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Restore & lab 2 17-2010 dd

Restore & lab 2 17-2010 dd






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  • Page 1
  • Script: Now I’d like to move into the protocol and procedure portion of the presentation and talk first about indications for implantation. Indications for the ISI Complete One-Piece System include an alternative to mandibular or maxillary bridges, immediately securing and stabilizing partial or full overdenture prosthesis; replacing missing single or multiple teeth. The system is also appropriate for healed extraction sites and selected new extraction sites when an implant with a diameter larger than the tooth removed can be placed.

Restore & lab 2 17-2010 dd Restore & lab 2 17-2010 dd Presentation Transcript

  • OCO Biomedical Presents The Next Generation of Endosseous Implants Restoring OCO Biomedical Dental Implant Systems
  • [ RESTORATIVE PROCEDURE AND LAB TECHNIQUE ] I-Mini, ISI Complete One-piece, TSI & ERI Two-piece Dual Stabilization ™ Implants July 20, 2010 THE DIRECT TECHNIQUE
  • The ISI Complete and TSI Immediate Load Dental Implant System
    • ISI Complete
    • Direct restorative only because it is a one-piece implant and abutment
    • Temporized and load/function after being placed
    • TSI (or ERI) with solid abutment
    • Two-piece implant with Morse taper lock
    • 6-8 Position indexed interface
    • TSI can be restored by either the Direct or Indirect Methods
    • All Two-piece abutments have 6 or 8 position indexing
    • Available: Three + Restorative Systems
    • 1 Direct and 2 Indirect and 3 modified indirect
    • The Conventional Two-piece Abutment System
    • Shielded margin abutment
    • 6-8 position indexed interface
    80%+ of cases can be loaded immediately and put in function after placement!
  • TRIP: Tissue Retraction Impression Pickup For Direct Restorative Technique For straight abutments For offset abutments
  • Dual Stabilization® Implant System
    • TSI Abutments
    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
  • Fixed CB Solid Abutments (4mm, 5.5mm, & 7mm heights)
  • IOT Over Denture Abutments (0mm, 2mm, 3mm, & 4mm heights)
  • Locator Abutments (.07mm, 2.0mm, 3.0mm, 4.0mm, 5.0mm, & 6.0mm heights)
  • Shielded Abutments (straight & 15degree offset) Long & Short Available
  • Pedestal Abutments (Straight & Offset)
    • The ISI Implant 1 to 2 months after placing
    • The ISI & TSI with solid abutment use the same direct method
    Ready to restore ISI & TSI Implant Restoration: Direct Method
    • Snap the TRIP (tissue retraction impression pickup) onto the Implant collar to prepare it for taking the impression
    ISI & TSI Implant Restoration: Direct Method
    • Make sure the TRIP displaces the gingiva and snaps over the top of the collar of the implant
    ISI & TSI with Pedestal Abutments Implant Restoration: Direct Method
  • TRIP Impression
    • Inject medium bodied impression material into the top of the TRIP until it flows from vents
    • Cover the impression pickup (TRIP) by flooding the area around it with
    • medium body impression
    • material
    Cover the TRIP
    • With heavy body or putty, complete the impression using a standard or triple-tray
    Complete the Impression
    • When set, remove tray
    • The TRIP is picked up into the impression
    Remove the Tray
    • Use the solid analog when the abutment is not modified
    • Use the Margin Analog (MA) when the abutment is modified
    Modified vs. Non-Modified Abutments
    • The lab model with the solid brass analog is used when the abutment is not modified
    • The Margin Analog (MA) is used when the abutment is modified vertically or for the TSI with an offset abutment
    Lab Models
    • Fill MA with hard implant stone, epoxy die material, composite, etc.
    • Pour the rest of the impression with die stone
    Lab Models
  • Margin Analog Example
  • Tissue Retraction Impression Pickup Snapped over the abutment
  • Take an impression
  • Indexing will be captured in the impression
  • Using the margin analog tool, gently dab the margin analog into the impression
  • The lab will pour in Polyurock and it will harden to replicate the abutment
    • The Acrylic Coping (AC) is used under temps for perfect marginal fit and as a base for wax-up prior to casting the metal coping for the final crown
    Acrylic Coping (AC) Acrylic Coping (AC)
    • Wax-up & casting on working and tissue model using the AC as a base for a perfect marginal fit
    • AC to final PFM crown
    Acrylic Coping (AC)
    • Final restoration completed and cemented into place with an excellent fit and emergence profile
    • Precision fit comes from the machining of the AC to match the margin at the implant abutment interface
    • Easier than conventional crown procedures and construction
    Final Restoration Complete
  • Oops – implant placed out of alignment? Or need to accommodate anatomy or emergence profile? TRIP OFF-SET TRIP Alignment Correction
    • Use the 2 piece off-set abutment to align and the off-set trip for the impression
    • The TSI Two-piece implant must be used
    • The top of the off-set TRIP is perpendicular to the implant
    • Straight pressure retracts the tissue and easily snaps over the top of the collar and around the margin with clearance for the off-set abutment
    Alignment Correction: Offset TRIP
    • The mal-aligned implant is now aligned with other ISI or TSI implants with one piece straight abutments or adjacent natural teeth
    Alignment Correction
    • Inject medium or regular bodied impression material over and around the abutments
    TRIP Impression
    • Snap the straight and off-set TRIPs over the abutments until you feel the ends stop firmly on the top of the collar of the implants
    TRIP Impression
    • Flood the area around the trips with more medium bodied impression material
    • Then complete the impression using heavy bodied or putty
    Complete the Impression
  • Pull the Impression
    • Pull the impression
    • Snap in a solid analog and a two-piece analog
  • Working Model
    • On an anterior tooth, the straight abutment may be out of alignment with the other teeth
    • Put in an offset abutment
    • Take your impressions
    Anterior alignment : TSI, ERI Implant
  • Model
    • Create the soft tissue model by putting soft tissue material around the analog
    • Fill the rest of the model with die stone
    • Then the crown is made on the model
  • Case Example: Simple Direct Restoration of an ISI, One-Piece and TSI with a Solid Abutment
  • Pre-op Surgical removal and grafting
  • 6 wks postop 4 mo postop
  • Ceka Bond (from Preat) placed on threads of the solid, C&B abutment
  • Solid abutment threaded into TSI Implant
  • Abutment torqued to 30 N/cm
  • TRIPS (Tissue Retraction Impression Pickups) “snapped” over the abutments onto the implant’s margin.
  • Flood Impression material through the occlusal opening and out the vents of the TRIP
  • TRIPS are pulled out into the impression perfectly capturing the margin and indexing of the implant/abutment
  • Solid Analog Modified to match the vertical height on the abutment of the implant
  • Analogs engaged in the Impression
  • Models poured, trimmed, ACs placed on analogs, crowns cast, porcelain added and finished. Easier than a conventional crown!
  • Crowns cemented
  • Finalized case. Total lab fee $410.00 - $50.00 implant surcharge. The surcharge was Removed
  • Restoring a 15 yr old case
  • TSI Implant Restoration: Example Cases
  • ISI & TSI Implant Restoration: Example Cases
  • ISI & TSI Implant Restoration: Example Cases
  • ISI & TSI Implant Restoration: Example Cases
  • Upper and lower Restored
  • But, Did She Like It, NO! Could Not Be Cleaned To Her Satisfaction ; so
  • Porcelain trimmed to make cleansable and soft gingival prosthesis constructed
  • Case finalized and cleansable
    • Chris – ready for the final restoration
    • Placing the offset TRIP to make sure it fits and snaps into place
    ISI & TSI Implant Restoration: Example Cases
    • Cover the abutment with medium body impression material
    ISI & TSI Implant Restoration: Example Cases
    • Then flood the area with the impression material
    ISI & TSI Implant Restoration: Example Cases
    • A triple tray filled with heavy body or impression putty and the impression taken
    ISI & TSI Implant Restoration: Example Cases
    • Bottom of the TRIP penetrating out of the impression
    • Shows the depth of the top of the lingual side of the implant
    ISI & TSI Implant Restoration: Example Cases
  • Information: Margin Analog (MA)
    • The Margin Analog (MA) used for offset abutments and modified straight abutments using the direct technique
    • Engage the non-beveled end
    • Tool used to snap the MA into the TRIP
    • With the tool, snap the MA into the TRIP and fill it with acrylic, composite material or any flowable crown build-up material
    Placing the MA
  • The Finished PMF Crown
  • Upper First Molar
  • Upper First Molar
  • Upper First Molar - Seated
  • Splinting Natural and Implant Supported Crowns
  • Use an Interlock , Small , Round, With No Stops. Allows Vertical Movement on Natural Tooth
  • Prepped Natural Tooth and Implants
  • Cemented Natural tooth and Implant Crowns
  • Completed Case
  • ISI & TSI Restorative Components For The Direct Technique Tissue Retraction Impression Pickup (TRIP) For straight abutments For offset abutments Margin Analogs (MAs)
    • Simple restorative procedures requiring minimal tools and components
    Acrylic Coping (AC) MA Placement Tool One- and Two-Piece Analogs
  • RESTORATIVE PROCEDURE AND LAB TECHNIQUE TSI/ERI Two-piece Dual Stabilization ™ Implants and the assortment of accessory Abutments that are modified, fitted, and made ready along with the restoration by the dental laboratory, to be delivered [ The Indirect Technique – TSI &ERI ]
  • Natural Contour Esthetic Abutment
  • Restoring Central Incisor with a 3mm Healing Cuff
  • 3mm Healing Cuff Removed
  • Placing the Impression Coping
  • The IC is engaged by threading in the ball impression screw by hand or with a .050 hex driver
  • With the tip removed, Inject Medium Body Impression Material Around the IC and Ball
  • Complete the Impression with Heavy Body Material in a Triple or Standard Tray
  • Snap on the TSI Analog If the I-TRIP is not removed with the impression, snap it into the TSI Analog, and then place both pieces into the boldly indexed impression area.
  • Snap Into The Impression
  • Pour and Articulate a Soft Tissue Model
  • Place a 2, 3, 4 or 5 mm Soft Tissue Healing Cuff to Maintain the Emergence Profile
  • The Dental Lab Shapes, Sizes and Parallels the Selected Abutment(s)
  • With the Abutments Shaped, the Restoration(s) is Completed on the Soft Tissue Model
  • With the Healing Cuff Removed, the Indexed Abutment(s) are Positioned with the Locking Screw – 20 n/cm
  • The Final Restoration(s) is Cemented to Place and the Case is Finalized
  • Conventional Construction of a Zirconium Core Crown total cost: $189.00
  • Open Tray Impression Technique for the ERI or TSI Dental Implants Using an impression coping and TSI/ERI Analogs
  • Two ERI Implant Placed (Central Incisors)
  • Engage the Natural Contour Esthetic Abutments and Ball Impression Screws
  • Glob around abutments and screws with medium body impression material
  • Fill the tray with hard body impression material and take an impression
  • Remove the ball impression screws and abutments and thread them into corresponding TSI/ERI analogs
  • Snap the abutments and analogs into the impression as indexed
  • Place healing screws in ERI or use two more abutments and make Temps
  • Final Crowns
  • Tissue needed to be trimmed away
  • Abutments are torqued to 25 N/cm
    • [ Custom Abutment Procedure ]
  • ERI (or TSI) Dental Implant placed further than 15 degrees out of parallel
  • 1mm healing collar is engaged for a period of healing
  • Remove the healing collar after implant integration
  • The Biotorq driver engages with the custom abutment and is used to fixate the abutment into the implant Biotorq Driver Custom Abutment Driver and Abutment engaged
  • Biotorq Driver threads in the fixed Custom Abutment
  • Torque the abutment to 30 N/cm
  • Engage the UCLA Impression pickup and position the flat side facially
  • Using the Thumb Knob and .050 hex driver, thread the ball impression screw into the UCLA Impression Pickup
  • Flood medium body impression material around the UCLA Impression Pickup
  • Use hard body impression material in the tray
  • Flat side of Impression Pickup is formed in the impression
  • Remove the UCLA Impression Pickup from the Custom abutment (in the mouth) and engage it to the Custom Abutment Analog
  • Warning! Do not remove the Custom Abutment or change its indexing. This abutment is to remain permanently fixated into the implant
  • Snap the UCLA Impression Pickup and the Custom Abutment Analog into the impression Match the flat side on the abutment to the flat side in the impression
  • Hand tighten Custom Abutment healing collar over the custom abutment with the same Thumb Knob and .050 hex driver
  • Impression with Custom Analog and Impression Pickup in place Octa Waxing Sleeve used by lab for custom abutment
  • [ O-BALL OVERDENTURE RESTORATIONS ] Using the Dual Stabilization ® Implant System
  • Ready to Restore
    • 4-on-the-Floor™ Placement Technique: Four to six ISI Complete ® (or 3.0mm I-Mini) One-Piece O-Ball or TSI/ERI Two-Piece (with O-Ball Abutments) Implants places (2 in lower anterior and 2 in lower quads) in the mandible.
    • Have a good, new denture made with proper plane of occlusion and esthetics.
  • Step 1: For TSI, Attach O-ball Abutments
    • For the TSI Implant, screw the O-Ball Abutments into implant bodies with O-Ball Driver (Cat# 0076 or 0076S).
  • Step 2: Take Impression
    • With ISI or ISD One-Piece O-Ball Implants in place, or TSI Two-Piece Implants in place with O-Ball Abutments, take an impression directly of the O-Ball Attachment/ Abutment, or with female caps and O-rings in place (if driving square is sub-gingival).
  • Step 3: Full Arch Impression
    • Use medium bodied impression material around the O-Ball Attachments and record a full-arch impression with standard (heavy) body material.
  • Step 4: Analogs
    • Snap O-Ball analogs into the impression (in female caps if are used) and forward to the laboratory.
  • Step 5: Temporary Retention
    • For the ISI or ISD One-Piece O-Ball Implants or the TSI Two-Piece Implants in place with O-Ball Abutments, use soft denture liner (PermaSoft) for denture retention while the new denture is being created or prior to final reline.
    • Excavate the original denture and fill with soft denture liner.
  • Step 6: Lab Model
    • The laboratory pours a working model using the O-Ball Analogs.
    • For a new denture or reline, use a sound, previously constructed denture.
  • Step 7: Final Denture
    • The laboratory will incorporate the O-ring encapsulators into the new denture or reline.
  • Step 8: Final Seating
    • Seat new denture.
    • Final restoration is complete.
    • After seating, if the denture is too tight, the lumen of the O-ring can be enlarged by opening with a #6 Round Bur
  • In less than 2 weeks the healing looks great and he’s ready for a reline and the final female attachments X
    • The abutments are flooded with medium body impression material and the TRIPs snapped to place
    • Do not use self curing acrylic to place attachments in the denture
    Impression and TRIPs
  • The relieved denture is put to place and the patient guided into occlusion
  • O-ball analogs placed into denture with impression
  • Analogs in model on reline jig female attachments are now placed on the analogs before processing
  • Finished Denture after Reline
  • Dentures in place and ground into occlusion
  • Flanges are trimmed and the size of the denture is minimized
  • I-Mini IOT Restoration Case
  • O-Ball Overdenture: creating a Chrome framework
  • Snap Caps (with O-rings) on to O-balls. Take an impression if deep in tissue.
  • Do not place caps in impression (have lab pour model)
  • The lab will create a cast chrome cobalt framework to be incorporated for the model
  • The lab will incorporate the framework into the denture
  • Thank You Questions? Q&A