Tooth #14, with flapless sinus graft, treatment planning with Blue Sky Plan and the ThinLayer^® Guide

In this case an expander was used to fracture the sinus floor. The case was done flapless, with a ThinLayer^® Guide from Guided Surgery Solutions.

In Blue Sky Plan, implants were placed in the panoramic view using the abutments as virtual teeth. The #14 implant abutment was placed at 7.5 mm diameter. A scan of the articulated model was merged into the plan, allowing visibility of the opposing teeth in the cross-sectional views and alignment of the #14 implant with the opposing lingual cusp. The 3D model of the arch allows for precise spacing of a “virtual tooth” relative to the distal of the first bicuspid. In the 3D view, the relationship of the implant to the adjacent roots can be seen. The 3D model of the arch shows where centerlines of implants are positioned on the soft tissue crest.

The surgery was performed with the tube and ThinLayer^® guides from Guided Surgery Solutions, who manufactures the guides from the 3D plan and provides custom drill stops for each drill in the sequence. The inner diameter of each drill stop fits flush to the drill shaft and fluted area. The outer diameter of each stop is flush with the inner diameter of the tube (in the tube guide) and the diameter of the hole in the ThinLayer^® Guide.

First the tube guide was placed, and a spear drill placed through the insert (drill stop) in the tube guide to create bleeding points in the implant positions. An endo file through the insert could also be used, if preferred. Next, a 2 mm pilot drill was placed through the insert in the tube guide to initiate preparation of the osteotomy and drilling through the gingvia to a 6.5 mm bone depth.

The tube guide was removed and the ThinLayer^® Guide placed. Its guide hole replicates the top of a guide tube. The open buccal window allows unobstructed view of surgical site. Next, four threaded BTI bone expanders, with increasing diameters, are used to advance the osteotomy. The first BTI expander is inserted and centered in the ThinLayer^® Guide. Once centered, the expander is tightened slowly to fracture the sinus floor. Bone allograft is placed in the osteotomy and the expander is again advanced vertically to a depth of 7.5 mm.

The osteotomy is enlarged to final diameter through the ThinLayer^® Guide and using custom drill stops to control depth. The tissue punch, cortical drill, and implant driver are also centered in the guide hole.

Radiographs of the planned and final implant positions are included.

Please visit our Advantages page for more information for about the ThinLayer^® Guide system.

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