11: Root Form Implant Surgery: Proprietary II

CHAPTER 11 Root Form Implant Surgery: Proprietary II

BIOHORIZONS IMPLANTS

The BioHorizons implant system consists of six styles of titanium alloy implants. These implants, which are threaded (reverse buttress threads), have either resorbable blast texturing (RBT) or a hydroxyapatite (HA) surface coating. The Tapered Internal design also has the proprietary Laser-Lok microchannels. The microchannels are a series of 8- and 12-μm grooves engineered onto the collar of the Internal implants, which come with an abutment and its retaining screw and a healing cover screw. The other implants have a polished collar. All of the implants have a lifetime unconditional restoration-to-implant warranty (Fig. 11-1, A).

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FIGURE 11-1. A, BioHorizons implants. These implants are made of a titanium alloy and have resorbable blast texturizing (RBT) threads (reverse buttress threads) with the proprietary Laser-Lok microchannels. B-E, The osteotomy method follows classic techniques using drills of increasing diameter.

(Courtesy BioHorizons Implant System, Birmingham, Ala.)

Overdenture Implant

The Overdenture implant is an affordable device for patients whose ridges are too narrow for wider, two-piece systems. The Overdenture’s one-piece, titanium alloy construction provides maximum strength, and its 3-mm diameter allows placement in narrow ridges. These implants are placed using a single-stage protocol, with options for either flap or flapless surgery. Each implant is packaged with the complete attachment system, with options for three levels of retention.

External Implant

The External implant features the 3inOne prepable titanium abutment and a 1-mm high external hex. The modified-square threads provide greater bone to implant contact and reverse torque values than V-thread designs. The series is available in four diameters (3.5, 4, 5, and 6 mm) and four lengths in each diameter size (9, 10.5, 12, and 15 mm).

Tapered Internal Implant

The Tapered Internal implant has the proprietary Laser-Lok microchannels and reverse buttress threads on an anatomically tapered implant body. The Tapered Internal Implant also has the 3inOne prepable titanium abutment, with the same 1.5-mm deep internal hex connection as the Internal and Single-stage implants. The Tapered Internal implant is available in three diameters (3.8, 4.6, and 5.8 mm) and five lengths (7.5, 9, 10.5, 12, and 15 mm).

Single-Stage Implant

For the Single-stage implant, the same surgical kit is used as for the Internal (two-stage) implant. The Single-stage also has the same internal hex connection. This allows the clinician to choose the implant design best suited to a particular case. The Single-stage implant is available in four diameters (3.5, 4, 5, and 6 mm) and five lengths (7, 9, 10.5, 12, and 15 mm).

Internal Implant

The Internal implant has the 3inOne prepable titanium abutment, a 1.5-mm deep internal hex connection, and the modified-square thread design. The Internal implant is available in four diameters (3.5, 4, 5, and 6 mm) and five lengths (7, 9, 10.5, 12, and 15 mm).

One-Piece 3.0 Implant

The One-piece 3.0 implant has an integrated crown and bridge abutment. It is specifically indicated for replacement of maxillary laterals and mandibular incisors. This implant allows the dental surgeon to treat spaces that cannot be handled with conventional two-piece implants. The prepable gold-colored titanium nitride coating on the abutment portion also improves soft tissue esthetics. The surgical protocol follows steps similar to those of the other implant lines.

Generic Surgical Protocol for BioHorizon Implants

The generic surgical protocol for BioHorizon implants proceeds through these steps.

1. A No. 6 round bur is used to start the osteotomy.
2. A 2-mm twist drill is used to create the initial osteotomy site to verify the angulation.
3. If the angulation is satisfactory, a 2.5-mm twist drill is used to a depth equal to the length of the implant.
4. The width-increasing drills then are used in ascending order (to the size just thinner than the diameter of the implant), depending on the density of the bone.
5. When the osteotomy is the correct size, the crestal bone drill is used, followed by the bone tap (depending on the bone quality) to complete the fully threaded osteotomy (Fig. 11-1, B to E).

BICON

Since 1985, Bicon implants have been promoted as the short implant of choice for the anatomically challenged areas where there is non-optimal alveolar height present in proximity to the inferior alveolar canal or the maxillary sinus. Implants are available with a grit blasted acid etched surface known as Inegra-Ti or with a calcium phosphate treatment (HA) known as Integra-CP.

In accordance with the manufacturer’s instructions for using a Bicon implant, initial cortical perforation is made with a 2.0-mm pilot drill with external irrigation to a depth 2.0 – 3.0-mm deeper than chosen implant (when practical) (Figure 11-2, A). Widening of the osteotomy is performed with sequentially larger reamers beginning with a 2.5-mm diameter and ending with the diameter of the intended implant (Figure 11-2, B). Reamers have horizontal markings at 6.0, 8.0, 11 and 14 mm, whereas older reamers may have different markings. It is imperative that the depth indicators on the latch reamers are known before surgery. No assumptions should be made about the height of the first marking on any latch reamer. If there is any doubt about the markings on any drill or reamer, take a measurement before using the reamer. Bone may be harvested from within the flutes of the reamers as no irrigation is utilized.

1. Widen the socket with successively wider reamer burs without any irrigation and at a maximum of 50 RPM (Figure 11-2, C).
2. For a one-stage procedure, remove the black healing plug (Figure 11-2, D).
3. Replace the black healing plug with an appropriate temporary abutment (Figure 11-2, E).
4. Insert the implant with abutment into the socket (Figure 11-2, F).
5. Trim tissue if necessary. Wait for a minimum of 10-12 weeks for osseointegration before removing temporary abutment (Figure 11-2, G).
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FIGURE 11-2. Bicon’s one stage surgical technique.

(Courtesy Bicon Dental Implants, Boston, Massachusetts.)

PARK DENTAL STAR/VENT

The Star/Vent implant is a single-stage, one-piece, titanium plasma spray (TPS) screw implant that allows immediate loading. It is available in diameters of 3.3 and 4 mm and lengths of 8, 11, 14, and 17 mm.

The Star/Vent implant has the StarimageLock internal hex screw and a press-fit cylinder in non-coated, restorable blast media–surface roughening treatment (RBM), TPS, or HA coated. Abutments are straight or 15 or 25 degrees. The implants are available in various diameters (3.3, 3.8, 4, 5, and 6 mm) and lengths (8, 10, 11, 13, 14, and 15 mm).

The external hex system in screw and press-fit cylinder shapes also is available. The different surfaces include RBM, surface roughening for noncoated implants, HA, and TPS. The HA and TPS coatings are available in all sizes.

For the osteotomy for the Star/Vent, the 3-mm generic spade drill is used to its planned depth.

1. The osteotomy is enlarged with the 3.17-mm spade drill to the predetermined depth.
2. The steps of enlargement are continued with the handheld final sizing reamer (3.3 mm).
3. Gentle finger pressure is used to form the countersink. The osteotomy is completed by hand and by using the counterbore reamer in a clockwise direction.
4. The millimeter-calibrated depth gauge should be used to confirm the depth of the osteotomy.
5. The one-piece Star/Vent insertion instrument is screwed to the implant.
6. The implant is seated, and the surgeon starts to thread it into the surgical preparation with the Star/Vent hand wrench. Seating is completed by using the ratchet wrench in a clockwise direction.
7. When the implant has been fully seated, the healing closure plug is placed using the plug socket and hex-head wrench.
8. The flaps are sutured.

MIS IMPLANT TECHNOLOGIES

MIS has a wide range of implants that allow reconstruction of a single tooth, screw-retained or cemented fixed bridges, and overdentures. These implants are made of biocompatible, medical grade titanium, and their surface is dual roughed by sand-blasting and acid-etching procedures. The product line ranges from root form implants to temporary provisionals to orthodontic anchorage.

The screw-type root form lines (i.e., BioCom, Seven, and Mistral) have an internal connection. Placement of these implants follows the generic surgical protocol for root form implants using either the flap or flapless approach. The osteotomy is created in incrementally increasing diameters of 0.5 to 1 mm until the ideal shape and size have been created. The implant then is either hand or engine driven to the full depth. A healing cover screw or an abutment is inserted on top of />

Related posts:

  1. Suggested Readings
  2. Postoperative Instructions for the Patient
  3. 19: Crte Mince, Mini-Implant, Transitional, Temporary Anchorage Devices, and other Implant Surgical and Prosthodontic Procedures
  4. 23: Root Form Implant Prosthodontics: Abutments
  5. 3: Evaluation and Selection of the Implant Patient
  6. 6: Preparations for Implant Surgery

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Jan 5, 2015 | Posted by in Implantology | Comments Off on 11: Root Form Implant Surgery: Proprietary II

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