This case demonstrates the implant placements, implant level transfer impression and restoration of two 4.5mm x 6.0mm short implants for two congenitally missing lateral incisors with Bicon Integrated Abutment Crowns™.
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View of preoperative sites after the removal of prosthesis.
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Pre-operative radiograph maxillary right lateral incisor.
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Pre-operative radiograph of maxillary left lateral incisor.
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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.
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Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.
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Osteotomy being enlarged with an olive green 2.5mm latch reamer bur rotating at 50RPM without water irrigation.
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Osteotomy being enlarged with a teal 3.0mm latch reamer bur rotating at 50RPM without water irrigation.
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Osteotomy being enlarged with a blue 3.5mm hand reamer.
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Osteotomy being enlarged with a red 4.0mm hand reamer.
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Osteotomy being enlarged with a silver 4.5mm hand reamer.
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Curette removing residual bone while confirming the integrity of the five bony walls of the osteotomy.
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A 4.5mm x 6.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.
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View of polyethylene healing plug in the well of the seated implant.
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Cut polyethylene healing plug being inserted into the well of the implant.
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Autogenous bone graft harvested during osteotomy being placed over the seated implants.
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Flap being sutured.
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Post-operative radiograph of the maxillary right lateral incisor implant immediately after placement..
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Initial incision being made prior to the osteotomy for the left lateral incisor implant.
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View of ridge.
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Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.
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Osteotomy being enlarged with an olive green 2.5mm latch reamer bur rotating at 50RPM without water irrigation.
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Osteotomy being enlarged with a teal 3.0mm latch reamer bur rotating at 50RPM without water irrigation.
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Osteotomy being enlarged with a blue 3.5mm hand reamer bur.
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Osteotomy being enlarged with a red 4.0mm hand reamer.
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A 4.5mm x 6.0mm HA coated implant being inserted into the osteotomy with an implant seating tip threaded on a straight driver.
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Implant seating tip attached to a straight handle is being tapped to seat implant farther into the osteotomy.
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View of polyethylene healing plug in the well of the seated implant.
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Cut polyethylene healing plug being inserted into the well of the implant.
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Sutured closure of flap.
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Post-operative radiograph of the maxillary left lateral incisor implant immediately after placement.
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Sutured sites.
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Second Clinical Visit: View of sites four months post implant placement prior to the uncovering and making of an implant level transfer impression.
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Trimmed polyethylene healing plug being removed from the uncovered maxillary right lateral incisor implant well with a healing plug removal instrument.
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A 3.0mm guide pin being inserted into the well of the implant.
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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.
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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.
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Periotester evaluating the Implant’s integration.
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Result of the Periotester indicating that the implant is well-integrated.
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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.
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Incision being made for the uncovering of the maxillary left lateral incisor implant.
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Healing plug being removed from the well of the implant with a healing plug remover.
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Healing plug being removed from the well of the implant with a healing plug remover.
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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.
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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.
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Green 3.0mm plastic impression post receiving its mandatory seating tap.
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Impression material being injected around the impression post for the making of a full arch implant level transfer impression.
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Integrated Abutment Crowns™ on stone model.
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View of maxillary right lateral incisor Integrated Abutment Crown™.
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View of maxillary left lateral incisor Integrated Abutment Crown™.
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Third Clinical Visit: View of sites prior to the insertion of Integrated Abutment Crowns™.
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Maxillary right lateral incisor Integrated Abutment Crown™ being inserted.
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An acrylic orientation jig being used to initially position the Integrated Abutment Crown™.
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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.
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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™.
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Trimmed polyethylene healing plug removed from the implant well with a healing plug removal instrument.
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Well of implant being cleaned with alcohol on cotton tipped applicator.
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Maxillary left lateral incisor Integrated Abutment Crown™ being inserted.
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An acrylic orientation jig being used to initially position the Integrated Abutment Crown™.
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Height of buccal gingiva being marked intraorally to facilitate the adjustment of the cervical aspect of the Integrated Abutment Crown™.
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Height of buccal gingiva being marked extraorally to facilitate the adjustment of the cervical aspect of the Integrated Abutment Crown™.
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Cervical aspect of the Integrated Abutment Crown™ being adjusted with 7408 carbide finishing bur.
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The left lateral incisor Integrated Abutment Crown™ being reinserted.
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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.
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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.
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View of seated Integrated Abutment Crowns™ one week post insertion.
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View of maxillary right lateral incisor Integrated Abutment Crown™ one week post insertion.
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Post insertion radiograph.
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View of maxillary left lateral incisor Integrated Abutment Crown™ one week post insertion.
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