Mandibular Ridge Split, Two Stage Implant Placement, Uncovering, and the Making of a Full Arch Implant Level Transfer Impression

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1.

First Visit: Pre-operative radiograph.

2.

Pre-operative site.

3.

View of broad base flap.

4.

View of bony ridge and the reflection of a full thickness mucoperiosteal flap.

5.

Crestal bony cut is being made with a thin fissure bur at high speed with external irrigation.

6.

Occlusal view of crestal cut.

7.

Labial view of a crestal, horizontal and two vertical bony cuts prior to soft tissue closure of the surgical site.

8.

Sutured site.

9.

Post-operative radiograph.

10.

Second Visit: – three weeks after previous visit Pre-operative site.

11.

Retraction suture placed.

12.

Minimal reflection of the labial mucosa.

13.

Osteotomy being prepared with 2.0mm pilot bur rotating at 1100RPM.

14.

Paralleling pin seated in pilot osteotomy indicating its trajectory.

15.

Paralleling pins in each pilot osteotomy indicating their trajectories.

16.

Osteotomy being enlarged with an olive green 2.5mm latch reamer rotating at 50RPM without water irrigation.

17.

A chisel being applied onto the crest without reflecting the buccal periosteum .

18.

Osteotomy being enlarged with blue 3.5mm hand reamer with hand reamer extension rotating at 50RPM without water irrigation.

19.

Osteotomy being enlarged with red 4.0mm hand reamer with hand reamer extension rotating at 50RPM without water irrigation.

20.

View of osteotomies.

21.

Osteotomy being enlarged with silver 4.5mm hand reamer with hand reamer extension rotating at 50RPM without water irrigation.

22.

Harvested bone in the flute of a silver 4.5mm hand reamer attached to the hand reamer extension.

23.

A 4.5mm x 8.0mm HA coated implant being inserted with the black polyethylene healing plug.

24.

A 4.5mm x 8.0mm HA coated implant being inserted with the black polyethylene healing plug.

25.

A 4.5mm x 8.0mm HA coated implant being inserted with the black polyethylene healing plug.

26.

A 4.5mm x 8mm HA coated implant being inserted with the black polyethylene healing plug.

27.

View of seated implants with polyethylene healing plugs.

28.

Implant being tapped into place.

29.

View of seated implants with polyethylene healing plugs.

30.

Trimmed polyethylene healing plug being inserted into the seated implant.

31.

View of seated implants with their cut black polyethylene healing plugs.

32.

SynthoGraft™, pure phase Beta-Tricalcium Phosphate, mixed with patient’s blood being placed over the implant.

33.

SynthoGraft™, pure phase Beta-Tricalcium Phosphate, mixed with patient’s blood being placed over the implant.

34.

Bicon resorbable collagen membrane cut to size and placed so that its margains extend onto surrounding bone on its mesial, distal, and apical borders.

35.

Sutured site.

36.

Post-operative radiograph.

37.

Third Visit: – Thirteen weeks after previous visit View of operative site prior to the two stage uncovering and the making of a full arch implant level transfer impression.

38.

Flap being reflected.

39.

Healing plug being removed with a healing plug removal instrument.

40.

Healing plug being removed with a healing plug removal instrument.

41.

Healing plug being removed with a healing plug removal instrument.

42.

Implants being tested with periotest to indicate their integration.

43.

Guide pins inserted into integrated implants.

44.

Green 3.0mm impression reamer inserted onto guide pin to remove any tissue which might inhibit the complete seating of an impression post.

45.

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.

46.

Green 3.0mm plastic impression post receiving its mandatory seating tap.

47.

Impression material being injected around the impression posts for the making of a full arch implant level transfer impression.

48.

Integrated Abutment Crowns™ on stone model.

49.

View of Integrated Abutment Crowns™.

50.

Twenty months post-insertion radiograph.

51.

Twenty months post-insertion view of Integrated Abutment Crowns™.