Two Extra-Orally Cemented Crowns On Immediately Placed and Loaded Implants

This case demonstrates the facility with which two maxillary central incisors can be extracted and replaced with two immediately loaded Bicon implants for the insertion of two extra-orally cemented all-ceramic crowns on the patient’s second clinical visit. It also demonstrates the ease of predictably achieving excellent gingival aesthetics.

SURGICAL: Extraction Immediate Placement
RESTORATIVE: All-Ceramic Crowns
TOPICS: Crown Insertion Impression
TAGS: Extra-Oral Cementation

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1.

Preoperative view of maxillary central incisors with lack of papilla.

2.

Preoperative radiograph revealing close proximity of endodontically treated roots.

3.

Extraction of maxillary left central incisor.

4.

Currette being used to remove remnants of periodontal ligament.

5.

Extraction sites.

6.

Latch reamer preparing osteotomy at 40RPM without water irrigation.

7.

Implant being placed onto implant inserter / retriever device.

8.

Implant being inserted into osteotomy site.

9.

Shoulder depth gauge seated into implant well to indicate the height of the mucosa relative to the shoulder position of the intended abutment.

10.

Acrylic sleeve being placed onto a 5.0mm x 4.0mm shouldered abutment.

11.

Acrylic sleeve and shouldered abutment being inserted into the implant.

12.

Second sleeve and abutment being placed into implant.

13.

Acrylic sleeves prior to temporization.

14.

Vacuum-formed template confirming clearance over one-piece acrylic sleeves.

15.

Composite transitional material being applied to acrylic sleeves.

16.

Transitional resin material being applied into the incisal half of template.

17.

Template being inserted over the splinted acrylic sleeves.

18.

Excess resin material being expressed from template.

19.

Transitional prosthesis being removed from shouldered abutments for polishing.

20.

Shouldered abutment being removed from implant well.

21.

Second abutment being removed.

22.

White impression post being inserted into 3.0mm implant well.

23.

Second impression post being seated with finger pressure into the implant well.

24.

Impression material being injected around impression post.

25.

Transfer pick up impression being made.

26.

White implant analogs seated onto impression posts.

27.

Adjacent teeth being etched prior to their being splinted to transitional prosthesis.

28.

Bonding agent being applied to adjacent teeth.

29.

Bonding agent being light cured.

30.

Polished transitional prosthesis with palatal aprons being confirmed for fit.

31.

Gingival view of prosthesis.

32.

A 5.0mm x 4.0mm shouldered abutment being inserted into the prosthetic sleeve.

33.

Shouldered abutments and transitional prosthesis being inserted into implants.

34.

Transitional prosthesis being inserted into implants.

35.

Prosthesis being bonded to adjacent teeth for stabilization of integrating implants.

36.

Bonded transitional prosthesis.

37.

Single midline suture attempting to improve gingival contour.

38.

Radiograph of immediately placed implants and abutments.

39.

Stone model with white implant analogs and 5.0mm x 2.0mm abutments.

40.

Aluminum oxide sleeves on shouldered abutments prior to porcelain application.

41.

All-ceramic crowns fabricated by adding porcelain directly onto aluminum-oxide sleeves.

42.

Red acrylic incisal template or jig for aiding in the orientation of the crowns intra-orally.

43.

Mirror view of all-ceramic crowns.

44.

View of transitional prosthesis 13 weeks after implant placement at the patient's second appointment.

45.

Removal of transitional prosthesis.

46.

View of finger seated abutments after removal of acrylic prosthesis.

47.

View of implant well and soft tissue sulcus.

48.

All-ceramic crown on a 5.0mm x 2.0mm shouldered abutment being placed into implant.

49.

All-ceramic crowns placed into implants for confirmation of aesthetics and fit.

50.

Ceramic coupler being applied to all-ceramic crown.

51.

Metallic coupler being to abutment.

52.

Bonding agent being applied to abutment and crown.

53.

Light curing of bonding agent.

54.

Extra-oral cementation of two all-ceramic crowns.

55.

Extraneous cement being removed with cotton.

56.

Extra-orally cemented crown being inserted into implant.

57.

Second crown being inserted into implant well.

58.

After proper alignment with acrylic orientation jig the extra-orally cemented crowns are seated with a tapping force in the long axis of the abutment shaft.

59.

Labial view of the seated all-ceramic crowns.

60.

Closer view of the completed restorations.

61.

Radiograph of two extra-orally cemented all-ceramic crowns on shouldered abutments thirteen weeks after the immediate placement and loading of two 5.0mm x 8.0mm Bicon implants.

Two Extra-Orally Cemented Crowns On Immediately Placed and Loaded Implants

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