Two Stage Placement of Four Mandibular Posterior SHORT® Implants and their Restoration With Bicon Integrated Abutment Crowns™

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1.

First Visit: Pre-operative radiograph.

2.

Pre-operative clinical photograph showing the patient's original prosthesis.

3.

Incision being made.

4.

Patients blood being collected from surgical site, which will be mixed with SynthoGraft™.

5.

Crestal incision being made with a #15 blade.

6.

Flap being reflected.

7.

A blue laboratory fabricated surgical guide shown in place to facilitate the mesio distal positioning of the pilot osteotomies.

8.

Pilot hole being drilled with a 2.0mm Bicon Pilot Drill.

9.

Pilot hole being drilled with a 2.0mm Bicon Pilot Drill.

10.

Paralleling pin seated in the pilot osteotomy indicating its trajectory. 

11.

Paralleling pins seated in the pilot osteotomies indicating their trajectories.

12.

Pilot hole being drilled with a 2.0mm Bicon Pilot Drill.

13.

Paralleling pins seated in the pilot osteotomies indicating their trajectories.

14.

Osteotomy being enlarged with an olive green 2.5mm latch reamer rotating at 50RPM without water irrigation.

15.

Harvested bone within the flute of an olive green 2.5mm latch reamer.

16.

Osteotomy being enlarged with a teal 3.0mm latch reamer rotating at 50RPM without water irrigation.

17.

Osteotomy being enlarged with a blue 3.5mm latch reamer rotating at 50RPM without water irrigation.

18.

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

19.

Osteotomy being enlarged with a silver 4.5mm latch reamer rotating at 50RPM without water irrigation.

20.

Osteotomy being enlarged with a gold 5.0mm latch reamer rotating at 50RPM without water irrigation.

21.

Harvested bone within the flute of a gold 5.0mm latch reamer.

22.

Harvested bone shown in a dappen dish.

23.

SynthoGraft™, a beta-tricalcium phosphate, being added to a dappen dish. 

24.

Blood that had been collected from the surgical site being placed into the dappen dish to be mixed with the SynthoGraft™.

25.

Using a periosteal elevator SynthoGraft is being mixed with the patient's blood. 

26.

Once a puddy like consistency has been achieved the SynthoGraft™ is ready for use.

27.

SynthoGraft™ will adhear to the back of a periosteal elevator when! it has reached the proper consistency for use.

28.

Using a graft delivery instrument, in this case a periosteal elevator, the SynthoGraft™ is transfered to the surgical site.

29.

Sterile guaze being used to absorb any excess. It also serves to compact the SynthoGraft™.

30.

Surgical site after the application of SynthoGraft™. 

31.

A doubly sealed packaged 5.0mm x 5.0mm implant with its black healing plug attached.

32.

Scissors being used to open the sterile plastic bag containing the implant and black healing plug.

33.

The black polyethylene healing plug being removed from the implant well.

34.

A low profile titanium healing abutment being placed into the implant well.

35.

A low profile titanium healing abutment after being placed into the well of the 5.0mm x 5.0mm implant.

36.

A 5.0mm x 5.0mm implant with a healing abutment seated within the osteotomy before being tapped to its definitive depth.

37.

A straight handled driver with an abutment seating tip is being used to definitively seat the implant into its osteotomy.

38.

A 4.5mm x 6.0mm implant with a low profile titanium healing abutment seated in the implants well.

39.

4.5mm x 6.0mm implant being inserted into its osteotomy.

40.

A 4.5mm x 6.0mm implant seated in its the osteotomy before receiving its definitive tap.

41.

4.5mm x 6.0mm implant definitevely seated in its osteotomy.

42.

4.5mm x 6.0mm implant seated in a osteotomy before receiving its definitive seating tap.

43.

4.5mm x 6.0mm implant definitevely seated in its osteotomy.

44.

A view of the surgical site after the placement of the harvested bone over the implants.

45.

View of the sutured surgical site.

46.

Post-operative radiograph.

47.

Second Visit: Seven months after previous visit. View of surgical prior to uncovering of the implants.

48.

Seven month post-operative radiograph

49.

View of the ridge after a crestal incision is made.

50.

Titanium healing abutment being removed from the well of the implant.

51.

Titanium healing abutment being removed from the well of the implant.

52.

Titanium healing abutment being removed from the well of the implant.

53.

View of the implant wells and surrounding bone after the removal of the titanium healing abutments.

54.

A 3.0mm green titanium impression post being inserted into the implant well. 

55.

View of all four 3.0mm green titanium impression posts after being inserted into the implant wells. 

56.

View of the four 3.0mm green titanium impressions posts after their plastics sleeves have been snapped on. 

57.

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

58.

View of transfer impression with 3.0mm green plastic impression sleeves.

59.

A green 3.0mm Impression post being inserted into its corresponding implant analog before being placed into the full arch transfer impression. 

60.

A green 3.0mm impression post attached to its corresponding analog being placed into the full arch impression.

61.

View of full arch transfer impression with implant analogs seated into the green 3.0mm transfer sleeves.

62.

Injection of Softissue Moulage, a gingival simulation material by Kerr, into the full arch impression, around the implant analogs.

63.

View after the addition of Ceramage body material and prior to the completion of the crowns.

64.

View of Integrated Abutment Crowns™ in the stone model.

65.

View of Integrated Abutment Crowns™ on a mirror.

66.

Third Visit: Four days after previous visit. Abutment removal forceps facilitating the removal of a low profile titanium healing abutment.

67.

Abutment post being cleaned with alcohol wipe to remove any debris, which could diminish the effectiveness of the locking taper connection.

68.

Integrated Abutment Crown™ being inserted.

69.

Integrated Abutment Crown™ being inserted.

70.

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.

71.

Patient biting on cotton tip applicator to seat an Integtrated Abutment Crown™.

72.

Facial view immediately after the initial insertion of Integrated Abutment Crowns™.

73.

Post-insertion radiograph.

74.

Facial view two weeks after the initial insertion of Integrated Abutment Crowns™.

75.

Two week post-insertion radiograph.