The Insertion of Two Contiguous Implants into a Mandibular Bone Void Using Sinus Lift Abutments with SynthoGraft®, and Their Subsequent Restoration with Two Integrated Abutment Crowns™
This treatment demonstrates the insertion of a 4.0 x 6.0mm implant and a 4.5 x 6.0mm implant into two contiguous mandibular osteotomies, which communicated with each other because of a bone void. After preparation of the implant osteotomies through the crest of cortical bone, the soft tissue content of the bone void was thoroughly removed from the bony walls of the defect with a spoon excavator prior to filling the defect with a putty-like consistency of the patient’s blood and SynthoGraft®, a pure-phase beta-tricalcium phosphate. A sinus lift abutment was used to prevent the implants from being displaced into the defect. Subsequently, the implants were restored with Universal Abutments and Integrated Abutment Crowns (IACs).
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Pre-operative radiograph revealing a large circumscribed lesion distal to the mandibular left premolar.
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Clinical view of two communicating osteotomies.
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Radiograph of a spoon excavator revealing the extent of the defect.
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Clinical view of a spoon excavator passing between the two osteotomies as it is being used to thoroughly removes soft tissue from the walls of bony defect.
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SynthoGraft® is being mixed with the patient's blood to a putty-like consistency in a dappen dish.
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SynthoGraft® mixture is being injected into the osteotomies.
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SynthoGraft® mixture is being placed into the osteotomies.
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A violet 4.0mm hand reamer is widening the osteotomy in the SynthoGraft® mixture next to adjacent implant's temporary abutment.
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Sinus lift abutment attached to an implant as its plateaus are mortised with SynthoGraft® mixture, prior to being inserted into its osteotomy.
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Sinus lift abutment attached to an implant is being inserted into its osteotomy.
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A temporary abutment and sinus lift abutment in their implants prior to being definitively seated.
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A temporary abutment and sinus lift abutment in their definitively seated implants.
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SynthoGraft® mixture is being applied around the transitional abutments.
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Post-operative radiograph with the SynthoGraft® material indicating the extent of the defect.
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One-month post-operative radiograph after the temporary abutment was removed and replaced with a black healing plug, revealing absorption of the SynthoGraft® material.
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Two-month post-operative radiograph revealing further absorption of the SynthoGraft® material.
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Four-month post-operative clinical view.
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Four-month post-operative radiograph revealing further absorption of the SynthoGraft® material.
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Six-month post-operative clinical view with slight soft tissue fistula over anterior implant.
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Sinus lift abutment is being removed from its uncovered implant.
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Black healing plug is being removed from its uncovered implant.
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A blue 2.5mm and a green 3.0mm guide pin confirm the stability, integration, and angulation of the implants.
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A green 6.5mm sulcus former attached to a threaded knob is being rotated on a green 3.0mm guide pin to remove tissue to conform to the hemispheric base of the intended 6.5mm abutment.
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A gold 5.0mm sulcus former attached to a threaded knob is being rotated on a blue 2.5mm guide pin to remove tissue to conform to the hemispheric base of the intended 6.5mm abutment.
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A blue 2.5mm and a green 3.0mm impression post seated in their implants for the making of an implant-level transfer impression.
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Blue and green acrylic sleeves on impression posts for the making of an implant-level transfer impression.
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Impression material is being injected around the blue and green acrylic sleeves and impression posts.
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Close-up view of blue and green acrylic sleeves captured within the full arch implant-level transfer impression.
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A 5 Low Profile (5L) Universal Abutment seated in its implant well.
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A temporization sleeve on the 5L Universal Abutment for the making of an occlusal registration.
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Bite registration material is being injected around the temporization sleeve.
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Bite registration material around the temporization sleeve with the natural teeth in occlusion.
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Temporization sleeve and Universal Abutment captured in the bite registration material, which will be used to articulate the models.
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Facial view of two initially placed Universal Abutments revealing the need to rotate abutments to achieve better trajectories.
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Occlusal view of the two Universal Abutments revealing the need for better positioning.
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Facial view of the two Universal Abutments after their re-seating to achieve proper angulation.
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White healing cap is being adjusted with a #7408 carbide bur.
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Facial view of the intraorally modified white healing caps.
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Facial view of a blue 2.5mm and a green 3.0mm guide pin in a soft tissue model prior to the fabrication of two Integrated Abutment Crowns™ (IACs).
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Occlusal view of a blue 2.5mm and a green 3.0mm guide pin in a soft tissue model.
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Facial view of two IACs in a soft tissue model.
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Occlusal view of two IACs.
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Two IACs prior to their seating.
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Universal Abutment is being removed from its implant well.
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View of sulci prior to the insertion of two IACs.
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Blue 2.5mm guide pin seated in the well of its implant.
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Green 6.5mm sulcus former attached to a threaded knob is being rotated on a blue 2.5mm guide pin to facilitate the insertion of the IAC.
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IAC is being inserted into its implant.
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View of IAC after its initial seating.
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IAC is being inserted into its implant.
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IACs are being definitively seated with occlusal pressure on a cotton roll.
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Dental floss is being used to confirm appropriate interproximal contacts.
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Articulating paper is being used to confirm occlusal contacts of seated IACs.
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