Extraction of a Maxillary Left First Premolar and its Replacement with a SHORT® 4.5 x 6.0mm Implant, and Grafting with LPRF, Collagen Membranes, and SynthoGraft™, a pure phase beta tricalcium phosphate

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1.

Pre-operative radiograph.

2.

Pre-operative site.

3.

Initial use of a periotome facilitates the extraction and preservation of alveolar bone.

4.

The extracted root.

5.

Blood being collected for later use with SynthoGraft™.

6.

Post-extraction site.

7.

A spoon excavator being used to currette the bony socket reveals a perforation.

8.

Facial view with a perforation.

9.

A 2.0mm pilot drill being used to determine the position and depth of the osteotomy.

10.

A light green 2.5mm latch reamer widening the osteotomy.

11.

A light blue 3.0mm latch reamer widening the osteotomy.

12.

A red 4.0mm hand reamer widening the osteotomy.

13.

A gray 4.5mm hand reamer widening the osteotomy.

14.

A gray 4.5mm hand reamer harvesting bone chips for later bone grafting.

15.

Spoon excavator being used to harvest bone chips, while also confirming the integrity of the osteotomy walls.

16.

The patient's blood was drawn and spun in a centrifuge for the making of a Leukocyte Platelet Rich Fibrin (LPRF) membrane.

17.

The isolated white blood cells are placed in a covered LPRF device for the making of the membrane.

18.

SynthoGraft™ being mixed to a putty-like consistency with the patient's blood in a dappen dish for grafting. Note the harvested bone is kept separately in the dappen dish.

19.

SynthoGraft™ was placed into the osteotomy with a bone graft syringe. Note the graft material filling the bone void.

20.

A 4.5 x 6.0mm SHORT® Implant being placed through graft material in the osteotomy.

21.

A 4.5 x 6.0mm SHORT®Implant being seated with a green 3.0mm seating tip.

22.

A mallet being tapped using a 3.0mm seating tip inserted in the implant for its definitive seating.

23.

SynthoGraft™ being applied to the area of the perforation with a cotton tip applicator.

24.

A trimmed collagen membrane being placed as a barrier over the SynthoGraft™.

25.

View of the seated implant and collagen membrane over the graft material.

26.

A black polyethylene healing plug being inserted into the well of the implant.

27.

Harvested bone being placed over the implant.

28.

Collagen membrane folded over the implant and harvested bone.

29.

LPRF membrane placed over the collagen membrane and implant.

30.

The LPRF membrane being sutured in place.

31.

Sutured site.

32.

Post-insertion radiograph. Note the radiopacity of the SynthoGraft™.

33.

A black polyethylene healing plug being removed from the implant four months post insertion.

34.

A 5.0mm sulcus former being inserted on a 3.0mm guide pin.

35.

5.0mm sulcus former being rotated on a guide pin seated in the well of the implant to remove tissue and to form a sulcus for the Universal Abutment.

36.

Impression material being injected around a green impression sleeve on a 3.0mm impression post for the making of an implant-level transfer impression.

37.

Green impression sleeve captured in the impression.

38.

A 5 low profile (5L) Universal Abutment being inserted into the well of the implant.

39.

A 5L Universal Abutment seated in the well of the implant.

40.

A 5L temporization sleeve being modified to fit in the interproximal space between the adjacent natural teeth.

41.

A modified temporization sleeve seated on the Universal Abutment.

42.

Temporary composite material being injected around the temporization sleeve for the making of a transitional crown.

43.

Facial view of an intra-orally modified transitional crown.

44.

Radiographic image with temporary composite four months post insertion.

45.

Facial view after insertion of the permanent Integrated Abutment Crown™(IAC).

46.

Facial view of the newly seated IAC in occlusion.

47.

Blue ink confirming occlusal contacts of the IAC.

48.

Post-insertion radiograph of the IAC.

49.

One-month post-insertion radiograph of the IAC.