Two Stage Placement of Two Implants and their Restoration with Integrated Abutment Crowns™ for Two Congenitally Missing Lateral Incisors

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1.

First clinical visit: Preoperative radiograph of the congenitally missing right lateral incisor.

2.

Preoperative radiograph of the congenitally missing left lateral incisor.

3.

Preoperative view.

4.

Preoperative smile.

5.

Preoperative smile after the removal of the prostheses.

6.

Close-up view of preoperative sites.

7.

Close-up view of preoperative sites after the removal of orthodontic retainer.

8.

Preoperative radiograph.

9.

Osteotomy being prepared for the left lateral incisor implant with 2.0mm pilot bur rotating at 1100RPM with external irrigation.

10.

Osteotomy being enlarged with an olive green 2.5mm latch reamer rotating at 55RPM without water irrigation.

11.

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

12.

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

13.

Osteotomy being enlarged with a red 4.0mm hand reamer.

14.

A 4.0mm x 11.0mm HA coated implant with a 2.0mm implant well being inserted with implant inserter/retriever.

15.

View of the well of seated maxillary left lateral incisor implant with black polyethylene healing plug.

16.

Osteotomy being prepared for the right lateral incisor with 2.0mm pilot bur rotating at 1100RPM with external irrigation.

17.

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

18.

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

19.

Osteotomy being enlarged with a blue 3.5mm hand reamer.

20.

Osteotomy being enlarged with a red 4.0mm hand reamer.

21.

A 4.0mm x 8.0mm HA coated implant with a 2.0mm implant well being inserted with implant inserter/retriever.

22.

Trimmed polyethylene healing plug being inserted into the seated implant for two stage placement.

23.

Harvested bone being placed over implant.

24.

Sutured sites.

25.

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

26.

Bonding agent being applied.

27.

Light curing of bonding agent.

28.

Composite material being added to form a strut between adjacent teeth.

29.

Light curing of composite material.

30.

Composite material being added to form a bonded strut between adjacent teeth.

31.

Light curing of composite material.

32.

Composite material being added.

33.

Light curing of composite material.

34.

Transitional prosthesis being contoured.

35.

Polishing of bonded prosthesis with a pink silicone disc.

36.

View of finished transitional prostheses.

37.

Post-operative radiograph.

38.

Post-operative radiograph.

39.

Second clinical visit: Bonded prostheses prior to their removal for the making of implant level transfer impression.

40.

Transitional prosthesis being removed.

41.

Healing plug remover being used to remove the cut polyethylene plug from the well of the implant.

42.

Polyethylene plug removed from the well of the implant using healing plug remover.

43.

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

44.

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.

45.

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

46.

Transitional prosthesis being removed.

47.

Healing plug remover being used to remove the cut polyethylene plug from the well of the implant.

48.

Polyethylene plug removed from the well of the implant using healing plug remover.

49.

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

50.

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.

51.

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

52.

View of bonded transitional stabilizing prostheses.

53.

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

54.

Integrated Abutment Crowns™ on stone model with yellow thermoplastic seating jigs, which were fabricated on a caliper like device to facilitate directing the seating forces in the long axis of the implant well and abutment post.

55.

View of Integrated Abutment Crown™.

56.

View of Integrated Abutment Crown™.

57.

Bonded transitional stabilizing prostheses prior to their removal.

58.

Transitional prosthesis being removed.

59.

Integrated Abutment Crown™ being inserted.

60.

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.

61.

Interproximal contact being adjusted with metal strip

62.

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

63.

Integrated Abutment Crown™ being inserted. Note the severe angulation.

64.

Interproximal contact being adjusted with a pink acrylic polishing wheel.

65.

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.

66.

View of Integrated Abutment Crowns™ immediately after being inserted.

67.

Patient’s smile after the insertion of Integrated Abutment Crowns™.

68.

Fourth clinical visit: Facial view of Integrated Abutment Crowns™ fourteen months post insertion.

69.

Left profile fourteen months post insertion of Integrated Abutment Crowns™.

70.

Right profile fourteen months post insertion of Integrated Abutment Crowns™.

71.

Patient’s smile fourteen months post insertion of Integrated Abutment Crowns™.

72.

Post operative radiograph fourteen months post insertion of Integrated Abutment Crowns™.