Placement of Two Bicon SHORT® Implants

So what we are gonna be concerned with this morning is the maxillary left area. The, the plan is to place a short implant in the first bicuspid with no sinus lift and the area of the first molar with an internal sinus lift. It is important to have good access here. We’ll use a little bit of blunt dissection. Before we, finish up all of the dissection, we will collect some blood. This will be used to moisten and enhance the synthograft when the time comes. We collect roughly about a third to a half a cc of, arterial and venous blood mix in this case. We will put a retraction suture. So all you wanna do now is just re suture it to, the mucosa above the incision. That way, it’ll open the door and keep it open for us like so. So we will be using a twist drill, two millimeters pilot drill, and that spins at roughly a thousand to eleven hundred RPM. It’s very sharp, so we do not need a a round bur to start the osteotomy. We will make two marks and check if we like the separation between the two. So you can look now. You see that the mesial starting osteotomy is slightly too distal. The distal one, I like its location. So I will move the mesial one about a millimeter to the edge of the incision. Now we will complete the pilot hole for the molar implant. I wanna go to a depth of about three. Before I continue, I wanna make sure we have the floor still intact. Okay. Perfect. Now we have two paralleling pins to look at our plan. So we have separation between the implants, and I think we’ll have plenty of separation with the sinus, excuse me, with the molar. So now the molar that’s continues to rotate at twenty thousand RPM will produce only fifty RPM at full speed. Because of this very low speed, we don’t need irrigation. There’s resistance because of the slow speed, but that’s a good thing. That means we didn’t get into the sinus. There is no marking at three millimeters, so you have to be careful not to overdrill because the bone is very soft. So what I will do is always kind of go very slowly and carefully. Next is a three millimeter reamer. The first one was two point five. This one is three. I’m reaming roughly about three millimeters in the distal, about eight millimeters in the mesial. Now because of the softness of the bone, I will switch to hand reaming. The advantage of having hand reamers is that we can selectively widen one area versus the other. We also can expand the osteotomy very slowly. Okay. So we start with four millimeters. So in the posterior, I just wanna remove bone from the mesial so we don’t get too close to the molar to allow for a papilla to continue to be present. Okay? So as you can see what we’re doing now is pushing off of the distal and cutting only the mesial or the front part. See? There’s a very gentle slope in the palatal part of the ridge that will create a little bit of a difficulty. So what I’m going to do is favor the buccal so that we can lower the buccal a little bit so slightly, but by going after it. So we’re going to go with the four point five and take some of the buccal, thereby protecting the palatal. Okay. I am now doing the same for the mesial, carving away at the buccal and distal, leaving the mesial and palatal intact, protecting the distal and palatal. That we’ve gotten past the top, we can finish it up and great. Floor is intact. That’s the most important part. We have a good thickness of bone between the osteotomy and the tooth. Maintenance of a healthy papilla. Okay. We go to the distal. Again, we have an intact floor. We have a good thickness of bone between the distal wall and the tooth, and we have good separation between the two implants, osteotomies. We will now introduce our osteotome and gently tap it till it’s seated against the floor. As you can see, we’re seated roughly about three millimeters, maybe shallower than that. And now we will start tapping a little bit heavier. And we’ve just as you can hear, there’s a slight difference. You hear now it’s solid. There is no resistance. So we’ve just up fractured the floor. We don’t need to move it, we just fracture it. Okay? We want to make sure that we have proper depth for the placement of a four point five by six millimeter implant. The other advantage of the hand reamer is that with pressure you can increase the depth slightly. This is a four point five millimeter wide six millimeter long implant. It’s placed on the inserter retriever. You can tap it the rest of the way. Yeah. The bone being type three is soft. It kinda bounces back, So it requires a little bit more tapping. Okay? And this is the implant in place. So for the graft, what we will do is take the blood. It’s now it’s mostly congealed, which is fine because we will break up the clot, and we will use SynthoGraft. It is the fine grain size and there is half a gram of it. I probably will not use all of it. Very importantly, mix most but not all of the grains so that we can control the moisture level. As you can see also, on the side is the autogenous bone that I collected. Now we gotta continue mixing. It’s a little bit too wet, so we’ll add more to get a putty like consistency. And then we mix it a lot. So as you see, we get to a putty like stage. Zoom in, please. After taking the black healing plug off, we will engage the locking taper of the inserter retriever, keeping the implant in the bag for the next minute or so. We take a metal syringe that’s about four millimeters in diameter. We will now fill it or take about a tenth of a cc or so of the graft. What you are trying to do next is actually accomplish the sinus lift, at least some of it. We will introduce the syringe into the osteotomy and then using a pumping and gentle motion push out the graft, this will now start elevating the sinus floor and mucosal lining. This in effect is the sinus lift. Now we take our implant out of the bag, sterilely just touch it to the bone and only to the bone. And because of those grains being in the way, it’s going to be a little catching. The idea is not to be overzealous with that, the mallet, yes. It is important to use the insert or retriever in case you didn’t, you know, you went a little bit too deep, you can take the implant back out. I want to place the implant at about two millimeters which is the first line of this. We will put one pin here and one pin here. As you can see these are parallel and straight. Now the gentlest way of putting the black healing plug in would be to cut it outside the mouth on the short side. We drape it over the periodontal probe and gently place it in the implant, seating it fully, but very gently. Okay. Again, we’ll place it in the anterior one. First thing we do is we take the autogenous bone that we collected from the osteotomies and we will place it over these shoulders. That creates the most favorable, type of bone on the crest. Okay, and we take sterile cotton tipped applicators and we pack the bone nicely over the shoulder. We will now close it. First thing we need to do is release the retraction suture. We are using four o gut suture, and we will use a continuous suture. I like to use this type of continuous suture when we are near the sinus because it creates the most watertight type of closure. Thank you for your attention. Thank you, Dr. Morgan, for facilitating, and safe travels.