Two Stage Placement of Maxillary Lateral Implants, Implant Level Transfer Impression and their Restoration with Integrated Abutment Crowns™

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1.

First clinical visit: Pre-operative radiograph.

2.

Pre-operative radiograph.

3.

Pre-operative site.

4.

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

5.

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

6.

Osteotomy being enlarged with a red 4.0mm hand reamer.

7.

Osteotomy being prepared with a silver 4.5mm bone expander.

8.

A 4.5mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant inserter/retriever.

9.

Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.

10.

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

11.

Osteotomy being enlarged with a blue 3.5mm hand reamer.

12.

Osteotomy being enlarged with a red 4.0mm hand reamer.

13.

A 4.0mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant inserter/retriever.

14.

View of polyethylene healing plugs seated in the well of the implants.

15.

Post-operative radiograph.

16.

Post-operative radiograph.

17.

Etchant being applied in preparation for the bonding of the transitional prosthesis to adjacent teeth.

18.

Bonding material being applied.

19.

Light curing of bonding material.

20.

Transitional composite material in vacuum-formed template being formed around acrylic sleeve.

21.

View of finished transitional stabilizing prostheses.

22.

View of finished transitional stabilizing prostheses.

23.

Second clinical visit: View after removal of transitional prosthesis prior to the uncovering of the implant and the making of a full arch implant level transfer impression.

24.

Healing plug removed with a healing plug removal instrument.

25.

View of a red 2.0mm guide pin being seated into the well of the implant.

26.

Red 2.0mm impression reamer being inserted onto guide pin to remove any tissue which might inhibit the complete seating of an impression post.

27.

Healing plug being removed with a healing plug removal instrument.

28.

Red 2.0mm plastic impression post being inserted into the 2.0mm well of an integrated implant for the making of an implant level transfer impression.

29.

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.

30.

Red 2.0mm plastic impression post receiving its mandatory seating tap.

31.

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

32.

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

33.

Third clinical visit: Integrated Abutment Crowns™ on stone model.

34.

View of transitional prostheses prior to their removal for the insertion of Integrated Abutment Crowns™.

35.

Red 2.0mm plastic impression post which was used as a temporary abutment is being removed.

36.

Green 3.0mm plastic impression post which was used as a temporary abutment is being removed.

37.

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

38.

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

39.

Red 2.0mm impression reamer being inserted onto guide pin to remove any tissue which might inhibit the complete seating of an Integrated Abutment Crown™.

40.

Integrated Abutment Crown™ being inserted.

41.

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.

42.

Integrated Abutment Crown™ being inserted.

43.

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.

44.

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

45.

Post operative radiograph after the insertion of an Integrated Abutment Crown™.

46.

Post operative radiograph after the insertion of an Integrated Abutment Crown™.

47.

Fourth clinical visit: Well of implant being cleaned after the patient presented with loose right Integrated Abutment Crown™ six weeks post insertion.

48.

Integrated Abutment Crown™ being inserted.

49.

View of right lateral incisor immediately after being retapped.

50.

Floss being used to confirm the fact that the interproximal contacts are passive and will not interfere with the engagement of the locking taper.

51.

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

52.

View of Integrated Abutment Crowns™ immediately after being retapped.

53.

View of Integrated Abutment Crowns™ two months post insertion.