connessioni che cambiano la vita - btlock · intra-oral x-rays, number and size of implants to be...

1 N E X T G E N E R A T I O N S Y S T E M

C o n n e s s i o n i c h e c a m b i a n o l a v i t a

b t l o c k s u r g i c a l m a n u a l3

INTRODUCTION

IMPLANTS AND SURFACES

MACHANICAL TESTS

PACkAgINg

FIXTURE DESIgN

SURgICAL kITS

EXPANDERS AND OSTEOTOMES

DRILLS

THREADFORMERS

ACCESSORIES

gUIDED SURgERY

SURgICAL PROCEDURES - 1 OR 2 STAgES

MISTAkES TO AVOID

EXPANDERS PROCEDURE

SURgICAL PROCEDURES - IMPLANTS

1 STAgE TECHNIQUE

2 STAgES TECHNIQUE

NOTES

I N d E X

PAg. 4

PAg. 6

PAg. 10

PAg. 16

PAg. 18

PAg. 20

PAg. 24

PAg. 26

PAg. 28

PAg. 30

PAg. 36

PAg. 38

PAg. 39

PAg. 40

PAg. 62

PAg. 63

PAg. 64

ø 3,75 CV1ø 4,50 CV2ø 5,50 CV3

PAg. 43PAg. 49PAg. 56

4

This surgical handbook costitutes a practical guide to an optimal use of BTLock implants and instrumentation, with special reference to their original design. This handbook has not to be considered a replacement for training courses. Procedures herein described are standard. Of course they may change according to the surgical case, to the professional experience and the personal preferences. It is obvious anyway that the use of BTlock products is out of any direct control of the company itself. The responsibility for a correct use of the products is referred to the final user (a qualified dentist).

Indications

Implant treatment is indicated in case of partial or total edentulousness.While selecting a candidate to implant treatment, some aspects must be carefully considered:• Patient’s expectations and motivations.• Patient’s general health conditions.• Oral hygiene.

General contraindications: low motivation, bad oral hygiene, cronical or tumoral illness, exceeding use of addicting substances, atrophy of maxillary teeth, illness of neuropsychiatric system, bone growth in progress.

For a correct diagnosis and for a good long-term prognosis of implant treatment, several factors are to be considered:• Bone structure.• Soft tissues, adherent gingiva.• Opposite dentition with evaluation of vertical dimension.• Number of implants to be inserted.• Choice of implants.• Size of implants.• Surface treatment of the implant.• Correct execution of surgical protocol.

A correct valutation of bone surfaces is anyway possible only when gingival flaps are opened.

In order to obtain the osteotomic site, BTLock suggests: use good cutting capability drills, a lot of water irrigation, avoid to overheat the bone, use micromotors with high number of turns and with high level of torque.

I N T R O d u C T I O N


Instrumentation needed for implant insertion provided by BTLock is not sterile and then must be sterilised before use.It is suggested to immerse instrumentation items in detergent solutions, to clean them by a brush in order to remo-ve any possible residual of organic material and then rinse them; after that, pass them through ultra-sounds and sterilize them by autoclave, according specifications given by the manufacturer.

During the pre-surgical stage it is very important to carry on an analysis of bone surfaces, thickness, opposite dentition to evaluate space of vertical dimension, and to consider ortopantomography, computer axial tomography, intra-oral x-rays, number and size of implants to be inserted, measurement of space with respect to both natural and artificial teeth. BTLock suggests at this proposal the use of 1:1, 1:1,3, 1:1,5 templates.

For a perfect allocation of implants on dental arch, BTLock suggests the use of surgical templates mounted on individual mask (see pages 34 and 35).

In order to track the implants, BTLock provides with patient’s forms where the batch is indicated for each implant inserted.

6

BT-Tite surface is the combination of a physical-mechanical treatment (sandblasting by material at controlled granulometry) and following che-mical treatments (acid-etching and passivation at controlled time).

The result is a highly porous surface with a high level of titanium oxyde, helping the attraction of cells starting osteointegration process. This also increases osteointegrating surface and primary stability, even in less thick bone.

Coronal side, not treated (machine-cut, 1.6mm high), allows a good peri-implant hygiene by the patient, even in case of bone re-absorption and exposure of fixture neck.

BT-Tite Standard

Thread detail (SEM picture), metallographic section (SEM), fixture-abutment connection (2 SEM pics), roughness diagram, surface (SEM) and surface analysis for BT-Tite Standard fixture.

I M p l A N T S A N d S u R f A C E S


BT-Tite surface is the combination of a physical-mechanical treatment (sandblasting by material at controlled granulometry) and following chemi-cal treatments (acid-etching and passivation at controlled time).

The result is a highly porous surface with a high level of titanium oxyde, helping the attraction of cells starting osteointegration process. This also increases osteointegrating surface and primary stability, even in less thick bone.

Coronal side, not treated (machine-cut, 1.6mm high), allows a good peri-implant hygiene by the patient, even in case of bone re-absorption and exposure of fixture neck.

This design feature an original downwarded thread especially indicated in case of immediate loading and post-extraction sites.

BT-Tite CV1

Thread detail (SEM picture), metallographic section (SEM), fixture-abutment connection (2 SEM pics), roughness diagram, surface (SEM) and surface analysis for BT-Tite One fixture.

8

Fixture

Throughscrew

Abutment

Abutment

Fixture

BT-Tite BTICV2

Crestal Micro-Grooves, totally new with respect to previous BTLock lines, are positioned on the periodontal collar, continuing deep thread on fixture body. Micro-Grooves and double acid-etching treatment allows to dispose of more osteo-integrating surface and to improve osteo-integration itself. Terminal side of the collar is machine-cut, in order not to interfere in the matching side between fixture and abutment.

Thread positioned in fixture body is very deep in order to optimize primary stability. Tapered shape reproduces better the natural profile of the tooth. For those feature, BT-Tite CV2 line is the recommended choice in case of immediate loading and post-extraction sites.

BT-Tite surface is generated by a combination of chemical-physical stages. The result is an active highly micro-porous surface which makes easier the settle of cells causing osteo-integration process.

For the features above mentioned, BT-Tite CV2 line is the reccomended choice in case of immediate load on stable crest.

Thread detail (SEM picture), metallographic section (SEM), fixture-abutment connection (2 SEM pics), roughness diagram, surface (SEM) and surface analysis for BT-Tite CV2 fixture.

I M p l A N T S A N d S u R f A C E S


BT-Tite BTICV3

Thread detail (SEM picture), metallographic section (SEM), fixture-abutment connection (2 SEM pics), roughness diagram, surface (SEM) with osteoblast in duplication and surface analysis for BT-Tite CV3 fixture.

The platform switching consists in the use of an abutment with a smallerdiameter than the fixture’s one. It allows to switch the margin of thejunction implant-abutment towards the centre of the implant axis.This system promotes the formation of a thicker gingival annulet which allows to obtain significant advantages as biological seal around the abutment.The longitudinal grooves, situated along the implant body till the collar, make the insertion into the osteotomic site easier and help to download tensive forces, gas, liquids and bone residues which are created during the screwing; morevoer, they prevent unscrewing till the first minutes from the insertion andincrease the osteointegrating surface.The terminal part of the collar (0,6 mm), which is treated, works as closureavoiding the infiltration of germs and bacteriums at the crest level.The DMA surface, obtained from physical-mechanical treatments (sandblstingby material at controlled granulometry) and chemical treatments (double acid-etching and passivation at controlled lengths) makes the surface nanoporous and, together with the deep thread, allows a better osteointegration and consequently a better primary stability even in less thick bone.The fixture is self-threading and anti-rotational.These features make the CV3 line the best choice for whatever situation,even in case of immediate-load and post-extractive sites.

1 0

BTLock S.r.l. requested to the Department of Chemistry, Materials and Chemical Engineering of the Politecnico di Milano (University of Milan - Italy) the mechanical evalutation of its titanium dental implants. Mechanical testings and analyses were performed as follows:

Static testing were performed according to practice Standards ISO 14801:2003 “Dentistry – Fatigue test for endos-seus dental implants”.

Materials used: • System T: Fixture 375115 BTICV1 (diameter 3.75mm ; length 11.5mm; titanium grade 4) Abutment 375 BTIPML (diameter 3.75mm; length 11mm; titanium alloy grade 5) Connection screw BTIVPC (thread diameter 1.8mm; titanium alloy grade 5).

• System S: Fixture 375115 BTIVSM (diameter 3.75mm; length 11.5mm; titanium grade 4) Abutment 375 BTIPML (diameter 3.75mm; length 11mm; titanium alloy grade 5) Connection screw BTIVPC (thread diameter 1.8mm; titanium alloy grade 5).

• System A: Fixture 375115 BTICV1 (diameter 3.75mm ; length 11.5mm; titanium grade 4) Abutment 375C BTIPMLI (diameter 3.75mm; length 11mm; titanium alloy grade 5; inclination 25°) Connection screw BTIVPC (thread diameter 1.8mm; titanium alloy grade 5)

Before static and fatigue testings, each fixture was connected to the abutment using its connection screw, applying a torque of 30 N x cm, as prescribed by the producer, through a specific dynamometric wrench.

Test Methods:Mechanical tests were performed using two Instron machines: an electrome-chanical for static tests and a servo hydraulic for dynamic fatigue tests.

M E C h A N I C A l T E S T S

b t l o c k s u r g i c a l m a n u a l1 1

Maximum bending moment was calculated as:M = 0.5 x F x LWhere L is the distance of the clamping plane to the loading center. Considering that the hemisphere has a radius of 5mm and that it is positioned protruding from the abutment of 2.8mm, the loading centre is located 2.2mm below the measure length L.

Results are as follows:• System T: Calculated maximum average load was 591 ± 52 N Average maximum bending was 220 ± 11 (N x cm)• System S: Calculated maximum average load was 774 ± 67 N Average maximum bending was 337 ± 20 (N x cm)• System A: Calculated maximum average load was 393 ± 47 N Average maximum bending was 213 ± 28 (N x cm)

Please note: All specimens (System T) showed a great plastic deformation. Only one was fractured at considered maximum level of strain.

Static Test Results

Static tests were performed applying a ramp at the constant rate of 0.03mm/s and measuring the resistand load.Tests were performed on 5 specimen. During the test the load level was acquired every 1 second. The tests was concluded when failure or plastic bending deformation higher than 5mm occurred (4mm for System A).

Curve di carico contro posizione per il “sistema T”

Curve di carico contro posizione per il “sistema S”

Curve di carico contro posizione per il “sistema A”

1 2

Fatigue tests results (System T)

A cyclic sinusoidal unidirectional load was applied. The minimum load of the sinusoidal cycle was selected as 10% of the maximum nominal load. The loading frequency was 10 Hz.

The 80% of the average maximum load calculated with the static tests described above, was used as starting load for fatigue tests. All tests were performed in air at 22 ± 3 °C.

Fatigue test results

Sample Ltot (mm) Cycle Max Load (N) Max bending Failure moment (Ncm)

1 8.6 428,000 472 203 Yes

2 8.7 358,000 472 205 Yes

3 8.7 173,000 413 180 Yes

4 8.5 5.62E+06 413 176 No

5 8.9 570,000 413 184 Yes

6 9.0 5.14E+06 384 173 No

7 8.5 4.20E+06 384 163 Yes

8 8.8 5.92E+06 354 156 No

9 8.7 7.48E+06 354 154 No

10 8.6 5.01E+06 354 152 No

M E C h A N I C A l T E S T S

The fatigue limit at 5 million cycles was identified at 354 N, corresponding to a maximum bending moment of 154 N x cm.


Torque tests results (System T)

Mechanical tests were performed on System T in order to evaluate the torque resistance of the connection between fixture and abutment

Compression Tests results (System T)

Mechanical compression tests were performed on System T in order to evaluate the compression resistance of the system.

The maximum compression average load was 6625 ± 377 N.

Please note: Specimens’ position change during compression tests was related to the gradual falling of the fixture in the connection jig and it is not connected with the mechanical performance of the connection.

Four specimens were acquired and recorded as the following diagram:

The maximum average torque was 366.5 ± 32 (N x cm).

Please note: Failure of all four tested implant took place inside the hollow abutment and the connection between the fixture and the abutment did not fail at all.

1 4

Measurement of the gap between fixture and abutment (System T)

The gap between fixture and abutment was measured on system T, both on not tested specimens and on specimens that survived the fatigue test (5 million cycle at 354 N).

Roughness measurement

Roughness was measured on the implant surface using a 3D laser profilometer.Three different surfaces were analysed:• BT-Tite (sandblasted and acid-etched)• Acid-Etched• HA Coated (Hydroxyapatite coated)

Rmax provided the following results:• BT-Tite: Ra = 2.13 ± 0.31 Rmax = 16.9 ± 1.6• Acid-Etched: Ra = 1.77 ± 0.16 Rmax = 15.18 ± 0.66• HA Coated: Ra = 0.58 ± 0.13 Rmax = 4.68 ± 2.21

b t l o c k s u r g i c a l m a n u a l1 51 5

1 6

BTLock S.r.l. Via Madonnetta 97/c36075 Montecchio Maggiore (VI)

T. +39 0444 492609 [email protected]

ITALY

TITANIUM IMPLANT450115 BTICV1BT-TITE CV1 IMPLANT

4,50 mm

JJJJ-MM

JJJJ-MM

xxxx/xx

0373RX ONLY

11,50 mm

The packaging is different according to the kind of device.

Fixtures, healing screws, and surgical screws are packed after having been gamma-ray sterilized. BTLock guarantees their sterility for 5 years.

Prosthetic components and instruments are packed decontaminated and require an autoclave sterilization before their use (see the information leaflet for further details). BTLock’s packaging conforms to the UE Directive for medical devices 93/42/EEC, and Modification 2007/47/CE.

Packaging for fixtures, healing screws, and surgical screws features a double package:

• PETG External Package, which is thermo-sealed with a double layer (aluminium and tyvek);• Crystal PST Internal Package with a ryblene cap.

Fixtures are packed comprehensive of a carrier (delivery carrier that prevents the direct touching of the fixture during its positioning inside the mouth), assembling screw, and surgical screw. Packaging also contains a double label to allow professionals to register the implant data on the patient’s information sheet.

Packaging for all other products has a single PVC package, which is thermo-sealed with a tyvek layer.

BTLock periodically verifies the validity of its sterilization process in external laboratories, both before and after the gamma-ray irradiation, which guarantee the sterility for 5 years (bioburden tests 5 years after the packaging are negative).

Please note: Packaging for BT-Tite CV3 fixtures and components is different from that one

of the other lines.

p A C K A G I N G


Please note: Each implant is packaged complete of no-touch delivery carrier for implant insertion. Surgical screw is included in the implant package.

Surgical Screw Surgical Screw

Implant carrier cap Implant carrier cap

Holder Holder

Implant Implant

Through screw Through screw

Implant carrier Implant carrier

CONFEzIONE IMPIANTO STANDARD CONFEzIONE IMPIANTO PER PROCEDURA MOTORIzzATA

1 8 f I X T u R E d E S I G N

Fixture CV1x2

2,88

2,55

x1

1,60

L0

x3

x4

x2

2,88

2,55

x1

1,60

L0

x3

x4

Fixture Standard

8 11,5 13 16L0

Implant lenght - VSM

10

3.50

3.10

3.30

2.10

4.70

4.30

4.50

3.20

5.70

5.30

5.50

3.50

6.70

6.30

6.50

4.40

x1

x2

x3

x4

Diameter

4.00

3.60

3.75

2.45

3,30 3,75 5,504,50 6,50

Note:The connection has the same sizes for all diameters except for 3,30 mm implants. Connection sizes for 3,30 mm implant are the following: 2,25 and 2,05 mm (instead of 2,88 and 2,55 mm).Tolerance of the connection ± 0,005 mm


x2

2,88

2,55

Fixture CV2

x1

1,60

L0

x3

x4

6,55,5 8 11,5 13 16L0

Implant lenght - CV1 CV2 CV3

10

x1

0,6

L0

x3

x4

Fixture CV3

Note:The connection has the same sizes for all diame-ters except for 3,75 mm. implants. Connection sizes for 3,75 mm implant are the following: 2,50 and 2,20 mm (instead of 2,88 and 2,55 mm).Tolerance of the connection ± 0,005 mm

4.50

3.70

2.85

2.55

5.50

4.40

2.85

2.55

x1

x2

x3

x4

Diameter

3.75

3.10

2.50

2.20

3,75 5,504,50CV3

x2

2,88

2,55

2 0 S u R G I C A l K I T S

n. 1n. 1 n. 1n. 1n. 1n. 1n. 1n. 1n. 1n. 1n. 1n. 1 n. 1n. 1n. 1n. 1n. 1n. 1n. 1n. 1n. 1n. 1 n. 1n. 1n. 1n. 1n. 1n. 1n. 1n. 1n. 1n. 1 n. 1n. 1n. 1n. 1n. 1n. 1

SURGICAL KIT

BTIKITC

Code

18x14x5 cm Surgical BoxPilot DrillTwist DrillDrill Extenter3,3 mm Conical Drill3,75 mm Conical Drill4,5 mm Conical Drill5,5 mm Conical Drill6,5 mm Conical Drill3,3 mm Neck Drill3,75 mm Neck Drill4,5 mm Neck Drill5,5 mm Neck Drill6,5 mm Neck Drill3,3 mm Threadformer3,75 mm Threadformer4,5 mm Threadformer5,5 mm Threadformer6,5 mm ThreadformerShort Standard ScrewdriverLong Standard ScrewdriverDriver ExtenderHand DriverMicro motor ReductionMicro motor DriverMicro motor ExtenderDepth GaugeParallelism Indicator for Surgical SiteParallelism Indicator for Surgical Site - Angle 10°Parallelism Indicator for Surgical Site - Angle 18°Parallelism Indicator for Inserted ImplantParallelism Indicator for Inserted Implant - Angle 10°Parallelism Indicator for Inserted Implant - Angle 18°Surgical Ratchet WrenchRatchet ExtenderStraight Surgical KeyBent Surgical KeyMounter-Blocking KeySURgICAL kIT

Please note: For standard implant lines, threadformers of the series BTIMSS are available. For BT-Tite CV1, BT-Tite CV2 and BT-Tite CV3 Lines, threadformers of the series BTIMS are available. Please see also page 58-59.


MINI SURGICAL KIT

BTIMKITC

Code

n. 1n. 1 n. 1n. 1n. 1n. 1n. 1n. 1n. 1n. 1n. 1n. 1 n. 1n. 1n. 1n. 1n. 1

12x8x5 cm Surgical BoxPilot Drill3,3 mm Conical Drill3,75 mm Conical Drill4,5 mm Conical Drill3,3 mm Neck Drill3,75 mm Neck Drill4,5 mm Neck Drill3,3 mm Threadformer3,75 mm Threadformer4,5 mm ThreadformerLong Standard ScrewdriverDriver ExtenderDepth GaugeParallelism Indicator for Inserted ImplantSurgical Ratchet WrenchStraight Surgical Key

MINI SURgICAL kIT

2 2 S u R G I C A l K I T S

SURGICAL BOx FOR SHORT IMPLANTS

Ratchet wrench

Straight key

Depth Gauge

Standard driver

Hand driver

5,50 mm short drill

4,50 mm short drill

3,75 mm short drill

3,3 mm short drill

2,2 mm twist drill

Pilot drill


SURGICAL KIT GUIDED TECHNIQUE

n. 1n. 1 n. 1n. 1n. 1n. 1n. 1n. 1n. 1n. 1n. 1 n. 1n. 1n. 1n. 1n. 1n. 1 n. 1n. 1n. 1n. 1n. 1 n. 1n. 1n. 1n. 1 n. 1n. 1

12x8x5 cm Surgical Box2,00 mm Pilot Drill2,20 mm Twist Drill3,30 mm Conical Drill3,75 mm Conical Drill4,50 mm Conical Drill5,50 mm Conical Drill2,00 mm Stop for Pilot Drill2,20 mm Stop for Twist Drill3,30 mm Stop for Conical Drill3,75 mm Stop for Conical Drill4,50 mm Stop for Conical Drill5,50 mm Stop for Conical Drill2,50 mm Expander3,30 mm Expander3,75 mm Expander4,50 mm Expander5,50 mm Expander 2,20 mm Ring Template3,30 mm Ring Template3,75 mm Ring Template4,50 mm Ring TemplateKey for Ring TemplateScrewdriverHand DriverSurgical Ratchet WrenchRatchet ExtenderStraight Surgical Key

SURgICAL kIT gUIDED TECHNIQUE

2 4 E X p A N d E R S A N d O S T E O T O M E S

Code 180 BTIES 215 BTIES 250 BTIES 330 BTIES 375 BTIES 450 BTIES 550 BTIES 650BTIES

Collar diameter 1,6 mm 2,0 mm 2,3 mm 3 mm 3,45 mm 4,2 mm 5,15 mm 6,1 mm

Apical diameter 1 mm 1,15 mm 1,3 mm 1,6 mm 2,2 mm 2,9 mm 3,5 mm 4,3 mm

Lenght 16 mm 16 mm 16 mm 16 mm 16 mm 16 mm 16 mm 16 mm

Implant diameter / / / 3,30 mm 3,75 mm 4,50 mm 5,50 mm 6,50 mm

Expanders are useful devices enabling to create osteotomies in cases where such operation would be very hard with traditional surgical procedures.Their use is advisable when it is important to create manually implant sites without risking bone loss. These tools:• progressively expand thin crests;• compact the walls of the implant site and increase the implant primary stability (in soft

bone);• offer a higher manual control with respect to rotating tools, which enables to penetrate

slowly into the bone, preserving the mandibular canal in border cases.

The full set is composed of 8 devices in titanium alloy. They are available in different diameters (easily recognizable thanks to the BTLock color coding) and laser depth markings.

8 m

m

6.5

mm

31 mm

4 mm

10 m

m

11.5

mm

16 m

m

13 m

m

Patent n° 0000264013


SCREW-IN OSTEOTOMES

Screw-in osteotomes are conceived to be used sequentially with expanders. They are characterized by color coding to better enable the right diameter identification. To insert a 3.30 mm fixture use the green expander and then the green screw-in osteotome. Follow a similar procedure to insert a 3.75 mm fixture (yellow expander and osteotome) and 4.50 mm implant (blue expander and osteotome). This technique is advised if the height between the crest and the bottom of the maxillary sinus is not less than 7 mm. If it is not possible to break the bottom sinus with the screwing, unscrew the osteotome for a half-turn and hammer.

OSTEOTOMI STANDARD

Gli osteotomi standard sono disponibili in un unico diametro (3,5 mm) e sono caratterizzati da 5 lunghez-ze: 4 - 6 - 8 - 10 e 12 mm. Il loro impiego prevede l’uso di una chiave dritta con snodo (BTICCS), apposi-tamente create per facilitare l’inserimento nelle zone posteriori, anche fra due denti.

4 6 8 10 12

Ratchet wrench

Straight surgical key

Mini pilot drill

Pilot drill

Key for standard osteotome

Depth gauge

Standard osteotome

Expander

Screw-in osteotome

2 6

33 m

m

0.6

mm 8 m

m 10 m

m

11.5

mm

13 m

m 16 m

m

33 m

m

0.6

mm

8 m

m10

mm

11.5

mm

13 m

m 16 m

m

d R I l l S

- To be used to secure the correctness of the drill depth during the insertion.- Stop for 6,5 mm available on request.- Color code.

KIT OF DRILL STOPS

Cutting and penetration features of this drill allow to perforate easily cor-tical bone. Specific stops available also for this drill.Side cut allows to correct possible anomalous directions.

This 2.2 diameter drill is used after pilot drill to improve depth of osteoto-mic site. Stops avaialble to ensure nedeed depth (strongly recommended).

PILOT DRILL

TWIST DRILL


33 m

m

8 m

m

X2RX

10 m

m

11.5

mm

13 m

m 16 m

m

X2 X1

3,3 3,75 4,50 5,50 6,50

CONICAL DRILL

NECK DRILL

26 m

m

0.5

mm

0.2

mm

3.5

mm

X3

X2

X1

This drill is used to countersink cortical bone in order to let implant neck (0,2 mm larger than implant body) confortably fit without stress into cortical bone. Each diameter is featured by colour code for easy and error-free handling.

Diameter X1 X2 X3

3,30 mm 3.30 2.20 1.80

3,75 mm 3.80 2.50 2.10

4,50 mm 4.50 3.10 2.50

5,50 mm 5.50 4.10 3.50

6,50 mm 6.50 5.10 4.50

3,3 3,75 4,50 5,50 6,50

Conical drill is used to enlarge progressively osteotomic site for BTLock implants. Available in five diametrs featured by BTLock colour code. Specific stops available.

Diameter X1 X2 RX

3,30 mm 2.90 1.90 0.90

3,75 mm 3.30 2.60 1.20

4,50 mm 3.95 3.20 1.50

5,50 mm 4.90 4.00 1.80

6,50 mm 5.85 5.00 2.10

2 8

4 mm

8 m

m

10 m

m

11.5

mm

13 m

m 16 m

m

24 m

m

3,3 3,75 4,50 5,50 6,50

T h R E A d f O R M E R S

3,3 3,75 4,50 5,50 6,50

This device is used to tap osteotomic sites for standard design fixtures. Its use is recommended with hard bone.Available in 5 diameters featured by colour code, with laser marking for depth control.

This device is used to tap osteotomic sites for One design fixtures. Its use is recommended in hard bone.Available in 5 diameters featured by colour code, with laser marking for depth control.

STANDARD THREADFORMER

THREADFORMER FOR BT-TITE CV1, BT-TITE CV2, BT-TITE CV3 LINES

4 mm

8 m

m 10 m

m

11.5

mm

13 m

m 16 m

m

24 m

m

3 0 A C C E S S O R I E S

- To be used to verify the implant site depth.- Laser markings for depth indication.

DEPTH GAUGE

- To be used to verify the implant site depth.- Laser markings for depth indication.- Gradual scale on the handle.

DEPTH RULER

- To be used to check the inclination of the surgical site, parallelism and blood flow.

- Available in 3 inclinations (10°-18°-25°), to check the inclination of the surgical site.

INDICATORE DI PARALLELISMO per sito chirurgico

- To be used to check the inclination of the inserted implant and for a correct choice of angled abutments.

- Available in 3 inclinations (10°- 18°- 25°).

PARALLELISM INDICATOR for inserted implant

1.95

10 1.8

82.5

1.95

6 65°

72°

80°

1.8

2.5

1.95

102.

6

2.5

2.6

65°

72°

80°

1.8

6

1.95

1.40

2.5

2.6

2.6


- To be used to screw the fixtures of the BTLock system.- Available in 2 lengths (18 - 28 mm).- Tip size: 1,25 mm.- To be used both manually and with the ratchet wrench.

STANDARD DRIVER

4

18

11

1.25

2.5

4

28

18

1.25

2.5

- Kit of laboratory indicators to be used to choose the abutments.- Straight and angled (10°-18°) indicators included.- Color code.

KIT OF LABORATORY INDICATORS

- To be used along with all BTLock screws.- Tip size: 1,25 mm.- Only to be used manually.- Available with 2 grip diameters (6,50 - 10 mm).

HAND DRIVER

- To be used for the screws of the screwable abutments (BTIVPMPA2, BTIVPMPB2, BTIVPMPC2, BTIVPMPD2).- Tip size: 1,55 mm.- To be used both manually and with the ratchet wrench.

DRIVER FOR SCREWABLE ABUTMENTS


- To be used to directly screw the fixtures.- Tip size: 2,5 mm.- To be used both manually and with the ratchet wrench.

DRIVER ExTENDER

- To be used to screw all BTLock fixture with the micro motor.- Tip size: 1,25 mm.

DRIVER for micro motor

- To be used to screw the fixture directly with the micro motor or with the implant carrier.- Tip size: 2,5 mm.

MICRO MOTOR ExTENDER

- To be used to connect the fixture to the micro motor.

MICRO MOTOR REDUCTION

- To be used to connect the MINI implant to the micro motor without the use of the implant carrier.

CONTRA ANGLE DRIVER for micro motor (Only for MINI Implants)


- To be used to screw the fixtures with the micro motor.- Suitable for diameters from 3,75 to 6,5 mm.

UNIVERSAL LOCK MICRO MOTOR REDUCTION

- To be used for implant insertion, along with BTLock drivers, threadformers, and expanders.

RATCHET WRENCH


- Maximum torque: 40 Ncm.

TORQUE WRENCH

- To be used to extend the implant carrier or ratchet drivers.

RATCHET ExTENDER


- To be used for to screw implants inside the osteotomy, along with BTLock drivers, threadformers, and expanders.

STRAIGHT SURGICAL KEY


BENT SURGICAL KEY

- To be used to easily insert standard osteotomes in the posterior areas.

KEY FOR STANDARD OSTEOTOME

- To be used to block the implant carrier during its unscrewing.

MOUNTER-BLOCKING KEY

3 6 G u I d E d S u R G E R Y

The software for guided surgery Sim-Plant®, made in cooperation with Ma-terialise Dental, world leader company for digital 3D implantology, allows the planning of the treatment easly, com-pletely and precisely, from first scan-ning to implant placement, trough special guides for drills and the mask.It is suitable for every kind of indi-cations, from single replacementto cases of complete edentolous jaws.Besides of a detailed planning of the surgery, the use of the digi-tal simulation allows to show the patient the preliminary conside-rations and how the surgical pro-cedure will be, making him feel confident and comfortable about it.

3 8 O N E O R T w O - S T A G E S p R O C E d u R E

VSM Standard, BTTITE CV1, CV2 e CV3 BTLock implant lines for two-stages technique.Two-stage technique requires the insertion of surgical screw included in the packaging with each fixture. Time to reopen flaps

depends from:• Implant position (inferior or superior maxillary arch)• Kind of thread (VSM, CV1 e CV2, CV3).• Kind of surface (BT-Tite, DMA).• Kind of bone

Time required to reopen flaps may vary from 2 to 6 months.

VSM Standard, BTTITE CV1, CV2 e CV3 BTLock implant lines for one-stage technique.Single-stage technique requires insertion of standard or widened healing screw, not included in the packaging with the fixture.

TWO-STAGES PROCEDURE

ONE STAGE PROCEDURE

b t l o c k s u r g i c a l m a n u a l3 9E R R O R I d A E v I T A R E

Respect the minimum space required between tooth and implant (1.5 mm) Respect the minimum space required between

two implants (3 mm)

Open very large flaps in order to better check concavities and possible alteration of maxillary teeth

While making the osteotomic site, check position, length of osteotomic site, the height of maxillary sinus and possible dental anomalies.

Please note: when planning implant position, keep in mind that implant neck is 0.2 mm larger than implant diameter!

4 0

1

1

1

1

1

E X p A N d E R S p R O C E d u R E

BTLock gives the possibility to use Expanders (expanders and compactors at the same time). The dentist may use these tools to optimize the making of osteotomic sites.

1 - To be used in case of hard bone.Please note: Protocol referred to 11,5mm-long fixture.


1

1

1

1

1

2

2

2

2

2

BTLock proposes three different protocol for implant insertion:1 - By surgical templates (see page 34)2 - By Expanders (see page 38)3 - Standard by drills, as follows:

1 - To be used in case of very thick crestal bone.2 - To be used in case of hard bone.Please note: Protocol referred to 13mm-long fixture.

4 24 2

b t l o c k s u r g i c a l m a n u a l4 3S u r g I C a l p r o C e d u r e ø 3 , 7 5 C V 1 4 3

Please Note: Use threadformer BTIMS in case of Standard fixture or BTIMS1 in case of One fixture.

Please note: having machine-cut collar, CV1 implant can be put at crestal or subcrestal level. the decision is up to the implantologist

4 4

Step IV - depth gauge

Use depth gauge (BTIIPR) in order to check correctness of implant site direction and depth.

As alternative, you may also use the depth ruler (BTIRP)

Step V - 330 conical drill

Use 330 Conical drill (330BTIFC) in order to progressively enlarge the osteotomic site.

Step VI - 375 conical drill

Use 375 Conical Drill (375BTIFC) in order to progressively enlarge the osteotomic site.

Step I - pilot drill

Once decided the right position for implant site, use a pilot drill in order to perforate bone crest and to easily pene-trate into medullary bone. Suggested number of turns: min. 900, max 1500 turns/minute.

In case the implant must be inserted between two teeth, or when the insersion needs an extention, use drill extension BTIPRF.

In order to avoid overheat, drilling must be very well irrigated and there must not be too much stress.

Step II - check for parallelism

By parallelism indicator (BTIIPA) carry on the check for parallelism with respect to other natural or artificial teeth.

Step III - twist drill

Use twist drill (BTITW) to reach depth needed for the case.In order to make this safer, it is sugge-sted to use drill stops.

Step VII - neck drill 375 BTIFSV

Use 375 Neck Drill (375 BTIFSV) in order to countersink the upper side of osteotomic site and to enable implant neck to fit there without stress.

Step VIII - threadformer

Use the threadformer (375 BTIMS1 for One Design, BTIMS for Standard Design), only in case of hard bone.

S u r g I C a l p r o C e d u r e ø 3 , 7 5 C V 1


Please note:

Before implant insertion, it is strictly recommended:- To check direction and depth of osteotomic site- To cause bleeding into the osteotomic site

Step Ix- Once the osteotomic site is ready

Once the osteotomic site is ready, check the implant (diameter and length) and its packaging, which must be undamaged. Open the packaging. According professio-nal preferences, the dentist may decide between two options to insert the implant (positioning of the implant):

1) Without implant-carrier cap. Taking out implant carrier cap by pliers.

Screw the implant into the osteotomic sites directly by hands.

2) With implant-carrier cap. Taking the fully assembled implant from the packaging, handling the implant-carrier cap.

Screw manually the implant inside the osteotomic site, without touching the tita-nium side (implant-carrier and fixture). Once inserted, taking out implant-carrier cap from implant-carrier by a skew move-ment.

Standard Procedure

4 6

1 2 3

Step x - Screwing

After implant insertion, implant have to be screwed inside the osteotomic site by hands or surgical key as deep as possible. BTLock gives three options to professional in order to complete insertion:- n.1 By micromotor and adapter BTICQM (15-20 turns per minute and 50N/cm of torque, while cooling by psysiologic solution.- n.2 By straight surgical key BTICCD- n.3 By ratchet BTICR

Step xI - Implant-carrier concavity leading to vestibular direction

Any method used to finish insertion, it is impor-tant that the mark on implant-carrier is at the end oriented in vestibular direction. This allows an easy use of esthetic and/or angled prosthetic solutions.

Standard

Standard

Step xII - Removal of implant-carrier

Block the implant carrier by mounter-blocking key (BTICCBM) or ratchet (BTICR) and unscrew the assembling screw by (3 options): 1. Hand driver (125BTICV); 2. Driver for micromotor (125BTICVM); 3. Standard driver for ratcher (12518BTICVQ).



Step xIII - Closing Screw (healing or surgical screw)

This step depends on the kind of preferred surgical method:In case of one-stage technique, the dentist will screw an healing screw (BTIVG). The diameter of the healing screw will be the same of the fixture, the heigth will depend on the heigth of the gingiva.In case of two-stage technique, use BTIVT (included in the package with each implant).

Please note: the right torque to screw healing screw is 10 N/cm.

Step xIV - Suture

Suture flaps in the original position, in order to speed up healing.In case of temporary or removable prostheses to be later adapted, download in a suitable way, avoi-ding any contact with underlying flaps and with the implant, in order not to interfere osteointegrating process.

4 84 8

b t l o c k s u r g i c a l m a n u a l4 9S u r g I C a l p r o C e d u r e ø 4 , 5 0 C V 2 4 9

5 0


Once decided the right position for implant site, use a pilot drill in order to perforate bone crest and to easily pene-trate into medullary bone. Suggested number of turns: min. 900, max 1500 turns/minute.

In case the implant must be inserted between two teeth, or when the insersion needs an extention, use drill extension BTIPRF.



By parallelism indicator (BTIIPA) carry on the check for parallelism with respect to other natural or arti-ficial teeth.


Use twist drill (BTITW) to reach depth needed for the case.In order to make this safer, it is sug-gested to use drill stops.








Step VII - 450 conical drill


Step VIII - neck drill 450 BTIFSV

Use 450 Neck Drill (450 BTIFSV) in order to countersink the upper side of osteotomic site and to enable implant neck to fit there without stress.

Step Ix - threadformer

Use the threadformer (450 BTIMS1 for One Design, BTIMS for Standard Design), only in case of hard bone.



Please note:


Step x - Once the osteotomic site is ready

check the implant (diameter and length) and its packaging, which must be undamaged. Open the packaging. According professio-nal preferences, the dentist may decide between two options to insert the implant (positioning of the implant):


Screw the implant into the osteotomic sites directly by hands.

2) With implant-carrier cap. Taking the fully assembled implant from the packaging, handling the implant-carrier cap.

Screw manually the implant inside the osteo-tomic site, without touching the titanium side (implant-carrier and fixture). Once inserted, taking out implant-carrier cap from implant-carrier by a skew movement.

Standard Procedure

5 2

Micro Motor Procedure

The micromotor procedure and the shorter implant carrier (4mm) are used to prevent eventual stress or cracking of the connection, leaving it intact and untouched. Furthermore, it is possible to preset the torque grade.

Please note:

Before implant insertion, it is strictly recommended:- To check direction and depth of osteotomic site- To cause bleeding into the oste-otomic site

Step x - Once the osteotomic site is ready

check the implant (diameter and length) and its packaging, which must be undamaged. Open the packaging.

After removing the implant carrier cap, remove also the safety seal. With the special key inserted in the micromotor, pick the implant directly from the holder and start screwing. If it is not possible to complete the operation with the motor, proceed manually with the racthet.

Go to step xII



1 2 3 4

Step xII - Implant-carrier concavity leading to vestibular direction

Any method used to finish insertion, it is important that the mark on implant-carrier is at the end oriented in vesti-bular direction. This allows an easy use of esthetic and/or angled prosthetic solutions.

Standard

Standard

Motor

Motor

Step xIII - Removal of implant-carrier

Block the implant carrier by mounter-blo-cking key (BTICCBM) or ratchet (BTICR) and unscrew the assembling screw by (3 options): 1. Hand driver (125BTICV); 2. Driver for micromotor (125BTICVM); 3. Standard driver for ratcher (12518BTICVQ).

Step xI - Screwing

After implant insertion, implant have to be screwed inside the osteotomic site by hands or surgical key as deep as possible. BTLock gives three options to professional in order to complete insertion:- n.1 By micromotor and adapter BTICQM (15-20 turns per minute and 50N/cm of torque, while cooling by psysiologic solution.- n.2 By straight surgical key BTICCD- n.3 By ratchet BTICR- n.4 By motor, as described in the previous page

5 4

Step xIV - Closing Screw (healing or surgical screw)



Step xV - Suture

Suture flaps in the original position, in order to speed up healing.In case of temporary or removable prostheses to be later adapted, download in a suitable way, avoiding any contact with underlying flaps and with the implant, in order not to interfere oste-ointegrating process.


5 6 S u r g I C a l p r o C e d u r e ø 5 , 5 0 C V 3









Step VII - 450 conical drill



Once decided the right position for implant site, use a pilot drill in order to perforate bone crest and to easily penetrate into medullary bone. Suggested number of turns: min. 900, max 1500 turns/minute.

In case the implant must be inser-ted between two teeth, or when the insersion needs an extention, use drill extension BTIPRF.



By parallelism indicator (BTIIPA) carry on the check for parallelism with respect to other natural or artificial teeth.


Use twist drill (BTITW) to reach depth needed for the case.In order to make this safer, it is sugge-sted to use drill stops.

Step VIII - conical drill 550 BTIFC

Use 550 Conical Drill (550 BTIFC) in order to progressively enlarge the osteotomic site.

5 8

Please note:


Step Ix - Once the osteotomic site is ready

check the implant (diameter and length) and its packaging, which must be undamaged. Open the packaging.

After removing the implant carrier cap, remove also the safety seal. With the special key inserted in the micromotor, pick the implant directly from the holder and start screwing. If it is not possible to complete the operation with the motor, proceed manually with the racthet.

Go to step xI

Micro Motor Procedure


The micromotor procedure and the shorter implant carrier (4mm) are used to prevent eventual stress or cracking of the connection, leaving it intact and untouched. Furthermore, it is possible to preset the torque grade.

Standard Procedure

Please note:


Step Ix - Once the osteotomic site is ready

Once the osteotomic site is ready, check the implant (dia-meter and length) and its packaging, which must be undamaged. Open the packa-ging. According professional preferences, the dentist may decide between two options to insert the implant (positioning of the implant):


Screw the implant into the osteo-tomic sites directly by hands. .

2) Direttamente con tappo por-taimpianto nel sito osteotomico.

Manualmente si avvita l’impianto nel sito osteotomico con il tappo portaimpianto.

6 0

4321

Step x - Screwing

After implant insertion, implant have to be screwed inside the osteotomic site by hands or surgical key as deep as possible. BTLock gives three options to professional in order to complete insertion:- n.1 By micromotor and adapter BTICQM (15-20 turns per minute and 50N/cm of torque, while cooling by psysiologic solution.- n.2 By straight surgical key BTICCD- n.3 By ratchet BTICR- n.4 By motor, as described in the previous page

Step xI - Implant-carrier concavity leading to vestibular direction

Any method used to finish insertion, it is important that the mark on implant-carrier is at the end oriented in vestibular direc-tion. This allows an easy use of esthetic and/or angled prosthetic solutions.

Standard

Standard

Motor

Motor

Step xII - Removal of implant-carrier

Block the implant carrier by mounter-blocking key (BTICCBM) or ratchet (BTICR) and unscrew the assembling screw by (3 options): 1. Hand driver (125BTICV); 2. Driver for micromotor (125BTICVM); 3. Standard driver for ratcher (12518BTICVQ).



Step xIII- Closing Screw (healing or surgical screw)



Step xIV - Suture

Suture flaps in the original position, in order to speed up healing.In case of temporary or removable prostheses to be later adapted, download in a suitable way, avoi-ding any contact with underlying flaps and with the implant, in order not to interfere osteointegrating process.

6 2 o n e S T a g e T e C h n I q u e

Step IOnce osteointegration is finished, unscrew healing screw.

Step IIChech the healing of surrounding tissues.

Step IIIIf the check gives a positive result, carry on with prosthetic stage.

b t l o c k s u r g i c a l m a n u a l6 3T w o S T a g e S T e C h n I q u e

Step IOpen flaps by bistoury.

Step IVInsert healing screw of same colour and then diameter.

Step IIOnce opened flaps, take out sur-gical screw by hand or standard driver.

Step IIICheck the colour of the screw.

Step VScrew the healing screw at 10 N/cm, checking that surrounding tissues are not taken into the assembled device.

Step VIAfter two weeks, surrounding soft tissues should have been shaped. Unscrew healing screw.

Step VIIIf the check gives a positive result, carry on with prosthetic stage.

6 4 n o T e

connessioni che cambiano la vita - btlock · intra-oral x-rays, number and size of implants to be...

Documents