Guided Bone Regeneration Using SynthoGraft™ and the Uncovering of a Bicon SHORT® Implant

My name is Shadi Daher. I am an oral surgeon. We are here today at the Implant Dentistry Center in Boston, Massachusetts and, scheduled today are procedures that are pertaining to guided bone regeneration, preservation of, the sockets or regenerating the bone, height in preparation, for the placement of an implant. If possible, we will try to place the implants at the same time. Otherwise, we will perform a minimally invasive ridge preservation procedure. And the second case will be uncovering of an implant, that was placed with a ridge, preservation or bone grafting procedure. The treatment plan, if we may have the radiograph, is for the, removal of the maxillary right central incisor, tooth number eight or number one one in international speak. And, as you see on the radiograph, the, very, apical area has a significant radiolucency that extends all the way around. The, tooth has had a root canal, treatment. It is now mobile. There is significant amount of crowding with an overlap of that tooth. So both in terms of occlusion and in terms of individual dental health, this area of the mouth stands to benefit greatly from implant treatment. As you can see, there is a significant mobility and we can easily, by taking a periodontal probe, do two things. First, I’ll show you where the bone is, deficient and we have a pocket here that is, about ten millimeters. And that is assuring us that we have good anesthesia. The peritome will allow us to sever whatever is left of the periodontal ligament attachment for this tooth. Now we will go around all sides. We went around the mesial and now over the facial. Now we’re going to the, distal. We’ll go to the palatal now. You can easily see that the palatal is a lot, a little bit tighter, and that will grasp the root surface and allow us to give a figure of eight luxation as well as a little bit of turning. And you see that there is a bit of a fracture or a missing part of the tooth and that kind of coincides with what the radiograph shows in terms of irregularity of the surface at the distal and at the distal apical. I feel bone, but we want to make sure we get no granulation tissue. There’s a significant amount of granulation tissue of course. The patient has been pre medicated with, amoxicillin, four grams. We will now collect some of the blood. You have the option of making another incision, collecting it from, a venipuncture in the dorsum of the hand or from the antecubital fossa, but I find that collecting a little bit, especially since we did not use Epinephrine, there is an abundant amount of supply. I’ll just use a little bit of blood. The, SynthoGraft should only be moistened with blood and it should be also mixed a lot to, break the surface tension of the micro and nano porosities. So using my finger on the facial, go to the bottom of the socket and drag it and the length of the defect is roughly ten millimeters. The width of the osteotomy or the socket, excuse me, is seven, about eight millimeters. The defect extends from one side to the other approximately seven millimeters as well. Now we will prepare our bone graft by using a syringe. We will take the membrane, we will push the membrane in. If need be, you can grab it as you’re inserting the bone graft. The bone graft itself goes in and starts stabilizing it in place. Take a sterilized cotton tipped applicator, pack it, it will pack as well as imbibe some of the liquid. And what I will do is take the, take that, is take a suture and we will get the suture ready and then put the plug over it and just cinch it down. And we will use an inverted figure of eight suture. And the trick here is not to let your, needle grab the membrane because then it will just pull it out. There is no cure here. You’ll then have to take it out completely. You will then have to redo the graft by actually collecting it back out. And when we’re suctioning and there’s all kinds of graft material, we will use a gauze over our suction. Here we are. The collagen plug gives you a little bit of an anchor that allows you to put your suture and kind of hold it in place. Okay. So I’m using an inverted suture because I want the knot to sit a little bit deeper in the socket to press the edges of this membrane in and hold it even deeper. So we get the needle in and we push down and then we turn instead of just getting it in and turning. There we are. Now make sure that the loop and the two ends are on opposite sides. You can’t cross under the loop. Alright, so here we are. Now we will take a moment to ensure hemostasis. Okay? And that’s it. You will see that we have our friend who had received an implant with a graft that required a membrane. The implant was placed just at the floor of the sinus. We used a Bicon Ultra Short implant, avoiding any sinus lifting. And at the same time, because this was a traumatic extraction previously, the facial aspect, or half of the facial aspect of the ridge in the edentulous space was missing. So upon the placement of the implant, we were able to place a bone graft covering approximately half of the implant’s plateaus as well as the shoulder and, using a retention suture held all of it together. Today, we will be, uncovering the implant. So we will make an incision that will allow us to regenerate some of that tissue. And it’s gonna be right on the crest. Do you feel this at all? Okay. It’s gonna be curvilinear, and it’s gonna come up to the mesial tooth. Alright? Also, we will make a tangential cut so that we do not extirpate the circulation of the, papillary tissues coming from the periodontal ligament of the adjacent teeth. Develop the full flap here. That will allow us a couple of things. A, to show you where the graft was and for us to see how it succeeded. So if you look closely, you’ll see that we have the full area here with the graft nicely covering the implant and I see the edge of the black healing plug. There we go. Okay, so we got the plug out. Then we’ll take a guide pin and insert it. Okay, and we want to check integration. Place the impression post and put a suture in there and I will take the first The nice thing about the vertical mattress sutures is that they will be out of the way for Doctor. Morgan. I will take this sleeve out. It will just make my job a little bit easier. Alright. Feel alright? Alright, here we go. Good, that’s it. Okay. I’ll turn it over to doctor Morgan now who will take an impression. So doctor Daher has placed the impression post with its green because it’s a three millimeter well and a three millimeter sleeve and all we’re going to do is take an impression. And so we have just removed the full arch impression. We’re going to use a plastic temporary stealth abutment with an acrylic sleeve. So these interproximal little wings were impinging upon the the adjacent teeth. Flea, you can go on. And we can add a composite material to it to make it look like a tooth. The key is to extrude the material slowly. Close. Can see the tongue just cleared the material from the palate. Palatal side. Open.