Two-Stage Placement of Four MAX 2.5™ Implants with a 2.5mm Diameter Well and their Restoration with Integrated Abutment Crowns™

1.

First Clinical Visit: Pre-operative radiograph.

2.

Pre-operative clinical photograph.

3.

Pre-operative site with surgical guide.

4.

Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external water irrigation while retraction sutures reflect the flaps.

5.

Paralleling pin seated in pilot osteotomy indicating its position and trajectory.

6.

Two paralleling pins seated in pilot osteotomies indicating their position and trajectory.

7.

Three paralleling pins seated in pilot osteotomies indicating their position and trajectory.

8.

Four paralleling pins seated in pilot osteotomies indicating their position and trajectory.

9.

Vacupress in place over paralleling pins to ensure proper positioning and trajectory of intended osteotomies.

10.

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

11.

Harvested bone within the flutes of teal 3.0mm latch reamer.

12.

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

13.

Curette removing residual bone while confirming the integrity of the five bony walls of the osteotomy.

14.

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

15.

Osteotomy being enlarged with a red 4.0mm hand reamer.

16.

A MAX 2.5™ 4.0 x 8.0mm Integra-CP™ implant with a 2.5mm well being inserted into the osteotomy.

17.

A MAX 2.5™ 4.0 x 8.0mm Integra-CP™ implant with a 2.5mm well being inserted into the osteotomy with an implant inserter/retriever.

18.

A MAX 2.5™ 4.0 x 8.0mm Integra-CP™ implant with a 2.5mm well being inserted into the osteotomy with an implant inserter/retriever.

19.

Straight handle with a seating tip attached is being tapped to seat implant farther into the osteotomy.

20.

View of guide pins seated in the implant wells.

21.

Cut polyethylene healing plug being inserted into the 2.5mm well of the implant.

22.

Cut polyethylene healing plug being inserted into the 2.5mm well of the implant.

23.

Harvested bone being placed over the shoulder of the implant.

24.

Sutured site.

25.

Post-surgical radiograph of four MAX 2.5™ 4.0 x 8.0mm Integra-CP™ implants with 2.5mm wells.

26.

Second Clinical Visit: (20 Weeks after prior visit) Radiograph taken prior to uncovering.

27.

Clinical photograph showing surgical site after healing.

28.

View of uncovering incisions.

29.

View of two black polyethylene healing plugs and bone covering the two central incisor implants.

30.

A #4 round bur facilitating the removal of bone over the polyethylene healing plugs.

31.

Healing plug being removed with healing plug removal instrument.

32.

Healing plug being removed with healing plug removal instrument.

33.

View of implant wells.

34.

A 4.0 x 3.5mm 0˚ Stealth Abutment being placed into the implant well.

35.

A 4.0 x 3.5mm 0˚ Stealth Abutment being placed into the implant well.

36.

A 4.0mm temporization sleeve being place over the Stealth Abutment.

37.

A 4.0mm temporization sleeve being place over the Stealth Abutment.

38.

View of temporization sleeves over Stealth Abutments.

39.

Accustomed template placed over the adjacent teeth to ensure temporization sleeves have proper clearance.

40.

A composite acrylic strut is being formed with "Integrity" by Dentsply.

41.

Transitional prosthesis after the removal of the accustomed template.

42.

Polished transitional prosthesis is being inserted onto stealth abutments.

43.

Patient's smile with transitional prosthesis in place.

44.

Third Clinical Visit: (5 Weeks after prior visit) Transitional prosthesis in place.

45.

Occlusal view of the implants wells.

46.

A 2.5mm titanium impression post being seated into the well of the implant.

47.

A 2.5mm titanium impression post being seated into the well of the implant.

48.

A blue 2.5mm plastic sleeve being inserted onto the 2.5mm titanium impression post.

49.

A blue 2.5mm plastic sleeve being inserted onto the 2.5mm titanium impression post.

50.

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

51.

View of transfer impression with 2.5mm blue plastic sleeve.

52.

View of 2.5mm titanium impression posts after the full arch implant level transfer impression.

53.

Red acrylic being injected around impression posts for an occlusal registration.

54.

Acrylic occlusal registration with blue plastic impression sleeves in place.

55.

View of full arch transfer impression with implant analogs seated into the blue acrylic transfer sleeves within the impression material.

56.

Acrylic being injected around blue impression posts to simulate soft tissues.

57.

View of assembled 2.5mm titanium impression posts and titanium implant analogs seated in the impression with replication of the soft tissue.

58.

View of full arch impression prior to dental stone being poured in to it.

59.

Dental stone after being poured into the transfer impression.

60.

View of implant analog wells in the soft tissue model.

61.

View of stealth abutments in soft tissue model.

62.

View of prepared stealth abutments with metal opaque layer seated in stone model.

63.

View after application of opaque dentin layer.

64.

View after application of cervical opaque dentin layer.

65.

View after the application of Ceramage body material.

66.

View after the application of incisal layer.

67.

View of Integrated Abutment Crowns™.

68.

View of Integrated Abutment Crowns™ in the stone model with the orientation jig in place.

69.

View of Integrated Abutment Crowns™ in the stone model.

70.

Right profile view of Integrated Abutment Crowns™ in the stone model.

71.

Left profile view of Integrated Abutment Crowns™ in the stone model.

72.

Occlusal view of Integrated Abutment Crowns™ in the stone model.

73.

View of Integrated Abutment Crowns™ with yellow thermo-plastic seating jigs.

74.

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

75.

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

76.

Integrated Abutment Crown™ being inserted.

77.

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.

78.

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

79.

Integrated Abutment Crown™ being inserted.

80.

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

81.

Integrated Abutment Crown™ being inserted.

82.

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

83.

Integrated Abutment Crown™ being inserted.

84.

Yellow thermoplastic custom seating jig which was formed in a crown alignment device is seated in a crown seating tip attached to a straight handle to facilitate directing the tapping forces in the long axis of the abutment post and implant well.

85.

Yellow thermoplastic custom seating jig which was formed in a crown alignment device is seated in a crown seating tip attached to a straight handle to facilitate directing the tapping forces in the long axis of the abutment post and implant well.

86.

Yellow thermoplastic custom seating jig which was formed in a crown alignment device is seated in a crown seating tip attached to a straight handle to facilitate directing the tapping forces in the long axis of the abutment post and implant well.

87.

Yellow thermoplastic custom seating jig which was formed in a crown alignment device is seated in a crown seating tip attached to a straight handle to facilitate directing the tapping forces in the long axis of the abutment post and implant well.