being enlarged with a olive green 2.5mm latch reamer bur rotating at 50 RPM without water irrigation.
49.
Osteotomy being enlarged with a teal 3.0mm latch reamer bur rotating at 50 RPM without water irrigation.
50.
Curette removing residual bone while confirming the integrity of the five bony walls of the osteotomy.
51.
Osteotomy being enlarged with a blue 3.5mm latch reamer bur rotating at 50 RPM without water irrigation.
52.
Harvested bone within the flute of blue 3.5mm latch reamer.
53.
Osteotomy being enlarged with a red 4.0mm latch reamer bur rotating at 50 RPM without water irrigation.
54.
A 4.0mm x 11.0mm HA coated implant being inserted into the osteotomy with a healing plug.
55.
A 4.0mm x 11.0mm HA coated implant being inserted into the osteotomy with a healing plug.
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A 4.0mm x 11.0mm HA coated implant being inserted into the osteotomy with a healing plug.
57.
A 3.5mm x 11.0mm HA coated implant being inserted into the osteotomy with a healing plug.
58.
A straight handle, with attached implant seating tip inserted into polyethylene healing plug, is being tapped to seat implant farther into the osteotomy.
59.
Harvested bone being placed over implant.
60.
Harvested bone being placed over implant.
61.
Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height.
62.
Stealth shouldered abutment 4.0mm wide with a shoulder height of 1.5mm is being inserted into the implant well with only finger pressure.
63.
Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height.
64.
Stealth shouldered abutment 4.0mm wide with a shoulder height of 1.5mm is being inserted into the implant well with only finger pressure.
65.
Modified tall acrylic sleeve being snapped on to stealth abutment.
66.
Vacuum formed template seated over acrylic sleeves and abutments to confirm the appropriateness of their placement.
67.
Transitional composite material being added to vacuum formed template to form a transitional prosthesis.
68.
Transitional composite material in vacuum-formed template being formed around acrylic sleeves.
69.
Transitional stabilizing prosthesis incorporating stealth acrylic sleeves prior to being polished.
70.
Post-operative radiograph.
71.
Radiograph two months after the four mandibular anterior implant placement.
72.
Mandibular full arch implant level transfer impression being taken.
73.
Facial view of the maxillary arch prior to the uncovering of the posterior Bicon implants and after removal of the transitional restoration on the non-Bicon implants.
74.
Healing plug being removed from the well of the implant.
75.
Healing plug being removed from the well of the implant.
76.
Green 3.0mm impression reamer being inserted onto guide pin to remove any tissue which might inhibit the complete seating of an impression post.
77.
Green 3.0mm impression reamer being inserted onto guide pin to remove any tissue which might inhibit the complete seating of an impression post.
78.
Stealth shouldered abutment being lightly tapped prior to being checked for integration.
Green 3.0mm plastic impression post being inserted into the 3.0mm well of an integrated implant for the making of an implant level transfer impression.
81.
Green 3.0mm impression reamer being inserted onto guide pin to remove any tissue which might inhibit the complete seating of an impression post.
82.
Green 3.0mm plastic impression post receiving its mandatory seating tap.
83.
Temporary abutment being unscrewed on a non-Bicon implant.
84.
Temporary abutment being unscrewed.
85.
View of the orifices of the non-Bicon implants.
86.
Impression coping for a non-Bicon implant being screwed in place for full arch implant level transfer impression and occlusal registration.
87.
Impression coping for a non-Bicon implant being screwed in place.
88.
View of seated impression copings on non-Bicon implants and green 3.0mm plastic impression posts in Bicon implants.
89.
Impression material being injected around the impression posts for the making of a full arch implant level transfer impression.
90.
Red acrylic being injected onto the impression copings.
91.
Red acrylic on impression copings for the recording of an occlusal registration.
92.
Right side of the mandibular prosthesis being removed for the recording of an occlusal registration.
93.
3.0mm green plastic impression post being inserted for the recording of an occlusal registration.
94.
Impression post being tapped into place to assure its proper seating.
95.
Impression post being tapped into place to assure its proper seating.
96.
View of seated impression posts on the right side.
97.
Impression posts being adjusted for clearance.
98.
Red acrylic being injected onto the impression posts and transitional abutments with Vaseline applied for protection.
99.
3.0mm green plastic impression post being inserted for the recording of an occlusal registration.
100.
Red acrylic on metal impression copings and plastic impression posts recording an occlusal registration.
101.
3.0mm green plastic impression post being removed.
102.
Transitional prosthesis being reinserted.
103.
Facial view of two maxillary Integrated Abutment Crowns™ and five maxillary porcelain fused to metal crowns on stone model.
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Palatal view of two maxillary Integrated Abutment Crowns™ and five maxillary porcelain fused to metal crowns on stone model.
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View of two maxillary Integrated Abutment Crowns™ and five maxillary porcelain fused to metal crowns.
106.
View of two maxillary Integrated Abutment Crowns™ and five maxillary porcelain fused to metal crowns.
107.
Facial view of custom abutments for non-Bicon implants.
108.
Palatal view of custom abutments for non-Bicon implants.
109.
Facial view of ten mandibular Integrated Abutment Crowns™ on stone model.
110.
Palatal view of ten mandibular Integrated Abutment Crowns™ on stone model.
111.
View of ten mandibular Integrated Abutment Crowns™.
112.
View of transitional prosthesis five weeks after the implant level transfer impression.
113.
View of transitional abutments on five non-Bicon implants and screwless shouldered abutments on two Bicon implants.
114.
Transitional abutment being removed.
115.
Insertion of a custom made abutment for the non-Bicon maxillary right incisor implant.
116.
Transitional abutment being removed for the insertion of a custom abutment and crown.
117.
Integrated Abutment Crown™ being inserted.
118.
Transitional abutment being removed.
119.
Facial view of maxillary arch immediately after the insertion.
120.
Articulating paper being used to confirm interproximal contacts for the insertion of the Integrated Abutment Crown™.
121.
Transitional prosthesis being removed.
122.
View of transitional abutments after the removal of transitional prosthesis.
123.
Integrated Abutment Crown™ being inserted.
124.
Crestal relieving incision being made to facilitate the seating of the Integrated Abutment Crown™.
125.
A 5.0mm sulcus reamer attached to a threaded knob is being inserted onto a guide pin.
126.
Integrated Abutment Crown™ being inserted.
127.
Integrated Abutment Crown™ being inserted.
128.
An acrylic orientation jig is being used to initially position the Integrated Abutment Crowns™.
129.
Transitional abutment being removed for the insertion of an Integrated Abutment Crown™.
130.
Two-unit Integrated Abutment Crown™ being inserted.
131.
Integrated Abutment Crown™ being inserted.
132.
Integrated Abutment Crown™ being inserted.
133.
Integrated Abutment Crown™ being inserted.
134.
White healing abutment in a straight handle is being used to tap the Integrated Abutment Crown™ into the well of the implant.
135.
Articulating paper being used to confirm interproximal contacts.
136.
Adjustment of interproximal contact since a too tight interproximal contact would prevent the engagement of the locking taper and possibly result in the subsequent loosening of the Integrated Abutment Crown™.
137.
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.
138.
White healing abutment in a straight handle is being used to tap the Integrated Abutment Crown™ into the well of the implant.
139.
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.
140.
White healing abutment in a straight handle is being used to tap the Integrated Abutment Crown™ into the well of the implant.
141.
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.
142.
Gingival height of contour being marked with a pencil for the adjustment of cervical area of the Integrated Abutment Crown™.
143.
Cervical area being adjusted for proper seating of the Integrated Abutment Crown™.
144.
Screw being torqued prior to the cementation of the crown.
145.
Temporary cement being applied to the crown.
146.
A fixed bridge being cemented temporarily.
147.
Articulating paper being used to confirm interproximal contacts.
148.
Interproximal contacts being adjusted.
149.
Maxillary left incisor PFM crown being temporarily cemented.
150.
Green 3.0mm plastic impression post being inserted.
151.
Cut polyethylene healing plug being removed from the well of an implant with a healing plug remover.
152.
Cut polyethylene healing plug being removed from the well of an implant with a healing plug remover.
153.
Green 3.0mm plastic impression post receiving its mandatory seating tap with an offset handle.
154.
Impression material being injected around the impression post for the making of a full arch implant level transfer impression.
155.
Articulating paper being used to confirm incisal contacts in all extreme excursions while the patient is clenching.
156.
Material being injected for occlusal registration.
157.
Occlusal registration being made.
158.
Occlusal registration being removed.
159.
Post-operative radiograph.
160.
Maxillary right posterior Integrated Abutment Crowns™ on stone model.
161.
Maxillary right posterior Integrated Abutment Crowns™.
162.
Maxillary left posterior Integrated Abutment Crowns™ on stone model.
163.
Maxillary left posterior Integrated Abutment Crowns™.
164.
View of plastic white healing abutments prior to the insertion of the Integrated Abutment Crowns™.
165.
Integrated Abutment Crown™ being inserted.
166.
Integrated Abutment Crown™ being inserted.
167.
White healing abutment in a straight handle is being used to tap the Integrated Abutment Crown™ into the well of the implant.
168.
White healing abutment in a straight handle is being used to tap the Integrated Abutment Crown™ into the well of the implant.
169.
View of plastic white healing abutments prior to the insertion of the Integrated Abutment Crowns™.
170.
View of seated Integrated Abutment Crown™.
171.
Integrated Abutment Crown™ being inserted.
172.
White healing abutment in a straight handle is being used to tap the Integrated Abutment Crown™ into the well of the implant.
173.
Cement being applied.
174.
Crown being cemented.
175.
Patient’s smile.
176.
Facial view of seated Integrated Abutment Crowns™ and PFM crowns.
177.
Facial view of maxillary Integrated Abutment Crowns™ and PFM crowns.
178.
Post-operative radiograph.
179.
Left profile view.
180.
Post-operative radiograph.
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Right profile view.
182.
Post-operative radiograph.
183.
Maxillary Integrated Abutment Crowns™ and PFM crowns two weeks post-insertion.
184.
Mandibular Integrated Abutment Crowns™ and PFM crowns two weeks post-insertion.
185.
Post-operative radiograph.
186.
Post-operative radiograph.
187.
Post-operative radiograph.
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Two weeks post-insertion view.
189.
Right side profile.
190.
Left side profile.
191.
Patient’s smile.
192.
Eleven weeks post insertion view of the maxillary arch.
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Eleven weeks post insertion view of the mandibular arch.
194.
Right side profile view eleven weeks post insertion.
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Left side profile view eleven weeks post insertion.
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Right side profile view eleven weeks post insertion.
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Left side profile view eleven weeks post insertion.
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