Immediate Loading Using Guided Surgery for Two Maxillary Incisor SHORT® Implants with Fixed-Detachable Universal Abutments and a Five-Unit TRINIA® Prosthesis
This case demonstrates the extraction of three maxillary incisor teeth and, using guided surgery, the placement of two 4.5 x 8.0mm SHORT® Implants for immediate loading with a prefabricated five-unit TRINIA® prosthesis on three Fixed-Detachable Universal Abutments, one of which was inserted into a previously-integrated canine implant for a 70-year-old male patient.
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Radiographic image prior to treatment. Note the previously-integrated canine implant.
2.
Radiographic image of incisors prior to being extracted.
3.
Occlusal view of screw-retained TRINIA® prosthesis on stone model.
4.
Facial view of TRINIA® prosthesis.
5.
Occlusal view of stone model with three Fixed-Detachable Universal Abutment Analogs.
6.
3D-printed resin surgical guide on stone model.
7.
Pre-operative smile.
8.
Pre-operative clinical view.
9.
Temporary prosthesis being removed.
10.
Pre-operative site.
11.
Positioning of surgical guide being confirmed.
12.
Periotome being used to remove root of lateral incisor.
13.
Lateral incisor root being elevated.
14.
Root of lateral incisor being removed.
15.
Central incisor being removed.
16.
Lateral incisor being removed.
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Boney defect being debrided.
18.
Extraction socket being debrided.
19.
Residual piece of amalgam being removed.
20.
Surgical guide positioned prior to being used only with the 2.0mm Pilot Drill.
21.
Surgical guide being used to direct a 2.0mm Pilot Drill for the lateral incisor osteotomy.
22.
2.0mm Pilot Drill being rotated at 1100RPM with irrigation to initiate the central incisor osteotomy.
23.
Light yellow 2.5mm Hand Reamer attached to a Threaded Instrument Adapter being rotated at 50RPM to widen the central incisor osteotomy. Note the fastened transitional coping on the Fixed-Detachable Universal Abutment.
24.
Teal 3.0mm Hand Reamer attached to a Threaded Instrument Adapter being rotated at 50RPM to widen the lateral incisor osteotomy.
25.
Blue 3.5mm Hand Reamer attached to a Threaded Instrument Adapter being rotated at 50RPM to widen the central incisor osteotomy.
26.
Magenta 4.0mm Hand Reamer attached to a Threaded Instrument Adapter being rotated at 50RPM to widen the central incisor osteotomy.
27.
A spoon excavator being used to harvest autogenous bone, while confirming the integrity of the five walls of the lateral incisor osteotomy.
28.
Gray 4.5mm Hand Reamer attached to a Threaded Straight Handle being used to widen the lateral incisor osteotomy.
29.
Blue 2.5mm Implant Inserter/Retriever being used to transport a 4.5 x 8.0mm Bicon SHORT® Implant to its prepared lateral incisor osteotomy.
30.
Blue 2.5mm Implant Inserter/Retriever being used to transport a 4.5 x 8.0mm Bicon SHORT® Implant to its prepared central incisor osteotomy.
31.
View of placed 4.5 x 8.0mm Bicon SHORT® Implants.
32.
Blue 2.5mm Guide Pins inserted into the well of the implants to confirm their trajectories, and if necessary, adjust them.
33.
SynthoGraft™ synthetic bone augmentation material being applied. Note the black polyethylene healing plug in the implant well.
34.
Suture being placed prior to adding more SynthoGraft™.
35.
Surgical site with SynthoGraft™ prior to placement of membrane.
36.
Resorbable collagen membrane placed and sutured over the implant and SynthoGraft™ .
37.
Surgical site prior to closure of the flap.
38.
Sutured surgical site. Note the two black polyethylene healing plugs and the fastened transitional coping on the Fixed-Detachable Universal Abutment on the previously-integrated implant.
39.
Transitional coping being removed from the Fixed-Detachable Universal Abutment on the previously-integrated implant prior to replacing it with a retentive coping.
40.
Post-insertion radiograph revealing two 4.5 x 8.0mm implants with Fixed-Detachable Universal Abutments.
41.
Prosthetic components used: 2.5mm Post x 4.0mm Width x 5.0mm Height Fixed-Detachable Universal Abutments, Retentive Copings, 5.0mm Hex Coping Screws, and Hex Retention Screws
42.
Transitional TRINIA® prosthesis being fitted around two fastened retentive copings on two Fixed-Detachable Universal Abutments.
43.
Transitional TRINIA® prosthesis being modified with a finishing bur to facilitate a passive seating on the retentive copings.
44.
Retentive Coping being fastened to the lateral incisor Fixed-Detachable Universal Abutment with a 5.0mm Hex Coping Screw.
45.
Retentive Coping being fastened to the central incisor Fixed-Detachable Universal Abutment with a 5.0mm Hex Coping Screw to determine if it is the most appropriate length to be used.
46.
Retentive Coping being fastened to the left canine Fixed-Detachable Universal Abutment with a Hex Retention Screw.
47.
Retentive Copings fastened to the Fixed-Detachable Universal Abutments. Note the lateral incisor 5.0mm Hex Coping Screw was replaced with a Hex Retention Screw to facilitate the insertion of the prosthesis.
48.
Blue ink confirming occlusal contacts prior to the cementation of the prosthesis onto the fastened retentive copings.
49.
Resin cement being applied to the bores of the transitional TRINIA® prosthesis.
50.
Transitional TRINIA® prosthesis being cemented onto the fastened retentive copings.
51.
Retention screw being unfastened to allow for the removal of the cemented transitional TRINIA® prosthesis.
52.
Retention screw being unfastened to allow for the removal of the cemented transitional TRINIA® prosthesis.
53.
Transitional TRINIA® prosthesis with cemented Fixed-Detachable Universal Abutment Copings after the extraoral removal of extraneous cement.
54.
Transitional TRINIA® prosthesis with three cemented retentive copings being reinserted onto three Fixed-Detachable Universal Abutments.
55.
Transitional TRINIA® prosthesis being definitively fastened to the Fixed-Detachable Universal Abutments using a Hex Screwdriver and a Hex Retention Screw.
56.
Transitional TRINIA® prosthesis being definitively fastened to the Fixed-Detachable Universal Abutments using a Hex Screwdriver and a Hex Retention Screw.
57.
Transitional TRINIA® prosthesis being definitively fastened to the Fixed-Detachable Universal Abutments using a Hex Screwdriver and a Hex Retention Screw.
58.
Patient's smile.
59.
Occlusal view of fastened transitional TRINIA® prosthesis.
60.
Radiograph of fastened transitional TRINIA® prosthesis.
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