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Categories ; Posterior, flapless, grafting, sinus lift,Nobel Biocare

Copyright Š 2011 Idondivi, Inc. All rights reserved.


Planning for two implants, and internal sinus lift

Copyright Š 2011 Idondivi, Inc. All rights reserved

2


Over extended impression captures large part of the alveolus

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3


Pre operative situation, abundant keratinized tissue allowing flapless placement

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4


5 bone sounding readings allow placement of Bucco -Lingual Positioner (BLP) for screw retained restoration with access hole in central fossa

Copyright Š 2011 Idondivi, Inc. All rights reserved

5


BLP is glued in with super-glue, locking in the Bucco Lingual and the top of the implant

Copyright Š 2011 Idondivi, Inc. All rights reserved

6


Second BLP positioned

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7


Buccal and lingual wings positioned, while maintaining previously established BL position

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8


Cross bars are removed after the wings are glued to the vacuform carrier with fast setting ortho acrylic

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9


Finished surgical guide

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10


Intra oral view to evaluate need for rotational adjustements. Note that the palate has been opened up, to facilitate x-ray positioning.

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11


X-ray is diagnostic as buccal and lingual Radiographic Implant Replica’s ( RIR’s) overlap. A 7 degree rotation is selected, although not mandatory in this case.

Copyright © 2011 Idondivi, Inc. All rights reserved

12


Initial osteotomy for 8.5 mm implant. ( 24-3-3 = 18 = 8 mm )

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13


Additional 3 MM flexi stop creates step back preparation for tapered implant

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14


8.5 x 3.5 Nobel Active

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15


Vertical stop with dedicated guided implant carrier

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16


Tissue punch

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17


Start drill

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18


24-3-3-3 = 15 = 5 mm osteotomy approaching sinus

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19


Still 1.5 mm to go

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20


24-3—3-1.5 = 16.6 = 6.5 mm osteotomy to sinus wall

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21


Safe / small distance to sinus membrane.

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22


Kavo Sonic hand piece with restorative diamond. Will abrade bone, but not damage sinus membrane

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23


Sonic energy abrade away the little part of bone, creating access to the sinus cavity

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24


Mis bone motorized expander is used to up-fracture the weakened sinus floor

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25


Collatape is used as a “cushion”

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26


Pushed into the sinus cavity, without having the instrument penetrate beyond the osteotomy.

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27


Synthetic grafting material is introduced under the membrane with the Leon Chen stopper

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28


Additional material is pushed in place with the motorized straight Mis compactor

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29


Stepped back preparation for 10 mm tapered implant

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30


4.3 x 10 mm Nobel active

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31


Implants placed as planned, with trans crestal sinus lift.

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32


Implants placed as planned, with trans crestal sinus lift.

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33


Sonic assisted trans-crestal sinus lift