Immediate Stabilization and Function / Polyceramic Material

Fused to Metal / Bicon Integrated Abutment Crowns™:

Placement of Seven Immediately Functioning Mandibular
Implants and their Restoration with six Integrated Abutment
Crowns™ and a Three Unit Fixed Polyceramic to Metal Bridge
This case demonstrates a patient’s attempt to solve his frustration with failed root
canal and conventional restorative treatments by using plumber’s cement to rescue
his mandibular fixed prosthesis as well as the insertion of seven implants and their
restoration with six Integrated Abutment Crowns™ and a three unit fixed
polyceramic to metal bridge.
     
1. Pre-operative radiograph of failed endodontically
treated teeth.

2. Pre-operative site revealing black plumber's

cement attempting to secure failed prosthesis.

3. Osteotomy being prepared with 2.0mm pilot bur

rotating at 1100 RPM.

4. Pilot bur preparing osteotomy parallel to the

inserted parallel pins
 5. Osteotomy being enlarged with a 2.5mm latch
reamer bur rotating at 50 rpm’s without water
irrigation.

6. Osteotomy being enlarged with a 3.5mm latch

reamer bur rotating at 50 rpm’s without water
irrigation.

7. Osteotomy being enlarged with a 4.0mm latch

reamer bur rotating at 50 rpm’s without water
irrigation.

8. Osteotomy being enlarged with a 4.5mm latch

reamer bur rotating at 50 rpm’s without water
irrigation.

9.Harvested bone collected in silicone dappen dish.

10. A 4.5mm x 8.0mm HA coated implant being

inserted into osteotomy with an inserter
retriever instrument on a threaded knob.
11. A 4.5mm x 8.0mm HA coated implant being
inserted into osteotomy with an inserter
retriever instrument on a threaded knob.

12. A 4.5mm x 8.0mm HA coated implant being

inserted into osteotomy with an inserter
retriever instrument on a threaded knob.

13. A 4.5mm x 8.0mm HA coated implant being

inserted into osteotomy with an inserter
retriever instrument on a threaded knob.

14. A 4.5mm x 8.0mm HA coated implant being

inserted into osteotomy with an inserter
retriever instrument on a threaded knob.

15. A 4.5mm x 8.0mm HA coated implant being

inserted into osteotomy with an inserter
retriever instrument on a threaded knob.
16. Implant being definitively seated into its
osteotomy by tapping on an offset driver
attached to an implant seating tip.

17. Osteotomy being prepared with 2.0mm pilot bur

rotating at 1100 RPM.

18. Pilot bur preparing osteotomy parallel to the inserted

parallel pin.

19. Pilot bur preparing osteotomy parallel to the

inserted parallel pins.
20. Osteotomy being enlarged with a 3.5mm latch
reamer bur rotating at 50 rpm’s without water
irrigation.

21. Osteotomy being enlarged with a 4.5mm latch

reamer bur rotating at 50 rpm’s without water
irrigation.

22. A 4.5mm x 8.0mm HA coated implant being

inserted into osteotomy with an inserter
retriever instrument on a threaded knob.

23. A 4.5mm x 8.0mm HA coated implant being

inserted into osteotomy with an inserter
retriever instrument on a threaded knob.

24. Implant being definitively seated into its

osteotomy by tapping on an offset driver
attached to an implant seating.
25.Black polyethylene healing plugs in implant wells
prior to their replacement with titanium stealth
abutments.

26. A 5.0mm tall acrylic sleeve on stealth abutment

being inserted into the well of the implant.

27. Shoulder depth gauge seated in the well of the

implant facilitates the selection of a stealth
abutment with an appropriate shoulder height.

28. A 5.0mm short acrylic sleeve on stealth

abutment being inserted into the well of the
implant.

29. Seated stealth shouldered abutments with

acrylic sleeves.

30. Acrylic sleeves being adjusted for occlusal

clearance.

31. Modified acrylic sleeve.

32. Vacuum formed template seated over modified

acrylic sleeves to confirm the occlusal clearance.
33. Bonding agent being applied to acrylic sleeves.

34. Light curing of bonding agent.

35. Polyceramic material “Diamond Crown” being

added to acrylic sleeve to form a bonded strut
between adjacent implants.

36. Light curing of vacuum formed template placed

over the strut material

37. Bonding agent being applied to strut.

38. Transitional composite material being injected

into vacuum formed template.

39. Additional polyceramic material in vacuum

formed template being added to the hardened
strut for aesthetic contouring.

40. Transitional composite prosthesis incorporating

modified acrylic sleeves snapped onto
abutments.

41. View of transitional stabilizing prosthesis in

place.
42. Radiograph of immediately placed and
functioning implants with transitional stabilizing
prosthesis.

43. View of transitional prosthesis six months after

implant placement and the removal of the most
posterior right implant.

44. View of transitional abutments after removal of

splinted prosthesis.

45. View of red acrylic resin on a green impression

post recording the occlusal relationship while the
transitional prosthesis is in place.

46. Green 3.0 mm plastic impression post being

inserted into the 3.0 mm implant well.

47. Red acrylic on impression posts recording an

occlusal registration.

48. Occlusal registration being removed from

implant wells.
49. View of implant wells after the removal of the
transitional prosthesis and the stealth
abutments.

50. Green 3.0 mm plastic impression post being

inserted into the 3.0 mm implant well.

51. Green 3.0 mm plastic impression post being

inserted into the 3.0 mm implant well.

52. View of seated impression posts after being

tapped into the well of their implant.

53. Impression material being injected around

impression posts for the making of an implant
level transfer impression.

54. Impression post being tapped out of implant

well.

55. Transitional prosthesis being re-inserted.

56. Milled abutments and occlusal registration rims
on dental models.

57. View of transitional abutments after removal of

splinted prosthesis one month after the patient’s
second visit.

58. Milled posterior abutment being inserted into

metal prosthesis.

59.Prosthesis being used to position milled posterior

abutment.

60. Milled anterior abutment being inserted into

metal prosthesis.

61. Prosthesis being used to insert milled abutments

into the well of their implants.
62. Transitional stealth abutment being removed.

63. An abutment prepared for an Integrated

Abutment Crown™ being inserted into the well of
an implant.

64. An abutment prepared for an Integrated

Abutment Crown™ being inserted into the well of
an implant.

65.Sulcus reamer being inserted into a seated guide

pin to remove soft tissue and bony interference
for the seating of a prepared Integrated
Abutment Crown™ abutment.

66. An abutment prepared for an Integrated

Abutment Crown™ being inserted into the well of
an implant.

67. Occlusal registration rim being used to position

cantilevered Integrated Abutment Crown™
abutment into the well of its implant.
68.Occlusal registration and anterior aesthetic being
established.

69. Transitional prosthesis being re-inserted.

70.Orientation jig on Integrated Abutment Crowns™

and three unit fixed prosthesis.

71. Mirror view of Integrated Abutment Crowns™

and three unit fixed prosthesis.

72. View of implant wells after the removal of the

transitional prosthesis and the stealth
abutments.

73. Posterior milled abutment being inserted into

prosthesis.
74. Prosthesis being used to position milled
abutment into the well of its implant.

75. Three unit prosthesis preliminarily positioned

with only posterior abutment.

76. Integrated Abutment Crown™ being inserted to

facilitate the positioning of adjacent three unit
prosthesis.

77. Anterior milled abutment being inserted into

prosthesis.

78. Prosthesis being used to position anterior

abutment into the well of its implant.

79.Dental floss indicates an inappropriately too tight

interproximal contact.
80. Prosthesis is being re-inserted with only the
anterior abutment to facilitate establishing an
appropriate interproximal relationship.

81. Posterior abutment is being re-inserted after an

appropriate anterior interproximal relationship
was established.

82. View of preliminarily positioned prosthesis prior

to radiographic confirmation of its adaptation.

83. Posterior abutment receiving a preliminary

seating tap.

84. Anterior abutment receiving a preliminary

seating tap with the aid of an orientation jig.

85. Anterior abutment receiving a definitive seating

tap in the long axis of its implant well and
abutment post.
86. Re-inserted prosthesis reveals blanching of soft
tissue beneath pontic.

87. Crestal relieving incision being made to

accommodate pontic.

88. Integrated Abutment Crown™ being re-inserted

after definitive seating of fixed posterior
prosthesis.

89. Orientation jig being used to facilitate

positioning of Integrated Abutment Crown™.

90. Polishing strip being used to adjust an

inappropriately tight interproximal contact.

91. A custom yellow seating jig is being used to

direct the seating forces in the long axis of the
implant well and abutment post.
92. Integrated Abutment Crown™ being inserted.

93. A custom yellow seating jig is being used to

direct the seating forces in the long axis of the
implant well and abutment post.

94. Integrated Abutment Crown™ being inserted.

95. Integrated Abutment Crown™ receiving a

preliminary seating tap with the aid of an
orientation jig.

96. Integrated Abutment Crown™ being inserted.

97. View of prostheses immediately after being

seated.
98. Post-operative radiograph of seated Integrated
Abutment Crowns™ and three unit fixed
prosthesis.

99. View of prostheses one month after insertion.