This case demonstrates the surgical placement and restoration of 24 immediately placed and loaded implants.
SURGICAL: Immediate Placement Uncovering
RESTORATIVE: Integrated Abutment Crowns™
TOPICS: Crown Insertion Impression SynthoGraft™
TAGS: Bicon Resorbable Collagen Membrane
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First Visit: Multiple extractions and implant placement. Pre-operative radiograph.
Pre-operative site.
Luxating carious tooth.
Extracted root.
View of mandibular site after all roots have been extracted.
Blood being collected from surgical site to be mixed with SynthoGraft™ Pure Phase Beta-Tricalcium Phosphate for bone grafting procedures.
Pilot osteotomy being drilled with a 2.0mm pilot drill parallel to adjacent gold colored paralleling pins.
View of paralleling pins seated in the initial osteotomies confirming their appropriate trajectory.
Osteotomy being enlarged with an olive green 2.5mm latch reamer rotating at 50RPM without irrigation.
Harvested bone in the flute of a teal 3.0mm hand reamer attached to a hand reamer extension.
Harvested bone in the flute of a blue 3.5mm latch reamer.
Harvested bone in the flute of a red 4.0mm latch reamer.
Harvested bone in the flute of a silver 4.5mm latch reamer.
Harvested bone in the flute of a gold 5.0mm latch reamer.
A 4.5 x 8.0mm Bicon implant being inserted into its osteotomy with an inserter/retriever instrument.
A 5.0 x 5.0mm Bicon SHORT® implant being inserted into its osteotomy with polyethylene healing plug.
A 5.0 x 6.0mm Bicon SHORT® implant being inserted into the osteotomy with an inserter/retriever instrument.
Bicon Resorbable Collagen Membrane cut to size is being placed so that its margins extend onto surrounding bone on its mesial, distal, and apical borders.
Mixture of patient’s blood and SynthoGraft™ being injected over the shoulder of the implant with a bone graft syringe.
Black polyethylene healing plugs prior to their being cut.
Shouldered stealth abutment being inserted into its implant to support a fixed transitional prosthesis.
Composite material Integrity™ injected over the stealth acrylic temporization sleeves.
Transitional prosthesis in vacuum formed template removed for polishing.
Reinsertion of the polished transitional prosthesis.
Pre-operative maxillary site.
Extracted root.
A blue light-cured resin surgical template being used to indicate the appropriate mesio-distal positioning of the pilot osteotomies.
Pilot osteotomy being drilled with a 2.0mm pilot drill with external irrigation.
View of paralleling pins seated in the initial osteotomies confirming their appropriate trajectory.
Osteotomy being enlarged with an olive green 2.5mm latch reamer rotating at 50RPM without irrigation.
Osteotomy being enlarged with a teal 3.0mm latch reamer rotating at 50RPM without irrigation.
Harvested bone in the flute of a blue 3.5mm latch reamer.
Osteotomy being enlarged with a red 4.0mm latch reamer rotating at 50RPM without irrigation.
Osteotomy being enlarged with a gold 5.0mm latch reamer rotating at 50RPM without irrigation.
A 5.0 x 6.0mm Bicon SHORT® implant being inserted into its osteotomy with an inserter/retriever instrument.
Bicon Resorbable Collagen Membrane cut to size is being placed so that its margins extend onto surrounding bone on its mesial, distal, and apical borders
Mixture of patient’s blood and SynthoGraft™ placed over the shoulder of the implant.
A 4.5 x 8.0mm Bicon implant being inserted into the osteotomy with an inserter/retriever.
Black polyethylene healing plugs prior to their being cut.
Stealth shouldered abutment is being inserted into its implant to support a fixed transitional implant.
An acrylic temporization sleeve is being inserted onto its stealth abutment to fabricate a fixed transitional prosthesis.
Appropriateness of the vacuum formed template is being confirmed.
Composite material Integrity™ injected over the acrylic temporization sleeves to form a strut.
Composite material Integrity™ injected into the vacuum formed template to be inserted over the strut.
Transitional prosthesis of acrylic sleeves and Integrity™ composite material is being formed.
Transitional prosthesis in vacuum formed template being removed for polishing.
Polished transitional prosthesis is being re-inserted onto the stealth abutments for the immediate loading of the implants.
Post-insertion radiograph.
Second Visit: Uncovering an implant level transfer impression of integrated implants. Black polyethylene healing plug being removed from the well of the implant with healing plug removal instrument.
Red 2.0mm, blue 2.5mm, and green 3.0mm titanium impression posts with corresponding acrylic sleeves in place for the making of a full arch implant level impression.
Impression material being injected around the red, blue and green impression sleeves for the making of a full arch implant level transfer impression
Impression sleeves within the full arch implant level transfer impression.
View of the titanium impression posts in place after the making of a full arch implant level transfer impression.
Stealth abutments being inserted and seated prior to snapping on the temporization sleeves for the making of a temporary prosthesis.
Facial view prior to snapping on of additional temporization sleeves for the making of a transitional fixed prosthesis.
Facial view of abutments with temporization sleeves.
Transitional composite material Integrity™ being injected around the acrylic temporization sleeves to form a strut.
Vacuum-formed template being inserted over the acrylic sleeves and strut to confirm its appropriateness.
Unpolished transitional prosthesis and vacuum formed template.
Transitional prosthesis being removed for polishing.
Polished transitional prosthesis after being snapped onto the abutments.
Edentulous maxillary ridge prior to the removal of black polyethylene healing plugs.
Black polyethylene healing plug being removed from the well of an implant with healing plug removal instrument.
Blue 2.5mm, and green 3.0mm titanium impression posts in place for the making of an implant level transfer impression.
Blue 2.5mm, and green 3.0mm titanium impression posts with corresponding acrylic sleeves in place for the making of a full arch implant level transfer impression.
Impression material being injected around the blue and green impression sleeves for the making of a full arch implant level transfer impression.
Impression sleeves within the full arch implant level transfer impression.
Temporization sleeve being inserted for the making of temporary guide tooth, which will give the technician the approximate length, width, midline, trajectory, and lip lines of the intended tooth.
Guide tooth being formed to provide technician with nonverbal information for the intended tooth.
Guide tooth and impression sleeves in place for the recording of the patients occlusal registration.
Pattern acrylic resin being applied to impression sleeves for the recording of a bite registration.
Recording a bite registration.
Maxillary temporary prosthesis being inserted.
Modifying the temporary prosthesis by injecting additional transitional.
Post impression radiograph revealing non-integrated implants.
Third Visit: Insertion of final and laboratory fabricated transitional prostheses.
Integrated Abutment Crowns™ and temporary prosthesis on stone model.
View of shouldered abutments on stone model.
Vaseline™ being applied to stabilize the partially seated abutments within the prosthesis, as they are transported intra-orally to their corresponding implant wells.
Milled abutments being incompletely inserted into the temporary prosthesis prior to their being transported to the mouth.
Edentulous maxillary ridge prior to the insertion of the temporary prosthesis and the Integrated Abutment Crowns™.
Temporary prosthesis being used to orient and individually seat the abutments into the wells of their corresponding implants.
Milled abutment being definitively seated into the well of its implant.
Temporary prosthesis being inserted onto the seated abutments.
A green 6.5mm sulcus reamer being used to remove any excess tissue above the implant prior to the insertion of an IAC® with an angled abutment.
Integrated Abutment Crown™ being inserted.
Integrated Abutment Crown™ being fully seated with a plastic healing abutment on a threaded straight handle.
Yellow thermoplastic custom orientation jig being used to confirm proper orientation of the Integrated Abutment Crowns™ and the temporary prosthesis.
Temporary prosthesis being inserted into the mouth.
Integrated Abutment Crown™ being inserted.
Integrated Abutment Crown™ being fully seated with a plastic healing abutment on a threaded straight handle.
Edentulous mandibular ridge prior to the insertion of Integrated Abutment Crowns™.
Integrated Abutment Crown™ being inserted.
Integrated Abutment Crown™ being inserted.
Integrated Abutment Crown™ being inserted.
Integrated Abutment Crown™ being fully seated with a plastic healing abutment on a threaded straight handle.
Fourth Visit: 2.5 months after the prosthetic insertion. Bone grafting and insertion of the remaining implants. Incision being made.
Blood being collected from surgical site to be mixed with SynthoGraft™ Pure Phase Beta-Tricalcium Phosphate.
View of the bony ridge.
Patients bone being removed for grafting.
View of the surgical site.
Perio probe being used to measure the site.
Osteotomy being enlarged with an olive green 2.5mm latch reamer rotating at 50RPM without irrigation.
Osteotomy being enlarged with a teal 3.0mm extended latch reamer rotating at 50RPM without irrigation.
Harvested bone in the flute of a red 4.0mm latch reamer.
A 4.5 x 8.0mm Bicon implant being inserted into the osteotomy with an inserter/retriever instrument.
Polyethylene healing plug being inserted into the well of the implant.
Mixture of patient’s blood and SynthoGraft™ placed over the shoulder of the implants.
Bicon Resorbable Collagen Plug placed over the SynthoGraft™.
Grafted surgical site prior to being sutured.
Sutured surgical site.
Post-operative radiograph.
Post-operative radiograph.
Fifth Visit: Six months after the placement of six Bicon implants. View of crestal ridge and two white temporary abutments in place prior to incisions being made.
Incision being made for the removal of the black polyethylene healing plugs.
Crestal incision revealing the black polyethlene healing plugs within the well of their implants.
Black polyethylene healing plug being removed from the well of the implant with a removal instrument.
Red 2.0mm and blue 2.5mm guide pins in the implant wells.
A magenta 4.0mm sulcus reamer being used to remove any excess tissue.
Shouldered abutment being tapped into place after the removal of the red 2.0mm paralleling pin.
Uncovering incision being made.
Healing plug being removed with a #110 endodontic file.
Well of the implant after the removal of the abutment.
Blue 2.5mm and green 3.0mm titanium impression posts in place.
Blue 2.5mm acrylic sleeve being placed onto corresponding titanium impression post.
Blue 2.5mm, and green 3.0mm titanium impression posts with corresponding acrylic sleeves in place for the making of a full arch implant level impression.
Impression material being injected around the blue and green impression sleeves for the making of a full arch implant level transfer impression.
Impression sleeves within the full arch implant level transfer impression.
Recording a bite registration after pattern acrylic resin was applied to the impression sleeves.
Occlusal registration being made.
Bite registration with impression sleeves in place.
Guide tooth being fabricated to provide technician with information for the size and morphology of the intended tooth.
Relieving incision being made.
Black polyethylene healing plug being removed from the well of the implant with healing plug removal instrument.
A magenta 4.0mm sulcus reamer being used to remove any excess tissue.
A red 2.0mm impression post being inserted into the implant well.
Red 2.0mm acrylic sleeve being placed onto corresponding titanium impression post.
Red 2.0mm, blue 2.5mm, and green 3.0mm titanium impression posts with corresponding acrylic sleeves in place for the making of a full arch implant level impression.
Impression material being injected around the red, blue and green impression sleeves for the making of a full arch implant level transfer impression.
Impression sleeves within the full arch implant level transfer impression.
Radiograph after uncovering.
Radiograph after uncovering.
Radiograph after uncovering.
Sixth Visit: Three months after the uncovering; insertion of the remaining IACs. Integrated Abutment Crowns™ on stone model
Temporary prosthesis being removed.
White healing abutment being removed.
Edentulous maxillary ridge prior to the insertion of the Integrated Abutment Crowns™.
Integrated Abutment Crown™ being inserted.
Yellow thermoplastic custom orientation jig being used to confirm proper orientation of the single Integrated Abutment Crown™.
Integrated Abutment Crown™ being inserted.
Integrated Abutment Crown™ being inserted.
Integrated Abutment Crown™ being inserted.
Integrated Abutment Crown™ being inserted.
Integrated Abutment Crown™ being inserted.
Integrated Abutment Crown™ being inserted.
Floss being used to confirm the fact that the interproximal contacts are passive and will not interfere with the engagement of the locking taper.
Yellow thermoplastic custom orientation jig being used to confirm proper orientation of the Integrated Abutment Crowns™.
Integrated Abutment Crown™ being fully seated with a plastic healing abutment on a threaded straight handle.
Yellow thermoplastic custom seating jig being used to facilitate directing the tapping forces in the long axis of the abutment post and implant well.
Removing the temporary prosthesis.
Edentulous mandibular ridge prior to the insertion of the Integrated Abutment Crowns™.
Integrated Abutment Crown™ being inserted.
Integrated Abutment Crown™ being inserted.
Blue 2.5mm paralleling pin being inserted into the well of the implant.
A magenta 4.0mm sulcus reamer being used to remove any excess tissue above the implant.
A gold 5.0mm sulcus reamer being used to remove any excess tissue above the implant.
Blue 2.5mm paralleling pin being removed from the well of the implant.
Excess tissue being removed from over the implant.
Integrated Abutment Crown™ being inserted.
Integrated Abutment Crown™ being inserted.
Yellow thermoplastic custom seating jig being used to facilitate directing the tapping forces in the long axis of the abutment post and implant well.
Floss being used to confirm the fact that the interproximal contacts are passive and will not interfere with the engagement of the locking taper.
Blue articulating paper being used to indicate occlusal contacts
Occlusal view indicating occlusal contacts.
Adjusting occlusal contacts.
Fourth Visit: Two weeks after the uncovering of two 4.0 x 8.0mm Bicon implants. Facial view of 12 maxillary IACs.
Facial view of 12 mandibular IACs.
Patient’s smile with 24 Integrated Abutment Crowns™.
Post-operative radiograph of 24 immediately restored implants with Integrated Abutment Crowns™.
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