To flap or not to flap, what is the answer?
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Transcript of To flap or not to flap, what is the answer?
Copyright © 2012 Idondivi, Inc. All rights reserved.
Categories ; Posterior, flapless, sinus lift, multiple implants, Nobel Biocare
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Partially edentulous
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Screw retained crown, prophetically driven implant placement.
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Generous ridge width at the second premolar site
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X-ray is diagnostic as the buccal and lingual RIR’s overlap, a 3 degree rotation is
indicated
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2 mm twist
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Direction OK, length will be OK for 8.5 mm long implant
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3.2 mm twist set at 18-10-3 = 5 mm, for stepped back preparation
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8.5 x 3.5 Nobel Active
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Motorized tissue punch
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18-10-3 = 5 mm twist drill
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Length can be increased 1.5 mm
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18-10-1.5 = 6.5 mm osteotomy
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Length is correct
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Osteotomy is widened to 3.2 mm at 6.5 mm
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Kavo sonic hand piece with 2.5 mm diamond coated tip. Tip will abrade bone,
while not damaging the sinus membrane. The “poor mans piezo”
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Miss expander used to up fracture weakened sinus floor, NOT to lift membrane
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Collatape is introduced as the first shielding layer
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Condenser does not penetrate into the sinus, only pushes material into the sinus
in so lifting the membrane
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Unigraft ceramic grafting material is placed in multiple small quantites. Each
quantity does lift the membrane slightly
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MIS condenser is used the drive grafting material into the sinus
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Guided screw tap
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8.5 x 4.3 Nobel Active
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Guided bone mill, to be able to place covers crew. Implants placed sub-crestal as
patient will be wearing her RPD during healing period
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Implants placed as planned, with sinuslift.
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Flapped versus flapless.