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: Pre-operative radiograph.

2.

Pre-operative site.

3.

View after removal of Maryland bridge.

4.

Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.

5.

Osteotomy being enlarged with an olive green 2.5mm latch reamer. Reamers are used at 50RPM without water irrigation.

6.

Osteotomy being enlarged with a teal 3.0mm latch reamer. Reamers are used at 50RPM without water irrigation.

7.

Harvested bone in the flute of a blue 3.5mm latch reamer. Reamers are used at 50RPM without water irrigation.

8.

Harvested bone in the flute of a red 4.0mm hand reamer. Reamers are used at 50RPM without water irrigation.

9.

Harvested bone in the flute of silver 4.5mm hand reamer. Reamers are used at 50RPM without water irrigation.

10.

Curette harvesting residual bone while confirming the integrity of the five bony walls of the osteotomy.

11.

A 4.5 x 6.0mm HA coated implant being inserted into the osteotomy with an implant inserter/retriever.

12.

Implant seating tip attached to a straight handle which will be tapped to definitively seat implant into the osteotomy.

13.

View of seated implant with polyethylene healing plug.

14.

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

15.

Harvested bone being placed over the seated implant.

16.

Sutured site.

17.

Post-operative radiograph.

18.

Second Visit: Four months after previous visit View of existing bonded Maryland bridge.

19.

View after removal of Maryland bridge.

20.

Healing plug being removed with healing plug removal instrument.

21.

Green 3.0mm impression reamer being rotated on a 3.0mm standard guide pin to remove any tissue which might inhibit the complete seating of an impression post.

22.

Green 3.0mm plastic impression post being inserted into the 3.0mm well of an integrated implant for the making of an implant-level transfer impression.

23.

Impression post being gently tapped into place to assure its proper seating.

24.

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

25.

Third Visit: Three weeks after previous visit View of Integrated Abutment Crown™ and veneer on a stone model.

26.

View of Integrated Abutment Crown™. Note the fact the the hemisphical base of the abutment is not covered by composite material.

27.

Removal of transitional prosthesis.

28.

Veneer try-in.

29.

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

30.

Integrated Abutment Crown™ being inserted.

31.

Integrated Abutment Crown™ after initial insertion.

32.

Roughening of surfaces prior to veneer bonding.

33.

Etchant being applied in preparation for the bonding of the veneer.

34.

Bonding material being applied.

35.

Light curing of bonding material.

36.

Bonding material being applied to the veneer prior to its bonding.

37.

Veneer being cemented.

38.

Light curing of bonding material.

39.

Removal of excess bonding material.

40.

Cervical aspect of the Integrated Abutment Crown™ being modified with 7408 carbide finishing bur.

41.

Cervical surface of the Integrated Abutment Crown™ being polished with a gray acrylic polishing wheel.

42.

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.

43.

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

44.

Yellow thermoplastic custom seating jig (formed with a crown alignment device) in a crown seating tip attached to a straight handle facilitates directing the tapping forces in the long axis of the abutment post and implant well.

45.

Integrated Abutment Crown™ being modified with 7408 carbide finishing bur after verification of appropriate incisal contacts.

46.

Facial view immediately after the definitive seating of the Integrated Abutment Crown™.

47.

Post-insertion radiograph.

48.

View of Integrated Abutment Crown™ one month post-insertion.

49.

Facial view of Integrated Abutment Crown™ one month post-insertion.

50.

Right profile view of Integrated Abutment Crown™ one month post-insertion.

51.

Left profile view of Integrated Abutment Crown™ one month post-insertion.

52.

Patient’s smile one month post-insertion.

53.

Integrated Abutment Crown™ one year post-insertion.

54.

Right profile view of Integrated Abutment Crown™ one year post-insertion.

55.

Right profile view of Integrated Abutment Crown™ in occlusion one year post-insertion.

56.

Patient’s smile one year post-insertion.

57.

One year post-insertion radiograph.