Sonic assisted trans-crestal sinus lift

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

Planning for two implants, and internal sinus lift

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Over extended impression captures large part of the alveolus

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Pre operative situation, abundant keratinized tissue allowing flapless placement

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

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

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Second BLP positioned

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

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

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Finished surgical guide

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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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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.

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

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

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8.5 x 3.5 Nobel Active

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Vertical stop with dedicated guided implant carrier

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Tissue punch

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Start drill

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

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Still 1.5 mm to go

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24-3â&#x20AC;&#x201D;3-1.5 = 16.6 = 6.5 mm osteotomy to sinus wall

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Safe / small distance to sinus membrane.

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

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

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

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Collatape is used as a “cushion”

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

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

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

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Stepped back preparation for 10 mm tapered implant

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4.3 x 10 mm Nobel active

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Implants placed as planned, with trans crestal sinus lift.

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Implants placed as planned, with trans crestal sinus lift.

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