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Part 4 |
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Inserting the Implant |
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1. Upper left premolar space after 5 months of
healing. Note how graft has restore the bone to its normal
architecture. |
2. The gums have been peeled back exposing the new
bone to view; it looks healthy and feels quite solid. The implant is
going to be screwed directly in to this bone that formed around the
graft material. |
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The Zimmer implant mounted on the screw
driver ready to be screwed in to the bony site.
URL: ZIMMER DENTAL IMPLANTS (INFO AND VIDEO) |
Bird's eye view of the implant |
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X-ray of the Zimmer implant in place.
Note carefully the healing cap screwed into the implant:
placement by
Dr. Mikey Zidile 11/
2/10 |
The implant surmounted with the healing cap |
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Side view: Note that implant is just below the
surface of the gums. A temporary bridge will now be placed |
Pic
of temporary bridge in place End part 4 begin Part
5 |
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Preview Part 5
The green piece you see here is called a "Fixture Mount"
(Impression coping) and will be used later when the dentist is ready
to make the crown. Upon the top of the implant is placed a "healing
cap" which is like a little hat protecting the opening of the
implant into which the crown will be screwed. The healing cap sticks
up slightly beyond level of the skin. |
View of the healing cap in place
End Part 4 |
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Part 5 |
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Preparation of items
required by laboratory |
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02/01/11:
PART V: Step-by-step preparation of the material required by
the lab to fabricate the crown that will screwed on to the
implant |
Temporary bridge removed exposing the healing cap
screwed on to the implant |
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Unscrewing the healing cap |
View of the implant without the healing cap |
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The Impression coping (Screw partly intruded) |
Details of the Impression coping (now
showing part that screws in to the implant) |
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Screwing the Impression Coping in to the implant
(the screwdriver forces out the screw part of the impression coping
enabling it to be screwed into the implant. |
Side view of the impression Coping screwed onto
the implant (side view and bird's-eye view using a mirror showing
the head of the screw inside) |
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Bird's-eye view of the impression coping screwed
into the implant. |
Making the impression of the upper teeth with the
Impression coping in place with special material called Poly Vinyl
Siloxane (PVS) |
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Impression of the upper teeth before inserting the
Impression Coping |
Impression of the upper teeth with the impression
coping in place |
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Detailed view of the impression coping
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Screwing the healing cap back on to the
implant |
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Healing cap screwed back on to the implant |
Making a bite registration will enable the
lab to see how the upper and lower molds of Dr. Ted's teeth
come together when he bites on his back teeth. That is how the lab
knows how tall the tooth should be made. |
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View of the inside of the bite registration |
Selection of shade with Vita 3D Master shade guide
(in this case 3M3) |
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Purposely empty |
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Temporary bridge rebonded |
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Impression with impression Coping in place
is now sent to the lab... |
...with the lower model of Dr Ted's teeth and the
bite registration... |
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...and the bite registration which shows the lab
exactly how to put together the upper and lower molds
representing Dr. Ted's teeth |
End Part 5
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Part 6
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On February 17, 2011 my
office received the abutment and the crown ready to assemble in my
mouth |
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Attaching the Abutment
to the Implant and gluing the Crown to the Abutment |
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The parts sent by the lab to
my office |
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| My upper and lower molds mounted on a simple hinge articulator
instrument |
Bird's eye view of implant screwed into the
transfer coping buried within
the model. The red material is simulation of my gums. |
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| Articulated molds of my teeth showing how I bite with the
implant (visible). The implant is screwed (screw not visible) to the
impression coping (buried inside the mold), Note the #12 facing out.
The abutment will be placed in to the implant in the same position. |
The porcelain crown (porcelain bonded to metal
crown) and an mini-screw (the company sends you two extra screws in
case one or two get lost).
Here you can get an idea of the size of the crown and the screw
which will be used to attach the crown to the abutment. |
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Trying in the crown to test for fit |
Bird's eye view of crown fitting exactly in to
place |
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The plastic jig tool to assist removing the implant from
the mold where it has been screwed on to the impression coping (You
must therefore first remove the screw that secures the abutment to
impression coping before trying to remove the abutment from the
mold. |
Plastic jig abutment-removing-tool seated tightly
on the abutment ready to lift out abutment.
(The internal mini-screw holding the abutment to the transfer coping has been removed) |
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Plastic jig abutment-removing-tool seated tightly
on the abutment ready to lift it out. |
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The
instruments/tools required to attach the abutment to the implant |
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| A Torqueing wrench and a
screw driver |
instruments placed on a
ruler to show their actual size. |
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A. The
mini-screwdriver: used to remove the screw from deep inside the
abutment (where it is holding the implant to the impression
coping buried inside the mold) and then later to re-screw it back in
to the implant thereby effectuating attaching the abutment to the
implant.
B. The pink jig tool:
to assist in removing the abutment from the model once the screw has
been removed (if the abutment does not remove easily
you may use a hemostat to grab the implant and pull it out. (No
harm will come to the implant since it is made of titanium steel and
is incredibly durable
C. The torqueing
wrench: to properly tighten the screw thereby properly
securing the abutment to the implant |
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Assembly instructions
provided by Duke the Senior lab assistant at Glidewell: |
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Remove the temporary bridge and the healing cap
Trial seat the new crown in the empty space in the patient's
mouth in its final position where it is going to be. Adjust/trim
the crown or better the teeth
in front and back of it.
Have your mini-screwdriver tool and your torqueing wrench tool
nearby
1. Use the mini-screwdriver and remove the screw (save screw) at
the bottom of the abutment. The screw is securing the abutment to
the transfer coping buried in the mold. The screw is not visible
to the naked eye. It
is impossible to remove the abutment from the model if you do
not remove the screw.
2 Place the pink jig on the implant in its proper position
and push it down on the abutment. It creates a friction grip on
the abutment.
Photo
3. Pullout the abutment from the stone model: if it does not
come out you can use a hemostat to pull it out (as long as you
have removed the screw
connecting the abutment to the transfer coping.)
4. The pink material around the abutment is made of silicone to
simulate the gum tissue and can be removed
5. NOW place the freed abutment on the implant in the patient's
mouth (the implant has number on its "face" which faces
outward). That is how you know
the implant is correctly positioned.
6. Place the screw you removed in step one back into the
abutment and with the screw driver tool, screw it in as far as
possible
7. Set the torqueing wrench tool to 30 "newtons" of force: apply
the torqueing wrench to the screw driver tool and keep turning
the torqueing wrench until you
begin to hear it start clicking---that is when you know you have
tightened the screw to 30 newtons of tightness. The abutment is
now SECURED to the implant.9
8. Fill up the abutment hole with
small pellets of cotton right up to the top (the cotton will
prevent the glue from getting deep down in the abutment hole
and cause clogging of the screw you just tightened to keep the
abutment secured to the implant.
9.Trial seat the crown again on the abutment which is now
screwed tightly into place in the implant in the patient's. Make
any necessary adjustments
to the crown or teeth in front and back of the implant, and then
remove it from the abutment.
11. Clean the abutment and the inside of the crown and finally
place crown cement inside the crown and place it onto the
abutment making to push/seat
it until is positively seated down all the way on to the
abutment and properly oriented. Clean the excess cement. [NOTE]
The lab provide TWO extra mini-screws just in case you lose a
screw or two.
Begin actual work done in mouth
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Temporary bridge removed exposing the
healing cap screwed on to the implant |
Unscrewing the healing cap |
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Trying in the fit of the crown: the new crown is being
held in place only by the pressure of the canine tooth
in front (darker) and the tooth with crown in back of
it. It is sitting over the abutment. In my mouth it
feels most natural and looks very natural as well. Now
we are ready place the abutment and screw the crown on
to it.
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The mini screwdriver being used to
unscrew the mini-screw holding the abutment on to the
transfer coping. To the right the dentist has is showing
the abutment which he has lifted out of the model. No
difficulty at all was encountered lifting the
abutment out of the model once the screw was removed,
and pink plastic jig tool shown above was not needed. |
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Placing the abutment on the implant; If you look closely
you can see the #12 etched into the face of the
abutment. This tells the dentist that the abutment is
positioned correctly (face outward) |
Screwing the abutment on to the
implant |
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The dentist is placing
the screwdriver in the torqueing wrench. The torqueing
instrument has been set to stop tightening the screw
holding the abutment when force applied to the screw
reaches 30 newtons. |
Here you see the
torqueing wrench/screwdriver instrument being used to
tighten the screw that holds the abutment to the
implant. The torqueing wrench is an instrument that
permits the dentist to tighten the screw that holds the
abutment to the implant to the exact tightness
recommended by the Zimmer company who manufactured the
abutment. |
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final cementation of the crown on the abutment the crown
is seated firmly on to the abutment and the patient is
asked to bite on blue paper. |
The blue paper shows
the dentist how hard and evenly the upper and lower
teeth are hitting each other. |
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dentist then lightly sands the crown and or the lower
teeth to make the upper and lower teeth come together
simultaneously. |
The dentist then uses the blue
paper for last time to make sure the blue marks are
evenly distributed. |
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the dentist removes the crown from the abutment, fills
the center hole of the abutment with cotton to prevent
glue from clogging the screw that he just screwed
in... |
...and then coats the
inside of the crown evenly with layer of glue and seats
it back firmly in the exact same place it was when he
did the final sanding of the crown. The glue sets
completely in three minutes |
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Ps: The fit and feel of the implant was so precise and
natural feeling that be the time I was ready to go to
sleep I had lost all sense of anything artificial in my
mouth. |
| "O frabjous day! Callooh!
Callay!' He chortled in his joy." (The
Jabberwocky) From Alice in Wonderland--Lewis
Carroll. |
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End part 6 |
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We accord a
special thank you to Zimmer Representative Eric Preza
for assisting us with know-how and instrumentation which
were vital to completion of the steps in Part 6:
Eric.Preza@zimmer.com |
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