User`s guide 2013 - EuroTeknika Implants
Contents
1. 7 6 Casting 8 b The ceramic part is shaped fired and tried out on the model 9 6 Cement the prosthesis on the implant head ZN the titanium abutments can not be modified or cut If a vertical reduction turns out necessary get rid of the ball on the implant having wait for the necessary time for the osseointegration and use a burn out abutment Overdenture STABILIZATION BE CAREFUL For the mandibile only Be careful to have a mucous support of the prosthesis not to concentrate all the support and retention on the implants had 5 2 O ring attachement Ref UPA FOR 52 O ring attachement are supplied with 3 different retaining LV vire prosthesis is made in the laboratory rings 50 60 et 70 shores MU tre removable prosthesis of the patient is re used The inner side of the removable prosthesis is hollowed out to place the female parts of all implant 1 A After the implant head is protected with a fine paper or insulating material the female part is snapped on the implant head some resin is introduced into the prosthesis which is then seating in mouth by adjusting the occlusion and the positioning The resin will get harder by autopolymerization 2 A After the hardening of the resin around the female attachments the prosthesis Is ready 3 A Reline the prosthesis to adjust the mucous support 1 5 Make the impression on the titanium implants 2 68 Withdraw the impression 3 5 Insert2. Use a safety thread if the geometry of the reference object allows it Then if the calculated magnification is 1 1 1 3 1 or 1 7 1 you may use the transparencies In all cases if the magnification is not 1 1 1 3 1 ou 1 7 1 it is not possible to use the transparencies provided by the euroteknika goupe but the bone volume may be determined thanks to proportionality calculation using the X ray and the mesured magnification In this pre implantation phase the practitioner must also design the coming prosthetic construction since implantology must be concidered as a prostheticaly driven project Indeed pre prosthetic planning and surgical planning are closely linked and any change to one will have consequence on the other It is during this phase that we may determine the number of implants their diameters their lengths their locations and their orientations in order that we may proceed with the planned prosthetic construction SURGERY euro teknika GROUPE LOS Presentation OF THE SURGICAL KIT AND GENERALITIES Surgical KIT The stake for the realization of the implant socket is on three levels a calibration of the socket to obtain a good primary stability of the implant main condition for the osteointegration minimum overheating to avoid all irreversible bone necrosis The socket preparation will be made under constant external irrigation with sodium chloride at 0 9 The critical temperature threshold is 47 C
3. and natural teeth Leave 3 mm between the thread of two implants Dimensions of the crown and occlusal A precise analysis of the forces is essential to estimate the feasibility of the treatment with a small diameter implant The supporting cusps must be situated in the implant axis better distribution of the efforts to the bone The implant must be placed in the center of the occlusal table and in the prosthetic axis In the labio lingual palatal direction Leave if possible 1 5 to 2 mm of bone thickness around the labial palatal amp lingual surfaces loads In the case of a removable prosthesis the implants will have to be strictly parallel between them and situated perpendicularly to the occlusal plane A regular relining of the prosthesis will allow to ensure the mucous support of the prosthesis and will so reduce the implants prompting Choice of the implant Only implants ref OIC 27 85 090 OIC 27 85 110 OIC 27 85 130 OIC 27 85 150 allow to realize fixed cement retained prosthesis These implants can also be used to stabilize a removable prosthesis in case of important gingival height euro J To stabilize a removable prosthesis we recommend to use 4 implants or at least 2 Select implants with a length of at least 11 mm if possible teknika GROUPE Use OF THE SURGICAL TRANSPARENCIES In order to guide the choice of the implant in terms of length and diamet
4. des implants en titane pur Docteur GUY HURE Implantodontie 1994 N 14 15 Comment choisir un anesth sique en odonto stomatomogie Soci t d Anatomie et de Pathologie Oro faciale Docteur J Fran ois GAUDY Ma tre de conference service d Anatomie Facult de chirurgie dentaire de Paris V Les bases buccale Anesth sie Infiltrations locales d articaine associ es une analgesie intraveineuse en chirurgie buccale chez les malades risque Par B Lefevre J Lepine D Perrin G Malka Le chirurgien dentiste de France N 566 23 Mai 1991 k Implantologie orale 2003 Commission des dispositifs m dicaux de l ADF k Facteurs de risques en implantologie Franck Renouard A GLOBAL SOLUTION FOR IMPLANTOLOGY 726 rue du General De Gaulle 74700 SALLANCHES France Tel 33 0 4 50 91 49 20 Fax 33 0 4 50 91 98 66 www euroteknika com Our ranges of implants are CE marked and conform to European Directive n 93 42 CEE N CE 0499 VERSION MU OBI GB 1202
5. for 1mn At 50 C the necrosis is irreversible amp the obtainment of a calibrated socket assuring a good imperviousness The drilling axis should be controlled to avoid any angle between the prosthesis and the implant Use the drill guide in the gingival cutter to respect a constant working axis The instruments are sorted by their stage of use as shown by a marked on the kit Numbers notify the main steps of each stage BE CAREFUL It is necessary to choose the prosthetic parts before the implant placement in order to insert the implant at the right place WARNING The minimum heating will be achieved with a good irrigation and with a good selection of drills with a good cutting power It is therefore necessary to check the number of use of the drills involved in the implant socket preparation Use the cursors in the surgical kit and change your drills after 10 to 15 uses Ref OICK 27 XX 00 1 Gingival cutter 2 Point drill 1 5 2 2 3 Drill 2 4 Depth Gauge 5 Paralleling pins Click wrench Internal hexagonal screwdriver 2 5 for the implant driving Mandrel Extension Internal hexagonal mandrel 2 5 for the implant driving long and short Pictures for illustration purposes only Mini implant range abutment ball 8 ball OBI Implants O 2 7 Implants O 2 7 for removable prosthesis h 6 8 mm A Supplied on demand with an O Ring attachement JA Supplied o
6. lateral incisor Contra indications FOR USE OF THE IMPLANTS REMINDER Absolute contra indications Major psychological disorders Risky cardiopathy amp Uncontrolled systemic pathology Alcoholism or medicinal drugs addiction Age of the patient young patient during growth Poor hygiene of the patient Relative contra indications They are represented by Insufficient volume and or an osseous quality An insufficient restorative space A patient presenting risks patient exposed to atomic radiation bruxism uncontrolled parodontitis addiction to smoking A D4 type bone for a single implant The OBI implant cannot be used for the stabilization of a canine For the replacement of a molar it must be placed with a second OBI implant or other Guarantee In case of non osseointegration you must inform your commercial representative so that we can examine the causes for the failure and bring the necessary corrective actions An exchange may take place when the defect of the product is established if the failure results from Parts PACKAGING Sterility and rule of asepty Most of our parts are delivered sterile and can therefore be used straightaway A reference indicator shows the components effective sterility on the packaging The sterility is guaranteed for 5 years from packaging date A standard expiry date is shown on the labelling Only an undamaged packaging can guar
7. to work according to a constant axis This movement does not require reverse motion of the motor direction if it is made at the right time If the drill is blocked it can be removed in reverse mode Maximum burying of the neck 0 6 mm The depth of use of the drill is going to determine the a P n ie ave g sk drill 2 You can third bury the bottom of the collar 0 6 mm without ip ore nam the pone ASS Musik preliminary instrumentation to limit the overtaking over provided with 4 marks at 9 11 13 and 15 mm These crestal of the implant lengths are point of drill included The peri implant bone in the apical area of the implant is generally not so hard the primary stability of the implant can be improved in this area by reducing the depth of drilling with regard to the total length of the implant The implant is slightly conical and has self tapping vents so it can progress in this area AJ contra OF THE SOCKET AXIS Insert the thinnest side of the parallelism gauge in the implant socket to evaluate the emergence axis of the implant and to guide the second drilling if necessary The top part of the gauge is necked to prefigure the implant neck prosthetic support and to save the necessary space between two implants euro teknika GROUPE Protocol STEP BY STEP LF metan INSERTION The implant can be positioned manually or with the contra angle This procedure must be done w
8. I is used in removable prosthesis the relining of the prosthesis is necessary to obtain a mucous support and not to concentrate the load on implants A regular relining is necessary to assure the durability of the treatment PRE IMPLANT STUDY euro teknika It is necessary to evaluate the possibility of an implantology treatment and to Pre implant STUDY determine the treatment plan IMPLANT treatment feasibility This study takes different elements into consideration A patient s questionnaire to reveal potential health medications problems which could have a bearing on the treatment success alcohol use tobacco or drugs general dental hygiene An oral examination which will give details about the mouth opening the lign of the patient s smile if it is a gingival smile the coronary height and the volume of bone available the type of occlusion Biological tests glycemy A complete X Ray file showing the available bone s volumes Complete tests studies with the two dental arches in occlusion An implant treatment cannot be started without a thourough cleaning of all the patient s infectious seats The ball abutment implant used for the fixed prosthesis has an extra osseous height of 8 5 mm This height can be limited by burying a part of the implant neck 0 6 mm see p 25 If it is necessary in case of reduced coronal height in fixed prosthesis the ball can be removed but on
9. MINI IMPLANT H euro tekni ss adi A d N jajigoloiSTeji oja euroteknika groupe is the result of 20 years of clinical applications and 24 years of research and development confirmed by valuable help of international research laboratories The design of our implants is based on the skills of our teams wich are both reactive and experienced in implantology Technical and biomechanical skills of our engineers enabling to guarantee the resistance of the component and their adaptation to the oral environment thanks to modern means of simulation Biological and physiological skills of the associated laboratories enabling to validate the capacity of osseointegration of our systems Clinical and practical skills of our dentists advisers ensuring the ergonomics of our products the confirmation of our protocols and the ranges adapted to the various clinical cases The OBI type implant has 30 years of clinical experience The first implants of this small size lt 3 mm were placed in the USA in 1976 The Obi implant was inspired by numerous concepts from the evidence of the implants of larger diameter asymmetrical thread flared neck it is a very usefull addition to your current system To enable you to take the best advantage of the OBI implant we created this manual with a profesionnal care We invite you to read it with your best attention Each detail even the least important has its impo
10. antee the products imperviousness and sterility Do not use implants with packaging which has been damaged or prematurely opened Our products have been designed so as to enable handling without affecting their sterility It is therefore important to follow a precise handling technique so as not to compromise the conventionnal hygiene conditions associated with the implant practice amp The non sterile instruments and items delivered used for the implantology treatment must be decontaminated and according to a tested process sterilized at the practice Storage OF THE PRODUCTS The implants must be stored in clean dry and cool conditions euro an incorrect clinical analysis a surgical protocol not adapted to the case from the use of blunt drills or for any other reason independant from the product quality the guarantee will not be taken into consideration No sterile Implants Prosthetic parts Drills Labels Our implants are delivered with 2 labels showing clearly the mark the reference and the lot number amp 1 label for the patient s file of the practioner who placed the implant amp 1 label for the correspondent if need be With this manual some patients cards are included to be filled in with the references of the implants placed and to be handed to the patient This enables any re intervention on socket wherever the patient lives teknika GROUPE CL LL m General INFORMATIONS Pr
11. ecautionary MEASURES It is strongly advised to keep in stock implants which cover the most frequently used diameters as well as the different lengths It is important to be able to correct an implant s choice during a procedure to replace an implant which has been contaminated for any reason to fit an extra implant in certain cases to insure the long term treatment SUCESS We recommend the use of a safety system floss attached to instruments or a suitable throat protection system on the instruments in case of accidental dropping of tools in the patient s throat It is strongly advised to put in place the receiving socket with euroteknika groupe instruments shown in this manual The use of the implant requires a good mastery of the occlusion regulation the management of implant axes during the preparation of the site as well as a precise location of implants with regard to cusps and to occlusal forces In a general way any element of the treatment having an incidence on the distribution and the orientation of the masticatory constraints must be taken into account not to overload the implant To use the OBI abutment implant in fixed prosthesis it is necessary to study the available restorative space before the implant placement and the feasibility of the insertion of the implant in the prosthetic axis This implant tolerates very few alterations see chapter about the pre implant study When the OB
12. er euroteknika goupe has developed surgical transparencies that show the dimensions of its different implants Thereby the implants are represented with 1 1 1 3 1 and 1 7 1 magnifications magnifications correspond to the usual magnifications of the different types of medical imaging systems retroalveolar X ray X ray dental panoramic and tomography analysis SCANORA CBCT Cone Beam When the practitioner accurately knows the magnification of the pre surgical X ray and if this magnification is 1 1 1 3 1 or 1 7 1 by a simple superposition of the corresponding template 1 1 template for a 1 1 magnification 1 3 1 template for a 1 3 1 magnification and 1 7 1 template for a 1 7 1 magnification it is possible to determine which type of implant can be placed in the available bone volume When the practitioner does not know the magnification of the X ray or to avoid any mistakes he may place a reference object with known dimensions in the mouth of the patient when performing the X ray examination in order to determine the associated magnification Lu dimensions of the reference object measured on the radiograph Magnification LL real dimensions of the reference object The real dimensions of the reference object shall be known to a minimum accuracy of 15um The reference object shall be held in position using wax for example or by embedding the object in a partial impression Care should be taken for the patient not to swallow the reference object
13. gration However the dentist must be able to analyze if the A in case of failure To remove an implant use a trephine with a greater diameter than the implant and remove the obtained bone cylinder The site can possibly be re implanted if the patient is fit to receive a new implant with an implant of greater diameter in the case that the placement of this implant occurs at the same time conditions of the clinical case are appropriate to an immediate loading Studies and scientific datas indicate that immediate loading has proven to be successful at the mandibular when the prosthesis is built on 4 implants or more linked together Immediate loading is not recommended on single implant To put another implant with a smaller diameter it is better to wait for the complete healing of the socket It is important that the reasons of the failure should be analyzed before placing a new implant The doctor decides if it is necessary to use some bone to fill in the socket THE PROSTHESIS euro teknika Cemented PROSTHESIS 1 Seat the titanium abutment on the coronary part of the implant the titanium abutment is provided with grooves to be able to use it as an impression coping 2 Making of the impression gt On the ball of the implant with an elastic impression material In this case withdraw the impression and insert the analog of the ball abutment directly in the impression intray gt On the tita
14. ith the greatest care so that the implant does not come in contact with any non sterile element before insertion in the bone site The cap of the implant tube can be used as an implant carrier Take the implant to the implant bed and insert it at the entrance of the well Screw some turns of threading Remove the cap and finish the screwing with the click wrench provided with the internal hexagonal key For a good positioning in with the contra angle we recommend a speed of 15 to 25 rpm to control the descent of the implant The positioning with the contra angle allows to measure the insertion torque of the implant and to evaluate its primary stability We recommend to set the implant at minimum 30 N cm for a delayed loading and higher than 40 N cm for early or immediate loading It is recommended to check the primary stability of the implant at the end of the screwing by trying to move tt If the implant is loose its primary stability is insufficient and will compromise the osseointegration it is better to remove it and to use an implant with a greater diameter if the bone volume allows tt JT Osseointegration The conventional period to get a good osseointegration IS 8 months at the mandibular The dentist must define this period by taking into account the bone quality the implant primary stability and the prosthetic plan In certain cases the dentist can decide to connect the prosthetic parts without waiting for the osseointe
15. ly once the osseo integration of the implant ended that is under a period from 3 to 6 months according to the arch Maximum burying of the neck 0 6 mm In spite of the one piece design of the implant the immediate loading is not compulsory possibility of leaving a prosthesis out of occlusion or in case of removable prosthesis not connecting ball abutments with the overdenture during the time necessary for the osseointegration However because of the non burying of the implant and its small diameter a precise analysis of the efforts applied to the implant and their distribution must be led to appreciate at best the feasibility of such a treatment The classification of osseous structures 1 very high density of compact bone 2 thick layer of cortical bone around a dense core of spongious tissue 3 thin layer of cortical bone around a big core of spongious tissue 4 thin layer of cortical bone around a big core of low density of spongious tissue important quality of remaining alveolar bone limited resorption of the alveolar bone crest important resorption of the alveolar bone crest beginning of the basal resorption bone important resorption of the basal bone Misch 1998 Lekholm and Zarb 1985 Classification of partially edentulous arches for implant dentistry Guide for the IMPLANTS CHOICE Available bone volume In the mesio distal plan Leave 2 mm between the implant s thread
16. n demand with a prosthetic part or an attachement A For cementer or removable prosthesis in case of important gingival thickness A reliable solution for OVERDENTURE STABILIZATION For thin edentulous crest as an economical solution for some patients or for patients who do not accept implant treatment that requires several surgeries J Click l l euro teknika GROUPE OBI implant Minimal spacing CASES The implant is well suited when Naturex O 3 2 2 implant is too large for the available bone space Implants PICTURES h 6 5 mm Etching Ceramic blasting Thread Commercial lenght OE ae Gingival cutter BE A are Example of insertion for a 11 mm long implant the same as for the other lengths of implants Surgical PROTOCOL IMPLANTS G 2 7 Ig 9 11 13 15 mm D4 D3 D2 D1 DRILL Gingival cutter to guide the drill OPTIONAL DRILL euro teknika GROUPE Protocol STEP BY STEP According to the available osseous volume and to the practitioner experience the incision will be practised Either with a blade of scalpal Make a crestal incision through the attached jaw and then lift a flap Either with a gingival cutter supplied in the surgical kit Center the gingival cutter on the site to be implanted and press remove the gingival piece in the center of the gingival cutter put back the punch in place by checking its angular orientation beca
17. nical advice in this manual are given solely as a guideline and cannot give rise to any claims All the essential information is indicated in the instruction for use supplied with products We have taken great care in the design and production of our products However we reserve the right to bring modifications or improvements arising from new technical developments in our implantology system We will advise of any modifications having an implication in the operation mode According to the importance of the modifications a new manual will be issued Indeed a mark on the back page indicates the date of issue of your surgery manual and enables us to check if you have the latest up date version You will also be able to access our web site to check the latest version of this manual The reproduction and distribution of all or part of this manual need previous agreement from euroteknika groupe GENERAL INFORMATION euro teknika General INFORMATIONS IMPLANT preferred usages Lack of retention of a prosthesis Instability of a prosthesis Functional discomfort with the prosthesis Psychological refusal of the wearing of a prosthesis Parafunctional practices which compromise the stability of a prosthesis Inadequate localization and number of remaining abutments The Obi implant implant is a trans muscous Conceived to be placed in one surgical operation its characteristics give it a greater primary stability so as
18. nium abutment withdraw the impression and place the ball implant analog in the abutment and then in the impression intray 3 Remove the impression At this stage a temporary tooth can be made to protect the implant and to propose a temporary aesthetic solution the temporary tooth is left out of occlusion in order not to damage osteo integration 4 Casting of the model LV use of the TITANIUM ABUTMENT 5 a Seat the titanium abutment on the analog head in the model in a conventional way the plane will be presented on the palatal side The titanium abutment has been designed to be as small as possible and cannot be cut If alterations are necessary we recommend you to use the burn out abutment see b G a Put one or two coats of separator 7 a Model the wax model 8 a Casting 9 a The ceramic part is shaped fired and tried on the model 10 2 Cement the titanium abutment on the implant then cement the prosthesis on the titanium abutment LV use of the BURN OUT ABUTMENT NOTE Only implants OIC 27 85 090 OIC 27 85 110 OIC 27 85 130 and OIC 27 85 150 allowed for this application 4 5 b Seat the burn out abutment on the analog head taken in the model its outline can be modified as often as you wish by the process of added wax The line of gingival finish can so be customized and answer many clinical situations particularly when the festoon is curved and irregular 6 b Modelling of the wax model
19. rtance and underlines even more the difference between the beginner and the specialist euro teknika GROUPE naan Warning p 6 General information p 07 to 10 Pre implant study p 11 to 14 Surgery p 15 to 22 SURGICAL KIT PRESENTATION p 16 IMPLANT SITE PREPARATION p 17 IMPLANTS PRESENTATION p 18 SURGICAL PROTOCOL p 19 The prosthesis p 23 to 25 CEMENTED p 24 REMOVABLE p 25 euro teknika ejido tl 15 The placement of euroteknika groupe implants must be done by a practioner who has been previously trained for the dental implantology technigues and in aseptic conditions specific to this type of treatment The following instructions will guide you throughout the different stages of your implantology treatments They contain advice as precise as possible but cannot be used as recipes every clinical situation must be evaluated for each patient A great number of factors acts independently to obtain success in an implantology treatment It is up to the practioner to recognize the key factors and to use his clinical experience Among other aspects the coordination between the prosthesis laboratory dental technician and the practioner must be perfect so as to give the global treatment plan more consisting Only the practioner remains responsible for his different choices and decisions as to the treatment s feasibility implants prosthetic parts materials used and settings The technical specifications and cli
20. the implant analogs in the impression 4 5 Cast the model 5 B Snap the female parts G B The prosthesis is made by means of teeth in resin positioned in the wax according to the same process as a complete prosthesis in exclusively mucous support 7 B The prosthesis is placed on the articulator to check the occlusion and the positioning of teeth adjustments if necessary 8 5 Put in the casting flask 9 5 Try the prosthesis on the model 10 5 Snap the prosthesis on the implants in the mouth teknika GROUPE umi Z MM euro STUDIES 8 PUBLICATIONS Les proth ses ost o int gr es Br nemark Zarb Albrektsson Quintessence Osseointegrated implants in the treatment of th edentulous jaw Experience from a 10 years period Branemark Hansson Adell Breine Lindstrom Hallen Ohman Almqvist and wiksell international Stockholm The Branemark osseointegrated implant Albrektsson Zarb Quintessence Osseointegration in oral rehabilitation Naert Jan Steenberghe Wortington Quintessence Limplantation en 1985 Desespoir ou des espoirs Analyse exhaustive de la methode de Branemark Experience clinique de 5 ann es GUY HURE Enclyclopedie m dico chirurgicale Odontologie 9 1989 23345 A Th rapeuthique implantologigue Endo osseuse originale Le site Tubero pterygo dien GUY HURE Les cahiers de proth se n 67 Septembre 1989 propos de l tat de surface
21. to perform immediate loading when the practioner consider that all the necessary conditions for this sort of accelerated treatment are present Implantation optimization Its small diameter and its reduced price allow to use it where a traditional implant is too voluminous lt is the case of central incisors or to use it as a supplement to the classic implants to give more support to the prosthesis Thanks to its burn out abutment it also allows to replace 2 roots of the same tooth for molars for instance Narrow mesio distal edentulous spaces Lack of dental abutment to perform a fixed prosthesis Edentulous area with healthy adjacent teeth Request for a treatment preserving the adjacent healthy teeth Dental agenesis Request for a preservation treatment reffusal of alteration of healthy teeth Overdentures stabilization On the narrow alveolar ridges and patients unable to afford full sized root form implants or prefer not to have several surgeries 2 to 4 OBI implants enable to stabilize an overdenture Temporary implant Their small diameters allow the practitioner to place mini implants between definitive implants within the same surgical time Whereas the latter will be buried mini implants will allow a provisory prosthesis to be seated thus bringing an esthetic solution to the patient while respecting necessary time for osseointegration of main implants Replacement of a central lower incisor or of a
22. use it will determine the drilling axis T Drill diameter 2 MM If the incision was carried by means of the gingival punch the drill 2 mm will be inserted into the central hole of the punch which will be used as a guide and will allow to stabilize the working axis of the drill at the time of the site shaping It will then be correctly dimensioned Check that the axis given by the mandrel of the drill is satisfactory before starting the motor Remove the punch after having made a first hole 3 or 4 mm deep The implants lengths 9 11 13 and 15 mm correspond to the threaded and_ sandblasted lengths but do not include the collar which will be placed over the crest p 21 BE CAREFUL Save a minimum space around the implants according to the rules of implantology In the labio lingual or palatal direction save 1 5 mm to 2 mm of bone In the mesio distal plan save 2 mm between a natural tooth amp the implant thread or 3 mm between 2 implants threads Finalize the drilling up to the determined mark on the drill under constant external irrigation of sodium chloride and at a speed ranging from 1000 to 1200 rpm according to the quality of the bone The progress of the drill has to be made without forcing If that was the case it indicates that osseous fragments do not manage to evacuate by going back up along the helix A simple up and down movement will allow to obtain a fluids progress of the drill Be careful
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