Two-Stage Implant Placement and Restoration with an Integrated Abutment Crown™ for a Congenitally Missing Maxillary Right Lateral Incisor

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1.

First Visit: Implant placement. Pre-operative radiograph.

2.

Pre-operative site.

3.

Paralleling pin seated in the pilot osteotomy indicating trajectory.

4.

Osteotomy being enlarged with an olive green 2.5mm latch reamer rotating at 50RPM without irrigation.

5.

Harvested bone within the flute of an olive green 2.5mm hand reamer.

6.

Harvested bone within the flute of a teal 3.0mm hand reamer.

7.

Harvested bone within the flute of a blue 3.5mm hand reamer.

8.

Harvested bone within the flute of a red 4.0mm hand reamer.

9.

Curette being used to remove residual bone while confirming the integrity of the five bony walls of the osteotomy.

10.

A 4.0mm x 8.0mm Integra-CP coated implant with a 2.5mm well being inserted into the osteotomy.

11.

Straight handle with a seating tip attached is being tapped to seat implant farther into the osteotomy.

12.

View of the well of the seated implant.

13.

Cut polyethylene healing plug being inserted into the 2.5mm well of the implant.

14.

Harvested bone shown in a dappen dish.

15.

Harvested bone being placed over the shoulder of the implant.

16.

Surgical site after the application of the harvested bone.

17.

View of the sutured surgical site.

18.

Post operative radiograph.

19.

Second Visit: Four months after previous visit. View of surgical site prior to uncovering of the implant.

20.

Incision being made for removal of healing plug.

21.

View of bone covering the shoulder of the implant.

22.

Healing plug being removed with healing plug removal instrument.

23.

Impression material being injected around the blue impression sleeve for the making of a full arch implant level transfer impression.

24.

View of transfer impression with 2.5mm blue plastic sleeve.

25.

Healing abutment seated in implant well.

26.

Third Visit: Three months after previous visit. View of Integrated Abutment Crown™ on stone model.

27.

Site after removal of transitional prosthesis.

28.

Well of implant being cleaned with alcohol on a cotton-tipped applicator.

29.

Integrated Abutment Crown™ being inserted.

30.

Diamond finishing strip being used to lighten the interproximal contact area eliminating the possibility that the tight contact may prevent the engagement of the locking taper connection.

31.

Yellow thermoplastic custom seating jig, which was formed in a crown alignment device, is seated in a crown seating tip attached to a straight handle is being used to facilitate directing the tapping forces in the long axis of the abutment post and implant well.

32.

Facial view immediately after the initial insertion of Integrated Abutment Crown™.

33.

Post insertion radiograph of Integrated Abutment Crowns™.