Two Stage Placement of Two Maxillary Central Incisor Implants and their Restoration with Integrated Abutment Crowns™

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1.

First Clinical Visit: Pre-operative radiograph.

2.

Pre-operative site.

3.

Pre-operative smile.

4.

Facial view of the pre-operative site.

5.

Flaps being retracted with retraction sutures.

6.

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

7.

Parallel pin confirming appropriate trajectory and acting as a guide for subsequent osteotomy.

8.

Parallel pins seated in pilot osteotomies indicating their trajectories.

9.

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

10.

Harvested bone within the teal 3.0mm latch reamer.

11.

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

12.

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

13.

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

14.

Harvested bone within the red 4.0mm hand reamer.

15.

Harvested bone within the silver 4.5mm hand reamer.

16.

Harvested bone within the gold 5.0mm hand reamer.

17.

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

18.

A 5.0mm x 8.0mm HA coated implant being inserted into the osteotomy with the black polyethylene healing plug.

19.

A 5.0mm x 8.0mm HA coated implant being inserted into the osteotomy with the black polyethylene healing plug.

20.

View of wells of the seated implants.

21.

An implant being tapped into place.

22.

View of wells of the implants after being tapped into place.

23.

Trimmed polyethylene healing plug being inserted into the seated implant.

24.

Harvested bone being placed over implants.

25.

Flaps being sutured.

26.

Sutured sites.

27.

Post-operative radiograph.

28.

Second Clinical Visit: View of operative site prior to the two stage uncovering and the making of an implant level transfer impression.

29.

Flap being reflected.

30.

View of trimmed polyethylene healing plug in the well of the integrated implant.

31.

Healing plug being removed with a healing plug removal instrument.

32.

Healing plug being removed with a healing plug removal instrument.

33.

Green 3.0mm impression reamer being rotated on guide pin to remove any tissue which might inhibit the complete seating of an impression post.

34.

Red 4.0mm sulcus reamer threaded on a straight driver being rotated.

35.

View of trimmed polyethylene healing plug and a guide pin in the wells of the implants.

36.

Healing plug being removed with a healing plug removal instrument.

37.

Healing plug being removed with a healing plug removal instrument.

38.

Green 3.0mm impression reamer being rotated on guide pin to remove any tissue which might inhibit the complete seating of an impression post.

39.

Green 3.0mm plastic impression post being inserted into the 3.0mm well of an integrated maxillary right central incisor implant for the making of an implant level transfer impression.

40.

Green 3.0mm plastic impression post being inserted into the 3.0mm well of an integrated maxillary left central incisor implant for the making of an implant level transfer impression.

41.

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

42.

View of seated green 3.0mm plastic impression posts.

43.

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

44.

Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height.

45.

Stealth shouldered abutment 5.0mm wide with a shoulder height of 2.0mm being lightly tapped.

46.

Tall acrylic sleeve snapped onto 5.0mm x 2.0mm stealth shouldered abutment being modified.

47.

Tall acrylic sleeve snapped onto 5.0mm x 2.0mm stealth shouldered abutment being modified.

48.

Tall acrylic sleeve snapped onto 5.0mm x 2.0mm stealth shouldered abutment being polished.

49.

Modified tall acrylic sleeve snapped onto 5.0mm x 2.0mm stealth shouldered abutment being inserted.

50.

Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height.

51.

Stealth shouldered abutment 5.0mm wide with a shoulder height of 2.0mm being inserted.

52.

Vacuum formed template seated over acrylic sleeves and abutments to confirm the appropriateness of their placement.

53.

Vaseline being applied.

54.

Transitional composite material being added to acrylic sleeves to form a bonded strut between adjacent teeth.

55.

Transitional composite material being added to vacuum formed template to form a transitional prosthesis.

56.

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

57.

Vacuum-formed template being removed.

58.

Transitional composite prosthesis incorporating modified acrylic sleeves being removed to be polished.

59.

Vaseline being applied around the polished transitional prostheses.

60.

Cement being applied.

61.

Transitional prostheses being cemented.

62.

View of finished transitional prostheses.

63.

Integrated Abutment Crowns™ on stone model.

64.

Third Clinical Visit: View of site after the removal of the transitional prostheses in preparation for the insertion of the Integrated Abutment Crowns™.

65.

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

66.

Maxillary left central incisor Integrated Abutment Crown™ being inserted.

67.

Maxillary right central incisor Integrated Abutment Crown™ being inserted.

68.

View of Integrated Abutment Crowns™ immediately after the insertion.

69.

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.

70.

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.

71.

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.

72.

Articulating paper being used to confirm interproximal contacts.

73.

Interproximal contacts being adjusted with a pink silicone polishing wheel.

74.

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

75.

Incisal contacts being adjusted with a 7404 carbide finishing bur.

76.

Incisal contacts being adjusted with a pink silicone polishing wheel.

77.

Seated Integrated Abutment Crowns™ after adjustment.

78.

Post-insertion radiograph immediately after insertions.

79.

Right profile view of seated Integrated Abutment Crown™ immediately after insertions.

80.

Left profile view of seated Integrated Abutment Crown™ immediately after insertions.

81.

Patient’s smile immediately after insertions.

82.

Facial view four months post insertion.

83.

Radiograph four months post insertion.

84.

Right profile view four months post insertion.

85.

Left profile view four months post insertion.

86.

Patient’s smile four months post insertion.