Crestal sinus lift and buccal grafting

Categories ; Posterior, Grafting, Sinus Lift, Nobel Biocare

A purposely over extended impression, pushing the soft tissue against the bone

2

Creates a cast with ample information

3

Substantial buccal defect

4

Vacuform carrier with buccal space for flap reflection

5

Screw access hole in central fossa

6

Top of implant not at top of narrow crest. In conventional surgery crest would be flattened before placement, here weâ&#x20AC;&#x2122;ll use a bone mill post placement

7

BLP in positioned, locking in the Bucco-Lingual axis and the implant platform

8

Regular Diameter Buccal wing selected. Note minimal Mesio-Distal space

9

No need for correction , so 0 - Degree ( green), rotation block is selected

10

2 MM twist drill taken to 6 mm based on sub-crestal placement , Stoppers were set at 13-3-3 = 7 mm

11

1 more MM to go before sinus floor

12

2 MM Twist drill set at 8 mm. Now weâ&#x20AC;&#x2122;ll enlarge osteotomy before sinus opening

13

2.8 mm twist drill taken to 8 mm

14

3.2 mm twist drill taken to 5 mm , step back preparation for tapered implant

15

Osteotomy fully in bone, despite buccal morphology

16

Introduction of Sonic diamond insert to chip away floor of sinus, while maintaining membrane integrity

17

Sonic diamond will abrade hard tissue (bone), but does not affect soft tissue ( membrane)

18

Upon entry , determined by bouncy feel of round probe, introduction of small piece of collatape

19

Synthetic graft material, mixed with blood, is gently elevating membrane. Instrument does not enter into sinus.

20

Note osteotomy, and entry into sinus, with dome of graft material

21

Implant 3.5 x 10 mm , Nobel Active

22

Torqued in place.

23

Guided bone mill, to remove bone after sub-crestal placement

24

Synthetic graft material, mixed with blood and resorbable membrane to “ bulkout” buccal defect, although implant is completely covered with bone.

25

Implant placed according to planning

26

Implant placed as planned, buccal contour augmented.

27

Turn static files into dynamic content formats.

Create a flipbook