Two Full-Arch TRINIA® Telescopic Restorations Featuring Seven Implant Placements and the Use of Both Retentive and Custom Cast Copings for a Seventy-Year-Old Patient in Five Clinical Visits

Posted on January 24, 2021 by Bicon

This case demonstrates the extraction of six teeth and the placement of four maxillary implants (two using sinus lift abutments and others using bone grafting procedures with SynthoGraft™ and Bicon Resorbable Collagen Membranes) and three mandibular implants, uncovering of implants and two conventional implant-level transfer impressions, two occlusal bite registrations, insertion of the mandibular TRINIA® restoration with three cemented Retentive Copings on Universal Abutments and the insertion of the maxillary TRINIA® restoration with four custom cast Sci-tec copings on modified Universal Abutments for a seventy-year-old female patient. The entire treatment was achieved in only five clinical visits during a seven-month period without fabricating any new transitional prostheses.

SURGICAL: Extraction Immediate Placement Two Stage Uncovering
RESTORATIVE: Fixed Telescopic Restorations
TOPICS: Impression SynthoGraft™ TRINIA®
TAGS: Bicon Resorbable Collagen Membrane Occlusal Registration Universal Abutments

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1.

FIRST VISIT: Preoperative clinical view.

2.

Preoperative radiograph.

3.

Preoperative view with two prostheses.

4.

Preoperative palatal view.

5.

Palatal incision for osteotomy.

6.

Pilot bur being used to initiate 2.0mm osteotomy.

7.

Light yellow 2.5mm two-fluted Latch Reamer widening osteotomy.

8.

Teal 3.0mm singled-fluted Hand Reamer attached to Threaded Straight Handle widening osteotomy.

9.

Blue 3.5mm singled-fluted Rand Reamer attached to Threaded Straight Handle widening osteotomy.

10.

Magenta 4.0mm singled-fluted Hand Reamer attached to Threaded Straight Handle widening osteotomy.

11.

SynthoGraft™, pure phase Beta-Tricalcium Phosphate, being mixed with patient's blood to be used for grafting with internal sinus lift procedure.

12.

SynthoGraft™ being transported to osteotomy with a Bone Graft Syringe.

13.

SynthoGraft™ being pushed into oteotomy with a blue 3.5mm Bone Expander.

14.

A 4.0mm x 6.0mm Bicon SHORT® implant attached to a blue Sinus Lift Temporary Abutment is being transported to the osteotomy.

15.

Sinus Lift Temporary Abutment is being pushed to seat the implant in the osteotomy.

16.

Implant partially seated in the osteotomy.

17.

Additional SynthoGraft™ is being placed around the implant.

18.

Sinus Lift Temporary Abutment is initially being tapped with a pink Seating Tip attached to a Threaded Straight Handle.

19.

Sinus Lift Temporary Abutment is being tapped with a large Seating Tip to elevate the sinus membrane as the implant is fully seated.

20.

SynthoGraft™ is being placed around Sinus Lift Temporary Abutment.

21.

Flap being sutured after placement of 4.0mm x 6.0mm Bicon SHORT® implant

22.

Post insertion radiograph of implant with Sinus Lift Abutment.

23.

Anterior prosthesis being removed with a crown removal device.

24.

Mucosal flap being reflected for placement of second implant.

25.

Pilot Bur initiating second osteotomy.

26.

Pilot Bur deepening second osteotomy.

27.

A light yellow 2.5mm singled-fluted Hand Reamer attached to a Threaded Instrument Adapter is widening second osteotomy.

28.

A blue 3.5mm Hand Reamer attached to a Threaded Straight Handle is widening the osteotomy.

29.

Bone chips are being removed from osteotomy with a spoon excavator.

30.

A magenta 4.0mm Hand Reamer attached to a Threaded Straight Handle is widening the osteotomy.

31.

SynthoGraft™ is being transported to the osteotomy.

32.

A 4.0mm x 6.0mm Bicon SHORT® implant is being transported to its osteotomy with a blue 2.5mm Implant Inserter/Retriever Instrument.

33.

Implant is being seated in its osteotomy.

34.

Implant Inserter/Retriever Instrument is being gently tapped to definitively seat the implant.

35.

A Universal Abutment is lightly placed in the implant to confirm appropriate positioning of implant by using a vacuum formed template.

36.

A Universal Abutment is lightly placed in the implant to confirm appropriate positioning of implant by using a vacuum formed template.

37.

Handle of black healing plug is being cut with a Healing Plug Cutter.

38.

View of cut Healing Plug in the well of the implant.

39.

SynthoGraft™ is being transported with a Bone Graft Syringe to surgical site.

40.

Mucosal flap is being manipulated to position a Bicon Resorbable Collagen Membrane.

41.

Collagen membrane is being placed over the surgical site.

42.

Mucosal flap is being positioned over the blood soaked membrane.

43.

Flap being sutured.

44.

Flap being sutured.

45.

Post implant insertion radiograph.

46.

Incision being made for third implant placement.

47.

Pilot Bur preparing 2.0mm osteotomy for third implant.

48.

View of pilot osteotomy.

49.

Osteotomy being widened with light yellow 2.5mm Hand Reamer attached to a Threaded Instrument Adapter.

50.

Osteotomy being widened with teal 3.0mm Hand Reamer attached to a Threaded Instrument Adapter.

51.

Osteotomy being widened with blue 3.5mm Hand Reamer attached to a Threaded Instrument Adapter.

52.

Osteotomy being widened with magenta 4.0mm Hand Reamer attached to a Threaded Straight Handle.

53.

View of a 4.0mm osteotomy.

54.

A 4.0mm x 6.0mm Bicon SHORT® implant being transported to its osteotomy with a 2.5mm Implant Inserter/Retriever.

55.

Implant being definitively seated in its osteotomy with a 2.5mm Implant Inserter/Retriever.

56.

View of 2.5mm well of seated implant.

57.

Vacuum-formed template being used to confirm the appropriateness of the implant's positioning.

58.

View of Healing Plug seated in the well of its implant.

59.

View of cut Healing Plug in the 2.5mm well of its implant.

60.

SynthoGraft™ being transported to surgical site with a Bone Graft Syringe.

61.

Mucosal flap being repositioned to close the surgical site.

62.

Sutured surgical site.

63.

Post implant insertion radiograph.

64.

Mucosal flap being elevated for placement of fourth implant.

65.

Pilot osteotomy being initiated with a 2.0mm Pilot Bur.

66.

Osteotomy being widened with a light yellow 2.5mm Latch Reamer.

67.

Osteotomy being widened with a teal 3.0mm Hand Reamer attached to a Threaded Straight Handle.

68.

Osteotomy being widened with a blue 3.5mm Hand Reamer attached to a Threaded Straight Handle.

69.

Osteotomy being widened with a magenta 4.0mm Hand Reamer attached to a Threaded Straight Handle.

70.

SynthoGraft™ being transported in Bone Graft Syringe to the prepared osteotomy.

71.

View of SynthoGraft™ covering osteotomy.

72.

Implant being inserted with a 2.5mm Sinus Lift Abutment into its osteotomy through SynthoGraft™ material to elevate the floor of the maxillary sinus.

73.

Blue 2.5mm Sinus Lift Abutment being tapped with a magenta 2.0mm Implant/Angled Abutment Seating Tip to definitively seat the implant and raise the floor of the maxillary sinus.

74.

SynthoGraft™ material being placed over the Sinus Lift Abutment.

75.

Post insertion radiograph of implant with Sinus Lift Abutment.

76.

View of sutured surgical site after placement of four implants.

77.

View of two residual teeth with retentive pins prior to the addition of a composite material to provide for the temporary retention of the patient's existing prosthesis.

78.

View of composite buildup around pins to provide retention of existing prosthesis on residual teeth.

79.

Resin cement being added to existing prosthesis prior to its being cemented to residual teeth.

80.

Mandibular wax rim.

81.

Maxillary rim.

82.

Wax rims being used to record the patient's vertical dimension of occlusion (VDO).

83.

Occlusion registration material being injected.

84.

Occlusal relationship being recorded.

85.

Mucosal flap being reflected.

86.

Pilot Bur being used to initiate an osteotomy.

87.

A teal 3.0mm Latch Reamer being used to widen the pilot osteotomy.

88.

A blue 3.5mm Hand Reamer attached to a Latch Reamer Extension is being used to widen the osteotomy.

89.

A magenta 4.0mm Hand Reamer attached to a Threaded Knob is being used to widen the osteotomy.

90.

A 4.0mm x 6.0mm Bicon SHORT® implant is being inserted in its osteotomy with a black Healing Plug.

91.

Implant is being definitively seated with a 2.5mm Seating Tip attached to a Threaded Straight Handle.

92.

Cut Healing Plug is being inserted in the well of the first implant with a Healing Plug Removal Instrument.

93.

First mandibular implant being covered with autogenous bone.

94.

View of second mandibular implant appropriately seated 3.0mm below the crest of bone.

95.

Cut Healing Plug being inserted into well of its implant.

96.

View of Bicon Resorbable Collagen Membrane positioned prior to the suturing of surgical site.

97.

Surgical site being sutured.

98.

Post implant insertion radiograph prior to extraction of canine tooth.

99.

Cut Healing Plug being inserted into well of third implant.

100.

Autogenous bone being placed over the appropriately placed implant.

101.

View of the sutured surgical site after the removal of the canine tooth.

102.

Post insertion radiograph of three mandibular anterior implants.

103.

SECOND VISIT: Cut Healing Plug being removed from well of left integrated implant.

104.

Second integrated implant being uncovered.

105.

Blue 2.5mm Guide Pin inserted into 2.5mm implant well.

106.

Cut Healing Plug being removed from implant well with a Healing Plug Removal Instrument.

107.

View of three seated Guide Pins.

108.

View of bone chips on magenta 4.0mm Sulcus Former.

109.

Magenta 4.0mm Sulcus Former being rotated on Guide Pin to shape the implant's sulcus.

110.

Gold 5.0mm Sulcus Former being rotated on Guide Pin to widen the Implant's sulcus.

111.

View of bone chips on gold 5.0mm Sulcus Former.

112.

Blue 2.5mm Impression Post being inserted in the implant's well.

113.

Blue 2.5mm Impression Sleeve being inserted onto its Impression Post.

114.

View of three Impression Sleeves.

115.

Impression material being injected around Impression Posts and Sleeves.

116.

Full arch implant level impression.

117.

Maxillary wax rim on stone model.

118.

Wax Rim being inserted to record occlusal relationship with three mandibular Impression Sleeves.

119.

Bite registration material being injected around Impression Sleeves.

120.

View of Occlusal Registration with black markings for midline and lipline.

121.

View of occlusal registration.

122.

Impression Sleeve being used to determine appropriate Vertical Dimension of Occlusion (VDO).

123.

VDO being recorded.

124.

Titanium Temporary Abutment being inserted in well of implant.

125.

Blue-ink marking being applied to temporary implant to facilitate seating of denture.

126.

View of one Peek and two Titanium Temporary Abutments.

127.

View of original prostheses.

128.

THIRD VISIT: View of TRINIA® telescopic prosthesis on stone model with three 5.0mm Universal Abutments with three purple Retentive Copings.

129.

View of three Retentive Copings on three 5.0mm Universal Abutments.

130.

View of mandibular TRINIA® prosthesis.

131.

View of mandibular TRINIA® prosthesis with three bores.

132.

View of resin seating jig seated on three Universal Abutments with numerals indicating seating sequence.

133.

View of three 5.0mm Universal Abutments seated in 2.5mm implant analogs within stone model.

134.

Temporary Abutment being removed.

135.

Universal Abutment being inserted in Vaseline lined bore of resin seating jig.

136.

First sequenced Universal Abutments being transported to their implants in seating jig.

137.

Resin seating jig being tapped to initially seat two Universal abutments.

138.

Universal Abutment being definitively seated by tapping of Seating Tip attached to Threaded Straight Handle.

139.

Resin seating jig being remover with a crown removal device.

140.

Universal Abutment being definitively seated by tapping of Seating Tip attached to Threaded Straight Handle.

141.

Cotton pliers being used to facilitate removal of abutment from its implant analog.

142.

Second sequenced abutment being inserted in to Vaseline lined bore of seating jig.

143.

Second sequenced abutment being transported to its implant's well with seating jig.

144.

Resin seating jig being tapped to initially seat third abutment.

145.

Universal Abutment being definitively seated by tapping of Seating Tip attached to Threaded Straight Handle.

146.

Resin seating jig being remover with a crown removal device.

147.

Universal Abutment being definitively seated by tapping of Seating Tip attached to Threaded Straight Handle.

148.

View of three seated Universal Abutments.

149.

TRINIA® Prosthesis seated on Universal Abutments to confirm passive fit.

150.

Vaseline being applied to bore of Retentive Coping.

151.

Retentive Coping being seated on Universal Abutment.

152.

Second Retentive Coping being seated on Universal Abutment.

153.

Retentive Coping being gently tapped to assure its definitive seating.

154.

Vaseline being removed from coping with alcohol.

155.

Vaseline being applied to facilitate removal of extraneous cement.

156.

Resin cement being applied to bores of TRINIA® prosthesis.

157.

TRINIA® prosthesis being cemented onto three Retentive Copings.

158.

Occlusal pressure is being applied during the cementing of the copings to the prosthesis.

159.

FOURTH VISIT: Incision being made to uncover maxillary implant.

160.

View of four blue 2.5 guide pins in the wells of the four maxillary implants prior to being used with Sulcus Formers.

161.

Gold 5.0mm Sulcus Former being rotated on guide pin to form the implant's sulcus.

162.

Blue 2.5mm Impression Post being inserted into well of implant.

163.

View of four Impression Sleeves.

164.

Impression material being injected around impression post and sleeve for the making of a full-arch implant-level impression.

165.

Image of a full-arch implant-level impression.

166.

Image of four impression sleeves within occlusal registration material.

167.

Titanium Temporary Abutment being inserted in well of implant.

168.

Titanium Temporary Abutment being gently tapped into well of implant.

169.

Titanium Temporary Abutment being inserted in well of implant.

170.

View of maxillary arch after the making of a full-arch implant level impression.

171.

FIFTH VISIT View of TRINIA® prosthesis on four Universal Abutments.

172.

View of TRINIA® prosthesis with four bores.

173.

View of four modified Universal Abutments in 2.5mm Implant Analogs within stone model.

174.

Resin seating jig seated on Universal Abutments.

175.

Prosthesis being removed with extraction of left canine.

176.

Image of extracted canine with prosthesis.

177.

Left central incisor being extracted.

178.

View of maxillary arch prior to insertion of TRINIA® prosthesis.

179.

Temporary Abutment being removed.

180.

View of four blue 2.5mm guide pins in the wells of their implants

181.

Gold 5.0mm Sulcus Former attached to a Threaded Straight Handle being rotated to shape the implant's sulcus.

182.

Gold 5.0mm Sulcus Former attached to a Threaded Knob being rotated to shape an implant sulcus.

183.

Vaseline being applied to bore of resin seating jig.

184.

Modified Universal Abutment being inserted into seating jig.

185.

Two modified Universal Abutments being transported to their implants.

186.

Seating jig being tapped to simultaneous seat two abutments.

187.

Abutment being tapped to be definitively seated.

188.

Seating jig being removed.

189.

Cotton pliers being used to facilitate removal of abutment from implant analog.

190.

Two modified Universal Abutments being transported to their implants.

191.

Seating jig being tapped to simultaneous seat two abutments.

192.

Abutment being tapped to be definitively seated.

193.

Seating jig being removed with crown removal instrument.

194.

Abutment being tapped to be definitively seated.

195.

TRINIA® prosthesis being seated on four modified abutments to assure passive fit.

196.

Vaseline being applied to bore of custom cast coping.

197.

Custom cast coping being seated on modified Universal Abutment.

198.

Custom cast coping being gently tapped to be definitively seated.

199.

Second cast coping being seated on abutment.

200.

Second custom cast coping being fully seated with a gentle tap.

201.

TRINIA® prosthesis being seated onto custom copings to assure a passive fit.

202.

Vaseline being applied to bore of fourth coping.

203.

Fourth coping being seated onto abutment.

204.

View of arch with four custom copings prior to insertion of TRINIA® prosthesis.

205.

Vaseline being removed with alcohol and a brush.t.

206.

Vaseline being applied to TRINIA® prosthesis to facilitate removal of extraneous resin cement.

207.

Vaseline being applied to TRINIA® prosthesis to facilitate removal of extraneous resin cement.

208.

Resin cement being applied to bores of TRINIA® prosthesis.

209.

TRINIA® prosthesis being cemented onto custom copings.

210.

TRINIA® being tapped to definitively seat the prosthesis onto the four custom copings.

211.

Occlusal pressure being applied to until the resin cement has set.

212.

TRINIA® prosthesis being removed with a crown removal instrument.

213.

Extraneous cement being removed with a scaler.

214.

Vaseline being applied to facilitate the removal of the prosthesis.

215.

TRINIA® telescopic prosthesis being reinserted onto four modified custom copings.

216.

Clinical view of two TRINIA® telescopic prostheses.

217.

View of occlusal contacts with ink markings.

218.

Final post treatment panoramic radiograph.

219.

Patient's smile.

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