Diagnosis and treatment planning part 2


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  • Shirley Plotnick
  • Diagnosis and treatment planning part 2

    1. 1. <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>
    2. 2. <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
    3. 3. 1938 Adams patent for a two-stage endosseous root form implant Classic two-stage dental implants covered by the 1938 Adams patent <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
    4. 4. Pinkie Adams 1938 Patent 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
    5. 5. The ISI Complete ™ , TSI, and The ERI Immediate Load capable Dual-Stabilization Dental Implant System In 2002 OCO Biomedical introduced the next generation of endosseous implants: July 20, 2010 Patent Pending
    6. 6. 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 Placement:
    7. 7. Product Overview Dual Stabilization and how it works July 20, 2010
    8. 8. 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
    9. 9. 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>
    10. 10. 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
    11. 11. 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>
    12. 12. 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>
    13. 13. 2 Bio Horizon implants placed in upper and 2 OCO Biomedical TSI implants in lower 6 yrs ago s
    14. 14. 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 over dentures </li></ul></ul>
    15. 15. 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>
    16. 16. The Economical I-Mini & Micro mini Implant Systems for 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 </li></ul></ul><ul><ul><li>Diameter: 3.0 mm </li></ul></ul><ul><ul><li>Lengths: 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>Soon to be released, the Locator over- denture attachment & 8mm length </li></ul></ul><ul><ul><li>Also, Micro Mini : 2.2mm @ 2.4mm Diam </li></ul></ul>
    17. 17. 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>
    18. 18. <ul><li>Evaluate study model for ridge width, alignment of adjacent teeth, if a dental implant can be placed using uncomplicated techniques. </li></ul>
    19. 19. <ul><li>Section the model through the edentulous area and after estimating gingival thickness, map it. </li></ul>
    20. 20. Mount study models, mounted. A must for treatment planning and Case Presentation
    21. 21. Study models, mounted. A must for treatment planning and Case Presentation
    22. 22. Edentulous Mandible An immediate denture placed 17 yrs ago July 20, 2010
    23. 23. Pantographic X=Ray, a must for any implant case. Is there abundance of bone?
    24. 24. Model of lower, sectioned at the center and mapped
    25. 25. Zoll bone width measuring device
    26. 26. Bone Densities July 20, 2010
    27. 27. 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
    28. 28. 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
    29. 29. Basics for fixed: 4 Main buttresses for fixed or implant supported teeth Ideal minimum Implant diameter Minimum implant length 10 to 12 mm
    30. 30. 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>
    31. 31. So, if not following the buttress parameters and ignoring the physical properties:
    32. 32. Edentulous upper left quadrant: Ideal implant placement 4.0mm bicuspid areas 5.0 mm 1 st molar area 4 or 5mm 2 nd molar
    33. 33. Bi-Lateral lower edentulous: R- normal ridge, L- narrow ridge Treatment R- Ideal, 5.0mm at Molar, 4mm for bicuspids L- Narrow ridge- compromise, 2 3.25 At molar. 3.25 in bicuspid Areas. Prosthesis, splinted crowns No wider than bicuspids, Lighter occlusion and no Lateral interferences.
    34. 34. Edentulous upper and lower Treatment: Stabilize lower denture Economy: I-Mini Implants <ul><li>4 on the floor </li></ul><ul><li>3.0mm I-Mini implants </li></ul><ul><li>Placed between mental foramina </li></ul>X X FOR A SIMPLE OVERDENTURE NEVER PLACE IMPLANTS IN THE POSTERIOR REGION
    35. 35. To maximise To maximize A-P place markers in the denture, take a pano and establish the location of the mental foramina O I I O
    36. 36. Implants placed and at least 3mm anterior to the mental foramina
    37. 37. Edentulous upper and lower Treatment: Stabilize lower denture Or, if the residual ridge Permits: moderate height, Wide ridge 4 to 6 standard sized 3.25 or 4mm Implants placed between the mental foramina, 2 - 4.0 mm 2 – 3.25 mm Never! 2 Implants in Cuspid Areas Crates a fulcrum The denture will rock
    38. 38. Edentulous upper and lower Treatment: Stabilize lower denture Or, if the residual ridge Permits: Tall, med width OR: 5 or 6 3.25 mm implants between the mental foramina
    39. 39. Five implants placed comfortably in the safety zone by placing markers in denture first
    40. 40. Post- Op Pano
    41. 41. In less than 2 weeks the healing looks great and he’s ready for a reline and the final female attachments
    42. 42. Flanges are trimmed and the size of the denture is minimized
    43. 43. The Chronic Perio Patient Presents for Implants
    44. 54. Simple Central Incisor Replacement – 5 Years after Ortho
    45. 67. 3 Months after Home Treatment, Deep Scaling & Extractions
    46. 92. <ul><li>Ask, “How was the tooth lost?” </li></ul>Why did this patient loose his lower central incisor?
    47. 93. <ul><li>The 3.0 diameter / 16mm length I-Mini™(ISD) implant was placed and put into immediate function </li></ul>Immediate Function
    48. 94. <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
    49. 95. <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
    50. 96. <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
    51. 97. <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 – No Bone Loss and Stable
    52. 98. 8-6-09 6years post-op
    53. 99. IMMEDIATE PLACEMENT PROTOCOL AND PROCEDURE ISI Complete ™ One-piece, TSI & ERI Two-piece Dual Stabilization ™ Implants July 20, 2010 <ul><li>Two Musts: </li></ul><ul><li>Break through cortical bone lining the socket in the alignment of the implant to be placed </li></ul><ul><li>Set depth with pilot drill 2mm beyond apex of the removed tooth root </li></ul>
    54. 100. Establishing the path of implant insertion after removing the tooth or tooth roots
    55. 101. With a high speed drill, always break through the cortical bone lining the socket wall in the direction of implant alignment Use a # 8 surgical or XXL straight fissure burr/ water cooling only, no air
    56. 102. Use the pilot drill in the surgical HP aligned and go to the final depth
    57. 103. Select the implant diameter by placing the final drill into the socket. It must not drop more that half the selected length
    58. 104. Drill with osteotomy former to the final depth established by the pilot Drill
    59. 105. Implant placed with grafting material, if dual stabilization is present, ISI can be used. If not, a TSI must be used
    60. 106. An emergency visit for a loose UL Cuspid
    61. 107. UL Cuspid has a RCT With a post and core. Fractured root
    62. 117. Impression taken the day the fractured root was removed and implant placed
    63. 123. Temp placed the same appointment, Patient left the office with a tooth
    64. 127. Zirconium core tried-in a month later
    65. 130. Final crown seated, note the emergence profile
    66. 132. Case finalized
    67. 133. Patient: 87 yr old Female Friend Full lower, all remaining teeth to be removed
    68. 134. First surgery, all fractured teeth removed, implants immediately placed and voids grafted
    69. 135. All lower teeth removed, voids grafted and implants placed immediately using single stage flapless procedure in edentulous areas
    70. 136. Lower temp in place
    71. 137. Final PFM final splint. Stress breakers on distal of cupids and dove tail on LL 2 nd Bi
    72. 138. Full upper and fixed lower
    73. 139. My 88 yr old friend no longer fears the horrors of a lower denture
    74. 140. Crown needed on # 31, large filling breaking down. Why not fill space with a simple pontic?
    75. 141. 3 Unit bridge? Then followed by constant pain, solution: RCT # 20
    76. 142. Pain persists, referred to endodontist
    77. 143. Bridge removed, molar sectioned and removed. Grafting and immediate placement of 5.0 X 10 TSI Implant
    78. 144. 4.0 X 12mm ISI placed at 30. Sutures removed , abutment and temp placed after 3 weeks
    79. 145. 6 Months post op, healing complete and 3 removed and grafted.
    80. 146. Healing after extracting # 3 with socket lift and bone grafting with pericardium barrier membrane
    81. 147. Teeth to be removed, 3 and 5. On which can an immediate implant be placed?
    82. 148. 1 st bicuspid removed buy teasing out with straight elevator and focepts
    83. 149. Root is not bifurcated and divergent, narrow and ideal for immediate placement
    84. 150. Place final drill to be used into socket, if half or less should bottom out to determine implant diameter to be used
    85. 151. Break through the cortical bone at the tip of the socket
    86. 152. Use the pilot drill to the final depth, in this case, 2mm beyond
    87. 153. Place colletape and bone into socket in case sinus was perforated and to fill gaps in final osteotomy
    88. 154. Use osteotomes to condense grated bone and open center for the implant
    89. 155. Driving the implant into the socket
    90. 156. Implant placed
    91. 157. Temp in place
    92. 158. Root tip and implant, sinus at the tip
    93. 159. Socket of 3 was elevated with a large osteotome, grafted, opening covered with pericardium and sutured
    94. 160. Implant placed in 5 and socket elevation and grafting on 3 to place a 5 X10mm Implant later
    95. 161. 5.0 X 10mm TSI placed 3 Mo Later
    96. 162. Thank You Questions? Q&A OCO Biomedical is a debt-free Company serving the dental Implant Community since 1976