This case demonstrates a protocol and nuances for extractions, intra-foraminal placements of four SHORT® Implants and three TP Fixed-Detachable Universal Abutment (FDUA) Transitional Implants, and immediate loading of the Transitional Implants with a full-arch TRINIA® prosthesis using a Gothic arch tracing technique, for the atrophic mandible of a sixty-six-year-old female patient in only three clinical visits.
Case continues here: VIEW CASE
TOPICS: TRINIA®
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Preoperative radiograph.
Preoperative clinical view.
Right preoperative profile view.
Left preoperative profile view.
Vertical Dimension of Occlusion (VDO) being recorded.
Mandibular wax rim with stylus for Gothic arch tracing.
Maxillary wax rim with metal plate for Gothic arch tracing.
Mandibular movements tracing Gothic arch on maxillary metal plate.
Bite registration being made with stylus positioned at the apex of the Gothic arch tracing.
Wax rims with bite registration being removed for articulation of models.
Fixed prosthesis being sectioned prior to the removal of the teeth.
Periotome being used to facilitate removal of a tooth.
View of extracted tooth.
Post extraction view.
Height of alveolar bone being reduced and shaped to facilitate prosthesis.
Initial osteotomy being prepared with 2.0mm Pilot Drill rotating at 1100RPM with external irrigation.
Adjacent Paralleling Pins being used to facilitate the positioning of the final osteotomy drill.
Teal 3.0mm Hand Reamer attached to a Threaded Instrument Adapter being rotated at 50RPM to widen the permanent implant osteotomy.
Blue 3.5mm Hand Reamer attached to a Threaded Instrument Adapter being rotated at 50RPM between Paralleling Pins in the Transitional Implant osteotomies.
Depth Gauge being used to confirm the depth of the permanent implant's osteotomy.
Gray 4.5mm Hand Reamer attached to a Threaded Instrument Adapter being removed with harvested bone from the osteotomy.
Components used in this case: Transitional Implant Latch Driver, Retentive Copings, 2.5 x 8.0mm Tall Profile (TP) Fixed-Detachable Transitional Implants, Hex Screwdriver, and 5.0mm Hex Retention Screws.
NOTE: The Tall Profile (TP) Fixed-Detachable Transitional Implant was chosen to provide prosthetic shoulder at or above the mucosa.
A 2.5 x 8.0mm Fixed-Detachable Transitional Implant is being transported to its osteotomy with cotton pliers.
Transitional Implant being inserted into osteotomy with Transitional Implant Latch Driver.
Transitional Implant being inserted into osteotomy with Transitional Implant Latch Driver
Transitional Implant fully seated with its hemispherical base resting on alveolar bone
Transitional Implant Latch Driver being used to rotate the Transitional Implant into its osteotomy.
Transitional Implant Latch Driver being used to rotate 2.5 x 8.0mm Transitional Implant into its osteotomy.
Three fully seated Transitional Implants as evidenced by their hemispherical base resting on alveolar bone.
Transitional TRINIA® prosthesis.
Liberal size opening within transitional TRINIA® prosthesis to accommodate screw retained copings in prosthetic components of Transitional Implants.
Tryin of TRINIA® prosthesis over Transitional Implants.
A 4.5mm x 6.0mm SHORT® Implant with a 3.0mm well being transported to the osteotomy with a black Healing Plug.
Osteotomy being enlarged with a gray 4.5mm Latch Reamer rotating at 50RPM without irrigation.
Bone chip being removed from osteotomy with a spoon excavator.
A 4.5mm x 6.0mm SHORT® Implant with a 3.0mm well being transported to the osteotomy with a black Healing Plug.
A 4.5mm x 6.0mm SHORT® Implant with a 3.0mm well being inserted into the osteotomy with a black Healing Plug.
Osteotomy being enlarged with a gray 4.5mm Latch Reamer rotating at 50RPM without irrigation.
A 4.5mm x 6.0mm SHORT® Implant with a 3.0mm well being inserted into the osteotomy with a black Healing Plug.
A 4.5mm x 6.0mm SHORT® Implant with a 3.0mm well being transported with a black Healing Plug to the osteotomy.
A black Healing Plug being removed from implant.
Implant is being definitively seated by a gentle tap with a 3.0mm Seating Tip attached to an Offset Driver.
Implant is being definitively seated by a gentle tap with a 3.0mm Seating Tip attached to an Offset Driver.
View of three green 3.0mm Guide Pins and three Transitional Implants.
Transitional TRINIA® prosthesis being seated over Guide Pins and Transitional Implants.
Occlusal view of seated TRINIA® Prosthesis with liberal size opening, which facilitates seating of the prosthesis over Transitional Implants.
Guide Pin being removed from permanent implant.
View of seated permanent SHORT® Implants and Transitional Implants.
Retraction suture being removed prior to the closure of the flap.
Harvested bone placed over permanent SHORT® Implants adjacent to Transitional Implants.
Surgical site being sutured.
Harvested bone being placed over permanent SHORT® Implants adjacent to Transitional Implants.
Clinical view of sutured site around prosthetic portion of three Transitional Implants.
Radiographic image of four permanent SHORT® Implants and three Transitional Implants.
4.0mm Coping being attached to Transitional Implant with a 5.0mm Hex Retention Screws.
Hex Screwdriver attached to a 5.0mm screw transporting coping to Transitional Implant.
Hex Screwdriver attached to a 5.0mm screw transporting coping to Transitional Implant.
View of three copings attached to prosthetic portion of Transitional Implants with 5.0mm Hex Retention Screws.
TRINIA® prosthesis being seated over Hex Retention Screws attached to Transitional Implants.
Occlusal view of seated prosthesis over Transitional Implants.
Vaseline being applied ONLY to Hex Retention Screws to facilitate their removal after resin cementation of the coping.
Vaseline being applied on sutures to prevent their attachment to resin cement.
Resin cement being applied to mechanically attach the copings to the TRINIA® prothesis.
Additional resin cement being injected into the screw-retained TRINIA® prosthesis.
Occlusal view of three 5.0mm Hex Retention Screws in in the resin cemented TRINIA® prosthesis.
Hex Screwdriver being used to unfasten 5.0mm Hex Retention Screw from Transitional Implant.
5.0mm Hex Retention Screw being removed from TRINIA® prosthesis.
Crown removal instrument being used to facilitate the removal of the prosthesis.
TRINIA® prosthesis prior to the removal of a resin embedded suture.
Occlusal view of TRINIA® prosthesis after removal of extraneous cement.
View of three mechanically cemented copings within TRINIA® prosthesis after the removal of extraneous cement.
TRINIA® prosthesis with with resin cemented copings being inserted onto Transitional Implants.
Prosthesis being fastened with a 5.0mm Hex Retention Screw.
View of seated TRINIA® prosthesis.
Hex Retention Screw being removed with a Hex Screwdriver to adjust the flange of the prosthesis, which was impinging on the mucosa.
Crown Removal Instrument being used to remove TRINIA® prosthesis.
View of TRINIA® prosthesis after the modification of the flanges, which were impinging on soft tissues.
Flange adjusted TRINIA® prosthesis being seated.
Hex Screwdriver being used to fasten the flange-modified prosthesis.
Flowable composite being applied to provide a smooth surface around the 5.0mm Hex Retention Screw.
Flowable composite being light cured.
View of screw-retained transitional TRINIA® prosthesis.
Patient's smile.
Post-insertion panoramic radiograph.
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