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

2 Copyright © 2012 Idondivi, Inc. All rights reserved

Partially edentulous


Screw retained crown, prophetically driven implant placement.


Generous ridge width at the second premolar site


X-ray is diagnostic as the buccal and lingual RIR’s overlap, a 3 degree rotation is

indicated


2 mm twist


Direction OK, length will be OK for 8.5 mm long implant


3.2 mm twist set at 18-10-3 = 5 mm, for stepped back preparation


8.5 x 3.5 Nobel Active


Motorized tissue punch


18-10-3 = 5 mm twist drill


Length can be increased 1.5 mm


18-10-1.5 = 6.5 mm osteotomy


Length is correct


Osteotomy is widened to 3.2 mm at 6.5 mm


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”


Miss expander used to up fracture weakened sinus floor, NOT to lift membrane


Collatape is introduced as the first shielding layer


Condenser does not penetrate into the sinus, only pushes material into the sinus

in so lifting the membrane


Unigraft ceramic grafting material is placed in multiple small quantites. Each

quantity does lift the membrane slightly


MIS condenser is used the drive grafting material into the sinus


Guided screw tap


8.5 x 4.3 Nobel Active


Guided bone mill, to be able to place covers crew. Implants placed sub-crestal as

patient will be wearing her RPD during healing period


Implants placed as planned, with sinuslift.


Flapped versus flapless.

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