17-Year Follow Up for Two Immediately Loaded Maxillary Central Incisors
Posted on October 16, 2019
This case demonstrates the extraction of two failed endodontically-treated maxillary central incisors, the immediate surgical placement and stabilization of two 5.0 x 8.0mm Bicon SHORT® Implants, and their subsequent restoration with two Integrated Abutment Crowns™ (IACs). This case also includes 6-year and 17-year follow-up radiographs and clinical images demonstrating not only impressive long-term bone maintenance, but also superior gingival aesthetics that last.
SURGICAL: Extraction Immediate Placement Immediate Stabilization and Function RESTORATIVE: Integrated Abutment Crowns™ TOPICS: Crestal Relieving Incision Crown Insertion Impression Long-Term TAGS: Long Term
Show Case Short Link
Click on an image to view it larger in a slideshow. Click arrow icons or use keyboard arrow to switch photos. To exit the slideshow, click the X in the upper-right or press ESC.
Click "Switch View" below to change to a layout optimized for printing the case.
Switch Thumb
1. Pre-operative radiograph of two failed endodontically-treated maxillary central incisors.
2. Periotome being used to facilitate the extraction of the two failed endodontically-treated maxillary central incisors.
3. Extracted left central incisor.
4. Extracted right central incisor.
5. Guide Pin seated in the pilot osteotomy of the left central incisor.
6. Pilot osteotomy being prepared with a 2.0mm Pilot Drill.
7. Osteotomy being widened with a 3.5mm Latch Reamer.
8. Bone being harvested from osteotomy with a curette.
9. A 5.0 x 8.0mm Bicon SHORT® Implant being placed into the right central osteotomy with a 3.0mm Implant Inserter/Retriever instrument.
10. A 5.0 x 8.0mm Bicon SHORT® Implant being placed into the left central osteotomy with a 3.0mm Implant Inserter/Retriever instrument.
11. View of the two implant wells.
12. Seating Tip attached to a Threaded Straight Handle being used to further seat the implant into the bone.
13. Abutment Shoulder Depth Gauge being used to confirm appropriate axial seating of the implant.
14. Further seating of the implant is accomplished by tapping the Threaded Straight Handle with a 3.0mm Seating Tip attached.
15. Abutment Shoulder Depth Gauge confirms the appropriate axial seating of the implant.
16. View of the implant wells of the fully seated immediately placed implants.
17. A 5.0 x 4.0mm Shouldered Abutment being placed with only finger pressure into the well of the right central implant.
18. A 5.0 x 4.0mm Shouldered Abutment being placed into the well of the left central implant.
19. A Temporization Sleeve being snapped onto the 5.0mm diameter Shouldered Abutment.
20. A Temporization Sleeve being reduced with a carbide finishing bur to facilitate the seating of an acrylic vacuum-formed template.
21. View of the facially reduced Temporization Sleeves.
22. A composite acrylic strut is being formed with the material "Integrity" by Dentsply.
23. Holes are being drilled into the template to prevent the entrapment of air.
24. Template being inserted over the composite strut to confirm fit.
25. Composite material "Integrity" by Dentsply being inserted only into the incisal portion of the template.
26. Thin coating of "Integrity" being applied onto the hardened composite strut.
27. Template with minimal composite material is being inserted onto the strut.
28. Newly formed transitional prosthesis is being removed for polishing.
29. Mesial aspect of adjacent teeth being acid-etched for the bonding of the transitional splint prosthesis.
30. Bonding material being applied.
31. Bonding material being light-cured.
32. Polished transitional prosthesis being inserted to confirm proper fit.
33. Bonding material being applied to the splint prosthesis.
34. Bonding material being applied to lateral incisor teeth.
35. Material being light-cured to achieve immobility of the immediately placed and stabilized implants.
36. Facial view of the transitional splint prosthesis after implant placement.
37. Radiograph at the conclusion of the patient's first treatment visit revealing the immediately placed and stabilized implants.
38. Facial view of the transitional splint prosthesis 10 weeks after implant placement.
39. View of Shouldered Abutments after the removal of the splint prosthesis.
40. Shouldered Abutment being removed from the right central implant 10 weeks after its placement.
41. View of implant wells ten weeks after their placement.
42. Patient's smile.
43. A white 3.0mm Impression Post being inserted into an implant well.
44. Impression Post being gently tapped to ensure its proper axial seating.
45. Impression material being injected around the white Impression Posts for the recording of an implant-level transfer impression.
46. Digital photo being taken of appropriate shade for transmission to dental technician.
47. Digital photo of a second shade being taken.
48. Transitional splint being used to orient the seating of the left Shouldered Abutment.
49. Transitional splint prosthesis after the recording of an implant-level impression.
50. Integrated Abutment Crowns™ (IACs) with a custom yellow hydroplastic resin orientation and seating jig.
51. Mirror view of IACs.
52. Transitional prosthesis prior to the insertion of the permanent IACs.
53. View of implant wells prior to the insertion of the IACs.
54. Crestal relieving incision being made to facilitate tissue displacement with the insertion and seating of the IACs.
55. View of the palatally placed crestal relieving incisions.
56. Right IAC being inserted.
57. Inserted IAC.
58. Yellow hydroplastic resin orientation and seating jig being used to confirm appropriate positioning of the inserted IAC.
59. Left IAC being inserted.
60. 13-week radiograph of two immediately placed and immediately loaded implants restored with IACs.
61. Right profile view.
62. Facial view.
63. Facial view.
64. Right profile view.
65. Facial view revealing superior gingival aesthetics, which were achieved with the IACs.
66. 6-year post-insertion radiograph.
67. 6-year post-insertion right profile view.
68. 6-year post-insertion left profile view.
69. 6-year post-insertion facial view.
70. 17-year post-operative CBCT slice of the maxillary right central incisor implant and IAC. Note the level of bone.
71. 17-year post-operative CBCT slice of the maxillary left central incisor implant and IAC. Note the level of bone.
72. 17-year post-operative radiograph.
73. 17-year post-operative facial view. Note the gingival aesthetics and preservation of the interdental papillae.
