This case demonstrates a sinus lift with SynthoGraft™ and the full mouth restoration of twenty-four implants with the placement of fourteen two-stage and ten immediately placed and stabilized implants while using three transitional implants, implant level transfer impressions, occlusal registration, and insertion of twenty-four Integrated Abutment Crowns™.
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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.
8.
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 teal 3.0mm 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 hand reamer.
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Harvested bone within the gold 5.0mm hand reamer.
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5.0 x 6.0 mm HA coated implant being inserted into the osteotomy with an implant inserter/retriever.
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4.5 x 8.0 mm HA coated implant being inserted into the osteotomy with an implant inserter/retriever.
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Sinus lift bur (260-201-029) being used to prepare osteotomy.
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Sinus lift curette being used to elevate sinus membrane.
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Patient’s blood being mixed with SynthoGraft™ (pure phase Beta-Tricalcium Phosphate) in dappen dish.
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The mixture of patient’s blood and SynthoGraft™ (pure phase Beta-Tricalcium Phosphate) being injected into the sinus floor.
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View of seated implants with polyethylene healing plugs.
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Post-operative radiograph.
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Shoulder depth gauge seated in the well of the implant facilitating the selection of a stealth abutment with an appropriate shoulder height.
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A 5.0 x 4.0mm 10˚ angled stealth shouldered abutment being inserted into the well of the implant.
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A modified acrylic sleeve being placed onto a stealth shouldered abutment.Transitional composite material “Integrity” by Dentsply being injected around acrylic sleeves to form a strut.
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Transitional composite material “Integrity” by Dentsply being injected around acrylic sleeves to form a strut.Transitional composite material being injected into vacuum formed template prior to its placement over the hardened strut.
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Transitional composite material being injected into vacuum formed template prior to its placement over the hardened strut.
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Transitional composite material in vacuum-formed template being formed around acrylic sleeves.
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Mandibular osteotomy being prepared with 2.0mm pilot bur rotating at 1100 RPM with external irrigation.
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Second clinical visit: Osteotomy being enlarged with an olive green 2.5mm latch reamer rotating at 50 RPM without water irrigation.Osteotomy being enlarged with a teal 3.0mm latch reamer rotating at 50 RPM without water irrigation.
29.
Osteotomy being enlarged with a teal 3.0mm latch reamer rotating at 50 RPM without water irrigation.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 blue 3.5mm latch reamer rotating at 50 RPM without water irrigation.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 red 4.0mm latch reamer rotating at 50 RPM without water irrigation.
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Harvested bone within the silver 4.5mm latch reamer rotating at 50 RPM without water irrigation.
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Harvested bone within the gold 5.0mm latch reamer rotating at 50 RPM without water irrigation.
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4.5 x 8.0 mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded.
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5.0 x 6.0 mm HA coated implant being inserted into the osteotomy with an implant inserter/retriever.
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Transitional implant being placed to stabilize the transitional prosthesis.
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View of seated implants with polyethylene healing plug.
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Transitional implant being placed.
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Transitional prosthesis is being sectioned prior to its seating.
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Cement being applied to the transitional prosthesis.
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Maxillary prosthesis being seated.
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Composite material being added interproximally.
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Light curing of composite material.
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View of seated stealth shouldered abutment and modified acrylic sleeves.
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Transitional composite material being added to vacuum formed template to form a mandibular transitional prosthesis.
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Transitional composite material in vacuum-formed template being formed around acrylic sleeves.
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Post-operative radiograph.
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Transitional prostheses in place.
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Third clinical visit: Healing plug being removed from the well of the mandibular implant.
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Healing plug being removed from the well of the maxillary 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 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 with an offset driver.
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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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Cement being applied for the recementation of the transitional prosthesis.
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Transitional prosthesis being seated.
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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 with an offset driver.
59.
Mandibular implant level transfer impression being made.
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A 4.0 x 1.5 mm stealth shouldered abutment being inserted for the fabrication of a new transitional prosthesis.
61.
A 4.0 x 3.5 mm stealth shouldered abutment being inserted for the fabrication of a new transitional prosthesis.
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A tall acrylic sleeve being placed onto the 4.0 x 3.5 mm shouldered abutment.
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Composite material being added to acrylic sleeves.
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Composite material being added to acrylic sleeves to form a strut.
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Vacuum-formed template seated over modified acrylic sleeves.
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Transitional composite material being added to vacuum formed template to form a transitional prosthesis.
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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 two stealth abutments.
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Polished transitional prosthesis being inserted.
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View of transitional stabilizing prosthesis.
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Post-operative radiograph with transitional prostheses.
72.
Green 3.0mm plastic impression post being inserted into the 3.0mm well of an integrated implant.
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Green 3.0mm plastic impression post receiving its mandatory seating tap.
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Recording vertical dimension.
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View of preliminary Integrated Abutment Crowns™ used for the making of occlusal registration.
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Resin being light cured for the recording of occlusal registration.
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Occlusal registration being made.
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Dental floss being used to mark midline.
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Midline marked on the light-cured resin.
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Light-cured occlusal registration being removed.
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Face-bow recording being made.
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Face-bow recording being made.
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Occlusal rim with abrasive plaster and few impression posts being seated.
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Maxillary occlusal rim with abrasive plaster being seated.
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Functionally-derived registration being made.
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Note the reduction of abrasive plaster after the functionally-derived registration.
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View of joined occlusal rims after the functionally-derived registration.
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Acrylic resin applied to join the occlusal rims after the functionally-derived registration.
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Removal of the joined occlusal rims after the functionally-derived registration.
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Facial view of seven maxillary Integrated Abutment Crowns™ on stone model.
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Occlusal view of seven maxillary Integrated Abutment Crowns™ on stone model.
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Facial view of eleven mandibular Integrated Abutment Crowns™ on stone model.
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Occlusal view of eleven mandibular Integrated Abutment Crowns™ on stone model.
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Fourth clinical visit: Close-up view of the transitional prostheses prior to their removal for the insertion of the Integrated Abutment Crowns™.
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Occlusal view of maxillary arch after the removal of the transitional prosthesis.
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Abutment post being cleaned with alcohol wipe to remove any debris which would diminish the effectiveness of the locking taper connection.
97.
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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Integrated Abutment Crown™ being inserted.
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Implant well being cleaned with alcohol and cotton tipped applicator.
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Integrated Abutment Crown™ being inserted.
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Integrated Abutment Crown™ being inserted.
103.
View of mandibular arch after the removal of the transitional prosthesis.
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View of implant wells after the removal of transitional prostheses and stealth abutments.
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Integrated Abutment Crown™ being inserted.
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Integrated Abutment Crown™ being inserted.
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Transitional implant being removed with straight stealth latch driver.
108.
View of removed transitional implant.
109.
White healing abutment in a straight handle is being used to tap the Integrated Abutment Crown™ into the well of the implant.
110.
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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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.
113.
Transitional implant being removed with straight stealth latch driver.
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View of removed transitional implant.
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Integrated Abutment Crown™ being adjusted.
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Roughening the surface for modification of an Integrated Abutment Crown™.
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Light curing of the modeling liquid.
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Composite material being added to incisal edge.
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Light curing of the composite material.
120.
Transitional implant being removed with straight stealth latch driver.
121.
View of removed Transitional implant.
122.
Post insertion radiograph with eighteen Integrated Abutment Crowns™ and twenty-four implants.
123.
Fifth clinical visit: 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 being inserted onto guide pin to remove any tissue which might inhibit the complete seating of an impression post.
125.
Floss is being used to confirm the fact that there is no contact between the Integrated Abutment Crown™ and the impression post.
126.
Contact being removed between the Integrated Abutment Crown™ and the impression post with a metal abrasive strip.
127.
Green 3.0mm plastic impression post receiving its mandatory seating tap.
128.
Impression material being injected around the impression posts for the making of a posterior arch implant level transfer impression.
129.
Red acrylic being injected around the impression posts.
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Red acrylic on the impression posts for the recording of an occlusal registration on the patient's right side.
131.
Occlusal registration being removed from the implant wells.
132.
View of left maxillary Integrated Abutment Crowns™ on a stone model.
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View of right maxillary Integrated Abutment Crowns™ on a stone model.
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Sixth clinical visit: Integrated Abutment Crown™ being inserted.
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Integrated Abutment Crown™ being inserted.
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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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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.
139.
Facial view immediately after the insertion of Integrated Abutment Crowns™.
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Right side profile view immediately after the insertion of Integrated Abutment Crowns™.
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Left side profile view immediately after the insertion of Integrated Abutment Crowns™.
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Patient’s smile immediately after insertion of Integrated Abutment Crowns™.
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Post operative radiograph 23 months after the initial implant placement.
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Five weeks post insertion view of the maxillary arch.
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Five weeks post insertion view of the mandibular arch.
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Left side profile view five weeks post insertion.
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Right side profile view five weeks post insertion.
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Facial view five weeks post insertion.
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Patient’s smile five weeks post insertion.
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Five weeks post insertion radiograph.
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Eighth clinical visit: Facial view ten weeks post insertion.
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Ten weeks post insertion view of the maxillary arch.
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