This case demonstrates the use of SynthoGraft™, pure phase Beta-Tricalcium Phosphate, for bilateral sinus lifts, subsequent maxillary ridge split, two stage placement of four maxillary implants, and their restoration with Brevis™ abutments and a metal framed implant retained overdenture.
SURGICAL: Ridge Splits Sinus Lifts Two Stage
RESTORATIVE: Overdentures
TOPICS: SynthoGraft™
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Pre-operative radiograph.
Post operative radiograph of maxillary right sinus lift.
Pre-operative site of left maxillary quadrant.
Elevated full thickness flap for maxillary lateral sinus lift with floor augmentation using SynthoGraft™, Beta-Tricalcium Phosphate.
Mx-Grafter being used to harvest bone shavings from the zygomatric buttress and facial surface of the canine fossa.
View of harvested bone in Mx-Grafter.
View of sinus membrane after prepared osteotomy. Note the perforation in the membrane.
Upon continued dissection, the perforation has widened to a tear.
Sinus lift curette being used to elevate sinus membrane. Note the large tear of the membrane.
View of torn membrane.
Bicon’s resorbable collagen membrane being used to bridge the tear for the containment of the SynthoGraft™, Beta-Tricalcium Phosphate, particles.
Bicon’s resorbable collagen membrane within the sinus.
Surgicell being placed over the collagen membrane for the reinforcement.
Bone harvested with Mx-Grafter being added to the mixture of SynthoGraft™, Beta-Tricalcium Phosphate, and patient’s blood in a dappen dish.
Grafting mixture being loaded into a glass syringe.
Mixture of patient’s blood and SynthoGraft™, Beta-Tricalcium Phosphate, being injected into the sinus cavity.
Sinus with SynthoGraft™, Beta-Tricalcium Phosphate, in place.
Bicon resorbable membrane cut to size and placed over the sinus window to cover the graft material.
Post-operative radiograph immediately after left lateral sinus lift.
Pre operative view four months after sinus lifts.
Initial incisions.
Right side retraction suture.
Retraction sutures.
Retraction sutures in place prior to bilateral ridge splitting procedure.
Alveolar ridge being marked with a #15 blade prior to being split with osteotomes.
Ridge being split with osteotome.
Ridge being split with successively larger osteotome.
Ridge being split with successively larger osteotome.
Ridge being split with successively larger osteotome.
Ridge being split with successively larger osteotome.
Ridge being split with two osteotomes.
Ridge being split with two osteotomes.
Ridge being split with two osteotomes.
Ridge being split with two osteotomes.
A 1.8mm site dilator being tapped with surgical mallet to make a pilot osteotomy.
A 1.8mm site dilator being tapped with surgical mallet to make a pilot osteotomy.
Parallel pin seated in pilot osteotomy indicating its trajectory.
Osteotomy being enlarged with an olive green 2.5mm hand reamer.
Clinician’s finger monitoring the buccal and palatal bone during the preparation of the osteotomy and the harvesting of bone with a teal 3.0mm hand reamer.
Clinician’s finger monitoring the buccal and palatal bone during the preparation of the osteotomy and the harvesting of bone with a blue 3.5mm hand reamer.
Clinician’s finger monitoring the buccal and palatal bone during the preparation of the osteotomy and the harvesting of bone with a red 4.0mm hand reamer.
Clinician’s finger monitoring the buccal and palatal bone during the preparation of the osteotomy and the harvesting of bone with a silver 4.5mm hand reamer.
Patient’s blood being added to SynthoGraft™, Beta-Tricalcium Phosphate, in a dappen dish.
Patient’s blood being mixed with SynthoGraft™, Beta-Tricalcium Phosphate, in a dappen dish.
A 4.5mm x 8.0mm HA coated implant being inserted into the osteotomy with the implant inserter/retriever device.
A 4.5mm x 8.0mm HA coated implant being inserted into the osteotomy with the implant inserter/retriever device.
Implant seating tip attached to a straight handle being tapped to seat implant farther into the osteotomy.
Trimmed black polyethylene healing plug being seated in the well of the implant for two stage placement.
The mixture of patient’s blood and SynthoGraft™, Beta-Tricalcium Phosphate, being placed on top of the implant shoulder.
The graft material being packed with a depth gauge over the implant shoulder.
Bicon’s resorbable collagen membrane placed over the SynthoGraft™, Beta-Tricalcium Phosphate, on the left side prior to closure of the flap.
Suture being placed.
The mixture of patient’s blood and SynthoGraft™, Beta-Tricalcium Phosphate, being placed on the right side.
View of SynthoGraft™, Beta-Tricalcium Phosphate, material in place.
Bicon collagen membrane being placed over the graft material.
View of Bicon collagen membrane and SynthoGraft™, Beta-Tricalcium Phosphate, in place.
Suture being placed.
Sutured site.
Post-operative radiograph six months after the ridge split and the initial implant placements.
View of initial incision prior to the two stage uncovering five months after the placement of the two posterior implants.
View of the well of the implant with trimmed black polyethylene plug prior to uncovering.
Healing plug being removed from the well of the maxillary implant.
View of removed healing plug with a healing plug removal instrument.
Healing plug being removed from the well of the maxillary implant with a healing plug removal instrument.
Green 3.0mm impression reamer being inserted onto guide pin to remove any tissue which might inhibit the complete seating of an impression post.
A gold 5.0mm sulcus reamer being used to remove soft tissue and bone to facilitate seating of Brevis abutment.
View of a black polyethylene plug and a green guide pin seated in the well of the implant.
A gold 5.0mm sulcus reamer being used to remove soft tissue and bone to facilitate seating of Brevis abutment.
View of the trimmed black polyethylene plug seated in the well of the implant.
Healing plug being removed from the well of the maxillary implant with a healing plug removal instrument.
View of removed healing plug with a healing plug removal instrument.
View of removed healing plug with a healing plug removal instrument.
View of four 3.0mm guide pins seated in implant wells.
Profile view of guide pins revealing angulations of integrated implants.
Shoulder depth gauge seated in the well of the implant to facilitate with the selection of a Brevis™ abutment with an appropriate post height.
Shoulder depth gauge seated in the well of the implant to facilitate with the selection of a Brevis™ abutment with an appropriate post height.
Shoulder depth gauge seated in the well of the implant to facilitate with the selection of a Brevis™ abutment with an appropriate post height.
Shoulder depth gauge seated in the well of the implant to facilitate with the selection of a Brevis™ abutment with an appropriate post height.
A 4.0mm 0° Brevis™ abutment with 3.0mm post being inserted in the maxillary right second bicuspid area.
A 6.0mm 15° Brevis™ abutment with 3.0mm post being inserted.
View of seated Brevis™ abutments in the wells of implants. Note that the post of one of the Brevis™ abutment for the maxillary left implant is too long and will have to be replaced.
Replacing the left Brevis abutment ,6.0mm 15° Brevis™, with a 4.0mm 15° Brevis™ abutment.
View of the non parallel abutments revealing the need for the adjustment of their angulation.
A 4.0mm 0° Brevis™ abutment with 3.0mm post is being inserted in the maxillary left second bicuspid area.
Brevis™ abutment being rotated to correct its angulation showing the advantage of 360º universal positioning.
Occlusal view of four seated Brevis™ abutments after their having been appropriately rotated to achieve parallelism.
Abutment seating tip attached to an offset handle being tapped to engage the locking taper connection between the implant and the Brevis™ abutment.
Abutment seating tip attached to an offset handle being tapped to engage the locking taper connection between the implant and the Brevis™ abutment.
Abutment seating tip attached to a straight handle being tapped to engage the locking taper connection between the implant and the Brevis™ abutment.
Abutment seating tip attached to a straight handle being tapped to engage the locking taper connection between the implant and the Brevis™ abutment.
Abutment seating tip attached to a straight handle being tapped to engage the locking taper connection between the implant and the Brevis™ abutment.
Brevis™ housing with plastic cap being snapped onto abutment.
Brevis™ housing with plastic cap being snapped onto abutment.
Top of the abutment being marked with a felt tip pen to indicate the location of the abutment on the denture.
Denture being inserted to mark the position of the abutment.
Palatal view of the patient’s denture with a marking indicating the location of the abutment.
Patient’s denture being relieved to accommodate Brevis™ housing.
Black plastic impression cap being snapped onto abutment prior to taking an impression.
View of black plastic impression caps snapped onto abutments.
Full arch impression being made.
Stone model of maxillary arch with four impression caps.
View of lab fabricated occlusal rim.
Adhesive placed in the palate to help retain the wax rim during the bite registration.
Insertion of wax rim.
Smile line being marked and vertical dimension of occlusion being adjusted.
Desired length of anterior teeth being marked.
Desired length of anterior teeth being marked.
Desired length of anterior teeth being marked.
View of the marked smile line and the desired incisal length.
Excess wax being removed.
View of completed wax rim.
Centric occlusion being recorded.
Confirmation of rest space.
Wax rim being marked to record the midline of the face, smile line and incisal length of anterior teeth.
Wax rim being marked to record the midline of the face.
Polyvinylsiloxane material injected for the making of an occlusal registration.
Palatal view of maxillary overdenture ready for insertion.
Maxillary overdenture showing the mesh designed to accommodate BrevisTM housings.
Occlusal view of maxillary overdenture ready for insertion.
Profile view of maxillary denture on a stone model.
Facial view of the maxillary denture on a stone model.
View of Brevis™ abutments prior to the insertion of maxillary overdenture.
Rubber dam aprons being placed.
View of rubber dam aprons seated over the shoulders of Brevis abutments to prevent the possibility of acrylic from locking onto the abutments.
Vaseline being injected to further prevent the acrylic from locking under the abutments during the chairside pick-up.
Brevis™ housing being placed.
Brevis™ housing being placed.
View of seated Brevis™ housings.
Maxillary denture being adjusted to accommodate BrevisTM housings.
Vaseline being applied between the housing cavities.
Cold curing acrylic being injected onto the denture.
Cold curing acrylic being placed around the Brevis™ housings.
Patient clenching bilaterally on cotton rolls to achieve proper seating of the denture.
Maxillary posterior teeth positioned two-third the height of the retromolar pad. Note the excessive wear of left mandibular posterior prosthesis.
Maxillary posterior teeth positioned two-third the height of the retromolar pad. Note the excessive wear of right mandibular posterior prosthesis.
Retention grooves being added to mandibular posterior teeth to increase retention for the composite material to correct occlusal discrepancies.
Bonding material being applied.
Bonding material being applied.
Light curing of bonding material.
Composite material being added to increase the length of mandibular posterior teeth.
Composite material being shaped.
Composite being light cured while patient is clenching.
Composite being light cured while patient is clenching.
Composite being light cured.
Maxillary overdenture being removed with incorporated Brevis housings.
View of maxillary overdenture immediately after its removal.
View of maxillary overdenture after polishing.
Maxillary overdenture being inserted,
Patient’s smile.
View of maxillary arch after the removal of patient’s denture three weeks post insertion.
View of denture three weeks post insertion.
Patient’s smile three weeks post insertion.
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