Nobel Biocare N1™ concept in the posterior maxilla with sinus floor elevation
Dr. Oded Bahat, Dr. Ion Zabalegui, Dr. Eva Berroeta, Mr. Javier Pérez
Spain
Implant placement associated with immediate sinus floor elevation at sites with inadequate vertical bone height.
Patient: female, 47 years
Clinical situation: healed site at tooth position 15, 16 (FDI) with bone resorption
Surgical solution: placement of two implants with simultaneous sinus floor elevation
Restorative solution: 2 single crowns
Surgery date: Bilbao, April 25, 2019
Total treatment time: 12 months
Tooth position: 15, 16 (FDI) 3,4 USA
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).
Surgical procedure
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.
Surgical procedure
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.
Surgical procedure
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.
Surgical procedure
Autogenous bone is maintained within the osteotomy and within the threads of the instrument (left)
Sinus lift with osteotomes after site preparation (right).
Surgical procedure
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
Surgical procedure
Transmucosal base placed at time of surgery (left).
Healing caps and the base function as healing abutments (right).
Surgical procedure
Flap closure. Healing caps and the base jointly shape mucosa (left).
Radiographs immediately post-op (right).
Surgical procedure
CBCT immediately post op illustrating the implants position and sinus floor.
Surgical procedure
CBCT Pre-op (position 16) illustrating inadequate vertical bone height.
Surgical procedure
CBCT Post-op (position 16) illustrating implant placement and sinus elevation.
Outcome
12 month post-op final restoration.
Outcome
35 months post-op. Follow up (left).
CBCT 35 months post-op (right).
Outcome
35 months post-op facial view.
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