This case demonstrates the uncovering of four two stage maxillary implants and the extraction of three incisors and their replacement with immediately placed and functioning implants as well as the restoration of seven Integrated Abutment Crowns™.
SURGICAL: Extraction Immediate Stabilization and Function Two Stage
RESTORATIVE: Integrated Abutment Crowns™
TOPICS: Crown Insertion Impression
TAGS: Occlusal Registration
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Pre-operative site.
Palatally placed crestal incision for the uncovering of four two stage implants,which by being incorporated into the transitional stabilization prosthesis will facilitate the stabilization of the immediately placed and functioning anterior implants.
Surgical site revealing black polyethylene healing plugs prior to their removal.
Guide pins seated into the wells of the integrated implants.
Extraction of the maxillary lateral incisor.
Extraction of the maxillary right central incisor.
Extraction of the maxillary left central incisor.
Clinician’s finger monitoring the buccal bone during the preparation of the osteotomy with a 2.0mm pilot bur rotating at 1,100RPM.
Osteotomy being prepared with 2.0mm pilot bur rotating at 1,100RPM.
Osteotomy being prepared with 2.0mm pilot bur rotating at 1,100RPM.
Three parallel pins seated in the initial osteotomies and two guide pins in the wells of the integrated implants.
Blue 3.5mm diameter latch reamer preparing osteotomy at 50RPM.
Blue 3.5mm diameter latch reamer being removed from the osteotomy.
Red 4.0mm diameter latch reamer preparing osteotomy at 50RPM.
A 4.5mm diameter latch reamer preparing osteotomy at 50RPM.
Yellow 5.0mm diameter latch reamer with harvested bone.
A 5.0 mm x 11 mm HA coated implant being inserted into the osteotomy with an implant inserter/retriever instrument.
Second 5.0 mm x 11 mm HA coated implant with a 3.0 mm implant well is being inserted.
Third 5.0 mm x 11 mm HA coated implant with a 3.0 mm implant well is being inserted.
View of wells of three seated implants.
Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height.
Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height.
Shoulder depth gauge seated in the well of the implant facilitates the selection of a stealth abutment with an appropriate shoulder height.
A 5.0mm x 4.0mm stealth shouldered abutment being inserted into the well of the left central incisor implant.
A 5.0mm x 4.0mm stealth shouldered abutment being inserted into the well of the right lateral incisor implant.
Since the left central incisor implant is deeply positioned the initially placed 5.0mm x 4.0mm abutment is being replaced with a 5.0mm x 6.0mm abutment whose 3.0mm diameter shank is 2.0mm longer than the shank of the 5.0mm x 4.0mm.
The narrower 4.0mm x 3.5mm stealth abutment is replacing the initially placed 5.0mm diameter abutment to allow for more room for the interproximal papillae.
A tall 5.0mm acrylic sleeve is being inserted onto the stealth abutment.
A tall 5.0mm acrylic sleeve is being inserted onto the stealth abutment.
Acrylic sleeve being adjusted for occlusal clearance.
Vacuum formed template placed over acrylic sleeves to confirm its appropriateness.
Transitional composite material being added to acrylic sleeves to form a transitional strut.
Transitional strut formed with acrylic sleeves.
Vacuum formed template placed over strut.
Transitional composite material being injected into template.
Transitional composite material being placed over strut.
Prosthesis being removed for polishing.
Polished transitional stabilizing prosthesis being inserted.
Occlusal contacts being recorded with blue articulating paper.
Transitional stabbilizing prosthesis snapped onto seven stealth abutments.
Post operative radiograph.
Post operative radiograph.
View of transitional prosthesis prior to its removal eleven weeks after implant placement.
View of implant wells after the removal of the transitional prosthesis and the stealth abutments.
A white 3.0 mm plastic impression post being inserted into the 3.0 mm well of the left central incisor.
A white 3.0mm impression post being inserted.
A white impression post receiving its mandatory seating tap.
Impression material being injected around white impression posts for the making of an implant level transfer impression.
Red acrylic on white impression posts recording an occlusal registration.
Occlusal registration being removed from implant wells.
Digital image being taken of shade guide against a black metal background to facilitate the fabrication of an aesthetic Integrated Abutment Crown™.
Patient’s smile with transitional prosthesis.
Integrated Abutment Crowns™ on stone models.
Integrated Abutment Crowns™ on stone models.
View of clear acrylic orientation jig on dental model.
Mirror view of Integrated Abutment Crowns™.
White healing abutments modeled with red acrylic to form a seating jig to facilitate directing the seating force in the long axis of the abutment post and implant well.
Transitional prosthesis prior to its removal for the insertion of the seven Integrated Abutment Crowns™.
Abutment being removed by tapping on the carbide tipped forceps.
Initial seating of Integrated Abutment Crown™.
Crestal relieving incision being made to facilitate the seating of the Integrated Abutment Crown™.
Adjustment of interproximal contact. A too tight interproximal contact will prevent the engagement of the locking taper and possibly result in subsequent loosening of the Integrated Abutment Crown™.
Integrated Abutment Crown™ being inserted into the well of the maxillary right incisor implant
Clear acrylic orientation jig being used to seat the crowns effectively.
White temporary abutment in a straight driver is being used to tap the orientation jig for the initial engagement of the Integrated Abutment Crowns™.
A white temporary abutment with red acrylic is being used to definitively seat the Integrated Abutment Crown™ by directing the seating forces in the long axis of the implant well.
A white temporary abutment with red acrylic is being used to definitively seat the Integrated Abutment Crown™ by directing the seating forces in the long axis of the implant well.
Integrated Abutment Crown™ being inserted.
A white temporary abutment with red acrylic is being used to definitively seat the Integrated Abutment Crown™ by directing the seating forces in the long axis of the implant well.
Integrated Abutment Crown™ being inserted.
Floss being used to confirm the fact that the inter-proximal contacts are passive and will not interfere with the engagement of the locking taper.
A white temporary abutment with red acrylic is being used to definitively seat the IAC by directing the seating forces in the long axis of the implant well.
Integrated Abutment Crown™ being inserted.
White temporary abutment in a straight driver is being used to tap the orientation jig for the initial engagement of the IAC.
Integrated Abutment Crown™ being inserted.
Integrated Abutment Crown™ being inserted.
Seven Integrated Abutment Crowns™ immediately after being seated.
Post insertion radiograph.
Post insertion radiograph.
Post insertion radiograph.
Seven Integrated Abutment Crowns™ two weeks after being inserted.
Post operative smile.
Post operative radiograph.
Six weeks post insertion image.
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