How Implants are Placed
and Restored
(A simple Case
Study)
The following page goes
through a complete case. There are some mildly graphic surgical images ahead, however the emphasis is more on the reconstruction.
The patient in this case is a
teenager with two congenitally missing lateral incisors, as you can see in the pictures
below:
His restorative
options were a Removable Partial Denture, a fixed Bridge or two dental implants. The patient chose the
implant option.
Below you can see the patient
during surgery. Two Root Form Implants (screw-type) are
placed in the edentulous sites. The two x-rays show before and after images.
After the implants
were placed, the tissues were sutured back together again. The sutures were removed
approximately ten days after the surgery. Four weeks after the surgery the patient
presented for a post-operative check-up. Below, you can see images of the surgical sites
four weeks after surgery.
The implants were left
undisturbed for approximately six months, after which they were uncovered. The Uncovery procedure involves a small exposure of the head
of the implant and placement of either a Healing Abutment
or a Temporary Crown. Both are designed to train
your gum tissues to grow around the future prosthesis in a collar-like fashion. The
temporary crowns are usually the better choice in an esthetic area, such as in this case,
since they are able to shape the gum tissues into the nice, scalloped appearance, which
makes the entire restoration look more natural and blend in better. The healing abutments
are designed to stick out of our gums after they are placed, which would make them
esthetically not so pleasing in this case, as you can see below.
 |
|
 |
Here you can see two images with healing abutments in place (not very esthetic).. |
 |
|
 |
These two images show the temporary crowns to be exchanged for the healing abutments.. |
 |
|
 |
This shows the patient with the temporary crowns in place. |
The Temporary Crowns were
left in place for approximately eight weeks. This is the amount of time it usually takes
for tissues to mature or get trained, before final impressions can be
taken for the permanent prostheses or crowns.
 |
|
 |
These two pictures show the healthy tissue condition, after the temporary crowns had been
in place for 8 weeks (and the patient had bleached his teeth somewhat). |
Once the tissues are in
satisfactory condition, a final impression is taken with the help of specialized transfer
impression pins, as you can see below to the left (the transfer pins
connect to implant analogs, which will record the position of the
implants in the stone cast). The impression is then poured into stone with the appropriate
implant analogs in place (below to the right). The analogs (arrows) are
metal components duplicating the exact position and neck morphology of the
implant fixture as it is in the patient’s mouth.
The laboratory technician
will then make custom abutments (red arrow in the left image below), which are attached to
the implant fixtures in the mouth via screws (green arrow in the left image below). The
crowns (blue arrow in the same picture) are then cemented over the custom abutments. Below
to the right you can see the custom abutments inserted. At this point, the screws,
connecting them to the implants will be torqued to a pre-determined torque value, in order
to achieve the correct pre-load value of the screw. This step is very
important, because it will prevent future loosening of the screws.
Once the abutments are
torqued in, the screw access is sealed off and the porcelain crowns are cemented onto the
abutments, much like crowns are cemented onto natural teeth. Below you can see two views
of the restored lateral incisors.
Again, please keep in mind
that this is only one example of how a condition like the one above can be restored. There
are always several solutions to a given problem in implant related reconstruction.
