This case demonstrates the uncovering and the temporization of nine maxillary two stage implants and the placement and temporization of nine immediately stabilized and loaded implants during a single four-hour patient visit.
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Wax bite rims being used to establish vertical dimension of occlusion.
2.
Initial vertical dimension of occlusion being recorded.
3.
Maxillary edentulous ridge with several implants appearing through the mucosa.
4.
Mandibular ridge with recent extraction sites.
5.
Crestal incision for the uncovering of nine two stage implants.
6.
Removal of 3.0mm black polyethylene healing plug from well of implant.
7.
Nine guide pins positioned in implants revealing their position and trajectory.
8.
Shoulder depth gauge inserted into implant well to indicate the appropriate shoulder height for desired gingival margin placement.
9.
A 5.0mm wide stealth abutment with a shoulder height of 4.0mm above the implant (5.0mm x 4.0mm) is being inserted into the implant well with only finger pressure.
10.
Shoulder depth gauge inserted into implant well to indicate the appropriate shoulder height for the desired gingival margin placement.
11.
An arbitrarily chosen vacuum-formed template being inserted over stealth abutments.
12.
Appropriateness of vacuum-formed template is being confirmed.
13.
Shouldered abutments seated with only finger pressure in the well of their implants.
14.
A short one-piece acrylic sleeve being inserted or snapped onto a stealth abutment.
15.
The trimming of a short one-piece acrylic sleeve to facilitate the development of a normal interdental papilla.
16.
Trimming of a second one-piece acrylic sleeve. Appropriate abutment and sleeve width is determined by the anatomy of the interdental papilla.
17.
Facial view of one tall and multiple short one-piece acrylic sleeves.
18.
Occlusal view of one-piece acrylic sleeves.
19.
Shortening of long acrylic sleeve which was chosen because of its narrow diameter.
20.
Composite material “Integrity” by Dentsply is being injected around one-piece sleeves to form a rigid strut.
21.
Composite material “Integrity” by Dentsply being injected forming a strut over the stealth abutments.
22.
Strut being reduced with a diamond bur to facilitate the chosen vacuum-formed template.
23.
Prepared strut prior to having additional composite material “Integrity” by Dentsply added to it.
24.
Perforations being made in template to facilitate the flow of material without trapping air during and after the placement of the material in the stent.
25.
Integrity” material only being injected into the occlusal portion of template.
26.
Additional “Integrity” material being injected onto strut.
27.
Template being inserted onto strut for the bonding of the new material to the strut.
28.
Newly added “Integrity” material is being bonded to the previously hardened “Integrity” material.
29.
Removal of Template.
30.
Removal of transitional prosthesis from stealth abutments for polishing.
31.
Insertion of right side of transitional prosthesis.
32.
Polished transitional prosthesis snapped onto stealth abutments without the use of any cement.
33.
Mandibular stone model marked for the fabrication of a surgical guide template.
34.
Pink surgical guide template on model.
35.
Mandibular crestal incision.
36.
Placement of surgical guide.
37.
Trajectory and position of pilot bur being facilitated by use of surgical guide.
38.
Eleven paralleling pins indicate the positioning of pilot osteotomies. Due to minimal bone, not all pilot holes will be used.
39.
Osteotomy is being enlarged with latch reamer bur.
40.
Latch reamer filled with harvested bone.
41.
Harvested bone in dappin dish.
42.
Black polyethylene implant inserting handle in seated implant.
43.
Two black inserting handles in implants prior to their being replaced with stealth shouldered abutments.
44.
Two shouldered abutments seated in implants with only finger pressure.
45.
Shouldered depth gauge being used to ascertain the appropriate abutment shoulder height.
46.
Insertion of shouldered abutment into implant well.
47.
Insertion of ninth abutment.
48.
Insertion of fifth short one-piece acrylic sleeve.
49.
Insertion of sixth short one-piece acrylic sleeve.
50.
Insertion of seventh short one-piece acrylic sleeve.
51.
Occlusal view of nine one-piece acrylic sleeves which have been snapped onto shouldered abutments.
52.
View of recently inserted maxillary transitional prosthesis and the nine short one-piece acrylic sleeves.
53.
Composite material “Integrity” being injected around one-piece sleeve to form a rigid strut.
54.
Rigid strut being made with one piece sleeves and Dentply’s product “Integrity”.
55.
Arbitrarily chosen vacuum formed template placed over strut to determine if reduction of the strut is necessary prior to additional “Integrity” material being added.
56.
Perforations are being made in template to prevent the entrapment of air in the transitional prosthesis.
57.
“Integrity” composite material is being injected only into the occlusal portion of the template.
58.
“Integrity” material is being injected over the previously hardened Integrity material prior to insertion of template.
59.
Transitional vertical dimension of occlusion is being established by contacting the maxillary transitional prosthesis.
60.
Confirmation of transitional vertical dimension is being confirmed with the previously recorded measurements.
61.
Blue markings indicate inappropriate occlusal contact.
62.
Contacts being reduced.
63.
A balanced functional occlusion was easily established by the additional application of the “Integrity” material to the occlusal surface of the mandibular prosthesis.
64.
Since Vaseline was applied to the maxillary occlusal surface the additional "Integrity" material only bonded to the mandibular prosthesis.
65.
Removal of transitional prosthesis for polishing.
66.
Shouldered abutments seated with finger pressure in the just placed implants.
67.
Polished transitional prosthesis prior to its insertion onto shouldered abutments.
68.
Transitional prosthesis being seated onto abutments.
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