Two-Stage Placement of Two 4.5 x 6.0mm Bicon SHORT® Implants with Bone Grafting of Thin Ridges Using Collagen Membranes, SynthoGraft™, and Autogenous Bone
This treatment demonstrates the placement of two 4.5 x 6.0mm Bicon SHORT® Implants with Collagen Membranes, SynthoGraft™, and autogenous bone for the grafting of a right thin ridge with a dehiscence and a left thin ridge without a dehiscence.
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2.0mm Pilot Drill being used at 1100RPM with external irrigation.
6.
Paralleling Pin being used to verify the position and angulation of the pilot osteotomy.
7.
Since the pilot osteotomy was intentionally kept shallow (5.0mm), the light yellow 2.5mm Hand Reamer attached to a Threaded Instrument Adapter being used to finalize the depth of the osteotomy to 9.0mm.
8.
Teal 3.0mm Hand Reamer attached to a Threaded Instrument Adapter being rotated at 50RPM to widen the osteotomy. Note: slow-speed drilling greatly reduces the risk of injury to delicate adjacent structures, i.e. the mandibular canal or mental foramen.
9.
Bone shavings collected in the flute of the blue 3.5mm Hand Reamer, which will be used for grafting.
10.
Blood being collected from the osteotomy to be used to wet the SynthoGraft™ substrate.
11.
A Lucas Curette being used to clean the osteotomy and assess the thickness and integrity of its walls.
12.
Magenta 4.0mm Hand Reamer attached to a Threaded Instrument Adapter being rotated at the full depth of the osteotomy.
13.
Bone shavings collected in the flute of the magenta 4.0mm Hand Reamer.
14.
Gray 4.5mm Hand Reamer attached to a Threaded Instrument Adapter being rotated.
15.
Bone shavings collected in the flute of the gray 4.5mm Hand Reamer.
16.
View of the prepared osteotomy with 4.0mm of a dehiscence at the crest of the buccal wall, which is thin (1.0-1.5mm thickness) for an additional 2.0-3.0mm beyond the defect.
17.
A 4.5 x 6.0mm Bicon SHORT® Implant being introduced into its osteotomy with a Healing Plug Inserter.
18.
Green 3.0mm Seating Tip being tapped with a surgical Mallet to seat the implant to its full depth.
19.
View of the fully seated implant with an exposed buccal shoulder, and of a carefully developed buccal flap pocket, which will serve as the retention and containment mechanism for the bone graft.
20.
Green 3.0mm Guide Pin being used to verify the proper positioning of the implant.
21.
Trimmed black healing plug seated in its implant.
22.
The depth of the buccal flap pocket being measured with a periodontal probe.
23.
Periodontal probe being used to mark the depth of the buccal flap pocket on a Collagen Membrane.
24.
The trimmed membrane being carefully introduced into the surgical site.
25.
Trimmed Collagen Membrane tucked into the developed buccal flap pocket.
26.
SynthoGraft™ mixed with blood being carefully placed over the buccal wall and defect.
27.
View of the placed SynthoGraft™. Note: with the expectation of some resorption and remodeling, the thickness for the graft needs to be 3.0-4.0mm.
28.
Harvested autogenous bone being collected from the Dappen Dish.
29.
Autogenous bone being placed over the crest to be directly under the suture line.
30.
View of the entire graft before being lightly compressed with finger pressure.
31.
Buccal view of the closed site, which was sutured with 4.0 chromic gut sutures.
32.
Occlusal view of the closed site, which was sutured with 4.0 chromic gut sutures.
33.
Post-operative radiograph of the 4.5 x 6.0mm Bicon SHORT® Implant.
34.
Left pre-operative radiograph.
35.
Left pre-operative site.
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Left pre-operative site.
37.
Flap being developed and retracted.
38.
Blood being collected to be used to wet the SynthoGraft™ substrate.
39.
The sharp tip of the 2.0mm Pilot Drill being used to mark the location of the intended osteotomy prior to drilling.
40.
Paralleling Pin being used to verify the position and angulation of the initiated pilot osteotomy.
41.
Light yellow 2.5mm Hand Reamer attached to a Threaded Instrument Adapter being rotated at 50RPM to widen the osteotomy.
42.
Teal 3.0mm Hand Reamer attached to a Threaded Instrument Adapter being rotated at the full depth of the osteotomy.
43.
Bone shavings collected in the flute of the teal 3.0mm Hand Reamer, which will be used for grafting.
44.
Blue 3.5mm Hand Reamer attached to a Threaded Instrument Adapter being rotated.
45.
Bone shavings collected in the flute of the magenta 4.0mm Hand Reamer.
46.
A Lucas Curette being used to clean the osteotomy and assess the thickness and integrity of its walls.
47.
Gray 4.5mm Hand Reamer attached to a Threaded Instrument Adapter being rotated.
48.
A 4.5 x 6.0mm Bicon SHORT® Implant being introduced into its prepared osteotomy with a Healing Plug Inserter.
49.
Green 3.0mm Seating Tip being tapped with a surgical Mallet to seat the implant to its full depth.
50.
Green 3.0mm Guide Pin being used to verify the proper positioning of the implant.
51.
Trimmed black healing plug being inserted into its implant.
52.
View of a carefully developed buccal flap pocket, which was dissected to expose the very thin buccal wall, which requires grafting even without a dehiscence.
53.
A trimmed Collagen Membrane being carefully tucked into the developed buccal flap pocket.
54.
SynthoGraft™ mixed with blood being placed between the membrane and the bone.
55.
Harvested autogenous bone being placed over the bone to be directly under the suture line.
56.
Buccal view of the closed site, which was sutured with 4.0 chromic gut sutures.
57.
Occlusal view of the closed site, which was sutured with 4.0 chromic gut sutures.
58.
Post-operative radiograph of the 4.5 x 6.0mm Bicon SHORT® Implant.
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