Internal Sinus Lift using SynthoGraft™ and Restoration with a CAD/CAM IAC®

This video demonstrates the simultaneous bone grafting of a large buccal defect and placement of a short Bicon 5x6mm implant with an internal sinus lift procedure, using SynthoGraft a sinus lift abutment, as well as the implant’s restoration of the CAD/CAM fabricated integrated abutment crown in only three clinical visits. After clinical and radiographic evaluation of the recent molar extraction site, the treatment begins with the reflection of a full thickness mucoperiosteal flap in the collection of blood from the surgical site. The collected blood will be mixed with SynthoGraft, a beta tricalcium phosphate bone grafting material, which will be used both for the buccal defect and for the internal sinus lift procedure. The mixture of SynthoGraft and blood is transported to the bony defect in a bone syringe. After the complete filling of the bony defect, the implant’s osteotomy is initiated with a two millimeter pilot bur, rotating at eleven hundred rpm, and subsequently widened in 0.5mm increments with hand reamers. The hand reamers are not only used to widen the osteotomy, but also to gently elevate the sinus floor, in conjunction with hand osteotomes. After final widening has been achieved, a gold five millimeters osteotome is used to gently elevate the sinus floor to the desired height, after which additional SynthoGraft material is introduced into the prepared osteotomy, prior to the insertion of the five x six millimeters Integra CP implant. After cutting the plastic bags containing the implant and sinus lift abutment, the implant’s black polyethylene healing plug is replaced with a six point five x two point five millimeters sinus lift abutment, attached to a purple two millimeters inserter-retriever instrument, is fastened to an offset driver, while the implant is still within its plastic bag. The implant, attached to the sinus lift abutment, is removed from its plastic bag and transported to the osteotomy with the inserter retriever instrument attached to an offset driver. The implant and sinus lift abutment are initially seated with the implant inserter-retriever instrument, and then definitively tapped into position with a large abutment seating tip attached to an offset driver. Additional SynthoGraft material is placed buccally over the implant, prior to the placement of a resorbable Bicon membrane over the sinus lift abutment and buccal bone graft. After closure and suturing of the flap, a postoperative radiograph reveals the sub crestal position of the five x six millimeters implant and SynthoGraft bone material. Five months after the implant’s placement, a crestal incision is made to reveal the sinus lift abutment, which is removed from the implant well with a rongeur. A green three millimeters metal impression post, with its acrylic sleeve attached, is inserted into the three millimeters well of the implant, with only finger pressure, for the making of a full arch implant level transfer impression. Upon removal of the impression, the green acrylic sleeve remains within the impression material and the green metal impression post is removed from the implant well with forceps. A white six point five millimeters temporary abutment is inserted into the implant well with a gentle tap to facilitate the healing and formation of an appropriate soft tissue sulcus. After the laboratory CAD/CAM fabrication of the integrated abutment crown and removal of the white six point five millimeters temporary abutment from the well of the implant, the IAC is brought to the mouth and inserted into the well of the implant. Definitive seating of the IAC is achieved by having the patient apply occlusal pressure on a cotton applicator. A post insertion radiograph is taken after confirmation of the appropriate interproximal and occlusal contacts. Hopefully this video has demonstrated how a patient with minimal bone can be successfully treated in only three clinical visits. Thank you for having watched.