This case demonstrates the sequencing of extraction, site preparation with a mandibular ridge split, two-stage implant placements, and implant-level transfer impression of two left mandibular teeth and their restoration with Integrated Abutment Crowns™.
SURGICAL: Extraction Ridge Splits Two Stage
RESTORATIVE: Integrated Abutment Crowns™
TOPICS: Crown Insertion
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First Visit: Pre-operative radiograph.
Pre-operative site.
Piezosurgery® device being used to facilitate the extraction.
View of extracted root.
Horizontal bony cut is being made with a Piezosurgery® device.
View of corticotomy with two vertical cuts and one horizontal and crestal cut.
Second Visit: Four weeks after previous visit View of operative site prior to implant placement.
Occlusal view of crestal cut.
Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM with external irrigation.
Paralleling pins in each pilot osteotomy indicating their mesio-distal positioning and trajectories.
Osteotomy being enlarged with an olive green 2.5mm latch reamer rotating at 50RPM without water irrigation.
Harvested bone within the flute of a red 4.0mm latch reamer after osteotomy was enlarged with a teal 3.0mm latch reamer and a blue 3.5mm latch reamer at 50RPM.
Curette being used to remove residual bone while confirming the integrity of the five bony walls of the osteotomy.
Osteotomy being enlarged with a silver 4.5mm latch reamer at 50RPM without irrigation.
Harvested bone within the flute of a silver 4.5mm latch reamer.
Osteotomy being enlarged with a gold 5.0mm latch reamer at 50RPM without irrigation.
A 5.0 x 6.0mm implant being inserted into the osteotomy.
View of black polyethylene plug inserted into the well of the implant.
Implant seating tip attached to an offset driver handle is being used to definitively seat the implant into the osteotomy.
Harvested bone being placed over the implants.
Sutured site.
Post-operative radiograph.
Third Visit: Four months after previous visit View of site prior to the making of an implant level transfer impression.
Crestal incision being made.
Polyethylene healing plug being removed with an angled curette.
Polyethylene healing plug being removed with an angled curette.
View of two 3.0mm guide pins seated in the wells of the implants to check the stability of the two implants.
Two 3.0mm titanium impression posts receiving a very gentle seating tap with an implant seating tip attached to an offset driver.
View of two 3.0mm titanium impression posts.
Plastic sleeves placed on the 3.0mm titanium impression posts.
Impression material being injected around the impression posts for the making of a full arch implant-level transfer impression.
View of implant-level transfer impression.
Reducing the height of the posts for occlusal clearance.
Two modified 3.0mm plastic impression posts being used for a bite registration.
Acrylic resin being added for the making of a bite registration.
Acrylic resin and green impression post being removed.
White temporary abutments inserted into implant wells.
Fourth Visit: One month after the previous visit White temporary abutments being removed.
Implant well being cleaned with a cotton-tipped applicator.
Integrated Abutment Crown™ being inserted.
Floss is being used to confirm passive interproximal contacts that will not interfere with the engagement of the locking taper of the Integrated Abutment Crowns™.
Use of articulating paper to check the interproximal contacts.
Integrated Abutment Crown™ being polished with a gray acrylic polishing wheel.
Integrated Abutment Crowns™ immediately after being inserted.
Definitive seating of the Integrated Abutment Crowns™ and engagement of its locking taper connection is being achieved by occlusal pressure on a cotton roll.
A straight handle with a polyethylene healing plug facilitates directing the tapping forces in the long axis of the Integrated Abutment Crown™.
Blue markings indicate the need to adjust occlusal contacts.
Occlusal surfaces of the Integrated Abutment Crowns™ being polished with a pink acrylic polishing wheel.
View of the definitively seated Integrated Abutment Crowns™.
Post-insertion radiograph.
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