Two-Stage Placement of a 5.0 x 6.0mm Bicon SHORT® Implant with an Internal Sinus Lift Procedure using Guided Surgery for a Maxillary Right First Molar and its Restoration with an Integrated Abutment Crown™ (IAC)
This treatment demonstrates the two-stage placement of a 5.0 x 6.0mm Bicon SHORT® Implant with an internal sinus lift procedure using guided surgery for a maxillary right first molar and its restoration with an Integrated Abutment Crown™ (IAC). Guided surgery designed for a 5.0 x 5.0mm Bicon SHORT® Implant was used to minimize the risk of sinus perforation and expedite the placement of the 5.0 x 6.0mm Bicon SHORT® Implant with an internal sinus lift procedure. The osteotomy was deepened using incrementally longer Guided Surgery Reamers through the orifice of a 5.0mm Guide Ring until the length of the intended implant was achieved. The top of the Guide Ring is designed to be 12.0mm above the top of the implant when the implant is placed 2.0 to 3.0mm below the alveolar crest of bone.
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Three-month post-extraction and pre-operative radiograph.
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The surgical guide was designed as if it were for the placement of a 5.0 x 5.0mm implant just at the sinus floor, without consideration of the shoulder position.
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Pre-operative clinical view three months after the extraction.
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Custom surgical guide with a gold-colored 5.0mm-diameter Guide Ring to facilitate the preparation of an osteotomy without violating the sinus floor.
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Custom surgical guide positioned on the adjacent teeth with its gold-colored 5.0mm Guide Ring over the intended implant site. The top of the Guide Ring will be 12.0mm above the top of the implant as positioned on the 3D scan.
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View of a Bicon 5.0mm Guided Surgery Kit.
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5.0mm Guided Tissue Punch being inserted into the 5.0mm Guide Ring to initiate a punch incision.
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5.0mm Guided Tissue Punch being used to initiate a punch incision through the Guide Ring.
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Partial view of a punch incison.
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Circular piece of keratinized tissue being removed and preserved.
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Blood being collected for later use with SynthoGraft™.
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5.0mm Guided Spade Drill being inserted into the Guide Ring to initiate the 5.0mm-wide-osteotomy for the intended implant.
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5.0mm Guided Spade Drill being rotated at 400 to 600RPM with external irrigation to remove the cortical layer of crestal bone.
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Gold-colored 5.0 x 5.0mm Guided Surgery Reamer being inserted into the Guide Ring.
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Gold-colored 5.0 x 5.0mm Guided Surgery Reamer being rotated to deepen the osteotomy up to the sinus floor.
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Harvested bone collected in the flute of the 5.0 x 5.0mm Guided Surgery Reamer.
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Custom surgical guide being removed.
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Bone and tissue collected on a Curette after it was used to check the integrity of the floor and walls of the osteotomy.
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Gold-colored 5.0mm Osteotome being inserted into the osteotomy to initiate the internal sinus lift.
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Gold-colored 5.0mm Osteotome being tapped with a Mallet to gently fracture the sinus floor.
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Blood being added to SynthoGraft™ in a Silicone Dappen Dish with autogenous bone kept separately on the side of the Dappen Dish.
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Blood and SynthoGraft™ being mixed together in a Silicone Dappen Dish with autogenous bone kept separately on the side.
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SynthoGraft™ mixture being placed into the prepared osteotomy with a 4.0mm Bone Graft Syringe.
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Gray 4.5mm Bone Expander being tapped with a Mallet to gently push the SynthoGraft™ material deeper into the prepared osteotomy.
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Gold-colored 5.0 x 3.0mm Guided Inserter being placed into the 3.0mm well of a 5.0 x 6.0mm Bicon SHORT® Implant to transport it from its sterile packaging to the prepared osteotomy.
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Gold-colored 5.0 x 3.0mm Guided Inserter being used to insert the 5.0 x 6.0mm Bicon SHORT® Implant into its prepared osteotomy through the Guide Ring.
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Knob of a gold-colored 5.0 x 3.0mm Guided Inserter being gently turned to release it from the placed implant.
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View of the implant seated 2.0 to 3.0mm below the crest of bone.
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Occlusal view of a green 3.0mm Guide Pin seated in the well of the implant to confirm the implant's trajectory.
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Facial view of a green 3.0mm Guide Pin seated in the well of the implant to confirm the implant's trajectory.
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Healing Plug Inserter being cut with a Healing Plug Cutter.
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Cut healing plug being transported to its implant with a periodontal probe.
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Autogenous bone being placed over the implant and its healing plug.
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Cotton swab being used to compress the autogenous bone over the implant and its healing plug.
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Circular piece of keratinized tissue being returned to the site of its excision.
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Circular piece of keratinized tissue placed in the surgical site.
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Circular piece of keratinized tissue sutured in the surgical site.
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Post-operative radiograph of the 5.0 x 6.0mm Bicon SHORT® Implant positioned 2.0 to 3.0mm below the crest of bone revealing SynthoGraft™ material elevating the sinus membrane.
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Six-month post-operative radiograph of the 5.0 x 6.0mm Bicon SHORT® Implant prior to its uncovering.
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Initial incision being made to uncover the implant.
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Uncovering flap being reflected.
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Healing plug being removed from its implant with a 110 endodontic reamer.
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Green 3.0mm Guide Pin being inserted into the well of the implant to confirm its osseointegration and trajectory.
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Green 6.5 Series Sulcus Former seated on a Guide Pin being rotated to remove tissue from the implant's sulcus.
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Green 3.0mm Impression Post being inserted into the well of the implant for the making of a full arch implant-level transfer impression.
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Green Impression Sleeve being inserted onto its corresponding 3.0mm Impression Post in the well of the implant for the making of a full arch implant-level transfer impression.
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Site around the seated Impression Post and Sleeve being sutured to facilitate tissue stability during the making of the full arch implant-level transfer impression.
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Impression material being injected around the Impression Post and Sleeve.
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Green Impression Sleeve captured within a full arch implant-level transfer impression.
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White 6.5 x 4.0mm Healing Abutment being inserted into the well of its implant.
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Large Seating Tip attached to a Threaded Handle being used to to gently tap the Healing Abutment.
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View of the seated Healing Abutment.
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View of the Healing Abutment prior to its removal for the insertion of an Integrated Abutment Crown™(IAC).
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White 6.5 x 4.0mm Healing Abutment being removed from the well of its implant.
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View of the IAC prior to its insertion.
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IAC being seated with occlusal pressure on a cotton swab.
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Dental floss being used to confirm appropriate interproximal contacts.
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Articulating paper being used to confirm appropriate occlusal contacts.
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White Healing Abutment attached to a Threaded Offset Handle being used to definitively seat the IAC with a gentle tap.
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Post-insertion clinical view of the definitively seated IAC.
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Post-insertion radiograph of the IAC with its 5.0 x 6.0mm Bicon SHORT® Implant.
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One-week post-insertion clinical view of the IAC.
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Nine-month post-insertion clinical view of the IAC.
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Five-year post-insertion radiograph of the IAC with its 5.0 x 6.0mm Bicon SHORT® Implant. Note the opacification of the bone around the body of the implant.
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