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

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1.

First Clinical Visit: Preoperative sites.

2.

View of preoperative sites after the removal of prosthesis.

3.

Pre-operative radiograph maxillary right lateral incisor.

4.

Pre-operative radiograph of maxillary left lateral incisor.

5.

Pilot bur initiating osteotomy for the right lateral incisor implant by having a trajectory that is more perpendicular to the palatal wall of the socket which will allow for its engagement. Immediately upon it will be up righted to a trajectory parallel to the adjacent teeth.

6.

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

7.

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

8.

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

9.

Osteotomy being enlarged with a blue 3.5mm hand reamer.

10.

Osteotomy being enlarged with a red 4.0mm hand reamer.

11.

Osteotomy being enlarged with a silver 4.5mm hand reamer.

12.

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

13.

A 4.5mm x 6.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.

14.

View of polyethylene healing plug in the well of the seated implant.

15.

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

16.

Autogenous bone graft harvested during osteotomy being placed over the seated implants.

17.

Flap being sutured.

18.

Post-operative radiograph of the maxillary right lateral incisor implant immediately after placement..

19.

Initial incision being made prior to the osteotomy for the left lateral incisor implant.

20.

View of ridge.

21.

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

22.

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

23.

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

24.

Osteotomy being enlarged with a blue 3.5mm hand reamer bur.

25.

Osteotomy being enlarged with a red 4.0mm hand reamer.

26.

A 4.5mm x 6.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.

27.

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

28.

View of polyethylene healing plug in the well of the seated implant.

29.

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

30.

Sutured closure of flap.

31.

Post-operative radiograph of the maxillary left lateral incisor implant immediately after placement.

32.

Sutured sites.

33.

Second Clinical Visit: View of sites four months post implant placement prior to the uncovering and making of an implant level transfer impression.

34.

Trimmed polyethylene healing plug being removed from the uncovered maxillary right lateral incisor implant well with a healing plug removal instrument.

35.

A 3.0mm guide pin being inserted into the well of the implant.

36.

Green 3.0mm impression reamer threaded onto a knurled knob being inserted onto guide pin to remove any tissue which might inhibit the complete seating of an impression post.

37.

A 4.0mm x 6.5mm non-shouldered abutment seated in the well of the implant for Periotester which facilitates the evaluation of implant’s integration.

38.

Periotester evaluating the Implant’s integration.

39.

Result of the Periotester indicating that the implant is well-integrated.

40.

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.

41.

Incision being made for the uncovering of the maxillary left lateral incisor implant.

42.

Healing plug being removed from the well of the implant with a healing plug remover.

43.

Healing plug being removed from the well of the implant with a healing plug remover.

44.

Green 3.0mm impression reamer threaded onto a knurled knob being inserted onto guide pin to remove any tissue which might inhibit the complete seating of an impression post.

45.

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.

46.

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

47.

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

48.

Integrated Abutment Crowns™ on stone model.

49.

View of maxillary right lateral incisor Integrated Abutment Crown™.

50.

View of maxillary left lateral incisor Integrated Abutment Crown™.

51.

Third Clinical Visit: View of sites prior to the insertion of Integrated Abutment Crowns™.

52.

Maxillary right lateral incisor Integrated Abutment Crown™ being inserted.

53.

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

54.

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.

55.

Healing plug being removed from the well of the maxillary left lateral incisor implant with a healing plug removal instrument for the insertion of Integrated Abutment Crowns™.

56.

Trimmed polyethylene healing plug removed from the implant well with a healing plug removal instrument.

57.

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

58.

Maxillary left lateral incisor Integrated Abutment Crown™ being inserted.

59.

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

60.

Height of buccal gingiva being marked intraorally to facilitate the adjustment of the cervical aspect of the Integrated Abutment Crown™.

61.

Height of buccal gingiva being marked extraorally to facilitate the adjustment of the cervical aspect of the Integrated Abutment Crown™.

62.

Cervical aspect of the Integrated Abutment Crown™ being adjusted with 7408 carbide finishing bur.

63.

The left lateral incisor Integrated Abutment Crown™ being reinserted.

64.

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.

65.

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.

66.

View of seated Integrated Abutment Crowns™ one week post insertion.

67.

View of maxillary right lateral incisor Integrated Abutment Crown™ one week post insertion.

68.

Post insertion radiograph.

69.

View of maxillary left lateral incisor Integrated Abutment Crown™ one week post insertion.

70.

Post insertion radiograph.

71.

Three months post insertion view.

72.

Three months post insertion radiograph.

73.

Seven months post insertion view.

74.

Seven months post insertion radiograph.