OCO Biomedical Presents The Next Generation of Endosseous Implants

Treatment Planning & Placement Presentation

If orthopedic and neurosurgeons doing hip replacement and spinal fusion have patients in function the same day, why should dental implants take 3 to 6 months before function? OCO Biomedical technology has made it a reality with the next generation of dental implants!The OCO DUAL STABILIZATION Line of Dental Implants, bioengineered to encourage bone growth

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The 1938 Adams patent covers the general form of all of todays classic two-stage root form dental implantsNot even industry leaders have innovated or made any major improvements since the original 1938 patent was issued

1938 Adams

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Examples of classic two-stage dental implants based on the 71 year old Adams U.S. patented technology:

Two-Stage Dental Implant Examples

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1938 Adams patent for a two-stage endosseous root form implant

One company, for example, claims 40 years of inventions and technological advances:

Evolution of threaded implants, not much change until introduction of dual-stabilization 19811992200020032004

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In 2002OCO Biomedical introduced the next generation of endosseous implants:

The ISI Complete, TSI, and The ERI Immediate Load capable Dual-Stabilization Dental Implant System*

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For a Predictable Immediate Load or 2 stage conventional Dental Implant:

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Product OverviewDual Stabilization and how it works*

The Next Generation in Implant TechnologyDual Stabilization implant design:Creates a true mechanical lock at the top and bottom of the implant, ensuring immediate stability and superior osseointegrationDurable, high-quality, immediate-performance implant and temporary crown in less than an hour in most cases.

OCO Biomedical Developed Many ChangesISI & TSI: Dual Stabilization for True Immediate LoadBull Nose TipThe unique tip locks the apex of ISI Complete and TSI in medullar bone

1Select surface treatment at tip: Apical portion of implant is not grit blasted to preserve cutting edge

Auger like thread pattern condenses bone after implant bottoms out by pulling it up and around the tip stimulating bone growth with tension

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High-Powered Images Show the Superior Features of the ISI Complete & TSI Dental Implant and the Cortico-Thread & Taper locking the top32x machined perio collar surface

Lighter grit blasted cortico-thread

High power illustrates fine machining of implant threads

10C um sem of proprietary surface treatmentMost porous in the industry

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Advantages of OCO ISI, TSI, and ERI ImplantsInnovator in Immediate Load/ Function Implant Technology: introduced in 2002Competitors re-engineering existing systems and force a larger implant into a smaller diameter hole. Or, a thread which increases in thickness along the long axis of the implant. Result, bone compressionOCO system developed dual stabilization; unique bull nosed tip pulls bone from beneath the implant up around the tip(tension) which encourages bone growth. The wide diameter top with cortico treads locks the top at the crest of the ridge. Thus; eliminating a fulcrum along the body of the implant.

Advantages (contd)Easy to use/learn system & instrumentationConventional flap & reflection or Single stage, flapless surgical procedure in less than 30 minReduced patient chair timeIncreased patient satisfactionWhy? No pain or swelling!Extremely high success rateUnchallenged successes history, not one reported case of crestal bone loss or cupping since introduction!Designed and manufactured in the USA

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

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Dual Stabilization Implant SystemISI Complete One-Piece ImplantCrown & Bridge or O-Ball overdenture prosthetic optionsDiameters: 3.25, 4.0 & 5.0 mmLengths: 8, 10, 12, 14 & 16 mmComplete system including implants, instrumentation, prosthetics and direct restorative componentsNow available, the Locator for overdentures

Dual Stabilization Implant SystemTSI Two-Piece Implant SystemVariety of prosthetic options:O-Ball/IOT, Straight C&B, Offset, Paralleled Wall, Pedestal, Skirted and other abutmentsDiameters: 3.25, 4.0 & 5.0 mmLengths: 8, 10, 12, 14 & 16 mmComplete system including implants, instrumentation, prosthetics and restorative components Can be restored using direct or indirect technique with a very large variety abutment options

Dual Stabilization Implant SystemTSI Abutments

IOT / O-BallParallel Wall (Indexed)15 degree Offset C&BStraight Skirted& Offset Skirted &Soon, scalloped-contoured Healing CuffsUMAUMA Healing CuffTSI C&B Taper/ StraightScallopedSkirtedAbutmentsIndexed & Non-Indexed Waxing Sleeves

OCO Biomedical Advantages More surgical placement options - simplicitySimplest and most economical restorative optionsLess occurrence of crestal bone loss highest percent of cases with immediate loading/functionUnchallenged long term success rateUnique dual stabilization design Most effective surface treatment

The Economical I-Mini Implant SystemEconomical Denture StabilizationLong Term Fixed Support I- Mini : 3mm Mini ImplantIntroduced 2002 Crown & Bridge or O-Ball/IOT & prosthetic options & soon, the LocatorDiameter: 3.0 mmLengths: 8,10, 12 & 14 mmComplete system including implants, instrumentation, prosthetics attachments and restorative componentsSimple, Economical introduction to full diameter ISI, TSI & ERI Implant Systems

Diagnosis and treatment planningMedical and dental historyHow did the patient loose the tooth or teethPano or cone-beam cat scan x-rayStudy modelsModel mapping on areas to be treated if neededIdentify bone type and densityEvaluate available bone in areas to be treatedInform before you performEvaluate the patient expectationsCan you meet those expectationsCan anyone achieve the expectationsEncourage the patient to get a second or third opinion and estimate

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Evaluate study model for ridge width, alignment of adjacent teeth, if a dental implant can be placed using uncomplicated techniques.

Section the model through the edentulous area and after estimating gingival thickness, map it.

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

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

Edentulous MandibleAn immediate denture placed 17 yrs ago*

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

Model of lower, sectioned at the center and mapped

Zoll bone width measuring device

*Bone Densities

Anterior Bone QualitiesLekholm and Zarbs four bone qualities for the anterior region of the jaws:Quality 1: Composed of homogenous compact bone Quality 2: Thick layer of cortical bone surrounding dense trabecular bone. Quality 3: Thin layer of cortical bone surrounded by dense trabecular bone of favorable strength. Quality 4: Thin layer of cortical bone surrounding a core of low-density trabecular bone.

D1D3D2D4

General Bone DensitiesBone Density Classification by Misch & Judy

D2D1D4D3

Bone DensityDescriptionTactile AnalogTypical Anatomical LocationD1Dense CorticalOak or maple woodAnterior mandibleD2Porous cortical and coarse trabecularWhite pine or spruce woodAnterior mandiblePosterior mandibleAnterior maxillaD3Porous cortical (thin) and fine trabecularBalsa woodAnterior maxillaPosterior maxillaPosterior mandibleD4Fine trabecularStyrofoamPosterior maxilla

Basics for fixed: 4 Main buttresses for fixed or implant supported teethIdeal minimumImplant diameterMinimum implant length 10 to 12 mm

A Dental Implant is not a natural tooth rootVertical tooth movement: 25 to 100 mVertical Implant movement: 0 to 10 m

Proprioception: Tooth yes Implant - no

Horizontal flex: Tooth yes Implant - no

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

[PLACEMENT PROTOCOL AND PROCEDURE]ISI Complete One-piece and TSI Two-piece Dual Stabilization Implants*

Ready to place: Flap or Flapless Direct?Indications: Any Dental Implant Situation 80%+ of which can be Immediately LoadedAlternative to mandibular or maxillary bridge, partial, or to stabilize a full prosthesisSingle or multiple tooth replacement Healed or selected new extraction sites (when an implant with a diameter larger than the tooth root removed can be placed)

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Full Surgical Kit ISI,TSI, ERI & I-Mini Dual Stabilization Implant Instrumentation System For placement of the ISI Complete One-piece, I-Mini and TSI, ERI Two-piece Dual Stabilization ImplantsAll drills for the ISI, TSI, ERI and I-Mini implant placementSimple step-by-step drill sequencesOrganized and color-coded (relative to implant diameter) to flow with the implant placement procedureComponents labeled for easy return to the tray after surgery

Convenient, Simple and VersatileFits easily into most autoclaves for sterilizationExtra compartment underneath the caddy allowing room for additional components and instrumentation

Drill Sequence :1. High Speed #8 surgical bur2. Pilot drill3. Guided tissue punch4. Counter sink if needed5. Pilot drill again to final depth6. Final osteotomy former (drill)

After palpating the buccal and lingual anatomy and determining the ridge width, mark the spot where the implant is to be placed with a high speed hand-piece and a #8 bur with water spray only

Mark the Spot, then flap to expose bone or use flapless direct technique proceeding to the next stepDrill through the gingiva and into the cortical bone

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With a low speed hand-piece and pilot drill, slide on 12mm a drill stop and or depth marking ringAlign with adjacent teeth or implants, and drill down to the 10mm mark

Establish Path-Alignment: Pilot Drill

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Place a paralleling pin (shaped like the abutment) and check alignment and distance from adjacent teeth or implantsIf off, remove pin and correct by re-drilling pilot hole, then replace pin and recheck

Check the Alignment & Clearance

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Next, use the tissue punch with center guide pin placed into the pilot holeDrill down through the gingiva and into the bone assuring youre through the periosteum

Punch the Tissue

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With a curette or irrigated high speed drill and #8 bur, remove the tissue plug. Remove all tissue tags and leaving a clean hole to the bone with the pilot hole in the exact center

High Speed Plug Removal

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Use the collar depth gauge countersink to make sure the collar is below the top of the gingiva, especially in the esthetic zone areas

Countersink Drill : Optional for ISI or TSI

In this example, a 12mm ISI implant will be placed, so use the 12mm drill stop on the pilot drillThen drill through the pilot hole, keeping the drill alignedDrill to the final seating depth when drill stop contacts bone

Pilot Final Depth

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Place the O ring marker at the 14mm mark on the final internally irrigated drill using a surgical hand-piece with water pumpDrill to the final seating depth

The final drill is designed to stop at the final depth established by the pilot drillIf more depth is needed, re-drill deeper with the pilot drill first

Final Drill

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ISIPlacing the Implant: ISI CompleteRemove implant from the vial

Implant is now placed with the cap into the prepared osteotomy site

ISIPlacing the Implant: ISI CompleteFinish seating the implant with the ISI sized driver and thumb wrench

Implant is now placed with the cap into the prepared osteotomy site

Use the ratchet wrench to finish seating in denser bone watching the collar to assure it continues seating. Use with caution!

TSIPlacing the Implant: TSI, ERI Two-PieceTSI Implants come suspended in a vile

Remove the color-coded cap uncovering the Ultum cap holding the TSI implant

Healing screw is set in the top of theUltum cap

TSIPlacing the Implant: TSI, ERI Two-PieceRemove the Ultum cap holding the implant with healing screw at top take to osteotomy without touching the implant

Carry the TSI implant to the osteotomy site with the Ultum cap and start seating

Use a TSI driver with the thumb wrench and continue seating the implant

TSIPlacing the Implant: TSI, ERI Two-PieceUse the ratchet wrench with the driver to complete seating the implant

After the ISI and TSI implants have bottomed out a couple of extra turns condenses the bone at the tip and the top of the implant establishing Dual Stabilization.

Check for Dual Stabilization with the torque wrench. 30 -40 n/cm in the maxilla and 40+ in the mandible

Placing the Implant: TSI, ERI Two-PieceIf a temporary prosthesis is not placed (Direct Technique) the healing screw provided with the implant or a 2,3,or 4 mm healing cuff is placed to cover the top of the implant and maintain the gingival emergence profile Torque on healing screws > 20 n/cm

A thumb wrench and driver is used to screw the ISI Complete towards its final seating depth.

Place the Implant

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Use the ratchet torque wrench and driver to fully seat the implant Then apply a few additional turns to 30 -50 n/cm to condense the bone at the tip and wedge the cortico-thread into the cortical bone This results in Dual-Stabilization with a true mechanical lock at the top and the bottom of the implant

Seat the Implant Firmly

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As the implant bottoms out, the bone is condensed by pulling bone up at the apex and locking the top in the cortical bone by the mini-threads at the bottom of the tapered collar :Dual Stablization

Seat the Implant, Lock with an additionalTurn (up to 180 degrees) : Dual Stabilization

The ISI Complete is now fully seated In our example, we were using a 12 mm implant (measured from tip to top of cortico-thread), plus 2 mm of divergent perio collar for a total of 14mm from tip to abutment

Seated Implant

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If necessary, shorten the abutment to provide space for the final crown with a 556 Great White Carbide Bur in a high speed hand-piece with water and air spray

Shorten the Abutment

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Placed implant with modified head ready for temporary crown

Ready for Crown

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Place machined acrylic coping on the abutment prior to placing tooth-colored temp form and acrylic over itThis will provide a perfect fit and margin

Coping and Temporary Crown

Acrylic Coping

Temporary crown in place in light occlusion

Crown Placement

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Review OF Preparing The Osteotomy

TSIThe two piece, one or two stage, immediate load version of the ISI CompleteAll TSI implants have 6 or 8 point indexing for use with all anti-rotational two-piece abutments

ABUTMENTSOne Piece (solid): Straight, 3 heights : DO NOT REMOVE AFTER PLACINGO-ball/IOT, 4 heightsHealing Cuffs, 4 heightsTwo piece:ParallelOffsetSkirted (offset & straight)Titanium Nitride Coated Scalloped (for ERI and TSI)Custom/UCLA

The TSI Two-Piece Implant System

2002: First version of ISI Complete, multiple drill system Well healed extraction site ideal forthe placement of the ISI Complete Dental Implant

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

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

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

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

The ISI implant removed from its vial

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

Fully seat ISI implant with a rachet/torque wrench. Torque to 30/40 n/cm in the maxilla, 40/60 n/cm in the mandible.

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

Temporary crown placed with light occlusion

In just 35 min, hes ready for his daughters wedding the next week!

Replacing lower molars with TSI Implants

Ask, How was the tooth lost?

Why did this patient loose his lower central incisor?

The 3.0 diameter / 16mm length I-Mini(ISD) implant was placed and put into immediate function

Immediate Function

Temp in place and put in immediate function without bonding to adjacent teethTime: 35 minutes

Immediate Function

Extreme lower level tongue thrust:8 lb pressure x2/ minute by day, X1 per min at night

Cause of tooth loss

Final restoration in place Implant with crown still in function3 years post-op

Final Restoration in Place

8-6-09 6years post-op

After 3 years, no appreciable bone loss And the ISI Complete still firm and functional

After 3 Years Successful

Missing Central with Moderate Facial Bone Loss

Missing Central with Extreme Facial Bone Loss

Missing Central with Extreme Facial Bone Loss

Treatment Planning and Whats needed Prior To Starting For A Predictable ResultPanoramic X-RayStudy ModelsCone Beam Cat Scan ImagingOr- Sectioned Model with Bone MappingDrill/Implant Guide for Correct Positioning and Alignment optional

Then ProceedSurgical Choice : Flap for Bone Exposure or Tissue PunchBone Grafting, Bone Expansion, Bone remodeling or BothISI Immediate Loading/Function, TSI with Straight, Offset Abutments or Delayed Loading With Selected Healing Cuff

Study Model

Cat Scan Image or Model Mapping toEvaluate Available Bone and Select Surgical Choice and Implant Selection

TSI Placement: Mark the Spot

Drill through the gingiva and into the cortical bone

Set the Depth: Pilot DrillNow use a 10mm drill stop to go 8mm into bone!

Set the Depth: Pilot Drill

Set the Depth: Pilot Drill

Set the Depth: Pilot Drill

Check the Alignment

Punch the Tissue

High Speed Plug Removal

Countersink Drill

Countersink Drill

Pilot Final DepthNow use the drill stop that corresponds to the implants length and drill to bone level!

Pilot Final Depth

Osteotomes used in Bone Spreading and Remodeling

Osteotomes used in Bone Spreading and Remodeling

Osteotomes used in Bone Spreading and Remodeling

Osteotomes used in Bone Spreading and Remodeling

Final DrillPlace the depth ring 2 mm above the implant length on the final internally irrigated drillThis is the length of the entire implant body and collar

Final Drill

Place the Implant

Seat the Implant Firmly

Seat the Implant FirmlyUse ratchet-torque wrench and driver to fully seat the implant and then turn additionally up to:30+ n/cm in the maxilla50+ n/cm in the mandible

This will condense bone at the tip and wedge the cortico-thread into the cortical bone for dual-stabilization

TSI Offset Abutment

Place the Offset Abutment

Place the Fixation Screw

Torque to 20 n/cm torque again 10 min later

Modify the Abutment

Adjust Length using 557 Great White inHigh Speed HP with Water & Air (round tip)

Establish Shape of the Emergence Profile

Modify the Abutment

Modify the Abutment

Check the Alignment and Clearance Have the patient bite

Place the Crown

Crown in Place

Emergence Profile

TSI Implant Placement with Offset Abutment

Two Weeks Post-Op

Final restoration, 3 months later

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

Pre Treatment

Edentulous area

Use of a drill guide

Position of Implant established by the drill guide

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

Pilot drill with 12mm drill stop to final depth

Placing a paralleling pin

Tissue Punch

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

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

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

Placing the implant using the TSI driver with a thumb wrench

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

A well placed TSI implant in the 2nd Bi, non esthetic zone. The top of the implant is at tissue level. A healthy situation

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

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

A TRIP, (tissue retraction impression pick-up) is snapped in place, med bodied material injected into the top and picked up with a tray of heavy body material

The pulled impression with the trip in place

The Implant lab analog snapped into the TRIP and ready to be poured and mounted ready for the final restoration to be constructed with less difficulty than a conventional crown

The temporary crown placed and put into light function

Post op digital x-ray Placement: Excellent

Ready to seat final crown

Zirconium Core Crown

Crown Seated

Lingual View

Final

An emergency visit for a loose UL Cuspid

Shirley Plotnick*

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

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

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

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Zirconium core tried-in a month later

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Final crown seated, note the emergence profile

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Case finalized

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The new ERI ImplantOCO DualStabilization Implant designed for the esthetic zone or in any case where a low gingival profile implant is indicated

ERI Implant with skirted Titanium Nitrite ScallopedAbutment

Diagnosis, Planning and Treatment

Bone loss on Facial with indent

Pre-op X-Ray

Model mapping

Post-op X-ray

Zirconium core crown NEW ERIIMPLANTUSED

Cotton stuffed in abutment set screw

Thin film of intermediate cement applied in crown

Crown cemented to place

Finalized 3.5 weeks after start, 2 visits

Beginning X-Ray

Check alignment with paralleling pin

Marking Abutment prior to prepping

Nitrite Skirted Abutment Prepped Chair Side for Temp Placement

Torque locking screw - twice

Prepped abutment ready for temp

Stock temp filled with Alike Temp Acrylic

Temp in place with IRM

Beginning x-ray: broken, abscessed lateral Incisor

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

Flipper worn for 6 weeks

Penetrating with high speed

Pilot to final depth with drill stop

Osteotomy completed and now form the emergence profile

Placing the ERI Implant

Torqued to 35 n/cm

Temp placed

Final crown

Extreme Chronic Perio, Patient Request: I Need Implants!

Post Op X-ray

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

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

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

Lower temp in place

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

Full upper and fixed lower

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

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

The I-Mini is a 3mm diameter ISI Implant

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

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

PRE OP

LINGUAL VIEW

FACIAL VIEW

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

REMOVING TOOTH

REMOVED TOOTH WITH SHORTENED, DAMAGED ROOT

WHAT COULD HAVE BEEN DONE TO ENHANCE EMERGENCE PROFILE?

PILOT DRILL WITHOUT DRILL STOP

DRILL TO FINAL SEATING DEPTH OF IMPLANT

FINAL DRILL WITH DRILL EXTENDER

FINAL TO DEPTH ESTABLISHED BY THE PILOT DRILL

I-MINI IMPLANT REMOVED FROM VIAL

PLACING IMPLANT WITH CARRIER FROM THE VIAL

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

SEATED IMPLANT

ACRYLIC COPING IN PLACE

TEMPORARY CROWN PLACED

POST OP XRAY

Implant Retained Overdentures

Or, use a prefabricated pilot drill guide

Locate and Position Implants Safely Between the Mental Foramina

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

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

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

Now you know Exactly Where The Mental Foramina are relative to the denture Transfer a Mark From the Denture To the Gingiva Approximately 3 mm mesial the metal markers

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

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

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

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

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

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

Denture with attachments returned from lab

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

Juan A trumpet player all his life in a premier mariachi group known throughout MexicoThat is until he lost his teethAnd with a lower denture he could no longer play!

Case Study

Pre-Op Pano

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

Post- Op Pano

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

In less than 2 weeks the healing looks great and hes ready for a reline and the final female attachments

The abutments are flooded with medium body impression. Denture filled with medium body and seated with light biting pressure.Recommended: Do not use self curing acrylic to place attachments in the denture

Impression to Reline Denture and add Attachments

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

O-ball analogs placed into denture with impression

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

Finished Denture after Reline

Dentures in place and ground into occlusion

Flanges are trimmed and the size of the denture is minimized

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

Extremely high success rateReportable FDA Failures: in 2006 .770/1,000 sold (4 from the same doctor), 2007(.90/1,000 sold), 2008 (1.1/1,000 sold).

Was this an implant failure?

Fractured I-Mini Implants, Why?

Thank You

Questions?OCO Biomedical is a debt-freeCompany serving the dental Implant Community since 1976

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Shirley Plotnick*

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