Ireland
CLINICAL CASE
Nobel Biocare N1™ concept in the posterior maxilla with sinus floor elevation
Dr. Oded Bahat, Dr. Ion Zabalegui,
Dr. Eva Berroeta, Mr. Javier Pérez
Initial clinical situation
Partial edentulism right side maxilla with vertical ridge deficiency.
Healed site before surgery. Lateral view (left).
Healed site before surgery. Occlusal view (right).
Treatment planning
CBCT Pre-op. CBCT illustrating inadequate vertical bone height, right side and healthy sinus. Mucosal thickening left sinus.
Surgical procedure
Flap delineation and full thickness elevation.
Marking of flap (left).
Buccal view of ridge (right).
OsseoDirector™ instruments (2000 rpm with irrigation). Initial osteotomy with the OsseoDirector instrument. The final length and implant position established (left).
Osseoshaper™ instrument* preparation of the site at 50rpm without irrigation (left).
* In this clinical case the pre-launch version of the OsseoShaper™ instrument has been used: the “CS Soft Bone Gizmo”. Black markings on the shaft and a 0.5 mm longer tip on the instrument are introduced on the final design of the OsseoShaper™ instrument.
Implant followed the direction created by the OsseoDirector™ and OsseoShaper™ instruments* (left).
Flat side of the trioval implant facing buccal (right).
* In this clinical case the pre-launch version of the OsseoShaper™ instrument has been used: the “CS Soft Bone Gizmo”. Black markings on the shaft and a 0.5 mm longer tip on the instrument are introduced on the final design of the OsseoShaper™ instrument.
OsseoShaper™ instrument* at full depth. The end of the threads indicates the position of the implant shoulder relative to the bone crest (left).
Reversing to remove the instrument (right).
* In this clinical case the pre-launch version of the OsseoShaper™ instrument has been used: the “CS Soft Bone Gizmo”. Black markings on the shaft and a 0.5 mm longer tip on the instrument are introduced on the final design of the OsseoShaper™ instrument.
Autogenous bone is maintained within the osteotomy and within the threads of the instrument (left)
Sinus lift with osteotomes after site preparation (right).
Implant insertion 70 Ncm. Final placement of the implants. Flat part on the implant driver and vertical corresponding groove within the mount corresponds to the trioval flat aspect facing the facial aspect
Transmucosal base placed at time of surgery (left).
Healing caps and the base function as healing abutments (right).
Flap closure. Healing caps and the base jointly shape mucosa (left).
Radiographs immediately post-op (right).
CBCT immediately post-op illustrating the implants position and sinus floor.
CBCT pre-op (position 16) illustrating inadequate vertical bone height.
CBCT Post-op (position 16) illustrating implant placement and sinus elevation.
Outcome
12 month post-op final restoration.
35 months post-op. Follow up (left).
CBCT 35 months post-op (right).
35 months post-op facial view.
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