TeethXpress. immediate load solutions. before TeethXpress. after TeethXpress

Transcription

1 TeethXpress immediate load solutions before TeethXpress after TeethXpress

2 TeethXpress immediate load solutions Laser-Lok technology creates a connective tissue seal and maintains crestal bone Intelligent component design for restorative flexibility and ease of use Optimized buttress threads engineered for superior stability essential for immediate load Faster osseointegration1 and superior bone maintenance from Laser-Lok implants TeethXpress benefits: reliable, predictable protocol that minimizes chair time implants and prosthetics designed to treat complex edentulous cases stability and predictability from a biomechanically driven protocol reduced treatment time compared to traditional hybrid restorations Multi-unit Components Tapered Internal & Tapered Plus TeethXpress Planning 7-12 TeethXpress Surgery TeethXpress Restoration Post-op Care 19

3 multi-unit abutments Straight Multi-unit Abutments 3.0mm platform 3.5mm platform 4.5mm platform 1mm collar 2mm collar 3mm collar 4mm collar 5mm collar TP3MU1 TP3MU2 TP3MU3 - - PYMU1 PYMU2 PYMU3 PYMU4 PYMU5 PGMU1 PGMU2 PGMU3 PGMU4 PGMU5 4.5mm 1mm 2.2mm 4.5mm 2.2mm 2mm 5.7mm platform PBMU1 PBMU2 PBMU3 - - Straight Multi-unit abutments may be used for multiple-unit restorations including: screw-retained restorations at the abutment level, cast alloy bars for overdentures and fixed/detachable (hybrid) restorations. Comes with a cover cap (PXMUCC). Final torque: 30 Ncm using a Multi-unit Hex Adapter. Titanium alloy. 17 Angled Multi-unit Abutments 3.0mm platform 2.25mm collar 3mm collar 4mm collar TP3MU172 TP3MU mm mm mm platform PYMU172 PYMU173 PYMU mm 3mm 4.5mm platform PGMU172 PGMU173 PGMU Angled Multi-unit abutments may be used to angle-correct divergent implants. Use for multiple-unit restorations including: screw-retained restorations at the abutment level, cast alloy bars for overdentures and fixed/detachable (hybrid) restorations. Comes with a cover cap (PXMUCC) and abutment screw (PXMUAS). Final torque: 30 Ncm. Titanium alloy. Conveniently deliver abutment one-handed using an.050 hex or Unigrip driver or two-handed using an angled Multi-unit carrier (MUCA). 30 Angled Multi-unit Abutments 3.0mm platform 3.5mm platform 3mm collar 4mm collar 5mm collar TP3MU303 TP3MU304 - PYMU303 PYMU304 PYMU mm 30 3mm 4.5mm 30 4mm 4.5mm platform PGMU303 PGMU304 PGMU Angled Multi-unit abutments may be used to angle-correct divergent implants. Use for multiple-unit restorations including: screw-retained restorations at the abutment level, cast alloy bars for overdentures and fixed/detachable (hybrid) restorations. Comes with a cover cap (PXMUCC) and abutment screw (PXMUAS). Final torque: 30 Ncm. Titanium alloy. Conveniently deliver abutment one-handed using an.050 hex or Unigrip driver or two-handed using an angled Multi-unit carrier (MUCA). 1

4 MULTI-UNIT COMPONENTS Multi-unit Copings PXMUTC PXMUGC Titanium Gold Custom Castable Use for fabricating acrylic temporary and final prostheses. May be trimmed for height. Packaged with prosthetic screw (PXMUPSR). Titanium alloy. 12mm 4.5mm to top of screw Use for fabricating metal-reinforced acrylic prostheses or bar overdentures. May be trimmed for height. Packaged with prosthetic screw (PXMUPSR). Coping has a gold alloy base with acetal resin (Delrin or Pomalux ) sleeve. 12mm 4.5mm to top of screw PXMUPC PXMUPFC Plastic Custom Castable Passive Fit Use for fabricating metal-reinforced acrylic prostheses or bar overdentures. May be trimmed for height. Packaged with prosthetic screw (PXMUPSR). Acetal resin (Delrin or Pomalux ) 12mm 4.5mm to top of screw Use for fabricating metal-reinforced acrylic prostheses or bar overdentures, cemented using the passive-fit technique. May be trimmed for height. Packaged with regular and long prosthetic screws (PXMUPSR, PXMUPSL). Coping has a titanium alloy base with acetal resin (Delrin or Pomalux ) sleeve. 12mm 4.5mm to top of screw Multi-unit Locators LMUTC-2 Locator Multi-unit Abutment w/ Ti Collar (2 pack) LMUTC-10 Locator Multi-unit Abutment w/ Ti Collar (10 pack) Use Male Processing Package for these collars (LMPP-2 or LMPP-10). 4.3mm 3mm LMUDC-2 Locator Multi-unit Abutment w/ Delrin Collar (2 pack) LMUDC-10 Locator Multi-unit Abutment w/ Delrin Collar (10 pack) Use Locator Multi-unit Bar Processing Package listed below for these collars. Abutment w/ Ti Collar Abutment w/ Delrin Collar LMUBPP-2 LMUBPP-10 Locator Multi-unit Bar Processing Package (2 pack) Locator Multi-unit Bar Processing Package (10 pack) Locator attachments for multi-unit abutments have been designed as a free-standing option (LMUTC) for the angled multi-unit posterior sites and for castable bar-splinted applications (LMUDC). The Locator Multi-unit Bar Processing Package includes Denture Cap with Yellow Bar Processing Male, Dual Retentive Replacement Males: Clear, Pink, Blue, and Block-Out Spacer. Offered in 2 packs and 10 packs. For complete instructions, visit the Zest Anchors web site. 2

5 MULTI-UNIT COMPONENTS Multi-unit Impression Copings PXMUDC Direct Pick-up Coping, Multi-unit Use to make a direct pick-up impression (open-tray) at the abutment level. Packaged with a prosthetic screw, long (PXMUPSL). Titanium alloy. Hand tighten. PXMUIC Indirect Transfer Coping, Multi-unit 18mm Use to make an indirect transfer (closed-tray) impression at the abutment level. Titanium alloy. Hand tighten. 9mm 8mm Direct Pick-up Indirect Transfer Multi-unit Coping Screws PXMUPSR PXMUPSL PXMUPSR25 Prosthetic Screw, Multi-unit, Regular (pack of 5) Prosthetic Screw, Multi-unit, Long (pack of 5) Prosthetic Screw, Multi-unit, Regular (pack of 25) 17mm For attaching copings to the Multi-unit abutments. Hand-tighten or torque to 15 Ncm with.050 (1.25mm) Hex Driver or Unigrip screw driver, depending on application. Titanium alloy. Included with copings where indicated but can also be ordered separately. Multi-unit Angled Abutment Screw & Abutment Carrier PXMUAS PXMUAS25 Abutment Screw, Multi-unit Abutment Screw, Multi-unit (pack of 25) For angled Multi-unit abutments only. Final torque: 30 Ncm with.050 (1.25mm) Hex Driver or Unigrip screw driver. Titanium alloy. Included with abutment but can also be ordered separately. MUCA Angled Multi-unit Abutment Carrier (pack of 3) Use to deliver angled Multi-unit abutments to the surgical site. Titanium alloy. 24mm 3

6 MULTI-UNIT COMPONENTS Multi-unit Cover Cap PXMUCC Cover Cap, Multi-unit Packaged with all Multi-unit abutments. Hand-tighten with.050 (1.25mm) Hex Driver or Unigrip screw driver. Titanium alloy. Multi-unit Abutment Replica & Protection Analog PXMUAR Abutment Replica, Multi-unit Use at lab to represent the Multi-unit/Implant assembly in the working cast. Not for use with implant-level impressions. Titanium alloy. PXMUPA Protection Analog, Multi-unit (pack of 5) Use to protect abutment-coping interface when polishing the metal framework. Titanium alloy. Multi-unit Try-in Abutments Multi-unit Try-in Abutments may be used to measure tissue thickness and verify proper prosthetic seating prior to final abutment seating. TRYTP3MU TRYPYMU TRYPGMU TRYPBMU 3.0mm Multi-unit Try-in Straight Abutment 3.5mm Multi-unit Try-in Straight Abutment 4.5mm Multi-unit Try-in Straight Abutment 5.7mm Multi-unit Try-in Straight Abutment 5mm 4mm 3mm 2mm 1mm Each Try-in is laser marked from 1mm to 5mm to correspond with the Straight Multi-unit Abutment collar heights and can also be used as a measuring tool for other abutment types. Try-in can be carried to the site by hand or with an.050 hex driver and snaps into the implant. Straight abutment Laser marking TRYTP3MU17 TRYPYMU17 TRYPGMU17 TRYTP3MU30 TRYPYMU30 TRYPGMU30 3.0mm Multi-unit Try-in 17 Angled Abutment 3.5mm Multi-unit Try-in 17 Angled Abutment 4.5mm Multi-unit Try-in 17 Angled Abutment 3.0mm Multi-unit Try-in 30 Angled Abutment 3.5mm Multi-unit Try-in 30 Angled Abutment 4.5mm Multi-unit Try-in 30 Angled Abutment Each Try-in is laser marked to correspond with the Angled Multi-unit Abutment collar heights. Try-in is carried to the site by the handle and snaps into the implant. 4mm 3mm 2.25mm 17 Angled Abutment Laser marking 5mm 4mm 3mm 30 Angled Abutment Laser marking 4

7 PROSTHETIC INSTRUMENTATION Paralleling Pins Straight Parallel Pins 20º Angled Parallel Pin 30º Angled Parallel Pin Use parallel pins to assess implant angulation and estimate which angled abutment is appropriate for the restoration. Multi-unit Hex Adapters for Straight Abutments PXMUHAM Manual Multi-unit Hex Adapter Use to hand tighten straight Multi-unit abutments. PXMUHAH Handpiece Multi-unit Hex Adapter Use to torque straight Multi-unit abutments. Driven by latch-type handpiece. Do not exceed 30 Ncm. PXMUHAR 4mm Square Multi-unit Hex Adapter Use to torque straight Multi-unit abutments. Driven by 4mm square drive handwrench, ratchet, or torque wrench. Do not exceed 30 Ncm. Manual Handpiece 4mm Square Torque Wrenches ATW AGYR ITL Precise Adjustable Torque Wrench Place both implants and abutments with 9 distinct torque settings (15, 20, 25, 30, 35, 40, 45, 50 and 60 Ncm). A simple twist of the handle locks in precision-engineered torque values and guarantees accuracy and repeatability. Use with 4mm square drive instruments. EL-C12374 Elos Adjustable Torque Wrench Lightweight titanium design is easy to use as an adjustable torque wrench or a ratchet. Quickly disassembles for cleaning. No calibration required. Torque Control Ergonomic design is the ideal solution for access to screws placed in the posterior. The 7 predetermined torque values (10, 15, 20, 25, 30, 32 and 35 Ncm) make it a tool of extreme precision..050 (1.25mm) Hex Drivers * * * Manual Hex Driver, Short Manual Hex Driver Manual Hex Driver, Long Handpiece Hex Driver Handpiece Hex Driver, Long 4mm Square Hex Driver 4mm Square Hex Driver, Long 4mm Square Hex Driver, Extra Long For installation and removal of cover caps, prosthetic and abutment screws. 6.5mm 8.5mm 13.5mm 6.5mm 11.5mm 6.25mm 12.5mm 19mm Manual Handpiece 4mm Square * Instrument o-rings & c-rings wear out over time. If an instrument is no longer held securely by its associated driver, order a replacement ring through Customer Care. 5

8 Tapered Internal & Tapered Plus BioHorizons Tapered dental implants provide excellent primary stability, maximum bone maintenance and soft tissue attachment for optimal esthetics. The Tapered implant achieves these benefits from its anatomically tapered dental implant body, aggressive buttress threads and advanced Laser-Lok surface technology. The deep 1.5mm internal hex connection with a lead-in tapered bevel create a rigid connection and a stable biologic seal. Mount-free Tapered Internal Implants body diameter 3.0mm 3.4mm 3.8mm 4.6mm 5.8mm prosthetic connection 3.0mm 3.0mm 3.5mm 4.5mm 5.7mm Laser-Lok zone 2.1mm 1.8mm 1.8mm 1.8mm 1.8mm apical diameter 2.0mm 2.4mm 2.8mm 3.1mm 3.9mm 7.5mm length TLX4607 TLX mm length TLX3409 TLX3809 TLX4609 TLX mm length TLX3010 TLX3410 TLX3810 TLX4610 TLX mm length TLX3012 TLX3412 TLX3812 TLX4612 TLX mm length TLX3015 TLX3415 TLX3815 TLX4615 TLX mm length TLX3418 TLX3818 TLX4618 Expanded Laser-Lok zone with no smooth, machined area. Resorbable Blast Texturing (RBT) on implant body. Packaged mount-free for quick placement and maximum site visibility. Comes packaged with a Cover Cap. Titanium Alloy (Ti-6Al-4V ELI). Tapered Plus Implants body diameter 3.8mm 4.6mm 5.8mm prosthetic connection 3.0mm 3.5mm 4.5mm Laser-Lok zone 1.8mm 1.8mm 1.8mm apical diameter 2.8mm 3.1mm 3.9mm platform switch 0.4mm 0.5mm 0.6mm 7.5mm length TLXP4607 TLXP mm length TLXP3809 TLXP4609 TLXP mm length TLXP3810 TLXP4610 TLXP mm length TLXP3812 TLXP4612 TLXP mm length TLXP3815 TLXP4615 TLXP5815 Laser-Lok collar with Resorbable Blast Texturing (RBT) on implant body. Mount-free for quick placement and maximum site visibility. Comes packaged with a Cover Cap. Titanium Alloy (Ti-6Al-4V ELI). Laser-Lok zone platform switch prosthetic connection body diameter implant length 6

9 TeethXpress Planning Immediate load should only be performed by a qualified, medical professional after the science behind the technique is firmly understood. Prior to performing the technique, the clinician should understand the differences between immediate load and the Brånemark loading protocol. Patient Selection 1. Dentition Requirements A) Fully edentulous or B) Multiple hopeless teeth If lesions of endodontic origin are present, avoid immediate implant placement and consider extraction and socket preservation with MinerOss. If no lesion of endodontic origin is present, the patient should be assessed for immediate implant placement and immediate loading. 2. Evaluate Medical History Follow a routine protocol for standard dental implant patients. 3. Analyze the Anatomy Mandibular Treatment Assess the height of the ridge between the two mental foramina. At least 12mm of bony height from the crest of the ridge to the inferior border of the mandible required (Figure 1). 12mm Patients with a larger frame may warrant a minimum of 14mm in vertical height Figure 1 Tip: Ideally, 10-12mm of implant surface should be in bone (Figure 2). If an implant with a Laser-Lok collar is being used, you will have the option of either sinking the Laser-Lok surface in the bone or leaving it above the bone. If a tissue level implant with a polished collar is being used, the polished titanium must be left above the bone. If a portion of the implant will be above the bone, consider a longer implant to achieve the goal of 10-12mm implant/bone interface mm At least 5mm of ridge width (buccal/lingual) is recommended. Maxillary Treatment Assess the height of the ridge within the intercanine space. At least 12mm of bony height from the crest of the ridge to the floor of the nose is required (Figure 3). Figure 2 At least 5mm of ridge width (buccal/lingual) is recommended. Assess the bone posterior to the canine area for possible implant placement. A minimum implant length of 9mm is recommended. 12mm If there is insufficient vertical height, sinus augmentation should be considered and delayed loading is recommended. Figure 3 7

10 TeethXpress Planning Patient Selection 4. Assess Smile and Gingival Exposure Evaluate the height of exposed gingiva with a full smile (Figure 4). Tip: To obtain the proper esthetics, consider an alveoplasty to hide the patient s gingiva at full smile without compromising the implant length requirement. Evaluate for appropriate lip support and nasolabial angle. Tip: Contour the prosthesis as necessary to achieve an appropriate esthetic outcome. Figure 4 5. Consider the Biomechanics Determine the patient s arch shape: Ovoid arch: Produces a favorable Anterior-Posterior (AP) spread. posterior Square arch: Limits the AP spread (Figure 5). If there is sufficient posterior height over the inferior alveolar nerve in the mandible or below the maxillary sinus in the maxilla, consider implant placement in the posterior area to increase the AP spread for better biomechanics (Figure 6). Figure 5 anterior limit for cantilever posterior line anterior line Tip: If there is limited vertical height in the posterior, consider placing a 7.5mm or 9mm Laser-Lok Complete implant. In extreme cases, consider placing Laser-Lok implants supracrestally. Patients with parafunctional habits, severe prognathic or retrognathic jaw relationships are not ideal candidates for immediate load procedures. posterior distal extension with short implants 6. Determine Patient Compliance Ensure the patient has adequate dexterity and sufficient oral hygiene to clean a fixed screw-retained prosthesis. Figure 6 anterior posterior line anterior line 8

11 TeethXpress Planning Pre-surgical Workup 1. Occlusal Considerations 1a) If the patient has a complete set of maxillary and mandibular dentures: Assess for balanced or lingualized occlusion. If teeth are already set in lingualized occlusion, proceed with further assessment of existing denture. Check the existing denture for excessive wear. Consider modifying the denture teeth if they are fully anatomic (>30 degree or higher) and set in a physiologic balanced occlusal scheme. Use a silicone polisher to reduce the cusp angulation of the lower posterior teeth to semi-anatomic or flat. Make sure there are no buccal cusp contacts in lateral excursions. Another alternative is fabricating a new denture. Ensure the denture maintains a proper Vertical Dimension of Occlusion (VDO). Maxillary denture esthetics: i. Ensure appropriate lip support and nasolabial angle from the prosthesis. ii. Tooth display should be between 0-3mm for older aged men and 2-6mm for older to middle-aged women. Phonetics: i. While making the V sound, incisal edges should gently touch the dry/wet line of the lower lip. ii. Maxillary incisal edges should be slightly anterior to the dry/wet line with F sounds. iii. Evaluate the patient s ability to clearly pronounce the S sound. If the patient whistles, the patient may have excessive freeway space. If there is a clicking noise between the dentures during conversation, the patient has limited freeway space. In either case consider fabricating a new denture. 1b) If only a single arch prosthesis is planned: Assess the contralateral arch to ensure the teeth are aligned prior to surgery. If the plane of occlusion is acceptable, continue to the next step. If the opposing teeth do not have a level plane of occlusion, consider additional restorative or prosthetic procedures to improve the bite prior to surgery. 9

12 TeethXpress Planning Pre-surgical Workup 2. Prepare Surgical Guide Use the current denture as a surgical guide, or fabricate a surgical guide by duplicating the existing denture. 2a) Mandible Mark the midline. Figure 1 7mm Consider using a paralleling tool to prepare all of the osteotomies in their proposed positions. Plan the distal implants in the anterior region of the mandible 7mm anterior to the mental foramen (Figure 1). Tip: The mental nerve typically makes a mesial loop 5-6mm from the mental foramen Plan the anterior implants halfway between the distal implants and the midline (Figure 2). Figure 2 After four implants are planned, evaluate for appropriate AP spread. If AP spread is adequate, consider placing a fifth implant at the midline for greater mechanical support (Figure 3). If AP spread is not adequate with four implants, consider placing two additional implants distal to the mental foramina to expand the AP spread (Figure 4). Tip: Fabricating a fixed, screw-retained prosthesis with 4-5 implants is possible (if AP spread is adequate) but will have higher biomechanical risk. Placing a minimum of six implants may be a more predictable treatment protocol in both the mandible and maxilla. Figure 3 If the vertical bone height above the mandibular nerve is adequate, place two 10.5mm implants. Tip: If there is a vertical bone deficiency, plan for two 9mm or 7.5mm Laser-Lok Complete implants. In extreme cases, consider placing Laser-Lok implants supracrestally. Figure 4 10

13 TeethXpress Planning Pre-surgical Workup 2b) Maxilla Mark the midline. When placing in the maxilla, plan for a minimum 6 implants. posterior implants To maximize the AP spread, plan the first two implants in the 1st or 2nd premolar regions symmetric to the midline (Figure 6). Figure 6 Plan the two anterior implants halfway between the distal implants and the midline (Figure 7). anterior implants The furthest two distal implants should be planned in the 1st or 2nd molar regions to eliminate the cantilever (Figure 8). Verify there is 10-12mm of vertical bony height from the crest of the ridge to the maxillary sinus. Figure 7 Tip: If there is not 10-12mm of vertical bony height for the furthest distal implants, sinus augmentation will be required. Delayed loading is recommended. 2c) Mandible or Maxilla molar implants Fill the proposed maxillary or mandibular sites within the surgical guide with a radiopaque material (e.g., gutta percha). Figure 8 Take a panoramic x-ray. Tip: If the proposed locations violate any anatomical landmarks (i.e. mental foramen or maxillary sinus), do not continue with this treatment modality. Consider moving the implants anterior or posterior to prevent harm to the patient. Also remember the AP spread cannot be compromised. Use a 2.5mm pilot drill to make a hole through the denture base at the determined implant locations (Figure 9). Figure 9 11

14 TeethXpress Planning Pre-surgical Workup 3. Create Occlusal Index Make an occlusal index of the denture occlusion. This index will be used the day of surgery (Figure 10). 4. Coordinate Treatment Timing Coordinate the proper timing of the surgery and delivery of the prosthesis with the restorative dentist. Figure Order Required Components Key Surgical Components Required Internal or Tapered Internal implants and surgical kit Multi-unit abutments Multi-unit drivers Calibrated torque wrench Key Restorative Components and Materials Self-curing acrylic or similar pick up material Rubber dam Titanium copings (PXMUTC) Bite registration material.050 hex drivers with 4mm square, long ( ) Micro applicators Two small rubber mixing cups Cotton pellets Cotton rolls Titanium abutment adjustment burs Calibrated torque wrench or prosthodontic screwdriver Articulating paper and forceps Tissue conditioner and soft liner #8 laboratory round bur 6. Schedule Laboratory Technician Office Visit Arrange for a laboratory technician to perform all modifications the day of surgery, including coping adjustment, polishing and finishing of the prosthesis. 12

15 TeethXpress Surgery Mandibular Surgery 1. Insert the surgical guide (existing denture or duplicated denture) into the patient s mouth, check the fit, and remove. 2. Anesthetize the patient and reinsert the surgical guide. Using the 2.5mm drill, drill through the guide, through the soft tissue and continue for at least 5mm into the bone (Figure 1). 3. Remove the guide. Make a crestal incision, develop a full thickness mucoperiosteal dissection, and expose the crest of the ridge (Figure 2). Figure 1 4. Mark the location of the implants with an indelible marker. Maintain that position by repeated use of the indelible marker if an alveoplasty is performed. 5. Extract the remaining teeth if dentate. If a lesion of endodontic origin is present within an extraction socket, do not immediately place an implant into the site. Tip: In this scenario perform an alveoplasty, socket preservation with MinerOss and suture the gingiva. Reline the denture with tissue conditioner prior to dismissing the patient. Figure 2 6. Consider an alveoplasty to: A) Widen the bony platform for ease of implant placement. B) Evenly contour the ridge to allow the prosthetic platform of all the multi-unit abutments to be at the same level. Leave sufficient bone for implant placement. Tip: Use a carbide bur to perform the alveoplasty. 7. If using a paralleling tool, mark the midline with a starter drill. Use the paralleling tool to prepare all of the osteotomies in their proposed positions. Figure 3 8. Use the surgical guide again to verify the trajectory of the anterior implants are lingual enough to have the lingual access holes of the supporting abutments in the cingulum of the anterior teeth (Figure 3). Tip: The trajectory of the anterior implants should be tilted slightly toward the lingual to ensure the lingual access holes will not be under the incisal edge of anterior teeth. If angulation needs to be corrected after the implants are placed, consider using angled multi-unit abutments to redirect the access holes. (Figure 4). Figure 4 13

16 TeethXpress Surgery Mandibular Surgery 9. Create osteotomy using standard surgical protocol. Place the implants into the prepared osteotomies. 10. If the AP spread is sufficient, plan for and place a 5th implant in the midline to enhance support for the prosthesis. The midline implant must be parallel to the previously placed implants (Figure 5). 11. If the AP spread is insufficient, place implants in the first molar area bilaterally to enhance the biomechanical aspect of the prosthesis (Figure 6). Figure Evaluate the primary stability of the implant using your preferred method: A) Measure the insertion torque value. A minimum of 35 Ncm is recommended. B) Use your clinical judgment. Determining primary stability is the most important element in the decision-making process. 13. If the primary stability is adequate, place multi-unit abutments using the color-coded carrier. Once seated, remove the carrier by bending it until it releases from the abutment (Figure 7). Complete abutment delivery by hand tightening using a manual multi-unit hex adapter. Do not overtighten. If you need to change the abutment to a different size, removing an overtightened abutment could compromise the stability of the implant. After healing has occurred, but prior to the delivery of the final prosthesis, the abutments should be tightened to 30Ncm. Tip: Choose the height of the multi-unit abutment according to the thickness of gingiva. The prosthetic platform of the abutment should be 2mm above the gingiva. Figure 6 Figure Suture the gingiva with a resorbable suture material and proceed to TeethXpress restoration. 15. If primary stability is not achieved, place cover caps, suture incisions with a resorbable material, reline the denture with a tissue conditioner and utilize a delayed approach (Figure 8). Figure 8 14

17 TeethXpress Surgery Maxillary Surgery 1. Insert the surgical guide into the mouth, check the fit and remove. 2. Anesthetize the patient and reinsert the surgical guide. Using the 2.5mm drill, drill through the guide, through the soft tissue and continue for at least 5mm into the bone (Figure 1). 3. Remove the guide. Make a crestal incision, develop a full thickness mucoperiosteal dissection, and expose the alveolar crest (Figure 2). Figure 1 4. Mark the location of the implants with an indelible marker. Maintain that position by repeated use of the indelible marker if an alveoplasty is performed. 5. Extract the remaining teeth if dentate. If a lesion of endodontic origin is present within an extraction socket, do not immediately place an implant into the site. Tip: In this scenario perform an alveoplasty, socket preservation with MinerOss and suture the gingiva. Reline the denture with tissue conditioner prior to dismissing the patient. Figure 2 6. Consider an alveoplasty to: A) Widen the bony platform for ease of implant placement. B) Evenly contour the ridge to allow the prosthetic platform of all the implants to be at the same level. C) Remove excess bony height if the patient s natural gingiva is exposed during full smile. Leave sufficient bone for implant placement. Tip: Use a carbide bur to perform the alveoplasty. Figure 3 7. If using a paralleling tool, mark the midline with a starter drill. Use the paralleling tool to prepare all of the osteotomies in their proposed positions. 8. Use the surgical guide again to verify the trajectory of the anterior implants are lingual enough to have the lingual access holes of the supporting abutments in the cingulum of the anterior teeth (Figure 3). Tip: The trajectory of the anterior implants should be tilted slightly toward the lingual to ensure the lingual access holes will not be under the incisal edge of anterior teeth. If angulation needs to be corrected after the implants are placed, consider using angled multi-unit abutments to redirect the access holes (Figure 4). Figure 4 9. Create osteotomy using standard surgical protocol. Place the implants into the prepared osteotomies. 15

18 TeethXpress Surgery Maxillary Surgery 10. If sufficient bone is present, place two implants into the molar region (Figure 5). Tip: A six implant arrangement is recommended for maxillary cases (Figure 6). However, immediate loading of a four-implant, fixed, maxillary, screw-retained prosthesis is possible as long as the supporting implants are providing adequate AP spread. A four implant fixed screw-retained prosthesis in the maxilla has a higher biomechanical risk. Figure If there is not 10-12mm of bone present for implant placement in the molar regions, sinus augmentation will be required. Evaluate for simultaneous implant placement and sinus lift: A) If only 4-10mm of vertical bony height is present in the molar region, perform a sinus lift and implant placement at the same time. Tip: Do not immediately load the implants if sinus augmentation and implant placement are performed simultaneously. anterior anterior implants posterior implants B) If there is less than 4mm of vertical bony height or primary stability cannot be obtained, do not immediately place the implants. Graft the sinus and place the implants after the graft material has incorporated within the sinus. Figure 6 posterior two short implants as distal stops 12. Evaluate the primary stability of the implant using your preferred method: A) Measure the insertion torque value. A minimum of 35 Ncm is recommended. B) Use your clinical judgment. Determining primary stability is the most important element in the decision-making process. 13. If the primary stability is adequate, place multi-unit abutments using the color-coded carrier. Once seated, remove the carrier by bending it until it releases from the abutment (Figure 7). Complete abutment delivery by hand tightening using a manual multi-unit hex adapter. Do not overtighten. If you need to change the abutment to a different size, removing an overtightened abutment could compromise the stability of the implant. After healing has occurred, but prior to the delivery of the final prosthesis, the abutments should be tightened to 30Ncm. Figure 7 Tip: Choose the height of the multi-unit abutment according to the thickness of gingiva. The platform of the abutment should be 2mm above the gingiva. 14. Suture the gingiva with a resorbable suture material and proceed to TeethXpress restoration. 15. If primary stability is not achieved, place cover caps, suture incisions with a resorbable material, reline the denture with a tissue conditioner and utilize a delayed approach (Figure 8). Figure 8 16

19 TeethXpress Restoration Immediate Loading 1. Verify abutment platforms extend 2mm outside the gingiva. 2mm clearance 2. Using a bite registration material on the tissue side of the denture, make an imprint of the abutment platforms as a reference for drilling holes in the denture base. 3. Use a fissure carbide bur to make a hole through the denture. Next, use a pear shape carbide to enlarge the hole to a desirable size. Figure 1 Tip: All of the holes should be large enough to provide 2mm of clearance between the acrylic and the abutments (Figure 1). 4. Check the occlusion with the pre-surgical bite registration index and ensure the denture fits passively over the abutments. 5. Hand tighten (5-10Ncm) the copings to the abutments (Figure 2). 6. Insert the denture over the copings (Figure 3). Mark the excess height of the copings with a permanent marker for trimming. Mark the copings 1mm shorter than the level of the posterior teeth and the lingual flange in the anterior part of the prosthesis. Figure 2 7. Mount each coping on a multi-unit abutment replica before prepping. 8. Reduce the copings. Cut the anterior copings in a slanted form and the posterior copings completely horizontal (Figure 4). 9. Smooth all the edges and rough surfaces left by the reduction process. Figure Use a silicone polisher to polish the surface and the edges of the copings. 11. Reattach the reduced copings and place a rubber dam to protect the tissue during the acrylic phase (Figure 5). 12. Use the occlusal index once again to make sure the patient can close completely in maximum intercuspation without any interference from the copings. Figure 4 Figure 5 17

20 TeethXpress Restoration Immediate Loading 13. Block out copings with cotton to keep acrylic out of the screw-access channels (Figure 6). 14. Use self-curing acrylic or another pick up material of choice to connect the denture to the copings to be picked up (Figure 7). Tip: All of the copings can be picked up at the same time. However, sometimes it is easier to pick up the central copings first and the lateral copings second. This approach helps you to first stabilize the denture base and then capture the rest of the copings. Figure Before the acrylic sets, have the patient bite down into maximum intercuspation with the pre-surgical bite registration. 16. If only the central copings were picked up prior to this step, capture the remaining copings. 17. After the acrylic is set, remove the cotton from the screw access channels and unscrew the copings from the abutments. Tip: If acrylic has covered up the cotton within the copings, use a round bur to clear out the acrylic and remove the cotton. 18. Remove the denture from the patient s mouth. Add acrylic to any voids around the copings. Figure Shorten the posterior cantilever to comply with the AP spread. 20. Remove the flanges from the denture as well as any contacts between the patient s tissue and the tissue side of denture base. Create a 2mm gap between the inferior border of the denture and the patient s mucosa to allow for appropriate hygiene. 21. Check for lingualized occlusion of the overdenture. Figure Polish and deliver the denture (Figure 8). Hand tighten prosthetic screws (Figure 9). Use of a torque wrench is not recommended until the delivery of the final prosthesis. 23. Place cotton into the screw access holes and seal the openings with a temporary filling or soft reliner. 24. Take a post delivery panoramic x-ray to verify full seating of the prosthesis over the multi-unit abutments. Figure 9 18

21 Post-op Care 1. After a minimum of two months of healing time, all abutments should be tightened to 30Ncm using a multi-unit hex adapter. If angled multi-unit abutments are placed, the abutment screws should be tightened to 30Ncm using a.050 hex driver. All prosthetic screws should be tightened to 15Ncm using an.050 hex driver. 2. For the first two weeks, use a Chlorhexidine mouth rinse only. No brushing or water pick. After two weeks, the patient can begin using a waterpik on a slow speed. 3. The patient has to remain on a soft diet for two months. 4. The prosthesis should not be removed during first two months of the healing phase unless there is an absolute need for it. 5. Prescribe an antibiotic regimen for one week and pain medications as needed. 6. Follow up in one week to ensure there has been no screw loosening or breakage of the prosthesis. 7. A weekly follow-up is recommended for the first month. A final impression can be taken after eight weeks postdelivery of the transitional prosthesis. 19

22 ICON LEGEND & REFERENCES Symbol Descriptions for Product Labeling Prosthetic platform REF LOT Reference/article number Lot/batch number Use before expiration date (YYYY-MM) 4.5 x 2mm Straight Multi-unit Abutment Birmingham, AL USA REF PGMU mm Prosthetic Platform 3.5mm Prosthetic Platform 4.5mm Prosthetic Platform 5.7mm Prosthetic Platform Manufacture date (YYYY-MM) Internal Multi-unit Abutment 4.5 plat, 2mm Collar, Straight LOT YYXXXXX Single use only STERILE R NON-STERILE Rx Only Caution: Federal (USA) law restricts these devices to the sale, distribution and use by, or on the order of, a dentist or physician. Artwork label number Sterile by gamma irradiation Non-sterile YYYY-MM expires YYYY-MM manufacture date STERILE R gamma irradiated Rx Only LPGMU2 Rev A do not re-use see instructions for use 0473 BioHorizons Multi-unit Abut REF PGMU2 LOT YYXXXXX 4.5 plat, 2mm Collar, Straight BioHorizons Multi-unit Abut REF PGMU2 LOT YYXXXXX 4.5 plat, 2mm Collar, Straight 0473 Refer to Instructions for Use BioHorizons products carry the CE mark and fulfill the requirements of the Medical Devices Directive 93/42/EEC EU Authorised Representative Quality First International Suites 317/318 Burford Business Centre 11 Burford Road, Stratford London E15 2ST United Kingdom Tel Telefax Multi-unit abutment carriers are color-coded to match BioHorizons implant prosthetic platforms. To ensure compatibility: (1) determine the BioHorizons implant system from the patient s record (e.g. Internal, Tapered Internal, Laser-Lok 3.0) (2) verify that the prosthetic component is intended for that system (3) match the carrier color with the implant prosthetic platform. References 1. Osseointegration on metallic implant surfaces: effects of microgeometry and growth factor treatment. SR Frenkel, J Simon, H Alexander, M Dennis, JL Ricci. J Biomed Res. 2002:63(6): Heat production by 3 implant drill systems after repeated drilling and sterilization. Chacon GE, Bower DL, Larsen PE, McGlumphy EA, Beck FM. J Oral Maxillofac Surg Feb;64(2):

23 ORDERING & WARRANTY INFORMATION Territory Manager: cell phone: and/or fax: BioHorizons Lifetime Warranty on Implants and Prosthetics: All BioHorizons implants and prosthetic components include a Lifetime Warranty. BioHorizons implant or prosthetic components will be replaced if removal of that product is due to failure (excluding normal wear to overdenture attachments). Additional Warranties: BioHorizons warranties surgical drills, taps and other surgical and restorative instruments. (1) Surgical Drills and Taps: Surgical drills and taps include a warranty period of ninety (90) days from the date of initial invoice. Surgical instruments should be replaced when they become worn, dull, corroded or in any way compromised. Surgical drills should be replaced after 12 to 20 osteotomies. 2 (2) Instruments: The BioHorizons manufactured instrument warranty extends for a period of one (1) year from the date of initial invoice. Instruments include drivers, implant site dilators and BioHorizons tools used in the placement or restoration of BioHorizons implants. Return Policy: Product returns require a Return Authorization Form, which may be acquired by contacting Customer Care. The completed Return Authorization Form must be included with the returned product. For more information, please see the reverse side of the invoice that was shipped with the product. Disclaimer of Liability: BioHorizons products may only be used in conjunction with the associated original components and instruments according to the Instructions for Use (IFU). Use of any non-biohorizons products in conjunction with BioHorizons products will void any warranty or any other obligation, expressed or implied. Treatment planning and clinical application of BioHorizons products are the responsibility of each individual clinician. BioHorizons strongly recommends completion of postgraduate dental implant education and adherence to the IFU that accompany each product. BioHorizons is not responsible for incidental or consequential damages or liability relating to use of our products alone or in combination with other products other than replacement or repair under our warranties. Distributed Products: For information on the manufacturer s warranty of distributed products, please refer to their product packaging. Distributed products are subject to price change without notice. Validity: Upon its release, this literature supersedes all previously published versions. Availability: Not all products shown or described in this literature are available in all countries. BioHorizons continually strives to improve its products and therefore reserves the right to improve, modify, change specifications or discontinue products at any time. Any images depicted in this literature are not to scale, nor are all products depicted. Product descriptions have been modified for presentation purposes. For complete product descriptions and additional information, visit store.biohorizons.com. 21

24 Direct Offices BioHorizons USA or BioHorizons Canada BioHorizons Spain BioHorizons UK +44 (0) BioHorizons Germany BioHorizons Chile +56 (2) BioHorizons Italy Distributors For contact information in our 90 countries, visit BioHorizons, Laser-Lok, MinerOss, AutoTac, Mem-Lok and TeethXpress are registered trademarks of BioHorizons. Unigrip is a trademark of Nobel Biocare AB. Zimmer Dental ScrewVent and Tapered ScrewVent are registered trademarks of Zimmer, Inc. AlloDerm and AlloDerm GBR are registered trademarks of LifeCell Corporation. Grafton DBM is a registered trademark of Medtronic, Inc. Spiralock is a registered trademark of Spiralock Corporation. Pomalux is a registered trademark of Westlake Plastics Co. Locator is a registered trademark of Zest Anchors, Inc. Delrin is a registered trademark of E.I. du Pont de Nemours and Company. Bio-Gide is a registered trademark of Edward Geistlich Sohne AG Fur Chemische Industrie. Not all products shown or described in this literature are available in all countries. As applicable, BioHorizons products are cleared for sale in the European Union under the EU Medical Device Directive 93/42/EEC and the tissues and cells Directive 2004/23/EC. We are proud to be registered to ISO 13485:2003, the international quality management system standard for medical devices, which supports and maintains our product licences with Health Canada and in other markets around the globe. Original language is English. BioHorizons. All Rights Reserved. *L01021* *REV E JUN 2017* L01021 REV E JUN 2017 Made in the USA shop online at store.biohorizons.com