1. OCO Biomedical Presents The Next Generation of Endosseous Implants Treatment Planning & Placement Presentation

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. 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. Product Overview Dual Stabilization and how it works July 20, 2010

14. 2 Bio Horizon implants placed in upper and 2 OCO Biomedical TSI implants in lower 6 yrs ago s

23. Mount study models, mounted. A must for treatment planning and Case Presentation

24. Study models, mounted. A must for treatment planning and Case Presentation

25. Edentulous Mandible An immediate denture placed 17 yrs ago July 20, 2010

26. Pantographic X=Ray, a must for any implant case. Is there an abundance of bone?

27. Model of lower, sectioned at the center and mapped

28. Zoll bone width measuring device

29. Bone Densities July 20, 2010

32. Basics for fixed: 4 Main buttresses for fixed or implant supported teeth Ideal minimum Implant diameter Minimum implant length 10 to 12 mm

34. So, if not following the buttress parameters and ignoring the physical properties:

35. [ PLACEMENT PROTOCOL AND PROCEDURE ] ISI Complete ® One-piece and TSI Two-piece Dual Stabilization ® Implants July 20, 2010

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)

61. Review OF Preparing The Osteotomy

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. The tissue plug removed exposing clean bone with few tissue tags and defining point of implant placement and emergence profile.

65. With an irrigated high speed drill and burr, remove any tissue tags and clean up definition of emergence profile pattern

66. First use the pilot drill to a depth of 8 to 10mm

67. Next the final drill for the diameter size ISI implant being used

68. The ISI implant removed from its vial

69. With the cap removed, thread the ISI implant in as far as you can with the thumb wrench

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. Shortening the abutment portion using an irrigated high speed drill and carbide bur

72. Temporary crown placed with light occlusion

73. In just 35 min, he’s ready for his daughter’s wedding the next week!

74. Replacing lower molars with TSI Implants

80. 8-6-09 6years post-op

82. Missing Central with Moderate Facial Bone Loss

83. Missing Central with Extreme Facial Bone Loss

84. Missing Central with Extreme Facial Bone Loss

86. Study Model

87. Cat Scan Image or Model Mapping to Evaluate Available Bone and Select Surgical Choice and Implant Selection

88. TSI Placement: Mark the Spot

89. Drill through the gingiva and into the cortical bone

90. Set the Depth: Pilot Drill Now use a 10mm drill stop to go 8mm into bone!

91. Set the Depth: Pilot Drill

92. Set the Depth: Pilot Drill

93. Set the Depth: Pilot Drill

94. Check the Alignment

95. Punch the Tissue

96. High Speed Plug Removal

97. Countersink Drill

98. Countersink Drill

99. Pilot Final Depth Now use the drill stop that corresponds to the implant’s length and drill to bone level!

100. Pilot Final Depth

101. Osteotomes used in Bone Spreading and Remodeling

102. Osteotomes used in Bone Spreading and Remodeling

103. Osteotomes used in Bone Spreading and Remodeling

104. Osteotomes used in Bone Spreading and Remodeling

106. Final Drill

107. Place the Implant

108. Seat the Implant Firmly

110. TSI Offset Abutment

111. Place the Offset Abutment

112. Place the Fixation Screw

113. Torque to 20 n/cm – torque again 10 min later

114. Modify the Abutment

115. Adjust Length using 557 Great White in High Speed HP with Water & Air (round tip)

116. Establish Shape of the Emergence Profile

117. Modify the Abutment

118. Modify the Abutment

119. Check the Alignment and Clearance Have the patient bite

120. Place the Crown

121. Crown in Place

122. Emergence Profile

123. TSI Implant Placement with Offset Abutment

124. Two Weeks Post-Op

125. Final restoration, 3 months later

126. An Immediate Load 1 st OCO placement by Dr Tim K A 24 yr Noble Biocare user

127. Pre Treatment

128. Edentulous area

130. Use of a drill guide

131. Position of Implant established by the drill guide

132. #8 HS surgical Drill Used to Mark the Spot and Indent the Cortical Bone

133. Pilot drill with 12mm drill stop to final depth

134. Placing a paralleling pin

135. Tissue Punch

136. Removed tissue plug reviling clean , flat cortical bone on crest of the ridge and adequate soft tissue thickness so no countersink is needed

137. Back with the pilot drill with stop down the bone at the crest to the final depth

138. The osteotomy completed with the final drill stopped at depth established by the pilot drill

139. Placing the implant using the TSI driver with a thumb wrench

140. Seating the implant to the final depth with the ratchet- torque wrench to 45 n/cm

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

142. A straight pedestal abutment is placed with the driver and torqued to 30 n/cm

143. The straight pedestal 5.5 mm abutment in place. Actually an ISI could have been used at less cost

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

145. The pulled impression with the trip in place

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

147. The temporary crown placed and put into light function

148. Post –op digital x-ray Placement: Excellent

149. Ready to seat final crown

150. Zirconium Core Crown

151. Crown Seated

152. Lingual View

153. Final

154. An emergency visit for a loose UL Cuspid

155. UL Cuspid has a RCT With a post and core. Fractured root

165. Impression taken the day the fractured root was removed and implant placed

171. Temp placed the same appointment, Patient left the office with a tooth

175. Zirconium core tried-in a month later

178. Final crown seated, note the emergence profile

180. Case finalized

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

182. ERI Implant with skirted Titanium Nitrite Scalloped Abutment

183. Diagnosis, Planning and Treatment

184. Bone loss on Facial with indent

185. Pre-op X-Ray

186. Model mapping

187. Post-op X-ray

188. Zirconium core crown NEW ERI IMPLANT USED

189. Cotton stuffed in abutment set screw

190. Thin film of intermediate cement applied in crown

191. Crown cemented to place

192. Finalized 3.5 weeks after start, 2 visits

193. Beginning X-Ray

197. Check alignment with paralleling pin

212. Marking Abutment prior to prepping

213. Nitrite Skirted Abutment Prepped Chair Side for Temp Placement

214. Torque locking screw - twice

215. Prepped abutment ready for temp

216. Stock temp filled with “ Alike ” Temp Acrylic

218. Temp in place with IRM

224. Beginning x-ray: broken, abscessed lateral Incisor

225. Tooth removed, curetted, Bone graphed and allowed to heal 8 weeks

226. Flipper worn for 6 weeks

227. Penetrating with high speed

228. Pilot to final depth with drill stop

229. Osteotomy completed and now form the emergence profile

230. Placing the ERI Implant

231. Torqued to 35 n/cm

232. Temp placed

233. Final crown

234. Extreme Chronic Perio, Patient Request: I Need Implants!

245. Post Op X-ray

246. Patient: 87 yr old Female Friend Full lower, all remaining teeth to be removed

247. First surgery, all fractured teeth removed, implants immediately placed and voids grafted

248. All lower teeth removed, voids grafted and implants placed immediately using single stage flapless procedure in edentulous areas

249. Lower temp in place

250. Final PFM final splint. Stress breakers on distal of cupids and dove tail on LL 2 nd Bi

251. Full upper and fixed lower

252. My 88 yr old friend no longer fears the horrors of a lower denture

253. For Over Dentures use ISI, I-Mini, or TSI Implants With O-Ball Abutments

254. The I-Mini is a 3mm diameter ISI Implant

255. [ Coming Soon: The I-Micro ] available in 2.2 & 2.5mm

256. IMMEDIATE REPLACEMENT OF A LOWWER CENTRAL INCISOR WITH AN I-MINI Case: Dr K

257. PRE OP

258. LINGUAL VIEW

259. FACIAL VIEW

260. STRIP GINGIVAL ATTACHMENT WITH A SHARP STRAIGHT ELEVATOR TO PRESERVE EMERGENCE PROFILE

261. REMOVING TOOTH

262. REMOVED TOOTH WITH SHORTENED, DAMAGED ROOT

263. WHAT COULD HAVE BEEN DONE TO ENHANCE EMERGENCE PROFILE?

264. PILOT DRILL WITHOUT DRILL STOP

265. DRILL TO FINAL SEATING DEPTH OF IMPLANT

266. FINAL DRILL WITH DRILL EXTENDER

267. FINAL TO DEPTH ESTABLISHED BY THE PILOT DRILL

268. I-MINI IMPLANT REMOVED FROM VIAL

269. PLACING IMPLANT WITH CARRIER FROM THE VIAL

270. TORQUE IMPLANT TO FINAL DEPTH PLUS ½ TURN TO ESTABLISH DUAL STABLIZATION, 4O+ n/c

271. SEATED IMPLANT

272. ACRYLIC COPING IN PLACE

273. TEMPORARY CROWN PLACED

274. POST OP XRAY

275. Implant Retained Overdentures

276. Or, use a prefabricated pilot drill guide

277. Locate and Position Implants Safely Between the Mental Foramina

278. Mark Right and Left Position of Foramina on the Denture With a Pencil

279. Drill a Small Shallow Hole Where the Denture is Marked With a #8 HS Burr

280. Drop a 5mm Metal Ball (or a BB) Into the Hole and Cover With a Drop of Soft Liner

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

282. Implants are placed low in the gingiva because of the vertical height of the denture

283. O-Ring capsules are placed on the heads prior to taking the impression

284. Relieve areas over implants in the denture and remove all soft liner

285. Paint adhesive on the denture and fill With medium bodied impression material

286. Inject medium body over heads and place the denture over the implants

287. Snap the attachments on the analog then snap the into the impression – send to lab

288. Denture with attachments returned from lab

289. Impressions taken in the morning and case delivered and finalized in the afternoon

291. Pre-Op Pano

292. Treatment Plan: 6, 3.25 mm Diameter ISI O-Ball Implants Supported Over-denture with 14 mm A-P Spread

293. Post- Op Pano

294. Adapting over-denture with firm soft-liner and next day follow-up

295. In less than 2 weeks the healing looks great and he’s ready for a reline and the final female attachments

297. The relieved denture is put to place and the patient guided into occlusion

298. O-ball analogs placed into denture with impression

299. Analogs in model on reline jig female attachments are now placed on the analogs before processing

300. Finished Denture after Reline

301. Dentures in place and ground into occlusion

302. Flanges are trimmed and the size of the denture is minimized

303. Two-Piece Implant Abutment Interface bone loss with a bone level implant and leakage at the abutment interface

305. Fractured I-Mini Implants, Why?

306. Thank You Questions? OCO Biomedical is a debt-free Company serving the dental Implant Community since 1976