Isi tsi treatment planning and placement (updated design)


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  • Shirley Plotnick
  • Isi tsi treatment planning and placement (updated design)

    1. 1. OCO Biomedical Presents The Next Generation of Endosseous Implants Treatment Planning & Placement Presentation
    2. 2. <ul><li>If orthopedic and neurosurgeons doing hip replacement and spinal fusion have patients in function the same day, why should dental implants take 3 to 6 months before function? </li></ul><ul><li>OCO Biomedical technology has made it a reality with the next generation of dental implants! </li></ul><ul><li>The OCO DUAL STABILIZATION Line of Dental Implants, bioengineered to encourage bone growth </li></ul>
    3. 3. <ul><li>The 1938 Adams’ patent covers the general form of all of today’s classic two-stage root form dental implants </li></ul><ul><li>Not even industry leaders have innovated or made any major improvements since the original 1938 patent was issued </li></ul>1938 – Adams
    4. 4. <ul><li>Examples of classic two-stage dental implants based on the 71 year old Adams’ U.S. patented technology: </li></ul>Two-Stage Dental Implant Examples
    5. 5. 1938 Adams patent for a two-stage endosseous root form implant <ul><li>One company, for example, claims 40 years of inventions and technological advances: </li></ul>Evolution of threaded implants, not much change until introduction of dual-stabilization 1981 1992 2000 2003 2004
    6. 6. In 2002 OCO Biomedical introduced the next generation of endosseous implants: The ISI Complete ® , TSI, and The ERI Immediate Load capable Dual-Stabilization® Dental Implant System July 20, 2010
    7. 7. OCO Biomedical’s Dual Stabilization Line designed to “grow bone” by compressing it with tension For a Predictable Immediate Load or 2 stage conventional Dental Implant:
    8. 8. Product Overview Dual Stabilization and how it works July 20, 2010
    9. 9. The Next Generation in Implant Technology <ul><li>Dual Stabilization™ implant design: </li></ul><ul><ul><li>Creates a true mechanical lock at the top and bottom of the implant, ensuring immediate stability and superior osseointegration </li></ul></ul><ul><ul><li>Durable, high-quality, immediate-performance implant and temporary crown in less than an hour in most cases. </li></ul></ul>Bull-Nose/ Auger Tip
    10. 10. OCO Biomedical Developed Many Changes ISI & TSI: Dual Stabilization ™ for True Immediate Load Bull Nose Tip <ul><li>The unique tip locks the apex of ISI Complete™ and TSI in medullar bone </li></ul>1 <ul><li>Select surface treatment at tip: Apical portion of implant is not grit blasted to preserve cutting edge </li></ul><ul><li>Auger like thread pattern condenses bone after implant bottoms out by pulling it up and around the tip stimulating bone growth with tension </li></ul>
    11. 11. High-Powered Images Show the Superior Features of the ISI Complete & TSI Dental Implant and the Cortico-Thread & Taper locking the top <ul><li>32x machined perio collar surface </li></ul><ul><li>Lighter grit blasted cortico-thread </li></ul><ul><li>High power illustrates fine machining of implant threads </li></ul><ul><li>10C um sem of proprietary surface treatment </li></ul><ul><li>Most porous in the industry </li></ul>2
    12. 12. Advantages of OCO ISI, TSI , and ERI Implants <ul><li>Innovator in Immediate Load/ Function Implant Technology: introduced in 2002 </li></ul><ul><ul><li>Competitors re-engineering existing systems and force a larger implant into a smaller diameter hole. Or, a thread which increases in thickness along the long axis of the implant. Result, bone compression </li></ul></ul><ul><ul><li>OCO system developed dual stabilization; unique bull nosed tip pulls bone from beneath the implant up around the tip(tension) which encourages bone growth. The wide diameter top with cortico treads locks the top at the crest of the ridge. Thus; eliminating a fulcrum along the body of the implant. </li></ul></ul>
    13. 13. Advantages (cont’d) <ul><li>Easy to use/learn system & instrumentation </li></ul><ul><li>Conventional flap & reflection or Single stage, flapless surgical procedure in less than 30 min </li></ul><ul><ul><li>Reduced patient chair time </li></ul></ul><ul><ul><li>Increased patient satisfaction </li></ul></ul><ul><ul><li>Why? No pain or swelling! </li></ul></ul><ul><li>Extremely high success rate </li></ul><ul><ul><li>Unchallenged successes history, not one reported case of crestal bone loss or cupping since introduction! </li></ul></ul><ul><li>Designed and manufactured in the USA </li></ul>
    14. 14. 2 Bio Horizon implants placed in upper and 2 OCO Biomedical TSI implants in lower 6 yrs ago s
    15. 15. Dual Stabilization® Implant System <ul><li>ISI Complete® One-Piece Implant </li></ul><ul><ul><li>Crown & Bridge or O-Ball overdenture prosthetic options </li></ul></ul><ul><ul><li>Diameters: 3.25, 4.0 & 5.0 mm </li></ul></ul><ul><ul><li>Lengths: 8, 10, 12, 14 & 16 mm </li></ul></ul><ul><ul><li>Complete system including implants, instrumentation, prosthetics and direct restorative components </li></ul></ul><ul><ul><li>Now available, the Locator for overdentures </li></ul></ul>
    16. 16. Dual Stabilization® Implant System <ul><li>TSI Two-Piece Implant System </li></ul><ul><ul><li>Variety of prosthetic options: </li></ul></ul><ul><ul><ul><li>O-Ball/IOT, Straight C&B, Offset, Paralleled Wall, Pedestal, Skirted and other abutments </li></ul></ul></ul><ul><ul><li>Diameters: 3.25, 4.0 & 5.0 mm </li></ul></ul><ul><ul><li>Lengths: 8, 10, 12, 14 & 16 mm </li></ul></ul><ul><ul><li>Complete system including implants, instrumentation, prosthetics and restorative components </li></ul></ul><ul><ul><li>Can be restored using direct or indirect technique with a very large variety abutment options </li></ul></ul>
    17. 17. Dual Stabilization™ Implant System <ul><li>TSI Abutments </li></ul>IOT / O-Ball Parallel Wall (Indexed) 15 degree Offset C&B Straight Skirted & Offset Skirted & Soon, scalloped- contoured Healing Cuffs UMA UMA Healing Cuff TSI C&B Taper/ Straight Scalloped Skirted Abutments Indexed & Non-Indexed Waxing Sleeves
    18. 18. OCO Biomedical Advantages <ul><li>More surgical placement options - simplicity </li></ul><ul><li>Simplest and most economical restorative options </li></ul><ul><li>Less occurrence of crestal bone loss </li></ul><ul><li>highest percent of cases with immediate loading/function </li></ul><ul><li>Unchallenged long term success rate </li></ul><ul><li>Unique dual – stabilization design </li></ul><ul><li>Most effective surface treatment </li></ul>
    19. 19. The Economical I-Mini Implant System Economical Denture Stabilization Long Term Fixed Support <ul><li>I- Mini : 3mm Mini Implant </li></ul><ul><li>Introduced 2002 </li></ul><ul><ul><li>Crown & Bridge or O-Ball/IOT & prosthetic options & soon, the Locator </li></ul></ul><ul><ul><li>Diameter: 3.0 mm </li></ul></ul><ul><ul><li>Lengths: 8,10, 12 & 14 mm </li></ul></ul><ul><ul><li>Complete system including implants, instrumentation, prosthetics attachments and restorative components </li></ul></ul><ul><ul><li>Simple, Economical introduction to full diameter ISI, TSI & ERI Implant Systems </li></ul></ul>
    20. 20. Diagnosis and treatment planning <ul><li>Medical and dental history </li></ul><ul><li>How did the patient loose the tooth or teeth </li></ul><ul><li>Pano or cone-beam cat scan x-ray </li></ul><ul><li>Study models </li></ul><ul><li>Model mapping on areas to be treated if needed </li></ul><ul><li>Identify bone type and density </li></ul><ul><li>Evaluate available bone in areas to be treated </li></ul><ul><li>Inform before you perform </li></ul><ul><li>Evaluate the patient expectations </li></ul><ul><li>Can you meet those expectations </li></ul><ul><li>Can anyone achieve the expectations </li></ul><ul><li>Encourage the patient to get a second or third opinion and estimate </li></ul>
    21. 21. <ul><li>Evaluate study model for ridge width, alignment of adjacent teeth, if a dental implant can be placed using uncomplicated techniques. </li></ul>
    22. 22. <ul><li>Section the model through the edentulous area and after estimating gingival thickness, map it . </li></ul>
    23. 23. Mount study models, mounted. A must for treatment planning and Case Presentation
    24. 24. Study models, mounted. A must for treatment planning and Case Presentation
    25. 25. Edentulous Mandible An immediate denture placed 17 yrs ago July 20, 2010
    26. 26. Pantographic X=Ray, a must for any implant case. Is there an abundance of bone?
    27. 27. Model of lower, sectioned at the center and mapped
    28. 28. Zoll bone width measuring device
    29. 29. Bone Densities July 20, 2010
    30. 30. Anterior Bone Qualities <ul><li>Lekholm and Zarb’s four bone qualities for the anterior region of the jaws: </li></ul><ul><ul><li>Quality 1: Composed of homogenous compact bone </li></ul></ul><ul><ul><li>Quality 2: Thick layer of cortical bone surrounding dense trabecular bone. </li></ul></ul><ul><ul><li>Quality 3: Thin layer of cortical bone surrounded by dense trabecular bone of favorable strength. </li></ul></ul><ul><ul><li>Quality 4: Thin layer of cortical bone surrounding a core of low-density trabecular bone. </li></ul></ul>D1 D3 D2 D4
    31. 31. General Bone Densities <ul><li>Bone Density Classification by Misch & Judy </li></ul>D2 D1 D4 D3 Bone Density Description Tactile Analog Typical Anatomical Location D1 Dense Cortical Oak or maple wood Anterior mandible D2 Porous cortical and coarse trabecular White pine or spruce wood Anterior mandible Posterior mandible Anterior maxilla D3 Porous cortical (thin) and fine trabecular Balsa wood Anterior maxilla Posterior maxilla Posterior mandible D4 Fine trabecular Styrofoam Posterior maxilla
    32. 32. Basics for fixed: 4 Main buttresses for fixed or implant supported teeth Ideal minimum Implant diameter Minimum implant length 10 to 12 mm
    33. 33. A Dental Implant is not a natural tooth root <ul><li>Vertical tooth movement: 25 to 100 mµ </li></ul><ul><li>Vertical Implant movement: 0 to 10 mµ </li></ul><ul><li>Proprioception: Tooth – yes </li></ul><ul><li>Implant - no </li></ul><ul><li>Horizontal flex: Tooth –yes </li></ul><ul><li>Implant - no </li></ul>
    34. 34. So, if not following the buttress parameters and ignoring the physical properties:
    35. 35. [ PLACEMENT PROTOCOL AND PROCEDURE ] ISI Complete ® One-piece and TSI Two-piece Dual Stabilization ® Implants July 20, 2010
    36. 36. Ready to place: Flap or Flapless Direct ? Indications: Any Dental Implant Situation –– 80%+ of which can be Immediately Loaded <ul><li>Alternative to mandibular or maxillary bridge, partial, or to stabilize a full prosthesis </li></ul><ul><li>Single or multiple tooth replacement </li></ul><ul><li>Healed or selected new extraction sites (when an implant with a diameter larger than the tooth root removed can be placed) </li></ul>
    37. 37. Full Surgical Kit – ISI,TSI, ERI & I-Mini Dual Stabilization™ Implant Instrumentation System <ul><li>For placement of the ISI Complete One-piece, I-Mini and TSI, ERI Two-piece Dual Stabilization™ Implants </li></ul><ul><li>All drills for the ISI, TSI, ERI and I-Mini implant placement </li></ul><ul><li>Simple step-by-step drill sequences </li></ul><ul><li>Organized and color-coded (relative to implant diameter) to flow with the implant placement procedure </li></ul><ul><li>Components labeled for easy return to the tray after surgery </li></ul>Convenient, Simple and Versatile <ul><li>Fits easily into most autoclaves for sterilization </li></ul><ul><li>Extra compartment underneath the caddy allowing room for additional components and instrumentation </li></ul>
    38. 38. Drill Sequence : 1. High Speed #8 surgical bur 2. Pilot drill 3. Guided tissue punch 4. Counter sink if needed 5. Pilot drill again to final depth 6. Final osteotomy former (drill)
    39. 39. <ul><li>After palpating the buccal and lingual anatomy and determining the ridge width, mark the spot where the implant is to be placed with a high speed hand-piece and a #8 bur with water spray only </li></ul>Mark the Spot, then flap to expose bone or use flapless direct technique proceeding to the next step <ul><li>Drill through the gingiva and into the cortical bone </li></ul>
    40. 40. <ul><li>With a low speed hand-piece and pilot drill, slide on 12mm a drill stop and or depth marking ring </li></ul><ul><li>Align with adjacent teeth or implants, and drill down to the 10mm mark </li></ul>Establish Path-Alignment: Pilot Drill
    41. 41. <ul><li>Place a paralleling pin (shaped like the abutment) and check alignment and distance from adjacent teeth or implants </li></ul><ul><li>If off, remove pin and correct by re-drilling pilot hole, then replace pin and recheck </li></ul>Check the Alignment & Clearance
    42. 42. <ul><li>Next, use the tissue punch with center guide pin placed into the pilot hole </li></ul><ul><li>Drill down through the gingiva and into the bone assuring you’re through the periosteum </li></ul>Punch the Tissue
    43. 43. <ul><li>With a curette or irrigated high speed drill and #8 bur, remove the tissue plug. </li></ul><ul><li>Remove all tissue tags and leaving a clean hole to the bone with the pilot hole in the exact center </li></ul>High Speed Plug Removal
    44. 44. <ul><li>Use the collar depth gauge – countersink to make sure the collar is below the top of the gingiva, especially in the esthetic zone areas </li></ul>Countersink Drill : Optional for ISI or TSI
    45. 45. <ul><li>In this example, a 12mm ISI implant will be placed, so use the 12mm drill stop on the pilot drill </li></ul><ul><li>Then drill through the pilot hole, keeping the drill aligned </li></ul><ul><li>Drill to the final seating depth – when drill stop contacts bone </li></ul>Pilot Final Depth
    46. 46. <ul><li>Place the “O” ring marker at the 14mm mark on the final internally irrigated drill using a surgical hand-piece with water pump </li></ul><ul><li>Drill to the final seating depth </li></ul><ul><li>The final drill is designed to stop at the final depth established by the pilot drill </li></ul><ul><li>If more depth is needed, re-drill deeper with the pilot drill first </li></ul>Final Drill
    47. 47. Placing the Implant: ISI Complete ISI <ul><li>Remove implant from the vial </li></ul><ul><li>Implant is now placed with the cap into the prepared osteotomy site </li></ul>
    48. 48. Placing the Implant: ISI Complete ISI <ul><li>Finish seating the implant with the ISI sized driver and thumb wrench </li></ul><ul><li>Implant is now placed with the cap into the prepared osteotomy site </li></ul><ul><li>Use the ratchet wrench to finish seating in denser bone watching the collar to assure it continues seating. Use with caution! </li></ul>
    49. 49. Placing the Implant: TSI, ERI Two-Piece TSI <ul><li>TSI Implants come suspended in a vile </li></ul><ul><li>Remove the color-coded cap uncovering the Ultum cap holding the TSI implant </li></ul><ul><li>Healing screw is set in the top of theUltum cap </li></ul>
    50. 50. Placing the Implant: TSI, ERI Two-Piece TSI <ul><li>Remove the Ultum cap holding the implant with healing screw at top take to osteotomy without touching the implant </li></ul><ul><li>Carry the TSI implant to the osteotomy site with the Ultum cap and start seating </li></ul><ul><li>Use a TSI driver with the thumb wrench and continue seating the implant </li></ul>
    51. 51. Placing the Implant: TSI, ERI Two-Piece TSI <ul><li>Use the ratchet wrench with the driver to complete seating the implant </li></ul><ul><li>After the ISI and TSI implants have bottomed out a couple of extra turns condenses the bone at the tip and the top of the implant establishing Dual Stabilization™. </li></ul><ul><li>Check for Dual Stabilization™ with the torque wrench. 30 -40 n/cm in the maxilla and 40+ in the mandible </li></ul>
    52. 52. Placing the Implant: TSI, ERI Two-Piece <ul><li>If a temporary prosthesis is not placed (Direct Technique) the healing screw provided with the implant or a 2,3,or 4 mm healing cuff is placed to cover the top of the implant and maintain the gingival emergence profile </li></ul><ul><li>Torque on healing screws > 20 n/cm </li></ul>
    53. 53. <ul><li>A thumb wrench and driver is used to screw the ISI Complete™ towards its final seating depth. </li></ul>Place the Implant
    54. 54. <ul><li>Use the ratchet torque wrench and driver to fully seat the implant </li></ul><ul><li>Then apply a few additional turns to 30 -50 n/cm to condense the bone at the tip and wedge the cortico-thread into the cortical bone </li></ul><ul><li>This results in Dual-Stabilization ™ with a true mechanical lock at the top and the bottom of the implant </li></ul>Seat the Implant Firmly
    55. 55. <ul><li>As the implant bottoms out, the bone is condensed by pulling bone up at the apex and locking the top in the cortical bone by the mini-threads at the bottom of the tapered collar :Dual Stablization </li></ul>Seat the Implant, Lock with an additional Turn (up to 180 degrees) : Dual Stabilization
    56. 56. <ul><li>The ISI Complete is now fully seated </li></ul><ul><li>In our example, we were using a 12 mm implant (measured from tip to top of cortico-thread), plus 2 mm of divergent perio collar for a total of 14mm from tip to abutment </li></ul>Seated Implant
    57. 57. <ul><li>If necessary, shorten the abutment to provide space for the final crown with a 556 Great White Carbide Bur in a high speed hand-piece with water and air spray </li></ul>Shorten the Abutment
    58. 58. <ul><li>Placed implant with modified head ready for temporary crown </li></ul>Ready for Crown
    59. 59. <ul><li>Place machined acrylic coping on the abutment prior to placing tooth-colored temp form and acrylic over it </li></ul><ul><li>This will provide a perfect fit and margin </li></ul>Coping and Temporary Crown Acrylic Coping
    60. 60. <ul><li>Temporary crown in place in light occlusion </li></ul>Crown Placement
    61. 61. Review OF Preparing The Osteotomy
    62. 62. TSI <ul><li>The two piece, one or two stage , immediate load version of the ISI Complete™ </li></ul><ul><li>All TSI implants have 6 or 8 point indexing for use with all anti-rotational two-piece abutments </li></ul><ul><li>ABUTMENTS </li></ul><ul><li>One Piece (solid): </li></ul><ul><ul><li>Straight, 3 heights : DO NOT REMOVE AFTER PLACING </li></ul></ul><ul><ul><li>O-ball/IOT, 4 heights </li></ul></ul><ul><ul><li>Healing Cuffs, 4 heights </li></ul></ul><ul><li>Two piece: </li></ul><ul><ul><li>Parallel </li></ul></ul><ul><ul><li>Offset </li></ul></ul><ul><ul><li>Skirted (offset & straight) </li></ul></ul><ul><ul><li>Titanium Nitride Coated Scalloped (for ERI and TSI) </li></ul></ul><ul><ul><li>Custom/UCLA </li></ul></ul>The TSI Two-Piece Implant System
    63. 63. 2002: First version of ISI Complete, multiple drill system Well healed extraction site ideal for the placement of the ISI Complete Dental Implant
    64. 64. The tissue plug removed exposing clean bone with few tissue tags and defining point of implant placement and emergence profile.
    65. 65. With an irrigated high speed drill and burr, remove any tissue tags and clean up definition of emergence profile pattern
    66. 66. First use the pilot drill to a depth of 8 to 10mm
    67. 67. Next the final drill for the diameter size ISI implant being used
    68. 68. The ISI implant removed from its vial
    69. 69. With the cap removed, thread the ISI implant in as far as you can with the thumb wrench
    70. 70. Fully seat ISI implant with a rachet/torque wrench. Torque to 30/40 n/cm in the maxilla, 40/60 n/cm in the mandible.
    71. 71. Shortening the abutment portion using an irrigated high speed drill and carbide bur
    72. 72. Temporary crown placed with light occlusion
    73. 73. In just 35 min, he’s ready for his daughter’s wedding the next week!
    74. 74. Replacing lower molars with TSI Implants
    75. 75. <ul><li>Ask, “How was the tooth lost?” </li></ul>Why did this patient loose his lower central incisor?
    76. 76. <ul><li>The 3.0 diameter / 16mm length I-Mini™(ISD) implant was placed and put into immediate function </li></ul>Immediate Function
    77. 77. <ul><li>Temp in place and put in immediate function – without bonding to adjacent teeth </li></ul><ul><li>Time: 35 minutes </li></ul>Immediate Function
    78. 78. <ul><li>Extreme lower level tongue thrust: </li></ul><ul><li>8 lb pressure x2/ minute by day, X1 per min at night </li></ul>Cause of tooth loss
    79. 79. <ul><li>Final restoration in place </li></ul><ul><li>Implant with crown still in function </li></ul><ul><li>3 years post-op </li></ul>Final Restoration in Place
    80. 80. 8-6-09 6years post-op
    81. 81. <ul><li>After 3 years, no appreciable bone loss </li></ul><ul><li>And the ISI Complete™ still firm and functional </li></ul>After 3 Years – Successful
    82. 82. Missing Central with Moderate Facial Bone Loss
    83. 83. Missing Central with Extreme Facial Bone Loss
    84. 84. Missing Central with Extreme Facial Bone Loss
    85. 85. Treatment Planning and What’s needed Prior To Starting For A Predictable Result <ul><li>Panoramic X-Ray </li></ul><ul><li>Study Models </li></ul><ul><li>Cone Beam Cat Scan Imaging </li></ul><ul><li>Or- Sectioned Model with Bone Mapping </li></ul><ul><li>Drill/Implant Guide for Correct Positioning and Alignment optional </li></ul>Then Proceed <ul><li>Surgical Choice : Flap for Bone Exposure or Tissue Punch </li></ul><ul><li>Bone Grafting, Bone Expansion, Bone remodeling or Both </li></ul><ul><li>ISI Immediate Loading/Function, TSI with Straight, Offset Abutments or Delayed Loading With Selected Healing Cuff </li></ul>
    86. 86. Study Model
    87. 87. Cat Scan Image or Model Mapping to Evaluate Available Bone and Select Surgical Choice and Implant Selection
    88. 88. TSI Placement: Mark the Spot
    89. 89. Drill through the gingiva and into the cortical bone
    90. 90. Set the Depth: Pilot Drill Now use a 10mm drill stop to go 8mm into bone!
    91. 91. Set the Depth: Pilot Drill
    92. 92. Set the Depth: Pilot Drill
    93. 93. Set the Depth: Pilot Drill
    94. 94. Check the Alignment
    95. 95. Punch the Tissue
    96. 96. High Speed Plug Removal
    97. 97. Countersink Drill
    98. 98. Countersink Drill
    99. 99. Pilot Final Depth Now use the drill stop that corresponds to the implant’s length and drill to bone level!
    100. 100. Pilot Final Depth
    101. 101. Osteotomes used in Bone Spreading and Remodeling
    102. 102. Osteotomes used in Bone Spreading and Remodeling
    103. 103. Osteotomes used in Bone Spreading and Remodeling
    104. 104. Osteotomes used in Bone Spreading and Remodeling
    105. 105. Final Drill <ul><li>Place the depth ring 2 mm above the implant length on the final internally irrigated drill </li></ul><ul><li>This is the length of the entire implant body and collar </li></ul>
    106. 106. Final Drill
    107. 107. Place the Implant
    108. 108. Seat the Implant Firmly
    109. 109. Seat the Implant Firmly Use ratchet-torque wrench and driver to fully seat the implant and then turn additionally up to: <ul><li>30+ n/cm in the maxilla </li></ul><ul><li>50+ n/cm in the mandible </li></ul>This will condense bone at the tip and wedge the cortico-thread into the cortical bone for dual-stabilization™
    110. 110. TSI Offset Abutment
    111. 111. Place the Offset Abutment
    112. 112. Place the Fixation Screw
    113. 113. Torque to 20 n/cm – torque again 10 min later
    114. 114. Modify the Abutment
    115. 115. Adjust Length using 557 Great White in High Speed HP with Water & Air (round tip)
    116. 116. Establish Shape of the Emergence Profile
    117. 117. Modify the Abutment
    118. 118. Modify the Abutment
    119. 119. Check the Alignment and Clearance Have the patient bite
    120. 120. Place the Crown
    121. 121. Crown in Place
    122. 122. Emergence Profile
    123. 123. TSI Implant Placement with Offset Abutment
    124. 124. Two Weeks Post-Op
    125. 125. Final restoration, 3 months later
    126. 126. An Immediate Load 1 st OCO placement by Dr Tim K A 24 yr Noble Biocare user
    127. 127. Pre Treatment
    128. 128. Edentulous area
    129. 130. Use of a drill guide
    130. 131. Position of Implant established by the drill guide
    131. 132. #8 HS surgical Drill Used to Mark the Spot and Indent the Cortical Bone
    132. 133. Pilot drill with 12mm drill stop to final depth
    133. 134. Placing a paralleling pin
    134. 135. Tissue Punch
    135. 136. Removed tissue plug reviling clean , flat cortical bone on crest of the ridge and adequate soft tissue thickness so no countersink is needed
    136. 137. Back with the pilot drill with stop down the bone at the crest to the final depth
    137. 138. The osteotomy completed with the final drill stopped at depth established by the pilot drill
    138. 139. Placing the implant using the TSI driver with a thumb wrench
    139. 140. Seating the implant to the final depth with the ratchet- torque wrench to 45 n/cm
    140. 141. A well placed TSI implant in the 2 nd Bi, non esthetic zone. The top of the implant is at tissue level. A healthy situation
    141. 142. A straight pedestal abutment is placed with the driver and torqued to 30 n/cm
    142. 143. The straight pedestal 5.5 mm abutment in place. Actually an ISI could have been used at less cost
    143. 144. A TRIP, (tissue retraction impression pick-up) is snapped in place, med bodied material injected into the top and picked up with a tray of heavy body material
    144. 145. The pulled impression with the trip in place
    145. 146. The Implant lab analog snapped into the TRIP and ready to be poured and mounted ready for the final restoration to be constructed with less difficulty than a conventional crown
    146. 147. The temporary crown placed and put into light function
    147. 148. Post –op digital x-ray Placement: Excellent
    148. 149. Ready to seat final crown
    149. 150. Zirconium Core Crown
    150. 151. Crown Seated
    151. 152. Lingual View
    152. 153. Final
    153. 154. An emergency visit for a loose UL Cuspid
    154. 155. UL Cuspid has a RCT With a post and core. Fractured root
    155. 165. Impression taken the day the fractured root was removed and implant placed
    156. 171. Temp placed the same appointment, Patient left the office with a tooth
    157. 175. Zirconium core tried-in a month later
    158. 178. Final crown seated, note the emergence profile
    159. 180. Case finalized
    160. 181. The new ERI Implant OCO Dual–Stabilization Implant designed for the esthetic zone or in any case where a low gingival profile implant is indicated
    161. 182. ERI Implant with skirted Titanium Nitrite Scalloped Abutment
    162. 183. Diagnosis, Planning and Treatment
    163. 184. Bone loss on Facial with indent
    164. 185. Pre-op X-Ray
    165. 186. Model mapping
    166. 187. Post-op X-ray
    167. 188. Zirconium core crown NEW ERI IMPLANT USED
    168. 189. Cotton stuffed in abutment set screw
    169. 190. Thin film of intermediate cement applied in crown
    170. 191. Crown cemented to place
    171. 192. Finalized 3.5 weeks after start, 2 visits
    172. 193. Beginning X-Ray
    173. 197. Check alignment with paralleling pin
    174. 212. Marking Abutment prior to prepping
    175. 213. Nitrite Skirted Abutment Prepped Chair Side for Temp Placement
    176. 214. Torque locking screw - twice
    177. 215. Prepped abutment ready for temp
    178. 216. Stock temp filled with “ Alike ” Temp Acrylic
    179. 218. Temp in place with IRM
    180. 224. Beginning x-ray: broken, abscessed lateral Incisor
    181. 225. Tooth removed, curetted, Bone graphed and allowed to heal 8 weeks
    182. 226. Flipper worn for 6 weeks
    183. 227. Penetrating with high speed
    184. 228. Pilot to final depth with drill stop
    185. 229. Osteotomy completed and now form the emergence profile
    186. 230. Placing the ERI Implant
    187. 231. Torqued to 35 n/cm
    188. 232. Temp placed
    189. 233. Final crown
    190. 234. Extreme Chronic Perio, Patient Request: I Need Implants!
    191. 245. Post Op X-ray
    192. 246. Patient: 87 yr old Female Friend Full lower, all remaining teeth to be removed
    193. 247. First surgery, all fractured teeth removed, implants immediately placed and voids grafted
    194. 248. All lower teeth removed, voids grafted and implants placed immediately using single stage flapless procedure in edentulous areas
    195. 249. Lower temp in place
    196. 250. Final PFM final splint. Stress breakers on distal of cupids and dove tail on LL 2 nd Bi
    197. 251. Full upper and fixed lower
    198. 252. My 88 yr old friend no longer fears the horrors of a lower denture
    199. 253. For Over Dentures use ISI, I-Mini, or TSI Implants With O-Ball Abutments
    200. 254. The I-Mini is a 3mm diameter ISI Implant
    201. 255. [ Coming Soon: The I-Micro ] available in 2.2 & 2.5mm
    203. 257. PRE OP
    204. 258. LINGUAL VIEW
    205. 259. FACIAL VIEW
    207. 261. REMOVING TOOTH
    217. 271. SEATED IMPLANT
    220. 274. POST OP XRAY
    221. 275. Implant Retained Overdentures
    222. 276. Or, use a prefabricated pilot drill guide
    223. 277. Locate and Position Implants Safely Between the Mental Foramina
    224. 278. Mark Right and Left Position of Foramina on the Denture With a Pencil
    225. 279. Drill a Small Shallow Hole Where the Denture is Marked With a #8 HS Burr
    226. 280. Drop a 5mm Metal Ball (or a BB) Into the Hole and Cover With a Drop of Soft Liner
    227. 281. Now you know Exactly Where The Mental Foramina are relative to the denture Transfer a Mark From the Denture To the Gingiva Approximately 3 mm mesial the metal markers
    228. 282. Implants are placed low in the gingiva because of the vertical height of the denture
    229. 283. O-Ring capsules are placed on the heads prior to taking the impression
    230. 284. Relieve areas over implants in the denture and remove all soft liner
    231. 285. Paint adhesive on the denture and fill With medium bodied impression material
    232. 286. Inject medium body over heads and place the denture over the implants
    233. 287. Snap the attachments on the analog then snap the into the impression – send to lab
    234. 288. Denture with attachments returned from lab
    235. 289. Impressions taken in the morning and case delivered and finalized in the afternoon
    236. 290. Juan – A trumpet player all his life in a premier mariachi group known throughout Mexico <ul><li>That is until he lost his teeth </li></ul><ul><li>And with a lower denture he could no longer play! </li></ul>Case Study
    237. 291. Pre-Op Pano
    238. 292. Treatment Plan: 6, 3.25 mm Diameter ISI O-Ball Implants Supported Over-denture with 14 mm A-P Spread
    239. 293. Post- Op Pano
    240. 294. Adapting over-denture with firm soft-liner and next day follow-up
    241. 295. In less than 2 weeks the healing looks great and he’s ready for a reline and the final female attachments
    242. 296. <ul><li>The abutments are flooded with medium body impression. Denture filled with medium body and seated with light biting pressure. </li></ul><ul><li>Recommended: Do not use self curing acrylic to place attachments in the denture </li></ul>Impression to Reline Denture and add Attachments
    243. 297. The relieved denture is put to place and the patient guided into occlusion
    244. 298. O-ball analogs placed into denture with impression
    245. 299. Analogs in model on reline jig female attachments are now placed on the analogs before processing
    246. 300. Finished Denture after Reline
    247. 301. Dentures in place and ground into occlusion
    248. 302. Flanges are trimmed and the size of the denture is minimized
    249. 303. Two-Piece Implant Abutment Interface bone loss with a bone level implant and leakage at the abutment interface
    250. 304. Extremely high success rate <ul><li>Reportable FDA Failures: in 2006 .770/1,000 sold (4 from the same doctor), 2007 (.90/1,000 sold), 2008 (1.1/1,000 sold). </li></ul>Was this an implant failure?
    251. 305. Fractured I-Mini Implants, Why?
    252. 306. Thank You Questions? OCO Biomedical is a debt-free Company serving the dental Implant Community since 1976