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Implant  placement procedure for Dr. Ted Rothstein
Part 1  P2   P3

Part 4     Part 5    Part 6:

 718 852 1551

DrTed35@aol.com

35 Remsen St, 
Brooklyn, NY 11201
 (MAP)

 

PART 4:  Sequential photos of implant procedure;  PART 5:  Step-by-step preparation of the material required by the  lab to fabricate the crown that will be screwed on to the implant PART 6    Attaching the abutment to the implant and gluing the crown on to the abutment

 see previous parts  Part 1    Part 2   Part 3 
Four-part film series (YouTube) showing Dr. Ted having a tooth removed and a bone graft in
in preparation for getting an implant:
Part 1    Part 2   Part 3 

 

Part 4

Inserting the Implant

   

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.

 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

 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

 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

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

Part 5

Preparation of items required by laboratory

   

 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

       

Unscrewing the healing cap

View of the implant without the healing cap

The Impression coping (Screw partly intruded)

Details of the Impression coping  (now showing part that screws in to the implant)

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)

 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)

Impression of the upper teeth before inserting the Impression Coping

Impression of the upper teeth with the impression coping in place

Detailed view of the impression coping

Screwing  the healing cap back on to the implant

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.

View of the inside of the bite registration

Selection of shade with Vita 3D Master shade guide (in this case 3M3)

Purposely empty

Temporary bridge rebonded

 

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...

   

 

...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

 

Part 6

On February 17, 2011 my office received the abutment and the crown ready to assemble in my mouth

 

 Attaching the Abutment to the Implant and gluing the Crown to the Abutment

 

The parts sent by the lab to my  office

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.

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.

Trying in the crown to test for fit

Bird's eye view of crown fitting exactly in to place

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)

   

EMPTY

Plastic jig abutment-removing-tool seated tightly on the abutment ready to lift it out.

 
   
The instruments/tools required to attach the abutment to the implant
A Torqueing wrench and a screw driver instruments placed on a ruler to show their actual size.

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

Assembly instructions provided by Duke the Senior lab assistant at Glidewell:

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.
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

Temporary bridge removed exposing the healing cap screwed on to the implant

Unscrewing the healing cap

 

 

      

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. 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.

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

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.

Prior to 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.

The 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.

   
Finally 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
   

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.  

End part 6

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

URL: ZIMMER DENTAL IMPLANTS (INFO AND VIDEO) 

Project completed March 3. 2011

November 12, 2010

Ted Rothstein, DDS, PhD  
Specialist in Cosmetic Orthodontics
and Dentofacial Orthopedics
Adults and Children
Specialist in Orthodontic Jaw Wiring

American Association of Orthodontists
Life-active Member
35 Remsen St., Bklyn, NY 11201
718 852 1551    Fx 718 852 1894
www.drted.com  
 drted35@aol.com