This case demonstrates the surgical exposure of the mental foramen prior to the two stage less than ideal shallow placement of three mandibular implants. Their restoration with three Integrated Abutment Crowns™ reveals the superior gingival aesthetics that can be achieved even with implants that are less than ideally placed.
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Buccal flap being reflected to locate and visualize the mental foramen.
4.
View of mental foramen.
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Periodontal probe being used to measure the height of bone above the mental foramen.
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Pilot bur being used to measure the height of bone above the mental foramen.
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Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.
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Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.
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Parallel pin confirming appropriate trajectory and acting as a guide for a subsequent osteotomy.
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Parallel pins confirming appropriate trajectories and acting as guides for a subsequent osteotomy.
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Parallel pins seated in pilot osteotomies indicating their trajectories.
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Osteotomy being enlarged with a olive green 2.5mm latch reamer bur rotating at 50RPM without water irrigation.
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Osteotomy being enlarged with a olive green 2.5mm latch reamer bur rotating at 50RPM without water irrigation.
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Osteotomy being enlarged with a teal 3.0mm latch reamer bur rotating at 50RPM without water irrigation with a parallel pin acting as a guide.
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Osteotomy being enlarged with a teal 3.0mm latch reamer bur rotating at 50RPM without water irrigation.
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Osteotomy being enlarged with a dark blue 3.5mm latch reamer bur rotating at 50RPM without water irrigation.
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Harvested bone within the flute of dark blue 3.5mm latch reamer.
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Osteotomy being enlarged with a dark blue 3.5mm latch reamer bur rotating at 50RPM without water irrigation.
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Harvested bone within the flute of dark blue 3.5mm latch reamer.
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Osteotomy being enlarged with a red 4.0mm latch reamer bur rotating at 50RPM without water irrigation.
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Osteotomy being enlarged with a red 4.0mm latch reamer bur rotating at 50RPM without water irrigation.
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Harvested bone within the flute of red 4.0mm latch reamer.
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Osteotomy being enlarged with a silver 4.5mm latch reamer bur rotating at 50RPM without water irrigation.
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Osteotomy being enlarged with a silver 4.5mm latch reamer bur rotating at 50RPM without water irrigation.
25.
View of seated implant with polyethylene healing plug.
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Implant seating tip attached to an offset driver handle is being tapped to seat implant farther into the osteotomy.
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View of seated implant with polyethylene healing plug.
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View of implant being inserted with black polyethylene handle.
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Black polyethylene plug handle is being cut slightly above the crestal level of the bone.
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View of seated implants with cut polyethylene healing plugs.
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Harvested bone collected in flexible dappin dish.
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Harvested bone being placed over implants.
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Sutured surgical site.
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Post insertion radiograph.
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View of surgical site revealing the fenestration of the black polyethylene healing plugs ten weeks after the two stage placement of the three implants.
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Radiograph ten weeks after implant placement and just prior to their being uncovered.
37.
Healing plug is being removed from the well of the 4.5mm x 8.0mm HA coated implant.
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Healing plug is being removed from the well of the 4.5mm x 8.0mm HA coated implant.
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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.
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Impression post being tapped into place to assure its proper seating.
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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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Seated impression posts remaining in implant wells for the recording of an occlusal registration.
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Red acrylic is being injected onto the seated impression posts
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Red acrylic on impression posts recording an occlusal registration.
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Occlusal registration being removed from implant wells.
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Digital image being taken of shade guide against a black plastic background to facilitate the fabrication of an aesthetic Integrated Abutment Crown™.
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Modified healing abutment being inserted into implant well.
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Integrated Abutment Crowns™ on stone model.
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Mirror view of Integrated Abutment Crowns™.
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White healing abutments prior to their removal for the insertion of the Integrated Abutment Crown™.
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White healing abutment being removed.
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View of implant wells and soft tissue sulci.
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Integrated Abutment Crown™ being inserted to initially evaluate its appropriateness.
54.
Floss being used to confirm the fact that the inter-proximal contacts are passive and will not interfere with the engagement of the locking taper.
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Integrated Abutment Crown™ is being slightly rotated with an extraction forceps and gauze to adjust its mesial interproximal contact.
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Definitive seating of the restoration and engagement of its locking taper connection is being achieved by occlusal pressure on a cotton applicator.
57.
Integrated Abutment Crown™ being inserted to initially evaluate its appropriateness.
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Floss being used to confirm the fact that the interproximal contacts are passive and will not interfere with the engagement of the locking taper.
59.
Adjustment of interproximal contact since a too tight interproximal contact will prevent the engagement of the locking taper and possibly result in subsequent loosening of the Integrated Abutment Crown™.
60.
Definitive seating of the restoration and engagement of its locking taper connection are being achieved by occlusal pressure on a cotton applicator.
61.
White healing abutment in a straight handle is being used to tap the Integrated Abutment Crown™ into the well of the implant.
62.
Post of Integrated Abutment Crown™ receiving its mandatory alcohol wipe for the removal of any contaminants that may interfere with the engagement of its locking taper connection.
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Integrated Abutment Crown™ being inserted to initially evaluate its appropriateness.
64.
Definitive seating of the restoration and engagement of its locking taper connection is being achieved by occlusal pressure on a cotton applicator.
65.
Post-insertion radiograph of Integrated Abutment Crowns™.
66.
Blue markings indicate excessive contact on the second premolar and the first molar.
67.
Seated Integrated Abutment Crowns™ after adjustment.
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