Two Stage Placement and Restoration of a Congenitally Missing Maxillary Left Lateral Incisor Implant with an Integrated Abutment Crown™

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1.

First Clinical Visit: Pre-operative radiograph.

2.

View of pre-operative site.

3.

Osteotomy being enlarged with a teal 3.0mm latch reamer rotating at 50 RPM without water irrigation after the initial osteotomy was made with the 2mm pilot bur.

4.

Osteotomy being enlarged with a red 4.0mm hand reamer rotating at 50 RPM without water irrigation.

5.

Bone depth gauge being used to measure the depth of the osteotomy.

6.

A 4.5mm x 6.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded onto a straight driver.

7.

Harvested bone being placed over the shoulder of the implant.

8.

Trimmed polyethylene healing plug being inserted into the seated implant.

9.

Post operative radiograph.

10.

Second Clinical Visit: Bonded prosthesis prior to its removal for the making of implant level transfer impression.

11.

View of operative site prior to the making of an implant level transfer impression.

12.

View of the trimmed black polyethylene plug seated in the well of the implant.

13.

Healing plug being removed with a healing plug removal instrument.

14.

Impression reamer being rotated on guide pin to remove any tissue which might inhibit the complete seating of an impression post.

15.

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.

16.

Green 3.0mm plastic impression post receiving its mandatory seating tap.

17.

Impression material being injected around impression post for the making of a full arch implant level transfer impression.

18.

Third Clinical Visit: View of Integrated Abutment Crown™ on stone model.

19.

Integrated Abutment Crown™ on stone model with acrylic orientation jig.

20.

View of Integrated Abutment Crown™.

21.

View of transitional prosthesis prior to its removal for the insertion of Integrated Abutment Crown™.

22.

Transitional prosthesis being removed.

23.

View of abutment being removed.

24.

Relieving incision being made to facilitate seating of the Integrated Abutment Crown™.

25.

Well of implant being cleaned with alcohol on a cotton tipped applicator.

26.

Integrated Abutment Crown™ being inserted.

27.

An acrylic orientation jig being used to initially position the Integrated Abutment Crown™.

28.

Diamond finishing strip being used to lighten the interproximal contact area eliminating the possibility that a too tight contact may prevent the engagement of the locking taper connection.

29.

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.

30.

Integrated Abutment Crown™ being adjusted with 7408 carbide finishing bur.

31.

Incisal edge being adjusted with a pink acrylic polishing wheel.

32.

View of Integrated Abutment Crown™ immediately after being inserted.

33.

Fourth Clinical Visit: View of maxillary left lateral incisor Integrated Abutment Crown™ one month post insertion.

34.

View of maxillary left lateral incisor Integrated Abutment Crown™ one month post insertion.

35.

View of left profile one month post insertion.

36.

One month post insertion radiograph.

37.

Fifth Clinical Visit: View of maxillary left lateral incisor Integrated Abutment Crown™ fourteen months post insertion.

38.

Facial view of maxillary left lateral incisor Integrated Abutment Crown™ fourteen months post insertion.

39.

Patients smile fourteen months post-insertion.