Bilateral Sinus Lifts with SynthoGraft™, Two Stage Full Arch Placement of Twelve Maxillary and Two Mandibular Implants, and their Restoration with Fourteen Bicon Integrated Abutment Crowns™
This case demonstrates the use of SynthoGraft™, pure phase Beta-Tricalcium Phosphate, for bilateral sinus lifts, two stage placement and restoration of fourteen implants, implant level transfer impressions, occlusal registration, and insertion of fourteen Integrated Abutment Crowns™ including one two-unit Integrated Abutment Crown™ for the intraoral fabrication of a three unit prosthesis.
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Window being prepared with Bicon sinus lift bur (260-201-029).
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Sinus lift curette being used to elevate sinus membrane.
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Sinus lift curette being used to elevate sinus membrane.
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Mixture of patient’s blood and SynthoGraft™, Beta-Tricalcium Phosphate.
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Bicon resorbable collagen membrane being placed into the sinus floor.
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The mixture of patient’s blood and SynthoGraft™, Beta-Tricalcium Phosphate, being injected.
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Osteotomy being prepared with 2.0mm pilot bur rotating at 1100 RPM with external irrigation.
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Parallel pin seated in pilot osteotomy indicating its trajectory.
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Osteotomy being prepared with 2.0mm pilot bur rotating at 1100 RPM with external irrigation.
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Osteotomy being enlarged with an olive green 2.5mm latch reamer rotating at 50 RPM without irrigation.
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Osteotomy being enlarged with a teal 3.0mm latch reamer rotating at 50 RPM without irrigation.
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Osteotomy being enlarged with a dark blue 3.5mm latch reamer rotating at 50 RPM without irrigation.
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Osteotomy being enlarged with a red 4.0mm latch reamer rotating at 50 RPM without irrigation.
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Harvested bone within the flute of the silver 4.5mm hand reamer.
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Osteotomy being enlarged with a gold 5.0mm hand reamer.
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A 4.5 mm x 8.0mm HA coated implant being inserted into the osteotomy with an implant inserter/retriever.
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A 5.0 mm x 6.0mm HA coated implant being inserted into the osteotomy with an implant inserter/retriever.
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Cut polyethylene healing plug being placed into the implant well for two stage implant placement.
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Cut polyethylene healing plug being placed into the implant well for two stage implant placement.
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View of initial incision.
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Osteotomy being prepared with 2.0mm pilot bur rotating at 1100 RPM with external irrigation.
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Parallel pins confirming appropriate trajectories and acting as guides for subsequent osteotomy.
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Maxillary osteotomy being prepared with 2.0mm pilot bur rotating at 1100 RPM with external irrigation.
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Parallel pins seated in pilot osteotomies indicating their trajectories.
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Osteotomy being enlarged with an olive green 2.5mm latch reamer rotating at 50 RPM without irrigation.
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Harvested bone within the flute of an olive green 2.5mm latch reamer.
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Osteotomy being enlarged with a teal 3.0mm latch reamer rotating at 50 RPM without irrigation.
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Osteotomy being enlarged with a dark blue 3.5mm latch reamer rotating at 50 RPM without irrigation.
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Osteotomy being enlarged with a red 4.0mm latch reamer rotating at 50 RPM without irrigation.
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Harvested bone within the flute of a silver 4.5mm hand reamer.
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Harvested bone within the flute of a silver 4.5mm hand reamer being placed into dappin dish.
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A 4.5 mm x 6.0mm HA coated implant being inserted into the osteotomy with an implant inserter.
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A 4.5 mm x 6.0mm HA coated implant being inserted into the osteotomy with an implant inserter.
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A 4.5 mm x 6.0mm HA coated implant being inserted into the osteotomy with an implant inserter.
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An implant being tapped into place.
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A 3.5 x 8.0mm HA coated implant being inserted into the osteotomy with an implant inserter/retriever.
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Cut polyethylene healing plug being placed into the implant well for two stage placement.
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Osteotomy being prepared with 2.0mm pilot bur rotating at 1100 RPM with external irrigation.
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Parallel pin confirming appropriate trajectory and acting as a guide for subsequent osteotomy.
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Osteotomy being enlarged with an olive green 2.5mm latch reamer rotating at 50 RPM without irrigation.
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Osteotomy being enlarged with a teal 3.0mm latch reamer rotating at 50 RPM without irrigation.
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Osteotomy being enlarged with a dark blue 3.5mm latch reamer rotating at 50 RPM without irrigation.
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Osteotomy being enlarged with a red 4.0mm latch reamer rotating at 50 RPM without irrigation.
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Osteotomy being enlarged with a silver 4.5mm hand reamer.
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A 4.5 mm x 6.0mm HA coated implant being inserted into the osteotomy with an implant inserter.
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Post operative radiograph.
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Second Clinical Visit: View of flap being reflected for the grafting of right mandibular molar area with SynthoGraft™, pure phase Beta-Tricalcium Phosphate (Ca3 (PO4)2).
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Mixture of patient’s blood and SynthoGraft™, Beta-Tricalcium Phosphate.
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Bicon collagen membrane covering the synthograft™, Beta-Tricalcium Phosphate.
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Bicon collagen membrane covering the synthograft™, Beta-Tricalcium Phosphate.
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Sutured site.
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View of torn sinus membrane.
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Bicon’s resorbable collagen membrane being used to bridge the tear for the containment of the SynthoGraft™, Beta-Tricalcium Phosphate, particles.
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The mixture of patient’s blood and SynthoGraft™, Beta-Tricalcium Phosphate, placed into the sinus floor.
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The mixture of patient’s blood and SynthoGraft™, Beta-Tricalcium Phosphate, being placed.
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View of sinus with SynthoGraft™, Beta-Tricalcium Phosphate, in place.
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Sutured site.
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View of extracted tooth.
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View of initial incision.
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Osteotomy being enlarged with an olive green 2.5mm latch reamer rotating at 50 RPM without irrigation.Osteotomy being enlarged with a silver 4.5mm hand reamer.
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Harvested bone within the flute of dark blue 3.5mm latch reamer.
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Osteotomy being enlarged with a silver 4.5mm hand reamer.
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A 4.5 x 6.0mm HA coated implant being inserted into the osteotomy with an implant inserter.
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A 5.0 x 6.0mm HA coated implant being inserted into the osteotomy with an implant inserter.
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Cut polyethylene healing plug being placed into the implant well for two stage placement.
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Osteotomy being prepared with 2.0mm pilot bur rotating at 1100 RPM with external irrigation.
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Osteotomy being prepared with 2.0mm pilot bur rotating at 1100 RPM with external irrigation.
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Osteotomy being enlarged with an olive green 2.5mm latch reamer rotating at 50 RPM without irrigation.
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Osteotomy being enlarged with a teal 3.0mm latch reamer rotating at 50 RPM without irrigation.
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Osteotomy being enlarged with a dark blue 3.5mm latch reamer rotating at 50 RPM without irrigation.
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Osteotomy being enlarged with a red 4.0mm latch reamer rotating at 50 RPM without irrigation.
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Osteotomy being enlarged with a silver 4.5mm latch reamer rotating at 50 RPM without irrigation.
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Harvested bone within the flute of a silver 4.5mm hand reamer.
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Harvested bone within the flute of a gold 5.0mm hand reamer.
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Curette harvesting residual bone while confirming the integrity of the five bony walls of the osteotomy.
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A 5.0 x 6.0mm HA coated implant being inserted into the osteotomy with an implant inserter/retriever.
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A 5.0 x 6.0mm HA coated implant being inserted into the osteotomy with an implant inserter/retriever.
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An implant being tapped into place.
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View of seated implants with their polyethylene healing plugs.
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Cut polyethylene healing plug being placed into the implant well for two stage placement.
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Harvested bone being placed over the shoulder of the implant.
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A stealth shouldered abutment 5.0mm wide with a shoulder height of 4.0 mm being inserted into the implant well with only finger pressure.
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Flap being reflected for the two stage uncovering of the implants.
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Healing plug being removed with a healing plug removal instrument.
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A 5.0mm x 4.0mm 10°stealth shouldered abutment being inserted into the implant well with only finger pressure.
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A 5.0mm x 4.0mm stealth shouldered abutment being inserted into the implant well with only finger pressure.
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A 5.0mm x 4.0mm stealth shouldered abutment being inserted into the implant well with only finger pressure.
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Post operative radiograph.
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Modified acrylic sleeve being snapped onto stealth abutment.
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Vacuum-formed template seated over acrylic sleeves to check for occlusal clearance.
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Composite material is being injected into vacuum-formed template.
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Composite material, “Integrity by Dentsply”, being added to acrylic sleeves to form a strut.
Fourth Clinical Visit: Red acrylic being injected around the impression posts for the recording of an occlusal registration.
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Red acrylic on impression posts for the recording of an occlusal registration.
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View after the removal of the transitional prostheses on the right side.
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Red acrylic being injected around the impression posts.
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Midline being marked on the red acrylic.
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View of occlusal registration with marked midline.
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High lip line being marked.
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Occlusal registration being removed.
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Scissors reflecting flap revealing black polyethylene healing plug prior to its removal.
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Healing plug removed from the well of the implant with a healing plug remover.
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A 3.0mm titanium impression post being seated into the well of an integrated implant for the making of an implant level transfer impression.
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A green 3.0mm plastic sleeve being snapped onto the 3.0mm titanium impression post.
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Healing plug being removed from the well of the implant with a healing plug remover.
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A 2.0mm titanium impression post being seated into the well of an integrated implant for the making of an implant level transfer impression.
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Healing plug being removed from the well of the implant with a healing plug remover.
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A 3.0mm titanium impression post being seated into the well of an integrated implant for the making of an implant level transfer impression.
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A red 2.0mm plastic sleeve being snapped onto the 2.0mm titanium impression post.
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Incision being made for the uncovering of the implant.
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Healing plug being removed from the well of the implant with a healing plug remover.
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A 4.0mm x 3.5mm stealth shouldered abutment being removed.
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A 3.0mm titanium impression post being seated into the well of an integrated implant for the making of an implant level transfer impression.
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Healing plug being removed from the well of the implant with a healing plug remover.
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Impression material being injected around the impression sleeves for the making of a full arch implant level transfer impression.
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View of trimmed black polyethylene healing plug seated in the well of the implant.
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Healing plug being removed from the well of the implant with a healing plug remover.
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A 2.0mm titanium impression post being seated into the well of an integrated implant for the making of an implant level transfer impression.
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A red 2.0mm plastic sleeve being snapped onto the 2.0mm titanium impression post.
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Impression material being injected around the impression sleeves for the making of a full arch implant level transfer impression.
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Digital image being taken of shade guide to facilitate the fabrication of aesthetic Integrated Abutment Crowns™.
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Fifth Clinical Visit: Mandibular Integrated Abutment Crowns™ on stone model.
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View of Integrated Abutment Crowns™.
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Maxillary Integrated Abutment Crowns™ on stone model.I
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View of Integrated Abutment Crowns™.
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ntegrated Abutment Crowns™ on stone model with yellow thermoplastic seating jigs, which were fabricated on a crown alignment device to facilitate directing the seating forces in the long axis of the implant well and abutment post.
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View of implant wells and soft tissue sulci.
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Integrated Abutment Crown™ being inserted.
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Well of implant being cleaned with alcohol on a cotton tipped applicator.
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Abutment post being cleaned with alcohol wipe to remove any debris which would diminish the effectiveness of the locking taper connection.
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Integrated Abutment Crown™ being inserted.
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Floss being used to confirm the fact that the interproximal contacts are passive and will not interfere with the engagement of the locking taper.
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Well of implant being cleaned with alcohol on a cotton tipped applicator.
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Abutment post being cleaned with alcohol wipe to remove any debris which would diminish the effectiveness of the locking taper connection.
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Integrated Abutment Crown™ being inserted.
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Integrated Abutment Crown™ being inserted.
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Floss being used to confirm the fact that the interproximal contacts are passive and will not interfere with the engagement of the locking taper.
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Abutment post being cleaned with alcohol wipe to remove any debris which would diminish the effectiveness of the locking taper connection.
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Integrated Abutment Crown™ being inserted.
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Well of implant being cleaned with alcohol on a cotton tipped applicator.
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Well of implant being cleaned with alcohol on a cotton tipped applicator.
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Integrated Abutment Crown™ being inserted.
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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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Interproximal contact being adjusted with metal finishing strip.
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Interproximal contact being adjusted.
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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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White healing abutment in a straight handle is being used to tap the Integrated Abutment Crown™ into the well of the implant.
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White healing abutment in a straight handle is being used to tap the Integrated Abutment Crown™ into the well of the implant.
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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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Composite being added to interproximal surface for intraoral bonding.
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The cantilevered Integrated Abutment Crown™ being seated prior to its being bonded intraorally for the fabrication of a three-unit fixed prosthesis.
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Light curing of the added composite material for the fabrication of a three-unit fixed prosthesis.
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Blue markings confirming appropriate occlusal contacts in all extreme excursions while the patient was clenching.
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Facial view immediately after insertion of Integrated Abutment Crowns™.
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Patient’s smile immediately after insertion of Integrated Abutment Crowns™.
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Integrated Abutment Crown™ being adjusted.
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Left profile view.
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Right profile view.
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View immediately after adjusting Integrated Abutment Crowns™.
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Patient’s smile immediately after adjusting Integrated Abutment Crown™.
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Post operative radiograph after the insertion of Integrated Abutment Crowns™.
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