This case demonstrates three extractions and the two-stage maxillary placement of eight Bicon implants, uncovering, implant-level transfer impression, and fabrication of two, five-unit TRINIA™ bridges and two extra-orally cemented TRINIA™ crowns.
SURGICAL: Extraction Two Stage Uncovering
RESTORATIVE: Bridges
TOPICS: Crestal Relieving Incision Impression SynthoGraft™ TRINIA®
TAGS: Extra-Oral Cementation Occlusal Registration
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First Visit: Implant placement. Pre-operative radiograph.
Pre-operative clinical site.
Luxating carious tooth.
Extracting root.
Root being elevated from its socket.
Extracted root.
Blood being collected from surgical site to be mixed with SynthoGraft™ Pure Phase Beta-Tricalcium Phosphate.
Pilot osteotomy being drilled with a 2.0mm pilot drill with external irrigation.
View of paralleling pins seated in the initial osteotomies confirming their appropriate trajectory.
Osteotomy being enlarged with an olive green 2.5mm latch reamer rotating at 50 RPM without irrigation.
Osteotomy being enlarged with teal 3.0mm extended latch reamer rotating at 50 RPM without irrigation.
Osteotomy being enlarged with a blue 3.5mm hand reamer attached to a hand reamer extension rotating at 50 RPM without irrigation.
Osteotomy being enlarged with a magenta 4.0mm hand reamer attached to a hand reamer extension rotating at 50 RPM without irrigation.
Osteotomy being enlarged with a silver 4.5mm hand reamer attached to a hand reamer extension rotating at 50 RPM without irrigation.
A 5.0mm osteotome being used to establish a hairline fracture around the floor of the osteotomy.
Two 4.0 x 8.0mm Bicon Integra-CP™ implants with a 2.5mm well being inserted into the osteotomies.
Two 5.0 x 6.0mm Bicon Integra-CP™ implants with a 3.0mm well being inserted into their osteotomies.
Two 4.5 x 8.0mm Bicon Integra-CP™ implants with a 3.0mm well being inserted into their osteotomies.
Implant being definitively seated with a seating tip attached to a threaded straight handle.
View of seated implant.
Blue 2.5 and green 3.0mm seated guide pins being used to assess the trajectory of the eight Bicon implants.
Trimmed polyethylene healing plug on a #110 reamer being inserted into the well of a seated implant.
SynthoGraft™ being mixed with the patient's blood.
Mixture of patient's blood and SynthoGraft™, Pure Phase Beta-Tricalcium Phosphate, placed over the shoulder of the implants.
Sutured surgical site.
Post-operative radiograph.
Second Visit: Uncovering four months after placement. Radiographs prior to uncovering the implants.
Second Visit: Uncovering four months after placement. Radiographs prior to uncovering the implants.
Second Visit: Uncovering four months after placement. Radiographs prior to uncovering the implants.
Second Visit: Uncovering four months after placement. Radiographs prior to uncovering the implants.
View of surgical site prior to uncovering the implants.
Uncovering incision being made.
View of a polyethylene healing plug on a #110 reamer after being removed from the well of the implant.
Green 3.0mm and blue 2.5mm seated guide pins being used to assess the integration and trajectory of the eight Bicon implants.
View of clinical site with titanium impression posts with acrylic sleeves in place for the making of a full arch implant level transfer impression.
Impression material being injected around the impression sleeves for the making of a full arch implant level transfer impression.
View of full arch implant level transfer impression with only the acrylic sleeves within the impression material.
A 5.0 x 4.0mm white PEEK healing abutment being inserted.
Healing abutment being seated into the implant well with an abutment seating tip attached to a threaded straight handle.
Eight 5.0 x 4.0mm white PEEK healing abutments in place.
Wax rim being used to record the midline of the face, smile line, and incisal length and trajectory of anterior teeth.
Occlusal registrations being made.
Blue mousse being injected onto wax rim for the making of an occlusal registration.
View of occlusal registration on the wax rim.
Third Visit: Insertion of two five-unit TRINIA™ prostheses and the two individual TRINIA™ crowns. Mirrored view of maxillary TRINIA™ CAD/CAM fiber reinforced prosthesis and crown prior to their being inserted.
View of TRINIA™ prostheses on stone model.
Milled abutments on stone model.
Individual Ceramage crown with CAD/CAM TRINIA™ coping prior to being extra-orally cemented onto milled abutment.
Applying cement to the CAD/CAM TRINIA™ coping within the crown.
Extra-orally cementing the CAD/CAM TRINIA™ crown to the abutment.
Light curing of dual cure resin cement.
Eight 5.0mm x 4.0mm white PEEK healing abutments prior to their removal.
White PEEK healing abutment being removed.
Relieving incision being made.
Gold 5.0mm sulcus reamer being used to remove any tissue which may interfere with the seating of the abutment.
TRINIA™ prosthesis with three incompletely seated abutments being transported to the mouth for the orientation and initial seating of the abutments within the well of the implant.
Extra-orally cemented TRINIA™ crown being transported to the well of its implant.
Abutments being initially seated by tapping on the prosthesis with a white healing abutment attached to a threaded straight handle.
Extra-orally cemented TRINIA™ crown being transported to the well of its implant.
TRINIA™ prosthesis with three incompletely seated abutments being transported to the implants well.
Abutments being initially seated by tapping on the prosthesis with a white healing abutment attached to a threaded straight handle.
Abutment being definitively seated with an abutment seating tip attached to a threaded straight handle.
Occlusal view of eight definitively seated abutments.
Interproximal contacts being checked with articulating paper.
Adjusting interproximal contacts.
Applying minimal cement to the bores of the TRINIA™ prostheses.
Applying minimal cement to the bores of the TRINIA™ prostheses.
Tapping the TRINIA™prosthesis with a white healing abutment attached to a threaded straight handle to fully seat the cemented prosthesis.
Light curing the dual cure resin cement.
Proxy brush being used to remove extraneous cement.
Occlusal view of four CAD/CAM TRINIA™ prostheses.
Facial view of TRINIA™ prostheses.
Post-treatment smile.
Post-insertion radiograph.
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