This case demonstrates the two-stage maxillary placement of four Bicon implants, uncovering, implant-level transfer impressions, the concept and clinical techniques for fabricating a maxillary and mandibular metal-free implant supported fixed TRINIA™ prosthesis on Bicon implants.
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Second Visit: Maxillary placement. Pre-operative radiograph.
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Pre-operative clinical image.
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Initial incisions.
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Mucosal flap reflection.
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Pilot osteotomy being drilled with a 2.0mm pilot drill.
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Paralleling pin seated in pilot osteotomy indicating its trajectory.
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Harvested bone in the flute of an olive green 2.5mm latch reamer.
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Osteotomy being enlarged with a teal 3.0mm hand reamer attached to a hand reamer extension.
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Harvested bone in the flute of a blue 3.5mm hand reamer.
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Osteotomy being enlarged with a magenta 4.0mm hand reamer attached to a hand reamer extension.
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Osteotomy being enlarged with a gray 4.5mm hand reamer attached to a hand reamer extension.
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Osteotomy being enlarged with a gold 5.0mm hand reamer attached to a hand reamer extension.
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A 5.0 x 6.0mm Bicon implant being inserted into the osteotomy.
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A 4.5 x 6.0mm Bicon implant with a 2.5mm well being inserted into the osteotomy.
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Seated 5.0 x 6.0mm implant with polyethylene healing plug prior to the plug being cut.
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Seated implants after polyethylene healing plugs have been cut.
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Harvested bone being placed over the shoulder of an implant.
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Bicon resorbable collagen membrane being placed over an implant and the bone.
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Sutured surgical site.
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Post-operative radiograph.
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Third Visit: Three months after the placement of one maxillary 5.0 x 6.0mm and three 4.5 x 6.0mm implants. Radiograph prior to uncovering the implants.
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View of surgical site prior to uncovering the implants.
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Green 3.0mm impression posts in place before the making of a full arch implant level transfer impression.
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Impression material being injected around the green impression sleeves for the making of a full arch implant level transfer impression.
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Green impression sleeves within the full arch implant level transfer impression.
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White healing abutment being tapped into place in the well of the implant.
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White healing abutments seated in the implant wells.
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View of surgical site prior to uncovering of the implants.
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Uncovering a mandibular implant.
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Black healing plug being removed.
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Green 3.0mm and blue 2.5mm seated guide pins being used to assess the trajectory of the four integrated Bicon implants.
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A blue 2.5mm titanium impression post with an acrylic sleeve being seated into an implant well.
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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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Green and blue impression sleeves within the full arch implant level transfer impression.
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White healing abutment being inserted into the well of an implant.
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White healing abutment being tapped into place.
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White healing abutments seated in the implant wells.
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Fourth Visit: Bite registration. White plastic healing abutment being removed.
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Green 3.0mm impression post being placed into the implant well.
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Green 3.0mm and blue 2.5mm impression posts in place.
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View of wax rim prior to recording an occlusal registration.
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Bite registration being made.
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Bite registration being made.
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Fifth Visit: Insertion. Mirrored view of the maxillary TRINIA™ fiber reinforced prosthesis prior to its being inserted.
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Mirrored view of the maxillary ridge side of the TRINIA™ prosthesis.
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Mirrored view of the mandibular TRINIA™ fiber reinforced prosthesis prior to its being inserted.
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Mirrored view of the mandibular ridge side of the TRINIA™ prosthesis.
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White plastic healing abutments being removed prior to the insertion of the mandibular TRINIA™ prostheses.
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Vaseline™ being applied to stabilize the partially seated abutments within the prosthesis as they are transported intra-orally to their corresponding implant wells.
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TRINIA™ prosthesis with four incompletely seated abutments being transported to the mouth.
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Abutments being initially seated by tapping on the prosthesis with a white plastic healing abutment attached to a threaded straight handle.
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View of four milled abutments after the removal of the TRINIA™ prosthesis.
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A milled abutment being definitively seated into the well of its implant.
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Vaseline™ being applied to the ridge area of the TRINIA™ prosthesis to facilitate the removal of any extraneous cement.
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Minimal resin cement being applied to the bores of the mandibular TRINIA™ prosthesis.
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Extraneous cement being removed.
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Mandibular TRINIA™ prosthesis after being permanently cemented.
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White plastic healing abutment being removed prior to the insertion of the maxillary TRINIA™ prosthesis.
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A gold 5.0mm sulcus reamer being used to remove any excess tissue above the implant to facilitate the seating of the milled abutment.
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TRINIA™ prosthesis with four incompletely seated abutments being transported to the mouth.
61.
Abutments being initially seated by tapping on the prosthesis with a white plastic healing abutment attached to a threaded straight handle.
62.
View of four milled abutments after the removal of the TRINIA™ prosthesis.
63.
Minimal cement being applied to the bores of the mandibular TRINIA™ prosthesis.
64.
Maxillary TRINIA™ prosthesis after being permanently cemented.
65.
Facial view of TRINIA™ prostheses after being permanently cemented.
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