To flap or not to flap, what is the answer?

Categories ; Posterior, flapless, sinus lift, multiple implants, Nobel Biocare

Partially edentulous

2

Screw retained crown, prophetically driven implant placement.

3

Generous ridge width at the second premolar site

4

X-ray is diagnostic as the buccal and lingual RIRâ&#x20AC;&#x2122;s overlap, a 3 degree rotation is indicated

5

2 mm twist

6

Direction OK, length will be OK for 8.5 mm long implant

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3.2 mm twist set at 18-10-3 = 5 mm, for stepped back preparation

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8.5 x 3.5 Nobel Active

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Motorized tissue punch

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18-10-3 = 5 mm twist drill

11

Length can be increased 1.5 mm

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18-10-1.5 = 6.5 mm osteotomy

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Length is correct

14

Osteotomy is widened to 3.2 mm at 6.5 mm

15

Kavo sonic hand piece with 2.5 mm diamond coated tip. Tip will abrade bone, while not damaging the sinus membrane. The “poor mans piezo”

16

Miss expander used to up fracture weakened sinus floor, NOT to lift membrane

17

Collatape is introduced as the first shielding layer

18

Condenser does not penetrate into the sinus, only pushes material into the sinus in so lifting the membrane

19

Unigraft ceramic grafting material is placed in multiple small quantites. Each quantity does lift the membrane slightly

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MIS condenser is used the drive grafting material into the sinus

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Guided screw tap

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8.5 x 4.3 Nobel Active

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Guided bone mill, to be able to place covers crew. Implants placed sub-crestal as patient will be wearing her RPD during healing period

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Implants placed as planned, with sinuslift.

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Flapped versus flapless.

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