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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.
  • Transcript

    • 1. OCO Biomedical Presents The Next Generation of Endosseous Implants Restoring OCO Biomedical Dental Implant Systems
    • 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. 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!
    • 4. TRIP: Tissue Retraction Impression Pickup For Direct Restorative Technique For straight abutments For offset abutments
    • 5. 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
    • 6. Fixed CB Solid Abutments (4mm, 5.5mm, & 7mm heights)
    • 7. IOT Over Denture Abutments (0mm, 2mm, 3mm, & 4mm heights)
    • 8. Locator Abutments (.07mm, 2.0mm, 3.0mm, 4.0mm, 5.0mm, & 6.0mm heights)
    • 9. Shielded Abutments (straight & 15degree offset) Long & Short Available
    • 10. Pedestal Abutments (Straight & Offset)
    • 11.
      • 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
    • 12.
      • Snap the TRIP (tissue retraction impression pickup) onto the Implant collar to prepare it for taking the impression
      ISI & TSI Implant Restoration: Direct Method
    • 13.
      • 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
    • 14. TRIP Impression
      • Inject medium bodied impression material into the top of the TRIP until it flows from vents
    • 15.
      • Cover the impression pickup (TRIP) by flooding the area around it with
      • medium body impression
      • material
      Cover the TRIP
    • 16.
      • With heavy body or putty, complete the impression using a standard or triple-tray
      Complete the Impression
    • 17.
      • When set, remove tray
      • The TRIP is picked up into the impression
      Remove the Tray
    • 18.
      • 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
    • 19.
      • 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
    • 20.
      • Fill MA with hard implant stone, epoxy die material, composite, etc.
      • Pour the rest of the impression with die stone
      Lab Models
    • 21. Margin Analog Example
    • 22. Tissue Retraction Impression Pickup Snapped over the abutment
    • 23. Take an impression
    • 24. Indexing will be captured in the impression
    • 25. Using the margin analog tool, gently dab the margin analog into the impression
    • 26. The lab will pour in Polyurock and it will harden to replicate the abutment
    • 27.
      • 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)
    • 28.
      • 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)
    • 29.
      • 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
    • 30. 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
    • 31.
      • 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
    • 32.
      • The mal-aligned implant is now aligned with other ISI or TSI implants with one piece straight abutments or adjacent natural teeth
      Alignment Correction
    • 33.
      • Inject medium or regular bodied impression material over and around the abutments
      TRIP Impression
    • 34.
      • 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
    • 35.
      • Flood the area around the trips with more medium bodied impression material
      • Then complete the impression using heavy bodied or putty
      Complete the Impression
    • 36. Pull the Impression
      • Pull the impression
      • Snap in a solid analog and a two-piece analog
    • 37. Working Model
    • 38.
      • 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
    • 39. 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
    • 40. Case Example: Simple Direct Restoration of an ISI, One-Piece and TSI with a Solid Abutment
    • 41. Pre-op Surgical removal and grafting
    • 42. 6 wks postop 4 mo postop
    • 43. Ceka Bond (from Preat) placed on threads of the solid, C&B abutment
    • 44. Solid abutment threaded into TSI Implant
    • 45. Abutment torqued to 30 N/cm
    • 46. TRIPS (Tissue Retraction Impression Pickups) “snapped” over the abutments onto the implant’s margin.
    • 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
    • 50. Solid Analog Modified to match the vertical height on the abutment of the implant
    • 51. Analogs engaged in the Impression
    • 52. Models poured, trimmed, ACs placed on analogs, crowns cast, porcelain added and finished. Easier than a conventional crown!
    • 53. Crowns cemented
    • 54. Finalized case. Total lab fee $410.00 - $50.00 implant surcharge. The surcharge was Removed
    • 55.  
    • 56.  
    • 57.  
    • 58.  
    • 59.  
    • 60.  
    • 61.  
    • 62.  
    • 63. Restoring a 15 yr old case
    • 64.  
    • 65.  
    • 66.  
    • 67.  
    • 68.  
    • 69.  
    • 70.  
    • 71.  
    • 72.  
    • 73.  
    • 74.  
    • 75.  
    • 76. TSI Implant Restoration: Example Cases
    • 77. ISI & TSI Implant Restoration: Example Cases
    • 78. ISI & TSI Implant Restoration: Example Cases
    • 79. ISI & TSI Implant Restoration: Example Cases
    • 80. Upper and lower Restored
    • 81. But, Did She Like It, NO! Could Not Be Cleaned To Her Satisfaction ; so
    • 82. Porcelain trimmed to make cleansable and soft gingival prosthesis constructed
    • 83. Case finalized and cleansable
    • 84.
      • 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
    • 85.
      • Cover the abutment with medium body impression material
      ISI & TSI Implant Restoration: Example Cases
    • 86.
      • Then flood the area with the impression material
      ISI & TSI Implant Restoration: Example Cases
    • 87.
      • A triple tray filled with heavy body or impression putty and the impression taken
      ISI & TSI Implant Restoration: Example Cases
    • 88.
      • 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
    • 89. 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
    • 90.
      • 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
    • 91. The Finished PMF Crown
    • 92. Upper First Molar
    • 93. Upper First Molar
    • 94. Upper First Molar - Seated
    • 95. Splinting Natural and Implant Supported Crowns
    • 96. Use an Interlock , Small , Round, With No Stops. Allows Vertical Movement on Natural Tooth
    • 97. Prepped Natural Tooth and Implants
    • 98. Cemented Natural tooth and Implant Crowns
    • 99. Completed Case
    • 100. 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
    • 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 ]
    • 102. Natural Contour Esthetic Abutment
    • 103. Restoring Central Incisor with a 3mm Healing Cuff
    • 104. 3mm Healing Cuff Removed
    • 105. Placing the Impression Coping
    • 106. The IC is engaged by threading in the ball impression screw by hand or with a .050 hex driver
    • 107. With the tip removed, Inject Medium Body Impression Material Around the IC and Ball
    • 108. Complete the Impression with Heavy Body Material in a Triple or Standard Tray
    • 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.
    • 110. Snap Into The Impression
    • 111. Pour and Articulate a Soft Tissue Model
    • 112. Place a 2, 3, 4 or 5 mm Soft Tissue Healing Cuff to Maintain the Emergence Profile
    • 113. The Dental Lab Shapes, Sizes and Parallels the Selected Abutment(s)
    • 114. With the Abutments Shaped, the Restoration(s) is Completed on the Soft Tissue Model
    • 115. With the Healing Cuff Removed, the Indexed Abutment(s) are Positioned with the Locking Screw – 20 n/cm
    • 116. The Final Restoration(s) is Cemented to Place and the Case is Finalized
    • 117. Conventional Construction of a Zirconium Core Crown total cost: $189.00
    • 118. Open Tray Impression Technique for the ERI or TSI Dental Implants Using an impression coping and TSI/ERI Analogs
    • 119.  
    • 120.  
    • 121.  
    • 122.  
    • 123.  
    • 124.  
    • 125.  
    • 126.  
    • 127. Two ERI Implant Placed (Central Incisors)
    • 128. Engage the Natural Contour Esthetic Abutments and Ball Impression Screws
    • 129. Glob around abutments and screws with medium body impression material
    • 130. Fill the tray with hard body impression material and take an impression
    • 131. Remove the ball impression screws and abutments and thread them into corresponding TSI/ERI analogs
    • 132. Snap the abutments and analogs into the impression as indexed
    • 133. Place healing screws in ERI or use two more abutments and make Temps
    • 134. Final Crowns
    • 135.  
    • 136. Tissue needed to be trimmed away
    • 137.  
    • 138.  
    • 139.  
    • 140. Abutments are torqued to 25 N/cm
    • 141.  
    • 142.  
    • 143.
      • [ Custom Abutment Procedure ]
    • 144. ERI (or TSI) Dental Implant placed further than 15 degrees out of parallel
    • 145.  
    • 146. 1mm healing collar is engaged for a period of healing
    • 147. Remove the healing collar after implant integration
    • 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
    • 149. Biotorq Driver threads in the fixed Custom Abutment
    • 150. Torque the abutment to 30 N/cm
    • 151.  
    • 152.  
    • 153.  
    • 154. Engage the UCLA Impression pickup and position the flat side facially
    • 155. Using the Thumb Knob and .050 hex driver, thread the ball impression screw into the UCLA Impression Pickup
    • 156.  
    • 157. Flood medium body impression material around the UCLA Impression Pickup
    • 158.  
    • 159. Use hard body impression material in the tray
    • 160.  
    • 161.  
    • 162.  
    • 163.  
    • 164. Flat side of Impression Pickup is formed in the impression
    • 165. Remove the UCLA Impression Pickup from the Custom abutment (in the mouth) and engage it to the Custom Abutment Analog
    • 166. Warning! Do not remove the Custom Abutment or change its indexing. This abutment is to remain permanently fixated into the implant
    • 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
    • 168.  
    • 169.  
    • 170. Hand tighten Custom Abutment healing collar over the custom abutment with the same Thumb Knob and .050 hex driver
    • 171.  
    • 172. Impression with Custom Analog and Impression Pickup in place Octa Waxing Sleeve used by lab for custom abutment
    • 173. [ O-BALL OVERDENTURE RESTORATIONS ] Using the Dual Stabilization ® Implant System
    • 174. 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.
    • 175. 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).
    • 176. 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).
    • 177. 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.
    • 178. Step 4: Analogs
      • Snap O-Ball analogs into the impression (in female caps if are used) and forward to the laboratory.
    • 179. 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.
    • 180. 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.
    • 181. Step 7: Final Denture
      • The laboratory will incorporate the O-ring encapsulators into the new denture or reline.
    • 182. 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
    • 183. In less than 2 weeks the healing looks great and he’s ready for a reline and the final female attachments X
    • 184.
      • 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
    • 185. The relieved denture is put to place and the patient guided into occlusion
    • 186. O-ball analogs placed into denture with impression
    • 187. Analogs in model on reline jig female attachments are now placed on the analogs before processing
    • 188. Finished Denture after Reline
    • 189. Dentures in place and ground into occlusion
    • 190. Flanges are trimmed and the size of the denture is minimized
    • 191. I-Mini IOT Restoration Case
    • 192.  
    • 193.  
    • 194.  
    • 195.  
    • 196.  
    • 197.  
    • 198.  
    • 199.  
    • 200. O-Ball Overdenture: creating a Chrome framework
    • 201. Snap Caps (with O-rings) on to O-balls. Take an impression if deep in tissue.
    • 202. Do not place caps in impression (have lab pour model)
    • 203.  
    • 204. The lab will create a cast chrome cobalt framework to be incorporated for the model
    • 205. The lab will incorporate the framework into the denture
    • 206.  
    • 207. Thank You Questions? Q&A