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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.