bicon surgical pdf

7/28/2019 Bicon Surgical PDF

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Simple. Predictable. Profitable.

Bicon Surgical Manual


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Dear Colleagues:

Since 1985, many o the procedures and techniques depicted in the

ollowing pages have been successully utilized by Bicon clinicians.

However, as any experienced dentist knows, there are many ways

o achieving a particular result and by no means are the depicted

techniques the only way o providing or your patients needs.

Clinicians or whom the Bicon system is a new experience should be

impressed with the exibility, orgivingness and acility with which Biconimplants can be placed and restored simply even in challenging

clinical situations.

Bicons benecial surgical attributes include: sub-crestal placement o

implants, harvesting o bone with slow-speed osteotomy preparation

without irrigation, and the use o narrow and short implants to avoid

vital structures. These clinical benets are directly related to the

implants elegant plateaued design, which provides cortical-like bone

around the implant with central vascular systems. The implants slopingshoulder provides sufcient space or the interproximal papillae, which

are crucial or gingivally aesthetic restorations. The implants 1.5 locking

taper connection provides or 360 o universal abutment positioning

prior to its engagement and is also proven to be a bacterial seal.

Hopeully, with the depicted techniques, you will enjoy the benets

o the Bicon system, such as never again having to apologize to your

patients or a dark metallic gum line even when an implant is less than

ideally positioned.

Sincerely,

Vincent J. Morgan, D.M.D.

Bicon 501 Arborway Boston, MA 02130 tel: (800) 88-BICON or (617) 524-4443 www.bicon.com


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teTable of Contents

Pre-Surgical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-7 Measurement of Bone

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

Bone Classication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Implant Size Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-5

Surgical Template Fabrication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-7

Instrumentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-17 Instrument Descriptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-17

Surgical Placement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-32

Flap Design. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

21 Pilot Drill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22-23

Latch Reamers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Hand Reamers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Implant Insertion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26-27

Two Stage Surgical Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-29

Immediate Stabilization and Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30-31

One Stage Surgical Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

33-49 Pilot Drill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Latch Reamers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Template Fabrication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Two Stage Surgical Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37-38

One Stage Surgical Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39-40

Two Stage Mandibular Ridge Split . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Internal Sinus Lift . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Lateral Sinus Lift. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

43 Handpiece Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

Abutment Measurement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Non-Shouldered Abutments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46-47

Stealth Shouldered Abutments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48-49


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Pre-Surgical


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age 2

Pre-Surgical: Measurement of Bone

Keys to Success

Examine patient with mouth closed to ascertain if there is enough inter-occlusal space for the intended prosthesis. A frenectomy may be advisable, to improve the soft tissue environment around the intended prosthesis. Computer Aided Tomography (CAT scan), although usually not necessary, can be of value in determining the best

implant placement sites where there is minimal bone or concern as to the exact location of anatomical structures.

are must be taken to avoid the inerior alveolar nerve and the mental

oramina in the premolar region, since the mandibular nerve is oten inclined

oronally in this area.

Care must be taken to avoid the penetration o the submandibular ossa w

is located below the mylohyoid line, and particularly the sublingual spa

the anterior mandible where the sublingual artery is located. Inadve

penetration o these lingual plates may be avoided by appropriately dire

the pilot bur and reamer burs toward the buccal and monitoring the area

digital contact while drilling.

he location o the maxillary sinus and nasal loor must be positively identiied

o avoid their inadvertent penetration with a reamer or an implant.

In general, 2.0mm o bone should separate the apex o the implant osteo

and the mandibular canal.

2.0mm

MylohyoidLine

SubmandibularFossa


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Pre-Surgical: Bone Classification Type I-

Description

Recommended

Implant Surface Integration TimeBone Type

Dense Cortical

Flute o a 3.5mm reamer

bur lled with bone andminimal blood

HA

Integra-Ti*

TPS

Approximately

16 weeks

Type I

Porous Cortical andCourse Trabecular


bur lled with blood

wetted bone

HAIntegra-Ti*

TPS

Approximately10 weeks

Type II

Description

Recommended


Porous Cortical and

Fine Trabecular


bur only partially lled

with blood wetted bone

HA Approximately

10-12 weeks

Type III

Description

Recommended


Fine Trabecular


bur devoid o bone

HA Approximately

16-20 weeks

Type IV

Description RecommendedImplant Surface Integration TimeBone Type

ince 1985, each Bicon implant has been grit blasted with alumina and passivated in a nitric acid solution. Bicon ormerly

eerred to this controlled surace as Uncoated; however, this controlled surace will now be reerred to as Integra-Ti.


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age 4

Pre-Surgical: Implant Size Selection

mplant Size SelectionThe appropriate implant length and width depends upon the available bone and the expected occlusal loads.

In general, choose the widest but not necessarily the longest implant possible.

Panoramic and periapical radiographs as well as diagnostic models and a clinical examination are used to determine

i enough mesio-distal space and vertical bone height exist to place a Bicon implant saely and appropriately in a

proposed site.A transparent ruler or an implant radiograph overlay, which depict implant outlines o actual size and 125% o actual

size, is helpul in selecting an appropriately sized implant. Since radiographs are not necessarily precise representation

knowledge o their magniication must be considered while using them to determine an appropriately sized implant.

Keys to Success

The 3.5mm diameter implants are generally for mandibular anterior teeth. If practical, their use should beavoided for maxillary anterior and all posterior teeth.

The 5.0 x 8.0mm and the 6.0 x 5.7mm implants are capable of supporting any tooth in the dental arch. From the canine posteriorly, if practical, place one implant per tooth being replaced.

Consider using HA coated implants in poor quality or grafted bone. It is advisable to have at least 1.0mm of bone around the implant. Therefore, an advisable bone width is 5.5mm

to comfortably accommodate a 3.5mm implant, unless ridge splitting or grafting techniques are employed towiden the site.

In the anterior maxilla, it is advisable to place 4.5mm wide or wider implants, especially when the use of an

angled abutment is intended. The width of the alveolar bone may be assessed with a periodontal probe or caliper. It is advisable to have 1.0m

of bone around an implant for a long-term favorable prognosis. For maxillary anterior implants, always anticipate the potential need for ridge splitting or bone grafting

techniques.

4.5 x 8mm 5 x 8mm5 x 8mm4 x 11mm3.5 x 11mm 4.5 x 8mm 5 x 8mm5 x 8mm4 x 11mm3.5 x 11mm6 x 5.7mm 6 x 5.7mm

0 1 2 3 4 5 6 7 8

1/8inch

1mm

0 1 2 3 4 5 6 7 8 9 10 1 1 1 2 1 3 1 4 1 5 1 6 1 7 1 8 1 9 2 0

(100%SCALE)(125%SCALE)

260-103-005

R0904

The Bicon Implant Ruler

The Bicon Implant Overlay


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3.5mm 4.0mm 4.5mm 5.0mm 6.0mm

4.5mm x 8.0mm or Wider

4.0mm x 11mm or Wider

4.5mm x 8.0mm or Wider

4.5mm x 8.0mm,

5.0mm x 6.0mm,

or Wider

5.0mm x 8.0mm

or 6.0mm x 5.7mm

3.5mm x 11mm or Wider

5.0 x 6.0mm or Wider

4.5mm x 8.0mm

5.0mm x 6.0mm

or Wider

5.0mm x 8.0mm

or 6.0mm x 5.7mm

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Pre-Surgical: Implant Size Selectio

mplant Size Recommendations:The ollowing chart contains recommendations only. Actual clinical conditions he clinicians assessment are the main criteria or choosing the size o an implant or a particular area.

3.5 x 143.5 x 113.5 x 8 4 x 144 x 114 x 8 6 x4.5 x 114.5 x 8 5 x 8 5 x 11 6 x 5.75 x 6

Maxilla

Mandible


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age 6

Pre-Surgical: Surgical Template

Surgical TemplateAccurate placement of any implant requires the awareness of its intended prosthetic restoration. Mounted study c

nd a diagnostic wax-up of the teeth to be replaced are usually necessary for the fabrication of a surgical temp

hat will aid the dentist in the appropriate placement of an implant. Although the location and availability of b

will dictate the ultimate trajectory of the pilot drill, clinicians should strive to stay within 10 of the ideal position

rajectory of the intended prosthesis.

Vacuum Formed TemplateAter making an impression and subsequent cast o the

diagnostic wax-up o the intended restoration, a vacuum

ormed template is prepared on the cast rom thin template

tock which is commonly used or the chairside abrication o

ransitional restorations. A hole is drilled in the middle o the

ncisal or occlusal surace o the template in the location o

he intended tooth. The vacuum ormed template, i possible,

s trimmed to include at least one tooth distal and three orour teeth mesial to the area o the intended replacement.

Template from Stone Model1 Using a duplicated stone model o the

diagnostic wax-up, draw a line through the

incisal edge and occlusal suraces o the teeth

and another line in the center o each tooth

to be replaced, intersecting the incisal or

occlusal line.

2 Remove the lingual hal o the teeth to be

replaced.3 Mold acrylic onto the lingual aspect o the

model up to the level o the central ossa or

incisal edge o the teeth to be restored.

4 Cut a 2.0mm wide groove in the acrylic

corresponding to the middle o each intended

tooth to be replaced.

2

Remove lingual half

3

Mold acrylic Cut 2.0mm groove

1

Stone model

4


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Keys to Success

The trajectory of the pilot bur will be the trajectory of the implant and the trajectory of a straight abutment. The final implant osteotomy, to the extent possible, should be centered in the middle of the intended prosthetic tooth.

An appropriate mesio-distal positioning of a pilot osteotomy is more critical than a slightly off axis trajectory. Both the vacuum formed and palatal templates are placed in cold sterilization prior to their being used to facilitate

achieving an appropriate trajectory for the pilot bur.

Pre-Surgical: Surgical Templa

Template determines mesio-distal positioning. Availability of

bone determines final bucco-lingual angulation.

Trim excess incisal length to prevent interference

with head of handpiece.

Fabrication of Palatal Template from Existing Prosthesis

1

Insert denture into alginate in

denture duplicator.

Apply separating medium. Fill other side with alginate. Close and allow alginate to set

2 3 4

5

Open and remove denture. Fill alginate mold with acrylic. Close and allow acrylic to polymerize. Open and remove duplicated prost

6 7 8

9

Draw a line in the middle of each tooth and a line

representing greatest concavity on the tissue side.

10

Cut a 2.0mm wide groove in center of each tooth

joining the lines representing the middle of each

tooth and greatest concavity of the tissue side.

11

Remove the buccal acrylic along the slope join

the two lines representing the middle of eac

tooth and greatest concavity of the tissue sid

12

0 15

13

For larger edentulous areas, abricate a palatal template by using an existing removable prosthesis. When abricating

palatal template, the buccal aspect is inclined rom the incisal edge or central ossa o the proposed teeth back to the c

o the alveolar ridge, which is represented on a duplicated prosthesis as the greatest concavity on the alveolar ridge sid

he prosthesis.


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Instrumentation


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age 10

nstrumentation: Descriptions

The Bico

Pilot DrillThe pilot drill was designed to prepare the initial pilot

osteotomy and to establish the osteotomys trajectory.

Latch ReamersThe latch reamers were designed to prepare an osteotomy

and to harvest autogenous grat material without irrigation at

a maximum speed o 50 RPM. Three lengths are available to

accommodate a variety o clinical situations.


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Instrumentation: Descriptio

rgical Kit

Paralleling PinsThe paralleling pins were designed as an aid

to properly align the pilot osteotomies and

subsequently the implants.

Latch Reamer Extension

The latch reamer extension was designed to lengthen a latchreamer to acilitate access when adjacent teeth interere with

the handpiece head. I the latch reamer is not ully engaged in

the latch extension prior to being used, the latch reamer may

become stuck or permanently damaged in the latch reamer

extension.

Implant Inserters/RetrieversThe inserters/retrievers were designed or use with

either a threaded knob or a threaded straight handle to

assist in the placement and retrieval o certain implants

depending upon the clinical situation. It is essential or

a clinician to understand how an implant is disengaged

rom the inserter/retriever instrument prior to using it

intra-orally.


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age 12


The BicoHealing Plug Removal Instruments

The removal instruments were designed to acilitate

the removal o the healing plug rom the implants well

during the uncovering procedure o an implant.

Hand Reamers & Hand Reamer ExtensionThe hand reamers were designed to be used with a threaded

straight handle to manually prepare an osteotomy.

The hand reamer extension was designed to give a clinician

more access when the interproximal space or opposing dentition

interere with the handpiece head by converting the hand reamers

to a latch style.


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rgical Kit

Sulcus ReamersThe sulcus reamers were designed to remove any sot

tissue or bone above the implant that could prevent the

locking taper engagement o an abutment into the well o

the implant.

Guide PinsThe standard and extended guide pins were designed

(depending upon an implants depth) to be used as a

guide or sulcus and impression reamers as well as or

tissue punches. They may also be used to assist in the

evaluation o how well an implant has osseointegrated.

The extended guide pins are used with deeply positioned

implants and long-shated abutments.

Implant/Abutment Seating Tips

The seating tips were designed or use with a threadedstraight or offset handle to acilitate the proper seating

o an implant or an abutment. When using the implant

seating tips, it is imperative that the seating tips be ully

seated into the well o the implant to avoid causing

distortion o the well during their use, which could

subsequently prevent the complete locking taper

engagement o an abutment.

Impression ReamersThe impression reamers were designed to remove any sot tissue or

bone above the implant well that could interere with the proper

seating o an impression post.


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age 14


The Bico

Sinus Lift OsteotomesThe sinus lit osteotomes were designed or use with

a threaded straight handle to make a greenstick

racture o the sinus oor during an internal sinus lit

procedure.

Bone ExpandersThe bone expanders were designed to assist in the ormation o an

osteotomy while using an expanding bone technique.


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rgical Kit

Threaded ChiselsThe threaded chisels were designed or use with

a threaded straight handle to split and widen thinalveolar ridges to allow or the insertion o implants

and/or interpositional bone grats.

Open Well for StorageThis additional storage space was designed or accessory

items such as instruments and abutments.


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age 16

nstrumentation: Tray Contents

The Bico

Top TrayThreaded Straight Handle

The straight handle was designed to be used with all threaded

instrumentation: hand reamers, sulcus reamers, inserters/retrievers,

tissue punches, osteotomes, chisels, bone expanders, seating tips and

impression reamers.

Threaded Oset HandleThe offset handle was designed or use with implant and abutment

seating tips when direct access is not possible.

Surgical Mallet

The surgical mallet was designed to be used with the threaded straight

or offset handles or the seating o implants and abutments. It may also

be used during ridge splitting and internal sinus lit procedures.

Dappen Dish

The dappen dish was designed to collect autogenous bone.

Bottom TrayThe bottom tray was desig

as or the 18:1 and 400:1 han

rom the surgical kit.


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Instrumentation: Tray Conten

rgical Kit

Middle TrayAbutment Shoulder Depth Gauge

The abutment shoulder depth gauge was designed to acilitate the

measuring o the sot tissue height above an implant or the selectio

o an abutment with an appropriate shoulder height.

Removal Wrench

The removal wrench was designed to loosen hand reamers, osteoto

chisels and bone expanders rom a threaded straight handle or a

threaded knob.

Bone Depth Gauge/Bone Plugger

The bone depth gauge was designed to acilitate the measuring o

the osteotomys depth. The bone plugger was designed to compre

autogenous bone grat material over the shoulder o the implant.

rage o accessory items as well

dpieces are sold separately


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Surgical Placement


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Surgical Placement: Flap Desig

Flap DesignAter appropriate local anesthesia, either an envelope or broad based pedicle lap is raised. In both designs, the crestal incision sh

be palatal or lingual to the actual crest o the ridge.

Broad Based Pedicle Type Flap

he broad based pedicle lap is recommended or use in the posterior part o the mouth or two stage surgical placements anarrow ridges. This lap consists o two near parallel incisions and one transverse incision lingual to the crest o the ridge. This lap

be easily modiied or the one stage or immediate stabilization and unction techniques.

1

Edentulous area

2

Incisions

3

Flap reflection

Semi-Lunar Type Flaphe semi-lunar lap is recommended or the one stage surgical technique, the immediate stabilization and unction technique an

esthetic areas. This lap consists o a pedicle lap based on the lingual or palatal aspect o the ridge. Caution is advised when u

he semi-lunar lap, since visualization o the implant site is limited to only the crestal aspect o the bone. As a result, inadvertent bu

or lingual enestrations are more likely to occur when using the semi-lunar lap.

1

Incision

2

Flap reflection

3

Retraction suture


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age 22

Surgical Placement: Pilot Drill

Pilot Drillhe pilot osteotomy should be positioned

n the center, when possible, of the

dentulous space of the proposed tooth

nd with the same trajectory as that of the

ntended prosthesis.

1 Using a surgical template, an 18:1 reductionhandpiece, and a 2.0mm pilot drill, make

the initial penetration into the ridge at

approximately 1,100 RPM with external sterile

irrigation. The pilot bur must completely

penetrate the crestal cortex.

2 Ater hal the necessary depth is achieved,

remove the pilot drill and insert a paralleling

pin into the newly ormed osteotomy

to assess the positioning and trajectory

o the preliminary pilot osteotomy. Use

intermittent pumping actions to cleanbone from the pilot drill flutes.

3

Place the vacuum ormed template over aparalleling pin to conirm the appropriateness

o the preliminary osteotomy. It is still

possible to change the positioning and

trajectory o the osteotomy, i necessary.

4 I the trajectory is appropriate, continue

drilling with the pilot drill to the depth

marking, which will allow or the chosen

implant to be seated below the bone. For

aesthetic areas, the implant should be placed

5.0mm below the buccal gingiva.

5 I multiple implants are being placed,

paralleling pins should be inserted

consecutively into the completed pilot

osteotomies to acilitate the establishmento the trajectory o the pilot drill or the

preparation o subsequent osteotomies.

1b

Penetrate crestal cortex

2

Insert paralleling pin

3

Assess positioning and trajecto

5

1a

Use surgical template

Assess trajectory

2.0mm

7.0mm to

8.0mm

5.7/6.0mm Implant Lengths

Drilling Depth:

Drilling Depth: Drilling Depth:

Drilling Depth:2.0mm

11mm

8.0mm Implant Lengths

2.0mm

14mm

11mm Implant Lengths

2.0mm

17mm


4a

Ideal drilling depth for different implant lengths

Crestal Cort


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Old Pilot Drill vs. New Pilot DrillPrior to using a pilot drill, it is imperativehat its markings are identified and

nderstood. No assumption should bemade about the height of the first marking.

Special Considerations

Maxillary Anterior Extraction Site

1 Initially drill into the palatal wall o the socket

more perpendicularly than the proposed

trajectory o the intended restoration.

2 Immediately upon the pilot drills engagement

o the bone, change the drills trajectory to be

more parallel with the adjacent teeth and the

proposed restoration.

Special Considerations: Pilot Dr

11mm

8mm

6mmNEW!

14mm

Old New

21

Initial trajectory Change trajectory

1

Uneven bone levels

2

Sulcus reamer

Uneven Crestal Bone

1 To prevent the inadvertent displacement oa reamer bur, uneven levels o bone must be

leveled at the pilot osteotomys oriice.

2 Rotate a sulcus reamer as a planisher on a2.0mm guide pin inserted into the 2.0mmpilot osteotomy. Alternatively, use a round bur

to even the bone level around the oriice o

the pilot osteotomy.


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age 24

Surgical Placement: Latch Reamers

2

Harvest autogenous bone

3

1

Initial 2.5mm latch reamer

2.0mm

8.0mm

5.7/6.0mm Implant Lengths

4.0

2.0mm

11mm

8.0mm Implant Lengths

4.0

2.0mm

14mm


4.0 2.0mm

17mm


4.0

Drilling Depth:

Drilling Depth: Drilling Depth:

Drilling Depth:

4

Keys to Success

To facilitate removal of the reamer from

the osteotomy, continue rotating thereamer while it is being withdrawn.

In very dense bone, it may be necessaryto use the 2.5mm and 3.0mm latchreamers at a speed of approximately

1,100 RPM with external sterile irrigationto prepare an osteotomy.

Avoid clogging the reamer flutes withbone shavings since the bony walls ofthe osteotomy may become overheated

due to friction. Using latch reamer burs in excess of 50

RPM may result in overheated bone andthe subsequent failure of the implant toosseointegrate.

Irrigation is not recommended since itdilutes the blood in the socket and in theharvested autogenous bone, which may

inhibit healing. It is not necessary to use all reamers

in creating an osteotomy. One must

only finish the osteotomy with the finalreamer and a reamer that is 0.5mm

smaller than the final reamer. Forexample, when drilling to a width of5.0mm one must finish the osteotomy

with 4.5mm and 5.0mm reamers.

2.5mm 3.0mm 3.5mm 4.0mm 6.0mm5.5mm5.0mm

14mm11mm

8.0mm

Latch reamers with newest measurements

17mm

4.5mm


6.0mm

Latch ReamersDuring the preparation of an osteotomy,

he latch reamers should be rotated at a

maximum of 50 RPM without irrigation.

he 400:1 handpiece will provide suff icient

peed reduction and increased torque to

ppropriately prepare an osteotomy.1 Using the 400:1 reduction handpiece and

a 2.5mm latch reamer, widen the pilot

osteotomy. It is best to use a two handed

drilling technique where one hand guides the

drill while the other applies apical pressure.

2 Place harvested autogenous bone,

intermittently removed rom the lutes o the

reamer burs, into a silicone dappen dish or

later use.

3 The reamers are used sequentially beginning

with a 2.5mm diameter and ending with the

diameter o the intended implant. The newest

reamers have horizontal markings at 6.0, 8.0,11, 14 and 17mm, whereas older reamers may

have dierent markings. It is imperative

that the depth indicators on the latchreamers are identified prior to surgery.

No assumptions should be made about

the height of the first marking on anylatch reamer.

4 Drill to the depth that will allow the chosen

implant to be seated below the bone. For

aesthetic reasons the implant should be

placed 5.0mm below the buccal gingiva.


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Surgical Placement: Hand Reame

Hand Reamers1 The threaded straight handle in conjunction

with the 2.5mm hand reamer may be used

to enlarge a pilot osteotomy. A two handed

technique should also be used with this

manual drilling method. One hand will rotate

the straight handle, while the other eels and

monitors the bone plates.

2 Place harvested autogenous bone in the

silicone dappen dish or later use.

3 The hand reamers are used sequentially to

widen and in some situations to deepen an

osteotomy to the size o the intended implant.

Hand reamers are marked horizontally at 6.0,

8.0, 11, 14 and 17mm.

4 Drill to the depth which will allow or the

chosen implant to be seated below the bone.

For aesthetic reasons, the implant should be

placed 5.0mm below the buccal gingiva.

2

Harvest autogenous bone

1

Thread hand reamers

Keys to Success

Hand reamers offer greater control

for the preparation of maxillaryosteotomies. They help to ensure

avoiding inadvertent penetrationof the sinuses, nasal floor and walls

of the osteotomy. The use of hand reamers facilitates

the clinicians perception of the

harder cortical layers of bone

before they are penetrated. Since hand reamers have onlyone cutting surface, they allow

for cutting only the palatal sideof an osteotomy while expandingthe buccal wall in the opposite

direction. Irrigation is not recommended since

it dilutes the blood in the socketand in the harvested autogenous

bone, which may inhibit healing.

3

Hand reamers

NNNN

$RILLING$EPTH $RILLING$E

NN*NQMBOU-FOHUIT

NNN

NN

NN

NN*NQMBOU-FOHUIT

$RILLING$EPTH

NN

N

NN*NQMBOU-FOHUIT

NN*NQMBOU-FOHUIT

$RILLING$E

NN

NN

NN

NN

NN

)BOE3FBNFS.BSLJOHT

4


6.0mm4.0mm 5.5mm3.5mm 5.0mm4.5mm3.0mm2.5mm

8.0mm11mm

14mm

17mm

6.0mm


26/50

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age 26

Surgical Placement: Implant Insertion

Option 1: Healing Plug Inserter1 Prior to the seating o an implant, the integrity

o the osteotomys bony structure should

be thoroughly assessed with a curette while

the bone shavings are being completely

removed from the osteotomy.

2 Conirm the prepared sockets depth with adepth gauge. I the site is not deep enough

or placement o an implant 5.0mm below

the crest o the buccal gingiva, make the

necessary depth changes with a pilot drill and

latch or hand reamers. Do not flush a socketto remove blood.

3 The implants sterile blister pack is dropped

onto a sterile tray prior to removing its tyvek

backing beore the implants inner packaging

is cut with a pair o scissors.

4 Grasp the healing plug inserter with gloved

ingers or orceps. Using the healing plug

inserter, insert the implant into the blood

illed osteotomy. Note:The implant shouldnot touch anything prior to being placed

and rotated into the prepared bleedingsocket. The implant should be wet with

blood during seating.

5 The implant may be more deinitively seated

into an osteotomy by using a seating tip

with the straight or oset handles. The

implant may be tapped with the healing plug

inserter in place, or directly into the well o

the implant. Use the 2.0mm implant/angled

abutment seating tip when tapping on a

healing plug inserter or a 2.0mm implant

well. Use the 3.0mm implant seating tip whentapping directly into a 3.0mm implant well.

Note:Care must be taken to assurethat the seating tip is fully seated in an

implant well prior to tapping to avoiddistortion of the well, which could

subsequently prevent the complete

locking taper engagement of anabutment.

2

Verify socket depth

3b

Open implant package

3a

Implant in packaging

1

Curette osteotomy

5a

5b

Keys to Success

The implant seating tips must be completely positioned into the well of the implant prior to the application of any

seating or moving force. Inappropriately applied force could distort the implants well which may prevent the completeengagement of the implants locking taper connection.

The implant is designed to be initially twisted into an osteotomy prior to any seating tap.

5c

Seat implant

4

Insert implant

2.0mm Implant/

Angled Abutment

Seating Tip

3.0mm Implant

Seating Tip

Seating Tip with Threaded Straight Handle

Threaded Offset Handle

Threaded Straight Handle

11mm

2.0mm

11mm

2.0


27/50

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Surgical Placement: Implant Insertio

Option 2: Implant Inserterhe inserter/retriever instruments can be

sed to either insert an implant into an

steotomy with a turning and pushing

motion or to remove an implant from

ts osteotomy with a turning and pulling

motion.1 Prior to the seating o an implant, the integrity

o the osteotomys bony structure should

be assessed with a curette while the bone

shavings are being completely removed.

2 Check the prepared sockets depth with a

depth gauge. I the site is not deep enough

or placement o an implant 5.0mm below

the crest o the buccal gingiva, make the

necessary depth changes with a pilot drill and

latch or hand reamers. Do not flush a socket

to remove blood.

3 The implants sterile blister pack is dropped

onto a sterile tray prior to removing its tyvekbacking beore the implants inner packaging

is cut with a pair o scissors.

4 Remove the implants black healing plug

inserter while holding the implant in its sterile

bag prior to inserting the appropriate implant

inserter/retriever into the well o the implant.

5 Select the inserter/retriever by matching the

diameter o the instrument with the diameter

o the implant well. Attach a threaded

knob or the threaded straight handle to

the inserter/retriever. It is essential for a

clinician to understand how an implantis disengaged from the inserter retriever

instrument prior to using it intra-orally.

6 Insert the implant into the osteotomy and

rotate the inserter/retriever assembly while

pressing it apically. To disengage the implant

rom the inserter/retriever, hold the assembly

while turning the central knob counter

clockwise, which will then push the implant

o the inserter/retriever instrument.

2

Verify socket depth

1

Curette osteotomy

4

Remove healing plug

6

Insert implant

5b

3.0mm

Long

2.0mm

Long

3.0mm

Standard

2.0mm

Standard

5a

Inserter/retriever

3b

Open implant package

3a

Implant in packaging

11mm

2.0mm

11mm

2.0m


28/50

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age 28

Surgical Placement: Two Stage Surgical Technique

Two Stage Surgical Placement1 The plastic healing plug is trimmed smoothly

either intra-orally or extra-orally with healing

plug cutters or a pair o scissors to the level

o the crest o the ridge to minimize mucosal

irritation during healing.

2 The space around the top o the seatedimplant is covered with the autogenous

bone particles that were harvested rom the

lutes o the reamers during the osteotomy

site preparation. Alternatively, i necessary,

a grating material may be used in lieu o

autogenous bone. Do not submerge the

plastic healing plug too deeply, since

it may be difficult to locate after theimplant has osseointegrated.

3 The mucoperiosteal laps are approximated

with sutures.

Note:Care should be taken to insure that

losure is achieved to prevent seepage of oraluids into the implant site and the loss of

rafted particles from the site. Membranes may

acilitate site closure.

1b

Insert trimmed healing plug

Autogenous bone

3

Approximate with sutures

1a

Trim healing plug

Keys to Success

Use HA treated implants for sites with poor quality bone.

Repair any penetration or fenestration of the osteotomy with a bonegraft either with or without the use of a membrane.

Avoid transmucosal loading of the newly placed implant. Provide appropriate antibiotic coverage after implant placement.

If there is only lateral movement of the implant after an appropriateperiod of healing, it may indicate the need for additional healing time.

However, apical mobility of the implant usually indicates a failure ofthe implant to osseointegrate.

To facilitate the seating of angled abutments, use a sulcus reamer thatis one size larger than the actual abutment diameter.

Cover with autogenous bon

2a 2b


29/50

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Surgical Placement: Two Stage Surgical Techniqu

Two Stage Surgical UncoveringAfter a minimum of two to four months of

ealing, the implant is surgically uncovered.

1 Locate the black healing plug. In non-

aesthetic areas, a slightly lingual or

palatal crestal incision is made with onlyenough periosteal reflection to expose

the black healing plug. For aestheticareas, the incision should be semi-lunar.

2 Remove the black healing plug by pressing

the healing plug removal instrument into

its center hole and using a simultaneous

twisting and pulling motion or a continuous

twisting motion until the plug is dislodged.

Alternatively, other dental instruments such a

#110 endodontic reamer, scaler, or round bur

may be used to remove a healing plug.

3 Insert an appropriately sized guide pin

corresponding to the implants 2.0 or

3.0mm well diameter to ascertain theimplants osseointegration by evaluating

its mobility. Mobility may indicate non-

osseointegration.

4 I the implant is deeply placed, the use o an

extended guide pin may be necessary. Its use

will prevent the unnecessary removal o bone

over the implant.

5 Remove any bone which may prevent the

seating o the intended impression post by

using the appropriately sized impression

reamer. Attach the impression reamer to a

threaded handle or knob. Insert the assembly

onto the appropriate guide pin seated inthe implant well and rotate while applying

apical pressure, which will shape the bone to

accommodate the desired impression post.

6 Remove any bone or sot tissue which

may prevent the seating o the intended

abutment by using an appropriately sized

sulcus reamer. The diameter o the sulcus

reamer corresponds to the diameter o the

intended abutment. Attach the sulcus reamer

to a threaded straight handle or knob. Insert

the assembly onto the appropriate guide pin

seated in the implant well and rotate while

applying apical pressure, which will shape the

bone to accommodate the desired abutment.

Note:To facilitate the seating of angledbutments, use a sulcus reamer that is one size

arger than the actual abutment diameter.

1b

Lingual crestal incision

2a

Implants with healing plugsin place

2b

Healing plug removalinstrument in use

1a

Edentulous implant site

3

Use appropriate guide pin to evaluate osseointegration

6

Use appropriate sulcus reamer(s) prior to abutment seating

There Should beNo Movement

4

Guide pin and extended guide pin

4b5

Impression reamer

2.0mm 3.0mm

5.0 5.0

6.5 6.5

6.5


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age 30

Surgical Placement: Immediate Stabilization and Function

The Immediate Stabilization and Function technique is a predictable treatment

egardless of the quality of bone or the initial stability of the implant in the

osteotomy. The only criterion for success of this treatment (in additiono the normal implant placement techniques) is the chairside prosthetic

tabilization of the implant with a transitional prosthesis. The prosthesismust be stabilized by bonding it to adjacent teeth or to other implants during

he period of osseointegration. A close working relationship between the

urgical and restorative dentist must be present for successful treatment with

compliant patient who will monitor and attempt to preserve the immobility

of the transitional prosthesis.

Protocol for Immediate Stabilization and Function Technique for a Single Tooth and Multiple Tee

Materials

HA coated implants (recommended) Stealth shouldered abutments

Tall and short acrylic sleeves

Vacuum-formed template of intendedtransitional prosthesis

Transitional crown bonding materials Transitional crown composite materia

Integrity by Dentsply and/orDiamondCrown by DRM

Reinforcing fiber (not necessary if

Integrity or DiamondCrown materiis used in suffi cient bulk)

3

Insert implant

4

Determine shoulder height

5

Confirm shouldered abutment

1

Extract tooth

6

Assemble acrylic sleeve

mmediate Stabilization and

Function Technique1 Extract tooth and/or prepare osteotomy in

conventional manner.

2 Prior to preparing the osteotomy, etch and

prepare the adjacent teeth or crowns or

bonding.

3 Insert appropriate implant so that it is at

least 5.0mm below the buccal sot tissue.

Harvested bone may be placed over the

implant prior to removal o the black healing

plug or the inserter/retriever.

4 Use shoulder depth gauge to determine the

appropriate shouldered abutment height.The 5.0 x 4.0mm or the 4.0 x 3.5mm

shouldered abutments are usually theappropriate abutments to be utilized. I

shrinkage o tissue were to occur during the

healing phase, a shorter abutment height

may be used or the inal prosthesis or a

subgingival margin.

5 Choose appropriate shouldered abutment

width based on the anatomy o interproximal

papillae. Abutments and acrylic sleevesshould be wide enough to support

the interproximal papillae without

encroaching upon the papillae.

6 Based on anatomical space considerationsassemble a tall or short acrylic sleeve to the

abutment intra-orally or extra-orally.

2

Etch/prepare adjacent teeth


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Surgical Placement: Immediate Stabilization and Functio

mmediate Stabilization andFunction Technique (cont.)

7 Place selected shouldered abutment into

implant with finger pressure only orabrication o a transitional stabilization

prosthesis.

8 Inject transitional crown material around theacrylic sleeves to make an acrylic strut or

bridge between the adjacent teeth.

9 Place a reinorcing iber such as Connect

by Kerr into lingual aspect o template to

strengthen the transitional prosthesis. The

reinorcing ribbon is usually not necessary

when using suicient bulk o Integrity

or DiamondCrown or the transitional

prosthesis.

0 Place transitional crown material into the

occlusal hal o vacuum ormed template and

insert the template over the acrylic sleeves

and strut intra-orally to orm the transitionalprosthesis.

11 Remove template and polish transitional

prosthesis leaving interproximal extensions or

stability.

2 Place polished transitional prosthesis onto

abutment to conirm it and occlusion. Usually,

no cement is required between the prosthesis

and the abutments, since the transitional

prosthesis snaps onto the abutments.

3 Bond transitional prosthesis to adjacent teeth

in a secure manner to stabilize the transitional

restoration. Alternatively, i care is taken, the

prosthesis may be bonded directly onto theadjacent teeth without being removed or

polishing, especially or a single implant when

DiamondCrown is used as a veneer over the

adjacent teeth.

4 IMPORTANT: Admonish patient that it isof paramount importance that there be

NO movement of the bonded transitional

prosthesis . Have patient return for

additional bonding, if any movement of

the transitional prosthesis is perceived.

5 Ater a minimum o 10 weeks o healing, the

transitional prosthesis may be removed and

the implants may be restored in the intended

manner.

6 Final restorations and radiograph o Integrated

Abutment Crowns.

Note:Statistically, a 2.0mm diameter abutmentost will move 0.1mm into the well of an implant

rom its initial insertion to its being definitively

eated, and a 3.0mm abutment will move

.25mm. It is advisable to have a compliant

atient who will monitor the site for mobility.

9

Place reinforcing fiber

10

Vacuum formed template

11

Remove prosthesis

8

Inject transitional crown mater

12

Place polished prosthesis

13

Bond transitional prosthesis

14

Transitional prosthesis

7

Place with finger pressure

15

Transitional prosthesis after 10 weeks

16

Final restorations


32/50

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age 32

Surgical Placement: One Stage Surgical Technique

One Stage Surgical Technique1 Insert the implant using a seating tip or an

inserter/retriever.

2 Place a temporary abutment into the clean

dry well o the implant. The temporary

abutment should be wide enough to

support the interproximal papillae withoutencroaching upon them. The temporaryabutment must have sufficient length

to provide support for the soft tissueand short enough so that it does not

interfere with the temporary prosthesis.

3 Using the straight or oset driver and

a seating tip, lightly tap the temporary

abutment into place. Use caution to avoid

seating the implant arther into the osteotomy

than the desired depth. I necessary, contour

any excess tissue.

4 It may be necessary to approximate the

mucoperiosteal laps with sutures.

Note:The osteotomy must be wide enought the crest to allow for the full seating of the

emporary abutment; counter sinking may be

chieved by using a latch, hand or sulcus reamer

o widen the orifice of the osteotomy.

2

Insert temporary abutmen

3a

Tap temporary abutment

3b

Seated temporary abutmen

4

1

Insertion

Sutured flaps

Keys to Success

The temporary abutment should be the same or smaller diameter of

the intended final abutment in order to yield the proper aestheticcontouring of the soft tissue.

Avoid placing pressure from the tongue on the temporary abutmentsand implants.

Do not use the one stage surgical procedure with a removabletransitional, full or partial overdenture.

If necessary, contour temporary abutments to provide space for theformation of interproximal papillae.


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References


34/50

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age 34

References: Pilot Drill

Pilot Drill

Pilot Drill Warning

t is imperative that the depth indicators on the 2.0mm Pilot Drill aredentified prior to surgery. No assumptions should be made about the

height of the first marking on the pilot drill.

11mm

8mm

6mmNEW!

14mm

Old New


35/50

Newest Latch Reamer Measurements with Corresponding Implant Examples

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Pag

References: Latch Reame

Latch Reamers with Newest Measurements

Latch Reamer Warning

The reamers are used sequentially beginning with a 2.5mm diameterand ending with the diameter of the intended implant. The newest

reamers have horizontal markings at 6.0, 8.0, 11, 14 and 17mm, wherea

older reamers may have different markings. It is imperative that the

depth indicators on the latch reamers are identified prior to surgery. N

assumptions should be made about the height of the first marking on

any latch reamer.

Latch Reamers

5.0mm 3.5 x 145 x 115 x 84.5mm4.0mm3.5mm3.0mm

14mm

11mm

8.0mm

17mm

5 x 65.5mm 6.0mm

6.0mm

2.5mm

2.5mm 3.0mm 3.5mm 4.0mm 6.0mm5.5mm5.0mm

14mm

11mm

8.0mm

17mm

4.5mm

6.0mm


36/50

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age 36

References: Template Fabrication

0 15

Template determines mesio-distal positioning

and availability of bone determines final bucco-lingual angulation.

5 0 15

Use vacu-press template and actual

abutment to confirm restorability ofosteotomy site.

6

Fabrication of Palatal Template from Diagnostic Model

Fabrication of Palatal Template from Existing Prosthesis

Place acrylic onto the lingual aspect

of the trimmed model.

3

Prepare vertical groove in

center of each tooth position toaccommodate 2.0mm pilot drill.

4

Make impression of edentulous ridge

and prepare diagnostic wax-up.

1

Duplicate model and remove

lingual cusps to central fossa.

2

1

Insert denture into alginate in Lang duplicator. Apply separating medium.

2

Fill other side with alginate.

3

Close and allow alginate to set.

4

Fill alginate mold with acrylic.

6

Close and allow acrylic to polymerize.

7

Open and remove duplicated prosthesis

85

Open and remove denture.

9

Draw a line in the middle of each tooth and a line

representing greatest concavity on the tissue side.

10

Cut a 2.0mm wide groove in center of each tooth

joining the lines representing the middle of each


11

Remove the buccal acrylic along the slope joining

the two lines representing the middle of each


12

Trim excess incisal length to prevent interference

with hub of handpiece.

0 15

Template determines mesio-distal positioning and availability

of bone determines final bucco-lingual angulation.

13


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References: Two Stage Surgical Techniqu

Two Stage Surgery Implant Insertion Technique

Extraction

site

Narrow

keratinized

tissue

Wide

keratinized

tissue

Flap Designs1

Drill 2.0mm pilot hole with external

irrigation to a depth 2.0mm-5.0mm

deeper than chosen implant.

2

Use paralleling pins to facilitate alignment

when placing multiple implants.

3

Place abutment into pilot hole and confirm

appropriateness with a vacu-press template.

4

Widen socket with reamer burs without

irrigation at a maximum of 50 RPM.

5

Harvest bone debris from reamer

flutes and socket.

6

Remove implant from plastic bag.

7

Seat implant by tapping gently on healing

plug or directly into the implant well.

8

Cut healing plug.

9

Place harvested bone graft over

shoulder of implant.

10

Close and wait a minimum of nine weeks

for osseointegration.

11


38/50

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age 38

References: Two Stage Surgical Technique

Insert chosen abutment.

7

Two Stage Surgery Implant Uncovering Technique with Non-Shouldered Abutment

Two Stage Surgery Implant Uncovering Technique with Temporary Abutment

Expose the implant in aesthetic areas

with a semilunar crestal incision.

1

Place guide pin to check integr

and angulation.

4

Flush and dry implant well andproceed to step 7 or to 6a below.

6

Inject acrylic around emergence cuff

or temporization sleeve and into vacu-

press template.

10

Remove excess bone with sulcus reamer corresponding to the

hosen abutment with either threaded knob or straight handle. Use

extended guide pins for long shafted abutments.

5

Use a 60 beaver blade or any blade to

make split thickness buccal flap.

2

Wait for soft tissue healing prior to

taking final impression.

13

Place template to form

temporary crown.

11

Remove and polish acrylic confluent with emergence cuff or

temporization sleeve to form sulcus.

12

Use a template to confirm appropriateness of abutment prior to

engagement of locking taper connection, then tap on abutment

in long axis of abutment shaft to engage locking taper.

8

Remove healing plug with a healing plug

removal instrument or small forceps.

3

Place temporary abutment.

6a

Allow for soft tissue healing before proceeding with

step 2 of one stage uncovering technique.

6b

Place an acrylic emergence cuff or temporization

sleeve and modify, if necessary.

9


39/50

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References: One Stage Surgical Techniqu

One Stage Surgery Implant Insertion Technique

Extraction

site

Narrow

keratinized

tissue

Wide

keratinized

tissue

Flap Designs1

Remove black healing plug.

6

Insert implant with abutment

into socket.

8

Replace black healing plug with

appropriate temporary abutment.

7

Countersink socket orifice 1.0mm-2.0mm.

5

Widen socket with successively wider reamer burs

without irrigation at a maximum of 50 RPM.

4

Place abutment into pilot hole and

confirm with vacu-press template.

3

Trim tissue if necessar y.

9

Drill 2.0mm pilot hole with external

irrigation to a depth 2.0mm-5.0mm

deeper than chosen implant.

2


40/50

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age 40

References: One Stage Surgical Technique

One Stage Surgery Implant Uncovering Technique with Non-Shouldered Abutment

Allow a minimum of nine weeks for

osseointegration.

1

Inject acrylic around emergence cuff or

temporization sleeve and into vacu-press stent.

8

Place template to form

temporary crown.

9

Remove and polish acrylic confluent with

emergence cuff or temporization sleeve

to form sulcus.

10

Remove temporary abutment

without anesthesia.

2

Place guide pin to check

integration and angulation.

3

Flush and dry implant well.

4

Insert abutment.

5

Use a template to confirm appropriateness of

abutment prior to engagement of locking taper

connection, then tap on abutment in long axis

of abutment shaft to engage locking taper.

6

Place an acrylic emergence cuff or

temporization sleeve and modify, if necessary.

7


41/50

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References: Two Stage Mandibular Ridge Sp

Two Stage Mandibular Ridge Split Technique

Coronal view of mandible.

1

Close for three or four weeks to re-establish

blood supply to the cortical bone.

4

Lateral view of two thin vertical osteotomies

and a wider horizontal osteotomy.

3

Buccal cortex is outfractured as

wider reamer burs are used.

6

Insert implant into a widened ridge

apical to the horizontal osteotomy.

7

Allow a minimum of four months for

osseointegration.

8

Without reflecting the buccal periosteum,

drill a 2.0mm pilot hole to a depth below

the horizontal osteotomy.

5

Make a full thickness flap and a narrow crestal

osteotomy. Make a wider horizontal osteotomy

3.0mm above the mandibular canal.

2


42/50

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age 42

References: Internal Sinus Lift

Internal Sinus Lift Technique

Internal Sinus Lift Technique - One Stage Alternative

3b

Close and wait a minimum of four

months for osseointegration.

Close and wait a minimum of four

months for osseointegration.

7

Place bone graft material

over shoulder of implant.

6

Tap directly on

temporary abutment.

3a

Tap implant into socket elevating sinu

floor. When beveled edge is at crest,

implant is at proper depth.

4

Prepare osteotomy to sinus floor.

1

Greenstick fracture sinus floor

with narrower osteotome.

2

Place bone graft material

into socket.

3

Insert and cut healing plugs.

5


43/50

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References: Lateral Sinus L

Possible Complication: Small Perforation

Possible Complication: Large Perforation

Lateral Sinus Lift Technique with Floor Augmentation

Large perforation of membrane.

1 2

Drill suture retention holes.

3

Lateral view of suture retention holes.

4

Suture resorbable membrane in place.

Trans-illuminate sinus to identify

osteotomy outline.

1

Elevate sinus floor keeping curette

in contact with bone.

3

Prepare osteotomy with external irrigation.

Inferior cut should be at level of sinus floor.

2

Small perforation of membrane.

3a

Cover small perforation with

resorbable membrane.

3b

After closure wait six months

prior to placing implants.

5

Place graft material under elevated

sinus membrane.

4

Final closure of graft under

resorbable membrane.

7

Place graft material under membrane.

65

Coronal view of membrane in place.


44/50

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age 44

References: Handpiece Maintenance

Handpiece Considerations The 400:1 handpiece has suffi cient torque to cut through bone at 50 RPM.

The 18:1 handpiece is designed to be used with the pilot drill at ~1,100 RPM with external irrigation.

Irrigation is not necessary at speeds of 50 RPM or lower.

Failure to observe speed limitation may result in burned or overheated bone which could result in substantial bone

necrosis.

The 20,000 RPM Air Motor attaches to conventional four hole dental tubing and is an alternative to the electric drill unit.

Air pressure of at least 80 PSI is recommended to drive the air motor with suffi cient torque in dense bone.

Proper maintenance of handpieces is crucial for long term success of handpieces.

Do not exceed 132C (275F) when sterilizing.

In order to prevent discoloration and/or damage to the plating of the handpieces from chemicals that are not

suffi ciently cleaned from other instruments, do not autoclave the handpieces with other instruments.

Always check the handpiece for any abnormal vibration, heating, noise, or sluggish operation. If any abnormality is

noticed, cease the use of the handpiece.

Handpiece Maintenance

Cleaning and LubricationClean and lubricate the contra-angle handpiece after each use.

Attach the metal spray nozzle into the back of the handpiece and insert the pana spray into the metal spray nozzle.

(Figure 1)

Spray for approximately 2 seconds

Disassemble the head from the handpiece using the supplied wrench. (Figure 2)

Spray into the head. (Figure 3)

Assemble the head to the handpiece sheath in the reverse order of disassembly. Make sure that the two keys at the

union nut align with the slots in the sheath and tighten the union nut.

Wipe the assembled handpiece clean.

SterilizationThe 400:1 and 18:1 handpieces are autoclavable.

Wipe any debris off with an alcohol-soaked cloth.

Lubricate the handpiece using spray lubricant. Insert the handpiece into a sterilizing pouch and seal it.

Autoclave for 15 minutes at 132 C (275 F). Do not set the sterilizer temperature above 132 C (275 F).

To expel excess oil, operate the handpiece before using it intra-orally.

Figure 3Figure 2Figure 1

Figure 1


45/50


46/50

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age 46

References: Non-Shouldered Abutments

Non-Shouldered Abutmen

4.0 x 6.5mmRestorative/Laboratory Kit

260-140-465

5.0 x 6.Restorative/La

260-15


260-150-450

3.5mm

Temporization Sleeve (2)260-135-165

5.0

x

6.5

15

260-150-

015

5.0

x

6.5

0

260-150-

001

5.0

x

5.0

15

260-150-

055

5.0

x

5.0

0

260-150-

050

5.0x

5.0

0

260-

350-

050

5.0x

5.0

15

260-

350-

055

5.0x

6.5

0

260-

350-

001

5.0x

6.5

15

260-

350-

015

5.


260-135-465

3.5mm Diameter

2.0mm Post4.0

x

6.5

0

260-140-

002

4.0

x

10

15

260-140-115

4.0

x

10

0

260-140-101

4.0x

6.5

25

260-140-

025

4.0x

6.5

15

260-140-

015

4.0

x

6.5

0

260-

340-

001

4.0

x

6.5

15

260-

340-

015

4.0mm Diameter

4.0 x 10mmRestorative/Laboratory Kit

260-140-410

4.0mm


Indirect Abutment Level Impression

Modied and unmodied

color-coded impression sleeves

are denitively seated on their

corresponding abutments.

Impression material is injected

around the impression sleeves

or the making o an abutment

level transer impression.

Acrylic impression sleeves withdrawn in impression

material prior to impression being sent to

the laboratory.

Sot tissue material being injected

around impression sleeves and

abutment transer dies.

Notes: Snap-on sleeves are only specific for abutment diameter. Abutment height is not a criterioBecause of machining tolerances, acrylic sleeve

6.5mm Height 6.5mm Height

10mm Height

3.5

x

6.5

0

260-135-

001

3.5

x

6.5

25

260-135-

025

3.5

x

6.5

15

260-135-

015

2.0mm Post

3.0mm Post

6.5mm Height

6.5mm H5.0mm Height

5.0mm Height6.5mm H

6.5mm H5.0mm Height

6.5mm Height

10mm Height

6.5mm Height

4.0

x

1015

260-

340-115

4.0

x

100

260-

340-101

10mm Height


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References: Non-Shouldered Abutmen

nd Prosthetic Components


260-150-412


260-150-410


260-175-480

7.5

x

8.0

0

260-

375-

801

7.5

x

8.0

15

260-

375-

815

7.5mm Diameter

6.5

x

5.0

0

260-165-

050

6.5

x

5.0

15

260-165-

055

6.5

x

6.5

0

260-165-

001

6.5

x

6.5

15

260-165-

015

6.5

x

5.0

0

260-

365-

050

6.5

x

5.0

15

260-

365-

055

6.5

x

6.5

0

260-

365-

001

6.5

x

6.5

15

260-

365-

015

6.5mm Diameter

5.0

x

12

15

260-150-

215

5.0

x

12

0

260-150-

201

5.0

x

10

15

260-150-115

5.0

x

10

0

260-150-101

5.0x

12

0

260-

350-

201

5.0x

12

1

5

260-

350-

215

meter


260-165-465


260-165-450

ve (2)

6.5mm


7.5mm


Direct Abutment Level Impression

Non-shouldered abutment being

prepared with a #1557 carbide bur.

Two prepared non-shouldered

abutments.

Impression material being injected

around non-shouldered abutments.

Full arch impression.

ection of snap-on sleeves. Transfer dies correspond to exact diameter and height of abutment placed.

h the height of contour for some angled abutments.

12mm Height10mm Height

ost

ost

12mm Height

3.0mm Post 3.0mm Post

8.0mm Height

6.5mm Height

5.0mm Height

6.5mm Height5.0mm Height

2.0mm Post

12mm Height10mm Height

5.0mm Height6.5mm Height 8.0mm Height

5.0

x

1015

260-

350-115

5.0

x

100

260-

350-101

10mm Height


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age 48

References: Stealth Shouldered Abutments

5.0mm

Stealth Shoulde

Aluminum Oxide Sleeves

One-Piece Acrylic Sleeves

3.5 x 7.0mm 4.0 x 7.0mm

Abutment Shoulder Gauge

5.0mmShort

5.0mmTall

4.0mmShort

4.0mmTall

3.5mm

5.0 x 10.0mm5.0 x 7.0mm

3.5mm 4.0mm

Stealth Shouldered Abutments with a 2.0mm Post

Abutment Transfer Dies*

5.0mmPlastic*

5.0mmBrass

4.0mmPlastic*

4.0mmBrass

3.5mmPlastic*

*NOTE: Plastic transer dies should not be used with metal castings.


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References: Stealth Shouldered Abutmen

Abutment System

5.0mm4.0mm

Abutment Shoulder Gauge

Stealth Shouldered Abutments with a 3.0mm Post

4.0 x 7.0mm 5.0 x 10.0mm5.0 x 7.0mm

Aluminum Oxide Sleeves

One-Piece Acrylic Sleeves

5.0mmShort

5.0mmTall

4.0mmShort

4.0mmTall

Abutment Transfer Dies*

5.0mmPlastic*

5.0mmBrass

4.0mmPlastic*

4.0mmBrass

*NOTE: Plastic transer dies should not be used with metal castings.


50/50

501 Arborway

Boston, MA 02130 USA

tel: (800) 88-BICON (617) 524-4443

fax: (800) 28-BICON (617) 524-0096

web: www.bicon.com

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