Restore & lab 2 17-2010 dd

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  • 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

    1. 1. OCO Biomedical Presents The Next Generation of Endosseous Implants Restoring OCO Biomedical Dental Implant Systems
    2. 2. [ RESTORATIVE PROCEDURE AND LAB TECHNIQUE ] I-Mini, ISI Complete One-piece, TSI & ERI Two-piece Dual Stabilization ™ Implants July 20, 2010 THE DIRECT TECHNIQUE
    3. 3. The ISI Complete and TSI Immediate Load Dental Implant System <ul><li>ISI Complete </li></ul><ul><li>Direct restorative only because it is a one-piece implant and abutment </li></ul><ul><li>Temporized and load/function after being placed </li></ul><ul><li>TSI (or ERI) with solid abutment </li></ul><ul><li>Two-piece implant with Morse taper lock </li></ul><ul><li>6-8 Position indexed interface </li></ul><ul><li>TSI can be restored by either the Direct or Indirect Methods </li></ul><ul><li>All Two-piece abutments have 6 or 8 position indexing </li></ul><ul><li>Available: Three + Restorative Systems </li></ul><ul><li>1 Direct and 2 Indirect and 3 modified indirect </li></ul><ul><li>The Conventional Two-piece Abutment System </li></ul><ul><li>Shielded margin abutment </li></ul><ul><li>6-8 position indexed interface </li></ul>80%+ of cases can be loaded immediately and put in function after placement!
    4. 4. TRIP: Tissue Retraction Impression Pickup For Direct Restorative Technique For straight abutments For offset abutments
    5. 5. 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
    6. 6. Fixed CB Solid Abutments (4mm, 5.5mm, & 7mm heights)
    7. 7. IOT Over Denture Abutments (0mm, 2mm, 3mm, & 4mm heights)
    8. 8. Locator Abutments (.07mm, 2.0mm, 3.0mm, 4.0mm, 5.0mm, & 6.0mm heights)
    9. 9. Shielded Abutments (straight & 15degree offset) Long & Short Available
    10. 10. Pedestal Abutments (Straight & Offset)
    11. 11. <ul><li>The ISI Implant 1 to 2 months after placing </li></ul><ul><li>The ISI & TSI with solid abutment use the same direct method </li></ul>Ready to restore ISI & TSI Implant Restoration: Direct Method
    12. 12. <ul><li>Snap the TRIP (tissue retraction impression pickup) onto the Implant collar to prepare it for taking the impression </li></ul>ISI & TSI Implant Restoration: Direct Method
    13. 13. <ul><li>Make sure the TRIP displaces the gingiva and snaps over the top of the collar of the implant </li></ul>ISI & TSI with Pedestal Abutments Implant Restoration: Direct Method
    14. 14. TRIP Impression <ul><li>Inject medium bodied impression material into the top of the TRIP until it flows from vents </li></ul>
    15. 15. <ul><li>Cover the impression pickup (TRIP) by flooding the area around it with </li></ul><ul><li>medium body impression </li></ul><ul><li>material </li></ul>Cover the TRIP
    16. 16. <ul><li>With heavy body or putty, complete the impression using a standard or triple-tray </li></ul>Complete the Impression
    17. 17. <ul><li>When set, remove tray </li></ul><ul><li>The TRIP is picked up into the impression </li></ul>Remove the Tray
    18. 18. <ul><li>Use the solid analog when the abutment is not modified </li></ul><ul><li>Use the Margin Analog (MA) when the abutment is modified </li></ul>Modified vs. Non-Modified Abutments
    19. 19. <ul><li>The lab model with the solid brass analog is used when the abutment is not modified </li></ul><ul><li>The Margin Analog (MA) is used when the abutment is modified vertically or for the TSI with an offset abutment </li></ul>Lab Models
    20. 20. <ul><li>Fill MA with hard implant stone, epoxy die material, composite, etc. </li></ul><ul><li>Pour the rest of the impression with die stone </li></ul>Lab Models
    21. 21. Margin Analog Example
    22. 22. Tissue Retraction Impression Pickup Snapped over the abutment
    23. 23. Take an impression
    24. 24. Indexing will be captured in the impression
    25. 25. Using the margin analog tool, gently dab the margin analog into the impression
    26. 26. The lab will pour in Polyurock and it will harden to replicate the abutment
    27. 27. <ul><li>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 </li></ul>Acrylic Coping (AC) Acrylic Coping (AC)
    28. 28. <ul><li>Wax-up & casting on working and tissue model using the AC as a base for a perfect marginal fit </li></ul><ul><li>AC to final PFM crown </li></ul>Acrylic Coping (AC)
    29. 29. <ul><li>Final restoration completed and cemented into place with an excellent fit and emergence profile </li></ul><ul><li>Precision fit comes from the machining of the AC to match the margin at the implant abutment interface </li></ul><ul><li>Easier than conventional crown procedures and construction </li></ul>Final Restoration Complete
    30. 30. Oops – implant placed out of alignment? Or need to accommodate anatomy or emergence profile? TRIP OFF-SET TRIP Alignment Correction <ul><li>Use the 2 piece off-set abutment to align and the off-set trip for the impression </li></ul><ul><li>The TSI Two-piece implant must be used </li></ul>
    31. 31. <ul><li>The top of the off-set TRIP is perpendicular to the implant </li></ul><ul><li>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 </li></ul>Alignment Correction: Offset TRIP
    32. 32. <ul><li>The mal-aligned implant is now aligned with other ISI or TSI implants with one piece straight abutments or adjacent natural teeth </li></ul>Alignment Correction
    33. 33. <ul><li>Inject medium or regular bodied impression material over and around the abutments </li></ul>TRIP Impression
    34. 34. <ul><li>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 </li></ul>TRIP Impression
    35. 35. <ul><li>Flood the area around the trips with more medium bodied impression material </li></ul><ul><li>Then complete the impression using heavy bodied or putty </li></ul>Complete the Impression
    36. 36. Pull the Impression <ul><li>Pull the impression </li></ul><ul><li>Snap in a solid analog and a two-piece analog </li></ul>
    37. 37. Working Model
    38. 38. <ul><li>On an anterior tooth, the straight abutment may be out of alignment with the other teeth </li></ul><ul><li>Put in an offset abutment </li></ul><ul><li>Take your impressions </li></ul>Anterior alignment : TSI, ERI Implant
    39. 39. Model <ul><li>Create the soft tissue model by putting soft tissue material around the analog </li></ul><ul><li>Fill the rest of the model with die stone </li></ul><ul><li>Then the crown is made on the model </li></ul>
    40. 40. Case Example: Simple Direct Restoration of an ISI, One-Piece and TSI with a Solid Abutment
    41. 41. Pre-op Surgical removal and grafting
    42. 42. 6 wks postop 4 mo postop
    43. 43. Ceka Bond (from Preat) placed on threads of the solid, C&B abutment
    44. 44. Solid abutment threaded into TSI Implant
    45. 45. Abutment torqued to 30 N/cm
    46. 46. TRIPS (Tissue Retraction Impression Pickups) “snapped” over the abutments onto the implant’s margin.
    47. 47. Flood Impression material through the occlusal opening and out the vents of the TRIP
    48. 49. TRIPS are pulled out into the impression perfectly capturing the margin and indexing of the implant/abutment
    49. 50. Solid Analog Modified to match the vertical height on the abutment of the implant
    50. 51. Analogs engaged in the Impression
    51. 52. Models poured, trimmed, ACs placed on analogs, crowns cast, porcelain added and finished. Easier than a conventional crown!
    52. 53. Crowns cemented
    53. 54. Finalized case. Total lab fee $410.00 - $50.00 implant surcharge. The surcharge was Removed
    54. 63. Restoring a 15 yr old case
    55. 76. TSI Implant Restoration: Example Cases
    56. 77. ISI & TSI Implant Restoration: Example Cases
    57. 78. ISI & TSI Implant Restoration: Example Cases
    58. 79. ISI & TSI Implant Restoration: Example Cases
    59. 80. Upper and lower Restored
    60. 81. But, Did She Like It, NO! Could Not Be Cleaned To Her Satisfaction ; so
    61. 82. Porcelain trimmed to make cleansable and soft gingival prosthesis constructed
    62. 83. Case finalized and cleansable
    63. 84. <ul><li>Chris – ready for the final restoration </li></ul><ul><li>Placing the offset TRIP to make sure it fits and snaps into place </li></ul>ISI & TSI Implant Restoration: Example Cases
    64. 85. <ul><li>Cover the abutment with medium body impression material </li></ul>ISI & TSI Implant Restoration: Example Cases
    65. 86. <ul><li>Then flood the area with the impression material </li></ul>ISI & TSI Implant Restoration: Example Cases
    66. 87. <ul><li>A triple tray filled with heavy body or impression putty and the impression taken </li></ul>ISI & TSI Implant Restoration: Example Cases
    67. 88. <ul><li>Bottom of the TRIP penetrating out of the impression </li></ul><ul><li>Shows the depth of the top of the lingual side of the implant </li></ul>ISI & TSI Implant Restoration: Example Cases
    68. 89. Information: Margin Analog (MA) <ul><li>The Margin Analog (MA) used for offset abutments and modified straight abutments using the direct technique </li></ul><ul><li>Engage the non-beveled end </li></ul><ul><li>Tool used to snap the MA into the TRIP </li></ul>
    69. 90. <ul><li>With the tool, snap the MA into the TRIP and fill it with acrylic, composite material or any flowable crown build-up material </li></ul>Placing the MA
    70. 91. The Finished PMF Crown
    71. 92. Upper First Molar
    72. 93. Upper First Molar
    73. 94. Upper First Molar - Seated
    74. 95. Splinting Natural and Implant Supported Crowns
    75. 96. Use an Interlock , Small , Round, With No Stops. Allows Vertical Movement on Natural Tooth
    76. 97. Prepped Natural Tooth and Implants
    77. 98. Cemented Natural tooth and Implant Crowns
    78. 99. Completed Case
    79. 100. ISI & TSI Restorative Components For The Direct Technique Tissue Retraction Impression Pickup (TRIP) For straight abutments For offset abutments Margin Analogs (MAs) <ul><li>Simple restorative procedures requiring minimal tools and components </li></ul>Acrylic Coping (AC) MA Placement Tool One- and Two-Piece Analogs
    80. 101. 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 ]
    81. 102. Natural Contour Esthetic Abutment
    82. 103. Restoring Central Incisor with a 3mm Healing Cuff
    83. 104. 3mm Healing Cuff Removed
    84. 105. Placing the Impression Coping
    85. 106. The IC is engaged by threading in the ball impression screw by hand or with a .050 hex driver
    86. 107. With the tip removed, Inject Medium Body Impression Material Around the IC and Ball
    87. 108. Complete the Impression with Heavy Body Material in a Triple or Standard Tray
    88. 109. 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.
    89. 110. Snap Into The Impression
    90. 111. Pour and Articulate a Soft Tissue Model
    91. 112. Place a 2, 3, 4 or 5 mm Soft Tissue Healing Cuff to Maintain the Emergence Profile
    92. 113. The Dental Lab Shapes, Sizes and Parallels the Selected Abutment(s)
    93. 114. With the Abutments Shaped, the Restoration(s) is Completed on the Soft Tissue Model
    94. 115. With the Healing Cuff Removed, the Indexed Abutment(s) are Positioned with the Locking Screw – 20 n/cm
    95. 116. The Final Restoration(s) is Cemented to Place and the Case is Finalized
    96. 117. Conventional Construction of a Zirconium Core Crown total cost: $189.00
    97. 118. Open Tray Impression Technique for the ERI or TSI Dental Implants Using an impression coping and TSI/ERI Analogs
    98. 127. Two ERI Implant Placed (Central Incisors)
    99. 128. Engage the Natural Contour Esthetic Abutments and Ball Impression Screws
    100. 129. Glob around abutments and screws with medium body impression material
    101. 130. Fill the tray with hard body impression material and take an impression
    102. 131. Remove the ball impression screws and abutments and thread them into corresponding TSI/ERI analogs
    103. 132. Snap the abutments and analogs into the impression as indexed
    104. 133. Place healing screws in ERI or use two more abutments and make Temps
    105. 134. Final Crowns
    106. 136. Tissue needed to be trimmed away
    107. 140. Abutments are torqued to 25 N/cm
    108. 143. <ul><li>[ Custom Abutment Procedure ] </li></ul>
    109. 144. ERI (or TSI) Dental Implant placed further than 15 degrees out of parallel
    110. 146. 1mm healing collar is engaged for a period of healing
    111. 147. Remove the healing collar after implant integration
    112. 148. 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
    113. 149. Biotorq Driver threads in the fixed Custom Abutment
    114. 150. Torque the abutment to 30 N/cm
    115. 154. Engage the UCLA Impression pickup and position the flat side facially
    116. 155. Using the Thumb Knob and .050 hex driver, thread the ball impression screw into the UCLA Impression Pickup
    117. 157. Flood medium body impression material around the UCLA Impression Pickup
    118. 159. Use hard body impression material in the tray
    119. 164. Flat side of Impression Pickup is formed in the impression
    120. 165. Remove the UCLA Impression Pickup from the Custom abutment (in the mouth) and engage it to the Custom Abutment Analog
    121. 166. Warning! Do not remove the Custom Abutment or change its indexing. This abutment is to remain permanently fixated into the implant
    122. 167. 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
    123. 170. Hand tighten Custom Abutment healing collar over the custom abutment with the same Thumb Knob and .050 hex driver
    124. 172. Impression with Custom Analog and Impression Pickup in place Octa Waxing Sleeve used by lab for custom abutment
    125. 173. [ O-BALL OVERDENTURE RESTORATIONS ] Using the Dual Stabilization ® Implant System
    126. 174. Ready to Restore <ul><li>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. </li></ul><ul><li>Have a good, new denture made with proper plane of occlusion and esthetics. </li></ul>
    127. 175. Step 1: For TSI, Attach O-ball Abutments <ul><li>For the TSI Implant, screw the O-Ball Abutments into implant bodies with O-Ball Driver (Cat# 0076 or 0076S). </li></ul>
    128. 176. Step 2: Take Impression <ul><li>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). </li></ul>
    129. 177. Step 3: Full Arch Impression <ul><li>Use medium bodied impression material around the O-Ball Attachments and record a full-arch impression with standard (heavy) body material. </li></ul>
    130. 178. Step 4: Analogs <ul><li>Snap O-Ball analogs into the impression (in female caps if are used) and forward to the laboratory. </li></ul>
    131. 179. Step 5: Temporary Retention <ul><li>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. </li></ul><ul><li>Excavate the original denture and fill with soft denture liner. </li></ul>
    132. 180. Step 6: Lab Model <ul><li>The laboratory pours a working model using the O-Ball Analogs. </li></ul><ul><li>For a new denture or reline, use a sound, previously constructed denture. </li></ul>
    133. 181. Step 7: Final Denture <ul><li>The laboratory will incorporate the O-ring encapsulators into the new denture or reline. </li></ul>
    134. 182. Step 8: Final Seating <ul><li>Seat new denture. </li></ul><ul><li>Final restoration is complete. </li></ul><ul><li>After seating, if the denture is too tight, the lumen of the O-ring can be enlarged by opening with a #6 Round Bur </li></ul>
    135. 183. In less than 2 weeks the healing looks great and he’s ready for a reline and the final female attachments X
    136. 184. <ul><li>The abutments are flooded with medium body impression material and the TRIPs snapped to place </li></ul><ul><li>Do not use self curing acrylic to place attachments in the denture </li></ul>Impression and TRIPs
    137. 185. The relieved denture is put to place and the patient guided into occlusion
    138. 186. O-ball analogs placed into denture with impression
    139. 187. Analogs in model on reline jig female attachments are now placed on the analogs before processing
    140. 188. Finished Denture after Reline
    141. 189. Dentures in place and ground into occlusion
    142. 190. Flanges are trimmed and the size of the denture is minimized
    143. 191. I-Mini IOT Restoration Case
    144. 200. O-Ball Overdenture: creating a Chrome framework
    145. 201. Snap Caps (with O-rings) on to O-balls. Take an impression if deep in tissue.
    146. 202. Do not place caps in impression (have lab pour model)
    147. 204. The lab will create a cast chrome cobalt framework to be incorporated for the model
    148. 205. The lab will incorporate the framework into the denture
    149. 207. Thank You Questions? Q&A

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