This case demonstrates the use of SynthoGraft™, pure phase Beta-Tricalcium Phosphate, for bilateral sinus lifts with floor transport technique using sinus lift temporary abutments, two stage placement, implant level impression and insertion of twelve maxillary full arch Integrated Abutment Crowns™.
SURGICAL: Sinus Lifts Two Stage
RESTORATIVE: Integrated Abutment Crowns™
TOPICS: Crown Insertion Impression SynthoGraft™
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Pre-operative radiograph before the placement of four implants for o-ring retained prosthesis.
Radiograph of four maxillary implants and o-ring abutments.
Flap is secured with retraction suture in preparation for the sinus lift on the right side with floor transport technique.
Sharp osteotome being used to score a rectangle approximately 3.0mm x 9.0mm in size.
Sharp osteotome being used to score a rectangle approximately 3.0mm x 9.0mm in size.
A 2.5mm Bicon sinus lift osteotome being used to gently fracture and apically displace the rectangular piece of bone.
View of the operative site.
A teal 3.0mm bone expander attached to a straight driver being used to dilate the site.
View of the operative site.
A blue 3.5mm hand reamer attached to a straight driver being used to complete the osteotomy.
A red 4.0mm hand reamer attached to a straight driver being used to complete the osteotomy.
A silver 4.5mm bone expander attached to a straight driver being used to dilate the site.
View of the operative site.
A gold 5.0mm hand reamer attached to a straight driver being used to complete the osteotomy.
A piece of Collatape™ is being placed over the osteotomy to seal small perforation.
View of SynthoGraft™, pure phase Beta-Tricalcium Phosphate, inside Collatape™.
A 5.0mm x 6.0mm short HA coated implant with sinus lift temporary abutment is being removed from its packaging with a rongeur.
A 5.0mm x 6.0mm short HA coated implant with sinus lift temporary abutment is being inserted into the osteotomy which is filled with SynthoGraft™, pure phase Beta-Tricalcium Phosphate, and Collatape™.
Straight handle with a seating tip attached is being tapped to seat implant farther into the osteotomy and complete the sinus lift.
View of operative site prior to closure of flap over temporary sinus lift abutment.
A 5.0mm x 8.0mm HA coated implant being inserted between the two existing implants with o-ring abutments.
SynthoGraft™, pure phase Beta-Tricalcium Phosphate, mixed with patient’s blood being placed over the implant.
View of alveolus with two mesio-distal cuts for the sinus lift on the left side with floor transport technique.
Sharp osteotome being used to score a rectangle approximately 3.0mm x 9.0mm in size.
Sharp osteotome being used to score a rectangle approximately 3.0mm x 9.0mm in size.
View of the operative site.
A 2.5mm Bicon sinus lift osteotome being used to gently fracture and apically displace the rectangular piece of bone.
View of the operative site.
A teal 3.0mm hand reamer attached to a straight driver being used to complete the osteotomy.
A blue 3.5mm hand reamer attached to a straight driver being used to complete the osteotomy.
View of the operative site.
A red 4.0mm hand reamer attached to a straight driver being used to complete the osteotomy.
A silver 4.5mm hand reamer attached to a straight driver being used to complete the osteotomy.
A gold 5.0mm hand reamer attached to a straight driver being used to complete the osteotomy.
SynthoGraft™, pure phase Beta-Tricalcium Phosphate, mixed with patient’s blood being placed into the osteotomy.
View of operative site with SynthoGraft™, pure phase Beta-Tricalcium Phosphate, in place.
A 5.0mm x 6.0mm short HA coated implant with sinus lift temporary abutment being inserted into the prepared osteotomy filled with SynthoGraftTM, pure phase Beta-Tricalcium Phosphate. and CollatapeTM.
Abutment seating tip attached to a straight handle is being tapped to seat implant farther into the osteotomy and complete the sinus lift.
View of operative site prior to closure of flap over temporary sinus lift abutment.
Post-operative radiograph of four existing implants with o-ring abutments and eight newly placed implants, two of which were placed simultaneously with sinus lift grafting.
Facial view of patient’s maxillary denture prior to taking an occlusal registration and implant level transfer impression twelve weeks after the last implant placement.
View of four o-ring abutments prior to their being removed for the making of the full arch implant level transfer impression.
Scissors being used to reflect tissue for the removal of the temporary sinus lift abutment.
Tissue reflection revealing temporary sinus lift abutment twelve weeks after the implant placement.
Sinus lift temporary abutment being removed from the well of the implant.
Green 3.0mm plastic impression post being inserted into the 3.0mm well of an integrated implant for the making of an implant level transfer impression.
Green 3.0mm plastic impression post receiving its mandatory seating tap.
Relieving holes in the patient’s existing denture to accommodate the impression posts for the recording of an occlusal registration.
Green 3.0mm plastic impression posts projecting through the denture which will be used with red acrylic to unilaterally record the patient’s existing vertical dimension.
Red acrylic being injected onto the trimmed impression posts to record a unilateral vertical stop prior to removing the denture for a more definitive bilateral occlusal registration.
Red acrylic being injected onto trimmed impression posts for the recording of a more definitive occlusal registration.
View of seated impression posts and red acrylic on the right side recording the occlusal registration.
Vertical dimension being recorded.
O-ring abutment on the left side being removed prior to the insertion of the green 3.0mm plastic impression post.
View of implant wells and soft tissue sulci.
Green 3.0mm impression reamer inserted onto guide pin to remove any tissue which might inhibit the complete seating of an impression post.
Green 3.0mm plastic impression post being inserted into the 3.0mm well of an integrated implant prior to the occlusal registration and implant level transfer impression.
Red acrylic being injected onto impression posts for the recording of left side occlusal registration.
Occlusal registration being made with red acrylic and impression posts.
Occlusal registration being removed from mouth.
O-ring abutment being removed from the patient’s right side.
Green 3.0mm impression reamer inserted onto guide pin to remove any tissue which might inhibit the complete seating of an impression post.
Healing plug being removed from the well of the implant with a healing plug removal instrument.
Green 3.0mm impression reamer inserted onto guide pin to remove any tissue which might inhibit the complete seating of an impression post.
Green 3.0mm plastic impression post being inserted into the 3.0mm well of an integrated implant for the making of an implant level transfer impression.
Green 3.0mm plastic impression post receiving its mandatory seating tap.
Green 3.0mm plastic impression post being inserted into the 3.0mm well of an integrated implant for the making of an implant level transfer impression.
Healing plug being removed from the well of the implant with a healing plug removal instrument.
Healing plug being removed from the well of the implant with a healing plug removal instrument.
Green 3.0mm impression reamer inserted onto guide pin to remove any tissue which might inhibit the complete seating of an impression post.
Green 3.0mm plastic impression post being inserted into the 3.0mm well of an integrated implant for the making of an implant level transfer impression.
Healing plug being removed from the well of the implant with a healing plug removal instrument.
Green 3.0mm impression reamer inserted onto guide pin to remove any tissue which might inhibit the complete seating of an impression post.
Green 3.0mm plastic impression post being inserted into the 3.0mm well of an integrated implant for the making of an implant level transfer impression.
Green 3.0mm plastic impression post receiving its mandatory seating tap.
Facial view of twelve seated green 3.0mm plastic impression posts.
Impression material being injected around the impression posts for the making of a full arch implant level transfer impression.
Green 3.0mm plastic impression posts being trimmed.
Reinserted o-ring abutment being tapped.
O-ring abutment being reinserted to retain denture while the Integrated Abutment Crowns™ are being fabricated.
O-ring abutment being reinserted to retain denture while the Integrated Abutment Crowns™ are being fabricated.
O-ring abutment being tapped.
Transitional prosthesis being reinserted.
Digital image being taken of shade guide against a black plastic background to facilitate the fabrication of aesthetic Integrated Abutment Crowns™.
Profile view of Integrated Abutment Crowns™ on stone model.
Palatal view of Integrated Abutment Crowns™ on stone model.
Facial view of Integrated Abutment Crowns™ on stone model.
View of Integrated Abutment Crowns™.
Patient’s smile after the removal of transitional prosthesis for the insertion of Integrated Abutment Crowns™ four weeks after the implant level transfer impression was taken.
Occlusal view of trimmed green 3.0mm plastic impression posts which served as temporary abutments and o-ring abutments prior to the insertion of Integrated Abutment Crowns™.
Abutment post being cleaned with alcohol wipe to remove any debris which would diminish the effectiveness of the locking taper connection.
Integrated Abutment crown™ being inserted.
Trimmed green 3.0mm plastic impression post being removed.
Abutment post being cleaned with alcohol wipe to remove any debris which would diminish the effectiveness of the locking taper connection.
Integrated Abutment Crown™ being inserted.
View of two seated central incisor Integrated Abutment Crowns™. Blanching of soft tissues with the initial seating of the Integrated Abutment Crown™ indicates the need for either relieving incisions or re-contouring of the cervical aspect of the integrated abutment crown™.
Crestal relieving incision being made to facilitate the seating of the Integrated Abutment Crown™.
Floss being used to confirm the fact that the interproximal contacts are passive and will not interfere with the engagement of the locking taper.
Yellow thermoplastic custom seating jig, which was formed with a crown alignment device, in a crown seating tip attached to a straight handle facilitates directing the tapping forces in the long axis of the abutment post and implant well.
Yellow thermoplastic custom seating jig, which was formed with a crown alignment device, in a crown seating tip attached to a straight handle facilitates directing the tapping forces in the long axis of the abutment post and implant well.
Trimmed green 3.0mm plastic impression post being removed.
Well of implant being cleaned with alcohol on a cotton tipped applicator.
Abutment post being cleaned with alcohol wipe to remove any debris which would diminish the effectiveness of the locking taper connection.
Integrated Abutment Crown™ being inserted.
Yellow thermoplastic custom seating jig, which was formed with a crown alignment device, in a crown seating tip attached to a straight handle facilitates directing the tapping forces in the long axis of the abutment post and implant well.
View of three seated anterior incisor Integrated Abutment Crowns™.
View of implant well and soft tissue sulcus.
Integrated Abutment Crown™ being inserted.
An acrylic orientation jig is being used to initially position the Integrated Abutment Crowns™.
Floss being used to confirm the fact that the interproximal contacts are passive and will not interfere with the engagement of the locking taper.
Polishing strip being used to lighten the interproximal contact area eliminating the possibility that the contact may prevent the engagement of the locking taper connection.
Yellow thermoplastic custom seating jig, which was formed with a crown alignment device, in a crown seating tip attached to a straight handle facilitates directing the tapping forces in the long axis of the abutment post and implant well.
View of four seated anterior incisor Integrated Abutment Crowns™.
O-ring abutment being removed.
Well of implant being cleaned with alcohol on a cotton tipped applicator.
Well of implant being cleaned with alcohol on a cotton tipped applicator.
Integrated Abutment Crown™ being inserted.
Crestal relieving incision being made to facilitate the seating of the Integrated Abutment Crown™.
An acrylic orientation jig is being used to initially position the Integrated Abutment Crowns™.
Yellow thermoplastic custom seating jig, which was formed with a crown alignment device, in a crown seating tip attached to a straight handle facilitates directing the tapping forces in the long axis of the abutment post and implant well.
View of five seated anterior Integrated Abutment Crowns™.
Trimmed green 3.0mm plastic impression post being removed.
Integrated Abutment Crown™ being inserted.
Seated Integrated Abutment Crown™.
Integrated Abutment Crown™ being inserted.
Adjustment of interproximal contact since a too tight interproximal contact would prevent the engagement of the locking taper and possibly result in the subsequent loosening of the Integrated Abutment Crown™.
White healing abutment in a straight handle is being used to tap the Integrated Abutment Crown™ into the well of the implant.
Integrated Abutment Crown™ being inserted.
View of six seated anterior Integrated Abutment Crowns™.
Integrated Abutment Crown™ being inserted.
View of seven seated Integrated Abutment Crowns™.
Integrated Abutment Crown™ being inserted.
White healing abutment in a straight handle is being used to tap the Integrated Abutment Crown™ into the well of the implant.
Integrated Abutment Crown™ being inserted.
White healing abutment in a straight handle is being used to tap the Integrated Abutment Crown™ into the well of the implant.
Integrated Abutment Crown™ being inserted.
White healing abutment in a straight handle is being used to tap the Integrated Abutment Crown™ into the well of the implant.
Trimmed green 3.0mm plastic impression post being removed.
Integrated Abutment Crown™ being inserted.
White healing abutment in a straight handle is being used to tap the Integrated Abutment Crown™ into the well of the implant.
White healing abutment in a straight handle is being used to tap the Integrated Abutment Crown™ into the well of the implant.
White healing abutment in a straight handle is being used to tap the Integrated Abutment Crown™ into the well of the implant.
Yellow thermoplastic custom seating jig, which was formed with a crown alignment device, in a crown seating tip attached to a straight handle facilitates directing the tapping forces in the long axis of the abutment post and implant well.
Yellow thermoplastic custom seating jig, which was formed with a crown alignment device, in a crown seating tip attached to a straight handle facilitates directing the tapping forces in the long axis of the abutment post and implant well.
Yellow thermoplastic custom seating jig, which was formed with a crown alignment device, in a crown seating tip attached to a straight handle facilitates directing the tapping forces in the long axis of the abutment post and implant well.
Yellow thermoplastic custom seating jig, which was formed with a crown alignment device, in a crown seating tip attached to a straight handle facilitates directing the tapping forces in the long axis of the abutment post and implant well.
Yellow thermoplastic custom seating jig, which was formed with a crown alignment device, in a crown seating tip attached to a straight handle facilitates directing the tapping forces in the long axis of the abutment post and implant well.
Yellow thermoplastic custom seating jig, which was formed with a crown alignment device, in a crown seating tip attached to a straight handle facilitates directing the tapping forces in the long axis of the abutment post and implant well.
White healing abutment in a straight handle is being used to tap the Integrated Abutment Crown™ into the well of the implant.
White healing abutment in a straight handle is being used to tap the Integrated Abutment Crown™ into the well of the implant.
White healing abutment in a straight handle is being used to tap the Integrated Abutment Crown™ into the well of the implant.
Facial view of Integrated Abutment Crowns™ immediately after insertion.
Left profile view of Integrated Abutment Crowns™ immediately after insertion.
Right profile view of Integrated Abutment Crowns™ immediately after insertion.
Occlusal view of Integrated Abutment Crowns™ immediately after insertion.
Articulating paper being used to confirm incisal contacts in all extreme excursions while the patient is clenching.
Blue markings indicate excessive contacts on right lateral incisor, left first premolar and left first molar.
Red Markings indicate excessive contacts on right lateral incisor and canine.
Adjustment of excessive facial contact which occurred during clenching while the mandible was being retruded.
Adjustment of excessive facial contact which occurred during clenching while the mandible was being retruded.
Adjustment of excessive facial contact which occurred during clenching while the mandible was being retruded.
Adjustment of excessive facial contact which occurred during clenching while the mandible was being retruded.
Blue markings indicate appropriate occlusal contacts in all extreme excursions while the patient is clenching.
Facial view of Integrated Abutment Crowns™ with a night guard.
Night guard being adjusted.
Left profile view of Integrated Abutment Crowns™ one day post insertion.
Right profile view of Integrated Abutment Crowns™ one day post insertion.
Facial view of Integrated Abutment Crowns™ one day post insertion.
Post operative radiograph of twelve maxillary full arch Integrated Abutment Crowns™.
One-year post insertion view.
One-year post insertion radiograph.
Two-year post insertion view.
Two-year post insertion radiograph.
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