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Simplified Implant Dentistry Through Innovative  Implant Design Brian A. Mahler, D.D.S., P.L.C. 10550 Warwick Avenue Fairf...
Placed March 1985, photo July 2004
Southern Implants <ul><li>Company background </li></ul><ul><li>Products </li></ul><ul><li>Unique products </li></ul><ul><l...
Southern Implants  <ul><ul><ul><li>Dental Implant Division founded 1987 </li></ul></ul></ul><ul><ul><ul><li>Other medical ...
Prosthetic heart valves Artificial back discs Six Southern Medical Groups
<ul><li>Dental Implant Division founded 1987 </li></ul><ul><li>Other medical device sister companies </li></ul><ul><li>Sig...
Tawse-Smith A., Payne A.G.T., Kumara R., Thomson W.M.  One-stage operative procedure using two different implant systems: ...
Nikellis,I., Levi A., Niccolopoulos, C.  “Immediate loading of 190 endosseous dental implants: A prospective observational...
Esposito M., Grusovin, M.G., Coulthard, P., kThomsen, P., Worthington, H.V.  A 5-year follow-up comparative analysis of th...
Southern Implants <ul><li>6 major clinical trials in peer reviewed journals with excellent results </li></ul><ul><li>Chose...
According to a review in JOMI,  Aug. 2005 by ESPOSITO There are only 4 manufacturers in the world with high level data to ...
A 5-year Follow-Up Comparative Analysis of the Efficacy of Various Osseointegrated Dental Implant Systems <ul><ul><li>No d...
Restorative Connections:  Proprietary or Not? <ul><li>Numerous good restorative connections </li></ul><ul><li>Southern res...
EXTERNAL HEX INTERNAL MORSE TAPER & OCTOGON INTERNAL TRI-LOBE Southern’s 3 Restorative Connectors
Very Wide Product Range <ul><li>Three non proprietary connections </li></ul><ul><li>“ Expanding Proven Concepts” </li></ul>
Tri-Nex Implant Internal Tri-Lobe Compatible with Nobel Biocare™ Select Connection
Tri-Nex Implant <ul><ul><li>1. Remain compatible with other connectors </li></ul></ul><ul><ul><li>2. Make improvements ove...
Tri-Nex Implant <ul><li>4 Diameters (3.5, 4.3, 5.0, 6.0) </li></ul><ul><li>5 Lengths (8.5, 10.5, 12, 13.5, 16.5) </li></ul>
Desired Improvements of  other Tri-Lobe Designs  <ul><li>Minimize flowering fractures </li></ul><ul><li>Improve primary st...
Minimize flowering fractures Weak point
Cross Section of 3.5 TriNex Implant Thicker wall to  minimize fracture or distortion Platform switch Binon’s work showed l...
Cross Section of 3.5 TriNex Implant Thicker wall to  minimize fracture or distortion Platform switch Internal Hex for inse...
Cross Section of 3.5 TriNex Implant Thicker wall to  minimize fracture or distortion Platform switch Internal Hex for inse...
  Desired Improvements of  other Tri-Lobe Designs  <ul><li>Minimize flowering fractures </li></ul><ul><li>Improve primary ...
Cross Section of 03.5 TriNex Implant Threads extending to apex of implant
<ul><li>Extending threads to apex of implant yields better primary stability for immediate implant placement </li></ul><ul...
Improvements of other Tri-Lobe Designs  Thicker wall Platform switch Smaller polished collar 0.6mm vs. 1.5mm Threads exten...
Southern Implants Enhanced Surface <ul><li>The surface is enhanced using a proprietary method of size specific surface abr...
Southern Implants
Southern Implants
<ul><li>Comparative Surface Analysis of 9 Implant Systems  </li></ul><ul><li>Bernard J.P., Szmukler-Moncler S., Belser U.C...
Efficient is being effective without wasting time, effort, or expense It implies the least costly production means without...
Efficient is being effective without wasting time, effort, or expense <ul><li>Save dentist’s time </li></ul><ul><li>Shorte...
Schropp L, Isidor F.  Timing of implant placement relative to tooth extraction.    J Oral Rehabil. 2008 Jan;35 Suppl 1:33-...
Molar sockets are too large and complex to allow for immediate placement of conventional implants
Delayed placement will result in longer treatment time and often a bone graft will be required Bone grafts are costly and ...
The Problem <ul><li>Molar sockets are  too large  and  too complex  to allow for easy immediate placement of current impla...
The Solution Develop  an  implant design and surgical protocol to facilitate immediate implant placement into molar sites ...
The MAX Implant  for  Molar Replacement
Bucco-palatal = 10.7 mm  range = 7.4 -14 mm M D B P 7.9 10.7 Cervical dimensions Maxillary first molar Mesio-distal = 7.9 ...
Bucco-lingual = 9.0 mm  Range = 7.3 -11.6 mm M D B P 7.9 10.7 Cervical dimensions Mandibular first molar Mesio-distal = 9....
MAX Implant Design <ul><li>Large diameter implant </li></ul><ul><li>Greater tapered body </li></ul><ul><ul><li>Preserve ap...
MAX Implant Range 8mmØ 9mmØ <ul><li>Self tapping flutes </li></ul><ul><li>External Hex </li></ul>
Tri-Nex Connection OCT Connection Courtesy of Andrew Ackermann, BChD, MChD
Section root and remove carefully preserving buccal plate
 
 
 
Socket Preparation Instruments same as tapered implants until final Round bur to create pilot hole Twist drills to enlarge...
Dedicated drills
 
 
Place deep enough, even buccal plate
Place deep enough
Final Dedicated MAX Shaping Drill Six total: One for each length and diameter of implants   8mm diameter MAX 7mm length  9...
Careful sectional removal of molar to preserve buccal plate
Pilot Drills and Tapered Drills in Inter-Radicular Bone
Preserve thin buccal plate
 
Not cover with tissue
 
 
23 months Buccal plate preserved
Tapered drills may be difficult to control when socket voids or irregular walls exist  <ul><li>MAX TAP/DRILL </li></ul><ul...
Dedicated Osteotome Bone Deformation <ul><li>Where to use the osteotome instead of a drill </li></ul><ul><li>Thin bone pla...
Final  Dedicated MAX Osteotomes Six total: One for each length and diameter of implants   8mm diameter MAX 7mm length  9mm...
MAX Implant Dedicated Instruments Drills Taps Osteotomes Three dedicated instruments to facilitate MAX placement
Immediate Placement of the MAX Implant  Follows the Same Principles as Immediate Placement of a Single Rooted Tooth  <ul><...
 
 
Complications <ul><li>Inadequate soft tissue </li></ul><ul><li>Often due to not placed deep enough </li></ul><ul><li>Damag...
Minimal Oral-Antral Bone Dimension Smoker / Immediate loading Immediate loading FAILURES
Be Aware of Interproximal Dimensions <ul><ul><ul><ul><ul><li>Inadequate inter-radicular bone width to adjacent tooth </li>...
<ul><li>A Retrospective, Multicentre Study on a Novo Wide Body Implant for Posterior Regions.  Vandewege S, Ackermann A, B...
MAX Implant <ul><li>May be placed immediately into a significant percentage of molar sockets </li></ul><ul><li>The short t...
The Co-Axis Implant
Threaded  implant with a 12° and 24° angle correction built into it
 
Co-Axis Implant Requirements <ul><li>12 & 24 degree angulation in implant </li></ul><ul><li>Threaded implant </li></ul><ul...
© 2009 Southern Implants, Inc.  All rights reserved. Co-Axis with Industry  Compatible Connections
Angled fixture mount allows symmetrical rotation when inserted How Do You Place This Implant? dimple on  most coronal side...
Fixture and mount WHY?
Tilted Implants <ul><li>Used to avoid anatomical structures </li></ul><ul><li>Eliminate many grafting procedures </li></ul...
Tilted Implants Literature Review 1 .  Sütpideler M. Eckert SE, Zobitz M. An KN .  Finite element analysis of effect of pr...
Tilted Implants Literature Review 11.  SF, Wolfinger GJ, Balshi TJ . Analysis of 356 pterygomaxillary implants in edentulo...
Tilted Implants Literature Review 21.  Krekmanov L, Kahn M, Rangert B, Lindström H .  Tilting of posterior mandibular and ...
Tilted Implants Literature Review 31.  Capelli M. Zuffettii F, Del Fabbro M, Testori T .  Immediate rehabilitation of the ...
Tilted Implants Literature Review 40.  Bevilacqua M, Tealdo T, Pera F, Menini M, Mossolov A, Drago C, Pera P . Three-dimen...
Tilted Implants Literature Review Tilted implants are a safe and effective treatment that has many benefits for the patient
Tilted Implants <ul><li>Avoid sinus and nerve without grafts </li></ul><ul><li>Decreases treatment time and cost  </li></u...
Added components Smaller screws Added modes of failure Increased cost Increased time Large Screw Retained Restorations
2 mm minimum distance  To correct angle More time and cost  than going direct to implant Potential aesthetic problems Angl...
Co-Axis Implant <ul><li>Tilted implants are effective and benefit patients </li></ul><ul><li>Intermediate abutments cost t...
 
Anatomy and/or bone loss often lead to less than ideal implant location in the maxillary anterior making their restoration...
<ul><li>Maxillary anterior often requires facial emergence </li></ul><ul><li>Cemented provisional </li></ul><ul><ul><li>Ti...
 
Co-Axis Implant Development It was determined by digital photographic analysis and cephalometric evaluation that an angle ...
C. Nikolopoulos, Oral Surgeon P. Youvanoglou, Pros. G. Ioannou, Technican Co-Axis Implant No intermediate abutments  No ta...
Co-Axis 24 º External hex with slightly shorter  screws and healing components
Restoring implants that intersect
<ul><li>Four on the floor </li></ul><ul><ul><ul><ul><li>Angle implants distal to mental foramen increase AP spread </li></...
The Co-Axis Implant Co-Axis implant may be placed into available bone while  leaving the restorative platform in an optima...
Co-Axis Implant Instrumentation 12 degree direction indicator (after twist) 12 degree direction indicator (after final sha...
 
 
Options
Advantages of Co-Axis Implant <ul><li>Increase AP spread in four on the floor cases without requiring intermediate abutmen...
Is It Strong Enough With That Thin Wall? Straight Implant  Co-axis Implant Same amount of titanium just more on one side t...
Finite element analysis 3.75 mm Implant Ext. Hex 350N load at 22° to long axis 350N load at 22° to long axis Finite elemen...
Co-Axis Implant Development <ul><li>Cyclic fatigue testing </li></ul><ul><ul><li>4.0mm and 5.0mm </li></ul></ul><ul><ul><l...
Pilot Clinical Study <ul><li>225 Co-Axis implants were placed by 14 surgeons </li></ul><ul><li>24 month period </li></ul><...
Serendipity Making a fortunate discovery while searching for other things
<ul><li>Initially not use Co-Axis aesthetic single teeth </li></ul><ul><li>Noticed results appeared as good, often better ...
Mid-Facial Soft Tissue Recession  in Single Tooth Restorations <ul><li>Interproximal bone levels determined by bone on  ad...
Mid-Facial Soft Tissue Recession  in Single Tooth Restorations Interproximal soft tissue levels  determined by bone on adj...
26° 17° Angle of Implant
10 degrees More vertical placement of implants Under contouring of restoration  Narrower healing caps Platform switching I...
Vertical Placement of Implants In Anterior Maxilla Anatomy of the anterior maxilla  often results in facially inclined imp...
In same osteotomy site a Co-Axis implant  will result in more mid-facial soft tissue than a straight implant
“ Need my crown recemented” Emergency immediate restoration
 
Immediate implant placement & restoration Final 13 months post insertion Pre-op model
Atraumatic extraction
Out of occlusion Post op instructions
 
 
 
 
 
The Co-Axis implant has two distinct axes to allow easier replication of the two  planes nature gave maxillary anterior te...
© 2008 Southern Implants, Inc.  All rights reserved. <ul><li>Easier to develop natural emergence profile </li></ul><ul><li...
Co-Axis allows for final screw retained crown <ul><li>Lingual access </li></ul><ul><li>Recession no problem / porcelain wi...
Conclusions <ul><li>Co-Axis implant significantly reduces the need for bone grafting  </li></ul><ul><li>This implant allow...
Co-Axis Implant <ul><li>“ The Co-Axis implant is like my cell phone. When I first got it I thought I would use it occasion...
Co-Axis and MAX Implants <ul><li>Less grafting  </li></ul><ul><li>Less cost and fewer complications </li></ul><ul><li>Elim...
Thank You Brian A. Mahler, D.D.S., P.L.C. 10550 Warwick Avenue Fairfax, Virginia [email_address]
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Simplified Implant Dentistry By Dr. Mahler

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Presentation detailing the benefits of using site specific implants in oral surgery

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  • Il Dr. Giuseppe Spinelli è uno specialista chirurgo orale sempre aggiornato sulle ultime tecniche di applicazione nel campo della chirurgia orale e della implantologia: http://www.giuseppespinelli.it/chirurgia-orale.html
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  • Southern has all these studies available upon request
  • Rct’s
  • Southern Philosophy. If only one best for you and patients than so be it
  • Benefit not first, not last
  • Take good idea and make it better
  • Nobel’s Select internal connection had been around about 5 yeas
  • Strength testing thicker wall tri lobe minimize flowering fracture or distorts top tri-lobe area ,or late fractures
  • Along w/ thicker tri lobe wall section helps fatigue added internal hex to minimize forces that may flower or distort top tri-lobe area
  • Smaller polished collar + micro-groves
  • Originally when Nobel developed immediate load experimental
  • lots of small changes that make it better for some cases,
  • Literature available form Southern
  • Just because unique doesn’t mean it’s a good thing, must not sacrifice quality
  • If not do one or more of above why??? Southern unique products , immediate placement
  • Shortens treatment time, more efficient, but molars lost more often in adults
  • Where the profile is strait or slightly tapered
  • Delayed placement is inefficient
  • Problem not as efficient as single rooted
  • Look at size of sockets 6, 6.5,. Or even 7mm usually too small
  • over 2 years of trials and 3 modifications developed the following history interesting, not time
  • Available in all 3 connections, use wide connectors
  • Location of self tapping flutes, lengths of 7mm, 9mm, 11mm
  • Round bur
  • Twist drills, 2 and 3mm
  • Large tapered drills work up depending on density and amount of bone
  • Notice so far same burs as for other impants
  • Final dedicated tapered drill
  • Insert impant
  • Countersink. 2 by 2 rule
  • Red arrows show all 4 walls have contact w/ implant and yellow arrow shows no contact, suture over need graft material to stop down growth or as is. 2 by 2 rule
  • Tarnow at AO, if not suture over site leave space clot, some graft other do not, very experienced users think depth of placement more important than graft
  • Hard to pull, leaves more attached tissue. Most do not suture
  • Note inter-proximal countersink again
  • voerman
  • Beyond the drills this tap/drill excellent for controlTap also drills some
  • Soft bone, single roots second molars, small sinus communications no big thing
  • Instruments are same for placement of any implant except for the final instrument before placement which is one of three
  • Implants are actually undersized for sockets, history of wides
  • Single implant into mesial or distal root
  • Exposed threads, not deep enough or inadequate or damaged buccal plate
  • Osteotome, six indentations
  • Dr. Graves, submitting article w/ 160 ?, and my numbers. Over 300 w/ about 94%?
  • 60% to 80%
  • Another unique implant , allows me to be more efficient w/o sacrificing quality, larger cases and less likely scenario
  • 12 degree 4mm external hex and 24 degree external hex use shorter screws, rest compatible
  • One optimal position, 0.6mm tread pitch
  • All three connections on 12 degree
  • Note internal hex is where insertion tool engages implant, minimize distortion or fracturing, more efficient
  • As with MAX more efficient for me , discuss large cases first, smaller next larger cases, full arch, want screw retained
  • I did literature review Southern has my literature review available and part referenced in Co-Axis article
  • 48 articles up to 15 years follow up
  • Works, less time and cost, maxillary sinus, mandibular nerve
  • More modes of failure on an all on 4,5, or 6
  • Immediate restoration, posteriors good, anteriors thru facial
  • Immediate restorations for me quite a few
  • Co-Axis takes access opening to the lingual, Fermit, light cured temporary , this how started in early 1990’s
  • With tooth and if bone loss significant
  • 2 24 degree in posteriors and 4 12 degrees in anterior
  • Surgeon gets his bone, restorative dentist gets his desired platform position.
  • For me, Screw retained or cemented not discuss I do most efficient,, larger cases screw retained, bridge taper porcealin chipper
  • Makes using tilted implants easier for dentist and patients
  • 3 exposed threads and 15mm?, anterior less stress on screw
  • FDA approval, most stringent to my knowledge. My experience 6 years
  • Implant higher interproximal like Nobelperfect or Innovas Anatomical implant, protottype
  • Problem single teeth, midfacial bone interproimal determined by bone on adjacent teeth
  • Dictated by anatomy, amount of bone
  • Theoretical, but does it happen
  • Everyday example
  • Surgical axis vs. prosthetic axis,
  • Believe secret to better esthetics in single teeth is:
  • The picture on R side shows what would be facial access opening of screw due to either bone loss before placement, angulation of facial plate relative to where clinical crown of natural tooth was, or poor surgical placement .
  • Anterior routinely done,
  • My conclusions about Coax and max with regard to what they do for my practice and my patients
  • Transcript of "Simplified Implant Dentistry By Dr. Mahler"

    1. 1. Simplified Implant Dentistry Through Innovative Implant Design Brian A. Mahler, D.D.S., P.L.C. 10550 Warwick Avenue Fairfax, Virginia USA
    2. 2. Placed March 1985, photo July 2004
    3. 3. Southern Implants <ul><li>Company background </li></ul><ul><li>Products </li></ul><ul><li>Unique products </li></ul><ul><li>What they do for me and my patients </li></ul>
    4. 4. Southern Implants <ul><ul><ul><li>Dental Implant Division founded 1987 </li></ul></ul></ul><ul><ul><ul><li>Other medical device sister companies </li></ul></ul></ul>
    5. 5. Prosthetic heart valves Artificial back discs Six Southern Medical Groups
    6. 6. <ul><li>Dental Implant Division founded 1987 </li></ul><ul><li>Other medical device sister companies </li></ul><ul><li>Significant studies </li></ul>Southern Implants
    7. 7. Tawse-Smith A., Payne A.G.T., Kumara R., Thomson W.M. One-stage operative procedure using two different implant systems: A prospective study on implant overdentures in the edentulous mandible. Clin Implant Dent Relat Res 2001; 3-4; 185-193. Watson G.K., Payne A.G.T., Purton D.G., Thomson W.M. Mandibular overdentures: Comparative evaluation of prosthodontic maintenance of three different implant systems during the first year of service. Int J Prosthodont 2002; 15: 259- 266. Tawse-Smith A., Payne A.G.T., Kumara R., Thomson W.M. Early loading of unsplinted implants supporting mandibular overdentures using a one-stage operative procedure with two different implant systems: A 2-year report. Clin Implant Dent Relat Res 2002; 4: 33-42. Daly P.F., Pitsillis A., Nicolopoulos S., Occlusal reconstruction of a collapsed bite by orthodontic treatment, pre-prosthetic surgery and implant supported prostheses. A case report. SADJ 2001; 56-6; 278 – 282. Dellow A.G., Driessen C.H., Nel H.J.C. Scanning Electron Microscopy evaluation of the interfacial fit of interchanged components of four dental implant systems. Int J of Prosthodont 1997 10; 216 – 221. Peer Reviewed Publications
    8. 8. Nikellis,I., Levi A., Niccolopoulos, C. “Immediate loading of 190 endosseous dental implants: A prospective observational study of 40 patient treatments with up to 2-year data” Int J Oral and Maxillofac Implants 2004; 19(1): 116-123. Boyes-Varley J.G., Lownie J.F., Howes D.G., Blackbeard G.A. Surgical modifications to the Branemark Zygomaticus Protocol in the treatment of the severely resorbed maxilla: a clinical report. Int J Oral Maxillo Facial Implants 2003. Boyes-Varley J.G., Lownie J.F., Howes D.G., Blackbeard G.A. Surgical modifications to the Branemark Zygomaticus protocol. COIR 2002; 13-4; xxxii Butz, S.J., Huys,LW. Long-term success of sinus augmentation using a synthetic alloplast: in 20 patients, a 7 year clinical report. Implant Dent. 2005 Mar; 14(1):36-42. Boyes-Varley J.G., Lownie J.F., Howes D.G. The Zygomatic Implant Protocol in the treatment of the severely resorbed maxilla. SADJ 2003; 58:3; 106-114. Peer Reviewed Publications
    9. 9. Esposito M., Grusovin, M.G., Coulthard, P., kThomsen, P., Worthington, H.V. A 5-year follow-up comparative analysis of the efficacy of various osseointegrated dental implant systems: a systematic review of randomized controlled clinical trials. Int J Oral Maxillofac Implants. 2005 Jul-Aug;20(4):557-68. Hall JA., Payne AG., Purton DG., Torr B., A randomized controlled clinical trial of conventional and immediately loaded tapered implants with screw-retained crowns. Int. Journal of Prosthodontics 2006 Jan-Feb;19(1):17-9. Hall JA., Payne AG., Purton DG., Torr B., Duncan WJ., DeSilva RK., Immediately restored, single-tapered implants in the anterior maxilla: prosthodontic and aesthetic outcomes after 1 year. Clin Implant Dent Relat Res. 2007 Mar;9(1):34-45. Vandeweghe S, Ackermann A, Bronner J, Hattingh A, Tschakaloff A, De Bruyn H. A Retrospective, Multicenter Study on a Novo Wide-Body Implant for Posterior Regions. Clin Implant Dent Relat Res. 2009 Dec 3. Peer Reviewed Publications
    10. 10. Southern Implants <ul><li>6 major clinical trials in peer reviewed journals with excellent results </li></ul><ul><li>Chosen by The Branemark Centre in Gothenburg for their Maxillary Immediate Loading Protocol </li></ul><ul><li>High level studies </li></ul>
    11. 11. According to a review in JOMI, Aug. 2005 by ESPOSITO There are only 4 manufacturers in the world with high level data to prove efficacy of use over a 5 year period Southern Implants <ul><li>Southern Implants </li></ul><ul><li>Nobel Biocare </li></ul><ul><li>Straumann </li></ul><ul><li>Astra </li></ul>
    12. 12. A 5-year Follow-Up Comparative Analysis of the Efficacy of Various Osseointegrated Dental Implant Systems <ul><ul><li>No differences in regard to failures and marginal bone levels after 5 years of function </li></ul></ul><ul><ul><li>High success rates can be achieved for all these systems analyzed after 5 years of loading </li></ul></ul>Esposito et al JOMI Aug 2005
    13. 13. Restorative Connections: Proprietary or Not? <ul><li>Numerous good restorative connections </li></ul><ul><li>Southern restorative systems are not proprietary </li></ul>
    14. 14. EXTERNAL HEX INTERNAL MORSE TAPER & OCTOGON INTERNAL TRI-LOBE Southern’s 3 Restorative Connectors
    15. 15. Very Wide Product Range <ul><li>Three non proprietary connections </li></ul><ul><li>“ Expanding Proven Concepts” </li></ul>
    16. 16. Tri-Nex Implant Internal Tri-Lobe Compatible with Nobel Biocare™ Select Connection
    17. 17. Tri-Nex Implant <ul><ul><li>1. Remain compatible with other connectors </li></ul></ul><ul><ul><li>2. Make improvements over other designs </li></ul></ul><ul><ul><li>(Replace Select™) </li></ul></ul>
    18. 18. Tri-Nex Implant <ul><li>4 Diameters (3.5, 4.3, 5.0, 6.0) </li></ul><ul><li>5 Lengths (8.5, 10.5, 12, 13.5, 16.5) </li></ul>
    19. 19. Desired Improvements of other Tri-Lobe Designs <ul><li>Minimize flowering fractures </li></ul><ul><li>Improve primary stability in immediate placement </li></ul>
    20. 20. Minimize flowering fractures Weak point
    21. 21. Cross Section of 3.5 TriNex Implant Thicker wall to minimize fracture or distortion Platform switch Binon’s work showed less fit of components increases chances of screw loosening
    22. 22. Cross Section of 3.5 TriNex Implant Thicker wall to minimize fracture or distortion Platform switch Internal Hex for insertion
    23. 23. Cross Section of 3.5 TriNex Implant Thicker wall to minimize fracture or distortion Platform switch Internal Hex for insertion Smaller polished collar 0.6mm vs. 1.5mm
    24. 24. Desired Improvements of other Tri-Lobe Designs <ul><li>Minimize flowering fractures </li></ul><ul><li>Improve primary stability in immediate placement </li></ul>
    25. 25. Cross Section of 03.5 TriNex Implant Threads extending to apex of implant
    26. 26. <ul><li>Extending threads to apex of implant yields better primary stability for immediate implant placement </li></ul><ul><li>Increase surface area </li></ul>Desired Improvements of other Tri-Lobe Designs
    27. 27. Improvements of other Tri-Lobe Designs Thicker wall Platform switch Smaller polished collar 0.6mm vs. 1.5mm Threads extending to apex of implant Internal Hex for insertion Compatible w/ Nobel Biocare
    28. 28. Southern Implants Enhanced Surface <ul><li>The surface is enhanced using a proprietary method of size specific surface abrasion followed by chemical conditioning </li></ul><ul><li>Since 1991 and well studied </li></ul>
    29. 29. Southern Implants
    30. 30. Southern Implants
    31. 31. <ul><li>Comparative Surface Analysis of 9 Implant Systems  </li></ul><ul><li>Bernard J.P., Szmukler-Moncler S., Belser U.C., Samson J. </li></ul><ul><li>University of Geneva </li></ul><ul><li>2004: Academy of Osseointegration: San Francisco </li></ul><ul><li>Southern has a reproducible process </li></ul><ul><li>Southern surface is not easily injured </li></ul><ul><li>No remnant blasting material found </li></ul>
    32. 32. Efficient is being effective without wasting time, effort, or expense It implies the least costly production means without sacrificing quality
    33. 33. Efficient is being effective without wasting time, effort, or expense <ul><li>Save dentist’s time </li></ul><ul><li>Shorten total treatment time </li></ul><ul><li>Eliminate unnecessary procedures </li></ul><ul><li>Save in components and materials cost </li></ul><ul><li>Save in laboratory cost </li></ul><ul><li>Minimize post treatment modifications or repairs </li></ul>
    34. 34. Schropp L, Isidor F. Timing of implant placement relative to tooth extraction. J Oral Rehabil. 2008 Jan;35 Suppl 1:33-43. Review. Wagenberg B, Froum SJ. A retrospective study of 1925 consecutively placed immediate implants from 1988 to 2004 . Int J Oral Maxillofac Implants. 2006 Jan-Feb;21(1):71-80. Chen ST, Wilson TG Jr, Hämmerle CH. Immediate or early placement of implants following tooth extraction: review of biologic basis, clinical procedures, and outcomes. Int J Oral Maxillofac Implants. 2004;19 Suppl:12-25. Review. Immediate Implant Placement Immediate implant placement shortens treatment time, decreases the number of surgical procedures, and often eliminates need for grafting When certain parameters are met, long term results of immediate implant placement appears comparable to delayed placement Single rooted relatively easy, but multi-rooted teeth difficult
    35. 35. Molar sockets are too large and complex to allow for immediate placement of conventional implants
    36. 36. Delayed placement will result in longer treatment time and often a bone graft will be required Bone grafts are costly and time consuming
    37. 37. The Problem <ul><li>Molar sockets are too large and too complex to allow for easy immediate placement of current implants </li></ul><ul><li>When left to heal first, maxillary molar extraction sites often require bone grafting of sinus floor </li></ul><ul><li>Multiple procedures lead to longer treatment time, cost, and possible resistance to implant treatment </li></ul><ul><li>Placement into one socket of multi- rooted site may create bio-mechanical and prosthetic compromises </li></ul>
    38. 38. The Solution Develop an implant design and surgical protocol to facilitate immediate implant placement into molar sites This would optimize / preserve available bone and significantly reduce the time, complexity, and cost of treatment
    39. 39. The MAX Implant for Molar Replacement
    40. 40. Bucco-palatal = 10.7 mm range = 7.4 -14 mm M D B P 7.9 10.7 Cervical dimensions Maxillary first molar Mesio-distal = 7.9 mm Range = 6.4 -10.9 mm Woelfel 1990
    41. 41. Bucco-lingual = 9.0 mm Range = 7.3 -11.6 mm M D B P 7.9 10.7 Cervical dimensions Mandibular first molar Mesio-distal = 9.2 mm Range = 7.7-12.4 mm M D 9.2 L B 9.0 Woelfel 1990
    42. 42. MAX Implant Design <ul><li>Large diameter implant </li></ul><ul><li>Greater tapered body </li></ul><ul><ul><li>Preserve apical inter-radicular bone </li></ul></ul><ul><ul><li>Fits tapering sockets </li></ul></ul><ul><ul><li>Avoid lateral sinus penetration </li></ul></ul><ul><ul><li>Avoid adjacent roots </li></ul></ul><ul><ul><li>Easier primary stability </li></ul></ul><ul><li>Platform switching </li></ul><ul><li>External and internal connectors </li></ul>
    43. 43. MAX Implant Range 8mmØ 9mmØ <ul><li>Self tapping flutes </li></ul><ul><li>External Hex </li></ul>
    44. 44. Tri-Nex Connection OCT Connection Courtesy of Andrew Ackermann, BChD, MChD
    45. 45. Section root and remove carefully preserving buccal plate
    46. 49. Socket Preparation Instruments same as tapered implants until final Round bur to create pilot hole Twist drills to enlarge 4.0mm, 5.0mm, 6.0mm tapered final shaping drill Final dedicated MAX shaping drill
    47. 50. Dedicated drills
    48. 53. Place deep enough, even buccal plate
    49. 54. Place deep enough
    50. 55. Final Dedicated MAX Shaping Drill Six total: One for each length and diameter of implants 8mm diameter MAX 7mm length 9mm length 11mm length 9mm diameter MAX 7mm length 9mm length 11mm length
    51. 56. Careful sectional removal of molar to preserve buccal plate
    52. 57. Pilot Drills and Tapered Drills in Inter-Radicular Bone
    53. 58. Preserve thin buccal plate
    54. 60. Not cover with tissue
    55. 63. 23 months Buccal plate preserved
    56. 64. Tapered drills may be difficult to control when socket voids or irregular walls exist <ul><li>MAX TAP/DRILL </li></ul><ul><ul><li>Concentric drilling difficult </li></ul></ul><ul><ul><li>Dedicated taps </li></ul></ul><ul><ul><li>Very dense bone </li></ul></ul><ul><ul><li>Some use in most sites </li></ul></ul>
    57. 65. Dedicated Osteotome Bone Deformation <ul><li>Where to use the osteotome instead of a drill </li></ul><ul><li>Thin bone plates – drilling is high risk </li></ul><ul><li>Sinus communication </li></ul><ul><li>Where bone expansion can be achieved </li></ul>
    58. 66. Final Dedicated MAX Osteotomes Six total: One for each length and diameter of implants 8mm diameter MAX 7mm length 9mm length 11mm length 9mm diameter MAX 7mm length 9mm length 11mm length
    59. 67. MAX Implant Dedicated Instruments Drills Taps Osteotomes Three dedicated instruments to facilitate MAX placement
    60. 68. Immediate Placement of the MAX Implant Follows the Same Principles as Immediate Placement of a Single Rooted Tooth <ul><li>Intact perimeter bone required </li></ul><ul><li>No significant infection </li></ul><ul><li>Adequate countersink for bone level implant </li></ul><ul><li>Avoid contact with facial plate </li></ul><ul><li>MAX osteotomy site preparation requires adjustments in surgical techniques facilitated by dedicated drills, taps, and osteotomes </li></ul>
    61. 71. Complications <ul><li>Inadequate soft tissue </li></ul><ul><li>Often due to not placed deep enough </li></ul><ul><li>Damaging buccal plate </li></ul>
    62. 72. Minimal Oral-Antral Bone Dimension Smoker / Immediate loading Immediate loading FAILURES
    63. 73. Be Aware of Interproximal Dimensions <ul><ul><ul><ul><ul><li>Inadequate inter-radicular bone width to adjacent tooth </li></ul></ul></ul></ul></ul>
    64. 74. <ul><li>A Retrospective, Multicentre Study on a Novo Wide Body Implant for Posterior Regions. Vandewege S, Ackermann A, Bronner J, Hattingh A, Tsjachaloff A, De Bruyn. Clinical Implant Dentistry and Related Research. 2009 Dec 3 (epub) </li></ul><ul><ul><li>93 MAX implants in 75 patients </li></ul></ul><ul><ul><li>69 one stage approach, 24 in healed bone </li></ul></ul><ul><ul><li>29 immediately loaded </li></ul></ul><ul><ul><li>Mean follow up of 14 months (range 6-34 months) </li></ul></ul><ul><ul><li>Implant survival of 95.7% </li></ul></ul>
    65. 75. MAX Implant <ul><li>May be placed immediately into a significant percentage of molar sockets </li></ul><ul><li>The short term outcome of treatment has been excellent </li></ul><ul><li>The potential duration, cost, morbidity and complexity of molar replacement has been substantially reduced </li></ul>
    66. 76. The Co-Axis Implant
    67. 77. Threaded implant with a 12° and 24° angle correction built into it
    68. 79. Co-Axis Implant Requirements <ul><li>12 & 24 degree angulation in implant </li></ul><ul><li>Threaded implant </li></ul><ul><ul><li>Primary stability </li></ul></ul><ul><ul><li>Immediate restoration </li></ul></ul><ul><li>Surface enhanced tapered implant </li></ul><ul><li>Use existing surgical protocol </li></ul><ul><li>Use existing surgical components and drills </li></ul><ul><li>Use existing restorative components* </li></ul>
    69. 80. © 2009 Southern Implants, Inc. All rights reserved. Co-Axis with Industry Compatible Connections
    70. 81. Angled fixture mount allows symmetrical rotation when inserted How Do You Place This Implant? dimple on most coronal side of restorative platform 0.6mm thread pitch
    71. 82. Fixture and mount WHY?
    72. 83. Tilted Implants <ul><li>Used to avoid anatomical structures </li></ul><ul><li>Eliminate many grafting procedures </li></ul><ul><li>Decreases treatment time and cost </li></ul><ul><li>Do tilted implants work long term? </li></ul>
    73. 84. Tilted Implants Literature Review 1 . Sütpideler M. Eckert SE, Zobitz M. An KN . Finite element analysis of effect of prosthesis height, angle of force application, and implant offset on supporting bone. Int J Oral Maxillofac Implants. 2004 Nov-Dec;19(6):819-25. 2. E, Griggs JA, Powers JM, Englemeier RL . Effect of abutment angulation on the strain on the bone around an implant in the anterior maxilla: a finite element study. J Prosthet Dent. 2007 Feb;97(2):85-. 3. Cehreli MC, Iplikcioğlu H, Bilir OG . The influence of the location of load transfer on strains around implants supporting four unit cement-retained fixed prostheses: in vitro evaluation of axial versus non-axial loading, J Oral Rehabil. 2002 Apr;29(4):394-400. 4. Brosh T, Pilo R, Sudai D . The influence of abutment angulation on strains and stresses along the implant/bone interface: Comparison between 2 experimental techniques. J Prosthet Dent 1998;79:328-334. 5. Clelland NL, Lee JK, Bimbenet OC, Brantley WA . A three-dimen­sional finite element stress analysis of angled abutments for an implant placed in the anterior maxilla. J Prosthodont 1995; 4:95-100 6. MC, Lplikçioğlu H . In vitro strain analysis and off-axial loading on implant supported fixed partial dentures. . Implant Dent. 2002;11(3):286-92. 7. O’Mahony A, Bowles Z, Woolsey G, Robinson SJ, Spencer P . Stress distribution in the single-unit osseointegrated dental implant: finite element analyses of axial and off-axial loading. Implant Dent. 2000;9(3):207-18. 8. Clelland NL, Gilat A, McGlumphy EA, Brantley WA . A photoelastic and strain gauge analysis of angled abutments for an implant system. Int J Oral Maxillofac Implants. 1993;8(5):541-8. 9. Celletti R, Pameijer Ch, Bracchetti G, Donath K, Persichetti G, Visani I . Histologic evaluation of osseointegrated implants restored in nonaxial functional occlusion with preangled abutments. Int J Periodontics Restorative Dent. 1995 Dec;15(6):562-73. 10. Barbier L, Schepers E . Adaptive bone remodeling around oral implants under axial and nonaxial loading conditions in the dog mandible. Int J Oral Maxillofac Implants. 1997 Mar-Apr;12(2):215-23.
    74. 85. Tilted Implants Literature Review 11. SF, Wolfinger GJ, Balshi TJ . Analysis of 356 pterygomaxillary implants in edentulous arches for fixed prosthesis anchorage. Int J Oral Maxillofac Implants. 1999 May-Jun;14(3):398-406. 12. Balshi SF, Wofinger GJ, Balshi TJ . Analysis of 164 titanium oxide-surface implants in completely edentulous arches for fixed prosthesis anchorage using the pterygomaxillary region. Int J Oral Maxillofac Implants. 2005 Nov-Dec;20(6):946-52. 13. Valerón JF, Valerón PF . Long-term results in placement of screw-type implants in the pterygomaxillary-pyramidal region. Int J Oral Maxillofac Implants. 2007 Mar-Apr;22(2):195-200. 14. Ahlgren F, Størksen K, Tomes K . A study of 25 zygomatic dental implants with 11 to 49 months' follow-up after loading Int J Oral Maxillofac Implants. 2006 May-Jun;21(3):421-5. 15. Aparicio C, Ouazzani W, Garcia R, Arevalo X, Muela R, Fortes V . A prospective clinical study on titanium implants in the zygomatic arch for prosthetic rehabilitation of the atrophic edentulous maxilla with a follow-up of 6 months to 5 years. Clin Implant Dent Relat Res. 2006;8(3):114-22. 16. Becktor JP, Isaksson S, Abrahamsson P, Sennerby L . Evaluation of 31 zygomatic implants and 74 regular dental implants used in 16 patients for prosthetic reconstruction of the atrophic maxilla with cross-arch fixed bridges Clin Implant Dent Relat Res. 2005;7(3):159-65. 17. Farzad P, Andersson L, Gunnarsson S, Johansson B . Rehabilitation of severely resorbed maxillae with zygomatic implants: an evaluation of implant stability, tissue conditions, and patients' opinion before and after treatment. Int J Oral Maxillofac Implants. 2006 May-Jun;21(3):399-404. 18. Eger DE, Gunsolley JC, Felmman S . Comparison of angled and standard abutments and their effect on clinical outcomes: a preliminary report. Int J Oral Maxillofac Implants. 2000 Nov-Dec;15(6):819-23. 19. Sethi A, Kaus T, Sochor P . The use of angulated abutments in implant dentistry: five-year clinical results of an ongoing prospective study. Int J Oral Maxillofac Implants. 2000 Nov-Dec;15(6):801-10. 20. Sethi A, Kaus T, Sochor P, Axmann-Krcmar D, Chanavaz M . Evolution of the concept of angulated abutments in implant dentistry: 14-year clinical data. Implant Dent. 2002;11(1):41-51.
    75. 86. Tilted Implants Literature Review 21. Krekmanov L, Kahn M, Rangert B, Lindström H . Tilting of posterior mandibular and maxillary implants for improved prosthesis support. Int J Oral Maxillofac Implants. 2000 May-Jun;15(3):405-14. 22. Maló P, Nobre Mde A, Petersson U, Wigren S . A pilot study of complete edentulous rehabilitation with immediate function using a new implant design: case series Clin Implant Dent Relat Res. 2006;8(4):223-32. 23. Rosén A, Gynther G . Implant treatment without bone grafting in edentulous severely resorbed maxillas: a long-term follow-up study. J Oral Maxillofac Surg. 2007 May;65(5):1010-6. 24. Calandriello R, Tomatis M . Simplified treatment of the atrophic posterior maxilla via immediate/early function and tilted implants: A prospective 1-year clinical study. Clin Implant Dent Relat Res. 2005;7 Suppl 1:S1-12. 25. Krennmair G, Fürhauser R, Krainhöfner M, Weinländer M, Plehslinger E . Clinical outcome and prosthodontic compensation of tilted interforaminal implants for mandibular overdentures. Int J Oral Maxillofac Implants. 2005 Nov-Dec;20(6):923-9. 26. Aparicio C, Perales P, Rangert B . Tilted implants as an alternative to maxillary sinus grafting: a clinical, radiologic, and periotest study. Clin Implant Dent Relat Res. 2001;3(1):39-49. 27 Msu ML, Chen FC, Kao HC, Cheng CK . Influence of off-axis loading of an anterior maxillary implant: a 3-dimensional finite element analysis. Int J Oral Maxillofac Implants. 2007 Mar-Apr;22(2):301-9. 28. Zampelis A, Rangert B, Heijl L . Tilting of splinted implants for improved prosthodontic support: a two-dimensional finite element analysis. J Prosthet Dent. 2007 Jun;97(6 Suppl):S35-43. 29. Francetti L, Agliardi E, Testori T, Romeo D, Taschieri S, Fabbro MD . Immediate rehabilitation of the mandible with fixed full prosthesis supported by axial and tilted implants: interim results of a single cohort prospective study. Clin Implant Dent Relat Res. 2008 Dec;10(4):255-63. 30. Testori T, Del Fabbro M, Capelli M, Zuffetti F, Francetti L, Weinstein RL . Immediate occlusal loading and tilted implants for the rehabilitation of the atrophic edentulous maxilla: 1-year interim results of a multicenter prospective study. Clin Oral Implants Res. 2008 Mar;19(3):227-32.
    76. 87. Tilted Implants Literature Review 31. Capelli M. Zuffettii F, Del Fabbro M, Testori T . Immediate rehabilitation of the completely edentulous jaw with fixed prostheses supported by either upright or tilted implants: a multicenter clinical study. Int J Oral Maxillofac Implants. 2007 Jul-Aug;22(4):639-44. 32. Rosén A, Gynther G . Implant treatment without bone grafting in edentulous severely resorbed maxillas: a long-term follow-up study J Oral Maxillofac Surg. 2007 May;65(5):1010-6. 33. Bedrossian E, Rangert B, Stumpel L, Indresano T . Immediate function with the zygomatic implant: a graftless solution for the patient with mild to advanced atrophy of the maxilla. Int J Oral Maxillofac Implants. 2006 Nov-Dec;21(6):937-42. 34. Koutouzis T, Wennström JL . Bone level changes at axial- and non-axial-positioned implants supporting fixed partial dentures. A 5-year retrospective longitudinal study. Clin Oral Implants Res. 2007 Oct;18(5):585-90. Epub 2007 Jun 30 35. Cruz M, Wassall T, Toledo EM, da Silva Barra LP, Cruz S . Finite element stress analysis of dental prostheses supported by straight and angled implants. Int J Oral Maxillofac Implants. 2009 May-Jun;24(3):391-403. 36. Lin CL, Wang JC, Ramp LC, Liu PR . Biomechanical response of implant systems placed in the maxillary posterior region under various conditions of angulation, bone density, and loading Int J Oral Maxillofac Implants. 2008 Jan-Feb; 23(1):57-64. 37. Al-Ghafli SA, Michalakis KX, Hirayama H, Kang K . The in vitro effect of different implant angulations and cyclic dislodgement on the retentive properties of an overdenture attachment system. J Prosthet Dent. 2009 Sep;102(3):140-7. 38. Bellini CM, Romeo D, Galbusera F, Agliardi E, Pietrabissa R, Zampelis A, Francetti L . A finite element analysis of tilted versus nontilted implant configurations in the edentulous maxilla Int J Prosthodont. 2009 Mar-Apr;22(2):155-7. 39. Fortin T, Isidori M, Bouchet H . Placement of posterior maxillary implants in partially edentulous patients with severe bone deficiency using CAD/CAM guidance to avoid sinus grafting: a clinical report of procedure Int J Oral Maxillofac Implants. 2009 Jan-Feb;24(1):96-102. prospective study. Clin Oral Implants Res. 2008 Mar;19(3):227-32. Epub 2008 Jan 3.
    77. 88. Tilted Implants Literature Review 40. Bevilacqua M, Tealdo T, Pera F, Menini M, Mossolov A, Drago C, Pera P . Three-dimensional finite element analysis of load transmission using different implant inclinations and cantilever lengths . Int J Prosthodont. 2008 Nov-Dec;21(6):539-42. 41. Agliardi EL, Francetti L, Romeo D, Taschieri S, Del Fabbro M . Immediate loading in the fully edentulous maxilla without bone grafting: the V-II-V technique. Minerva Stomatol. 2008 May;57(5):251-9, 259-63. 42. Zampelis A, Rangert B, Heijl L .Tilting of splinted implants for improved prosthodontic support: a two-dimensional finite element analysis. J Prosthet Dent. 2007 Jun;97(6 Suppl):S35-43. Erratum in: J Prosthet Dent. 2008 Mar;99(3):167. 43. Francetti L, Agliardi E, Testori T, Romeo D, Taschieri S, Fabbro MD . Immediate rehabilitation of the mandible with fixed full prosthesis supported by axial and tilted implants: interim results of a single cohort prospective study. Clin Implant Dent Relat Res. 2008 Dec;10(4):255-63. Epub 2008 Apr 1. 44. Testori T, Del Fabbro M, Capelli M, Zuffetti F, Francetti L, Weinstein RL . Immediate occlusal loading and tilted implants for the rehabilitation of the atrophic edentulous maxilla: 1-year interim results of a multicenter prospective study. Clin Oral Implants Res. 2008 Mar;19(3):227-32. Epub 2008 Jan 3. 45. Cruz M, Wassall T, Toledo EM, da Silva Barra LP, Cruz S . Finite element stress analysis of dental prostheses supported by straight and angled implants Int J Oral Maxillofac Implants. 2009 May-Jun;24(3):391-403. 46. Kao HC, Gung YW, Chung TF, Hsu ML . The influence of abutment angulation on micromotion level for immediately loaded dental implants: a 3-D finite element analysis. Int J Oral Maxillofac Implants. 2008 Jul-Aug;23(4):623-30 47. Las Casas EB, Ferreira PC, Cimini CA Jr, Toledo EM, Barra LP, Cruz M . Comparative 3D finite element stress analysis of straight and angled wedge-shaped implant designs. Int J Oral Maxillofac Implants. 2008 Mar-Apr;23(2):215-25. 48. Markarian RA, Ueda C, Sendyk CL, Laganá DC, Souza RM . Stress distribution after installation of fixed frameworks with marginal gaps over angled and parallel implants: a photoelastic analysis. J Prosthodont. 2007 Mar-Apr;16(2):117-22.
    78. 89. Tilted Implants Literature Review Tilted implants are a safe and effective treatment that has many benefits for the patient
    79. 90. Tilted Implants <ul><li>Avoid sinus and nerve without grafts </li></ul><ul><li>Decreases treatment time and cost </li></ul><ul><li>Increased patient acceptance </li></ul><ul><li>Angle corrected abutments required </li></ul>
    80. 91. Added components Smaller screws Added modes of failure Increased cost Increased time Large Screw Retained Restorations
    81. 92. 2 mm minimum distance To correct angle More time and cost than going direct to implant Potential aesthetic problems Angle corrected abutments often require tabling of bone Templates for lab to mouth
    82. 93. Co-Axis Implant <ul><li>Tilted implants are effective and benefit patients </li></ul><ul><li>Intermediate abutments cost time and money </li></ul><ul><li>Co-Axis Implant usually eliminates the need for intermediate abutments </li></ul>
    83. 95. Anatomy and/or bone loss often lead to less than ideal implant location in the maxillary anterior making their restoration difficult Problem:
    84. 96. <ul><li>Maxillary anterior often requires facial emergence </li></ul><ul><li>Cemented provisional </li></ul><ul><ul><li>Time consuming and trapped cement </li></ul></ul><ul><ul><li>Difficult to retrieve </li></ul></ul><ul><li>Direct to implant provisional </li></ul><ul><ul><li>Time consuming </li></ul></ul><ul><ul><li>Must replicate esthetics each time remove provisional </li></ul></ul><ul><li>Intermediate abutment </li></ul>
    85. 98. Co-Axis Implant Development It was determined by digital photographic analysis and cephalometric evaluation that an angle correction of 12 degrees would allow for vast majority of maxillary anterior implant restorations to be screw retained Edentulous areas
    86. 99. C. Nikolopoulos, Oral Surgeon P. Youvanoglou, Pros. G. Ioannou, Technican Co-Axis Implant No intermediate abutments No tabling bone
    87. 100. Co-Axis 24 º External hex with slightly shorter screws and healing components
    88. 101. Restoring implants that intersect
    89. 102. <ul><li>Four on the floor </li></ul><ul><ul><ul><ul><li>Angle implants distal to mental foramen increase AP spread </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Requires intermediate abutment </li></ul></ul></ul></ul>
    90. 103. The Co-Axis Implant Co-Axis implant may be placed into available bone while leaving the restorative platform in an optimal position Use Co-Axis implants in locations where conventional implants would require a bone graft or result in the inability to easily or adequately restore the implant Correct angle in implant, not the restoration
    91. 104. Co-Axis Implant Instrumentation 12 degree direction indicator (after twist) 12 degree direction indicator (after final shaping) in 10, 13 and 15mm
    92. 107. Options
    93. 108. Advantages of Co-Axis Implant <ul><li>Increase AP spread in four on the floor cases without requiring intermediate abutments </li></ul><ul><li>Avoid maxillary sinus augmentation without requiring intermediate abutments </li></ul><ul><li>Eliminates tabling of bone in many situations </li></ul><ul><li>Allow lingual access opening for easier immediate restorations </li></ul><ul><li>Large screw retained restorations without requiring intermediate abutments </li></ul>
    94. 109. Is It Strong Enough With That Thin Wall? Straight Implant Co-axis Implant Same amount of titanium just more on one side than other
    95. 110. Finite element analysis 3.75 mm Implant Ext. Hex 350N load at 22° to long axis 350N load at 22° to long axis Finite element analysis Co-Axis 12 degree Finite Element Analysis
    96. 111. Co-Axis Implant Development <ul><li>Cyclic fatigue testing </li></ul><ul><ul><li>4.0mm and 5.0mm </li></ul></ul><ul><ul><li>Gold alloy screw to 32Ncm </li></ul></ul><ul><ul><li>Cycled 5 million times or to failure </li></ul></ul><ul><ul><li>22 degrees to implant axis </li></ul></ul><ul><ul><li>15 mm from restorative platform </li></ul></ul><ul><ul><li>600 N </li></ul></ul>Results: All five samples withstood five million cycles without any screw loosening or component deformation
    97. 112. Pilot Clinical Study <ul><li>225 Co-Axis implants were placed by 14 surgeons </li></ul><ul><li>24 month period </li></ul><ul><li>90% of the implants immediately or early loaded </li></ul><ul><li>Restored with screw retained prostheses </li></ul><ul><li>2 implants (immediately loaded) lost 4 weeks after placement </li></ul><ul><li>99.2% success rate over this time period </li></ul>
    98. 113. Serendipity Making a fortunate discovery while searching for other things
    99. 114. <ul><li>Initially not use Co-Axis aesthetic single teeth </li></ul><ul><li>Noticed results appeared as good, often better </li></ul><ul><li>Eventually realized better aesthetic results </li></ul>
    100. 115. Mid-Facial Soft Tissue Recession in Single Tooth Restorations <ul><li>Interproximal bone levels determined by bone on adjacent teeth </li></ul><ul><li>DeRouck, T. et. al. Single Tooth Replacement in the Anterior Maxilla by Means of Immediate Implantation and Provisionalization : A review, JOMI, 2008 </li></ul><ul><li>“ management of papillia levels seem predictable”…”however maintaining the midfacial gingival margin may be more problematical ” </li></ul>
    101. 116. Mid-Facial Soft Tissue Recession in Single Tooth Restorations Interproximal soft tissue levels determined by bone on adjacent teeth
    102. 117. 26° 17° Angle of Implant
    103. 118. 10 degrees More vertical placement of implants Under contouring of restoration Narrower healing caps Platform switching Immediate restoration Increase amount of tissue
    104. 119. Vertical Placement of Implants In Anterior Maxilla Anatomy of the anterior maxilla often results in facially inclined implants that leads to long teeth
    105. 120. In same osteotomy site a Co-Axis implant will result in more mid-facial soft tissue than a straight implant
    106. 121. “ Need my crown recemented” Emergency immediate restoration
    107. 123. Immediate implant placement & restoration Final 13 months post insertion Pre-op model
    108. 124. Atraumatic extraction
    109. 125. Out of occlusion Post op instructions
    110. 131. The Co-Axis implant has two distinct axes to allow easier replication of the two planes nature gave maxillary anterior teeth
    111. 132. © 2008 Southern Implants, Inc. All rights reserved. <ul><li>Easier to develop natural emergence profile </li></ul><ul><li>Fewer custom abutments required </li></ul><ul><li>Less preparation of stock abutments </li></ul><ul><li>Greater wall thickness of abutments </li></ul>Cemented Restoration Advantages
    112. 133. Co-Axis allows for final screw retained crown <ul><li>Lingual access </li></ul><ul><li>Recession no problem / porcelain within.5mm of implant </li></ul><ul><li>No cement complications </li></ul><ul><li>100% retrievable </li></ul><ul><li>Some labs not trained </li></ul>
    113. 134. Conclusions <ul><li>Co-Axis implant significantly reduces the need for bone grafting </li></ul><ul><li>This implant allows for screw retained restorations in most cases and makes cemented cases easier </li></ul><ul><li>Co-Axis implant is useful where anatomy restricts conventional implant placement </li></ul><ul><li>Results in more mid facial soft tissue than a conventional straight implant placed in the same osteotomy site </li></ul><ul><li>Success rates are comparable to non Co-Axis implants </li></ul>
    114. 135. Co-Axis Implant <ul><li>“ The Co-Axis implant is like my cell phone. When I first got it I thought I would use it occasionally, but as time passed I use this new technology more and more .” </li></ul><ul><ul><li>Stuart Graves, D.D.S. </li></ul></ul>
    115. 136. Co-Axis and MAX Implants <ul><li>Less grafting </li></ul><ul><li>Less cost and fewer complications </li></ul><ul><li>Eliminate components </li></ul><ul><li>Shorter treatment time </li></ul><ul><li>Increased patient acceptance </li></ul><ul><li>Better mid-facial aesthetics </li></ul><ul><li>Happier patients and staff </li></ul>
    116. 137. Thank You Brian A. Mahler, D.D.S., P.L.C. 10550 Warwick Avenue Fairfax, Virginia [email_address]
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