OCO Biomedical Presents

The Next Generation of Endosseous Implants

Restoring OCO Biomedical Dental Implant Systems

[RESTORATIVE PROCEDURE AND LAB TECHNIQUE]

I-Mini, ISI Complete One-piece, TSI & ERI Two-piece Dual Stabilization Implants

THE DIRECT TECHNIQUE

December 19, 2013

The ISI Complete and TSI Immediate Load Dental Implant System
ISI Complete
Direct restorative only because it is a onepiece implant and abutment Temporized and load/function after being placed

Available: Three + Restorative Systems

1 Direct and 2 Indirect and 3 modified indirect The Conventional Twopiece Abutment System Shielded margin abutment 6-8 position indexed interface

TSI (or ERI) with solid abutment

Two-piece implant with Morse taper lock 6-8 Position indexed interface TSI can be restored by either the Direct or Indirect Methods All Two-piece abutments have 6 or 8 position indexing

80%+ of cases can be loaded immediately and put in function after placement!

TRIP: Tissue Retraction Impression Pickup For Direct Restorative Technique

For straight abutments

For offset abutments

Dual Stabilization Implant System

TSI Abutments

TSI C&B Taper/ Straight

IOT / O-Ball

Parallel Wall (Indexed)

15 degree Offset C&B

Healing Cuffs

Straight Skirted & Offset Skirted & Soon, scallopedcontoured

UMA

UMA Healing Cuff

Scalloped Skirted Abutments

Indexed & NonIndexed Waxing Sleeves

Fixed CB Solid Abutments (4mm, 5.5mm, & 7mm heights)

IOT Over Denture Abutments (0mm, 2mm, 3mm, & 4mm heights)

Locator Abutments (.07mm, 2.0mm, 3.0mm, 4.0mm, 5.0mm, & 6.0mm heights)

Shielded Abutments (straight & 15degree offset) Long & Short Available

Pedestal Abutments (Straight & Offset)

ISI & TSI Implant Restoration: Direct Method

The ISI Implant 1 to 2 months after placing The ISI & TSI with solid abutment use the same direct method

Ready to restore

ISI & TSI Implant Restoration: Direct Method

Snap the TRIP (tissue retraction impression pickup) onto the Implant collar to prepare it for taking the impression

ISI & TSI with Pedestal Abutments Implant Restoration: Direct Method
Make sure the TRIP displaces the gingiva and snaps over the top of the collar of the implant

TRIP Impression
Inject medium bodied impression material into the top of the TRIP until it flows from vents

Cover the TRIP

Cover the impression pickup (TRIP) by flooding the area around it with medium body impression material

Complete the Impression

With heavy body or putty, complete the impression using a standard or triple-tray

Remove the Tray

When set, remove tray The TRIP is picked up into the impression

Modified vs. Non-Modified Abutments

Use the solid analog when the abutment is not modified

Use the Margin Analog (MA) when the abutment is modified

Lab Models
The lab model with the solid brass analog is used when the abutment is not modified
The Margin Analog (MA) is used when the abutment is modified vertically or for the TSI with an offset abutment

Lab Models
Fill MA with hard implant stone, epoxy die material, composite, etc. Pour the rest of the impression with die stone

Margin Analog Example

Tissue Retraction Impression Pickup Snapped over the abutment

Take an impression

Indexing will be captured in the impression

Using the margin analog tool, gently dab the margin analog into the impression

The lab will pour in Polyurock and it will harden to replicate the abutment

Acrylic Coping (AC)

The Acrylic Coping (AC) is used under temps for perfect marginal fit and as a base for wax-up prior to casting the metal coping for the final crown Acrylic Coping (AC)

Acrylic Coping (AC)

Wax-up & casting on working and tissue model using the AC as a base for a perfect marginal fit

AC to final PFM crown

Final Restoration Complete

Final restoration completed and cemented into place with an excellent fit and emergence profile Precision fit comes from the machining of the AC to match the margin at the implant abutment interface Easier than conventional crown procedures and construction

Alignment Correction
Oops implant placed out of alignment? Or need to accommodate anatomy or emergence profile?
Use the 2 piece off-set abutment to align and the off-set trip for the impression The TSI Two-piece implant must be used

TRIP

OFF-SET TRIP

Alignment Correction: Offset TRIP

The top of the off-set TRIP is perpendicular to the implant Straight pressure retracts the tissue and easily snaps over the top of the collar and around the margin with clearance for the off-set abutment

Alignment Correction
The mal-aligned implant is now aligned with other ISI or TSI implants with one piece straight abutments or adjacent natural teeth

TRIP Impression
Inject medium or regular bodied impression material over and around the abutments

TRIP Impression
Snap the straight and off-set TRIPs over the abutments until you feel the ends stop firmly on the top of the collar of the implants

Complete the Impression

Flood the area around the trips with more medium bodied impression material Then complete the impression using heavy bodied or putty

Pull the Impression

Pull the impression Snap in a solid analog and a two-piece analog

Working Model

Anterior alignment : TSI, ERI Implant

On an anterior tooth, the straight abutment may be out of alignment with the other teeth Put in an offset abutment Take your impressions

Model
Create the soft tissue model by putting soft tissue material around the analog Fill the rest of the model with die stone Then the crown is made on the model

Case Example: Simple Direct Restoration of an ISI, One-Piece and TSI with a Solid Abutment

Pre-op

Surgical removal and grafting

6 wks postop

4 mo postop

Ceka Bond (from Preat) placed on threads of the solid, C&B abutment

Solid abutment threaded into TSI Implant

Abutment torqued to 30 N/cm

TRIPS (Tissue Retraction Impression Pickups) snapped over the abutments onto the implants margin.

Flood Impression material through the occlusal opening and out the vents of the TRIP

TRIPS are pulled out into the impression perfectly capturing the margin and indexing of the implant/abutment

Solid Analog Modified to match the vertical height on the abutment of the implant

Analogs engaged in the Impression

Models poured, trimmed, ACs placed on analogs, crowns cast, porcelain added and finished. Easier than a conventional crown!

Crowns cemented

Finalized case. Total lab fee $410.00 $50.00 implant surcharge. The surcharge was Removed

Restoring a 15 yr old case

TSI Implant Restoration: Example Cases

ISI & TSI Implant Restoration: Example Cases

ISI & TSI Implant Restoration: Example Cases

ISI & TSI Implant Restoration: Example Cases

Upper and lower Restored

But, Did She Like It, NO!

Could Not Be Cleaned To Her Satisfaction ; so

Porcelain trimmed to make cleansable and soft gingival prosthesis constructed

Case finalized and cleansable

ISI & TSI Implant Restoration: Example Cases

Chris ready for the final restoration Placing the offset TRIP to make sure it fits and snaps into place

ISI & TSI Implant Restoration: Example Cases

Cover the abutment with medium body impression material

ISI & TSI Implant Restoration: Example Cases

Then flood the area with the impression material

ISI & TSI Implant Restoration: Example Cases

A triple tray filled with heavy body or impression putty and the impression taken

ISI & TSI Implant Restoration: Example Cases

Bottom of the TRIP penetrating out of the impression Shows the depth of the top of the lingual side of the implant

Information: Margin Analog (MA)

The Margin Analog (MA) used for offset abutments and modified straight abutments using the direct technique Engage the non-beveled end Tool used to snap the MA into the TRIP

Placing the MA
With the tool, snap the MA into the TRIP and fill it with acrylic, composite material or any flowable crown buildup material

The Finished PMF Crown

Upper First Molar

Upper First Molar

Upper First Molar - Seated

Splinting Natural and Implant Supported Crowns

Use an Interlock , Small , Round, With No Stops. Allows Vertical Movement on Natural Tooth

Prepped Natural Tooth and Implants

Cemented Natural tooth and Implant Crowns

Completed Case

ISI & TSI Restorative Components For The Direct Technique

Simple restorative procedures requiring minimal tools and components
Tissue Retraction Impression Pickup (TRIP)
Margin Analogs (MAs) One- and Two-Piece Analogs

For straight abutments

For offset abutments

MA Placement Tool

Acrylic Coping (AC)

RESTORATIVE PROCEDURE AND LAB TECHNIQUE [The Indirect Technique TSI &ERI]
TSI/ERI Two-piece Dual Stabilization Implants and the assortment of accessory Abutments that are modified, fitted, and made ready along with the restoration by the dental laboratory, to be delivered

Natural Contour Esthetic Abutment

Restoring Central Incisor with a 3mm Healing Cuff

3mm Healing Cuff Removed

Placing the Impression Coping

The IC is engaged by threading in the ball impression screw by hand or with a .050 hex driver

With the tip removed, Inject Medium Body Impression Material Around the IC and Ball

Complete the Impression with Heavy Body Material in a Triple or Standard Tray

Snap on the TSI Analog

If the I-TRIP is not removed with the impression, snap it into the TSI Analog, and then place both pieces into the boldly indexed impression area.

Snap Into The Impression

Pour and Articulate a Soft Tissue Model

Place a 2, 3, 4 or 5 mm Soft Tissue Healing Cuff to Maintain the Emergence Profile

The Dental Lab Shapes, Sizes and Parallels the Selected Abutment(s)

With the Abutments Shaped, the Restoration(s) is Completed on the Soft Tissue Model

With the Healing Cuff Removed, the Indexed Abutment(s) are Positioned with the Locking Screw 20 n/cm

The Final Restoration(s) is Cemented to Place and the Case is Finalized

Conventional Construction of a Zirconium Core Crown total cost: $189.00

Open Tray Impression Technique for the ERI or TSI Dental Implants
Using an impression coping and TSI/ERI Analogs

Two ERI Implant Placed (Central Incisors)

Engage the Natural Contour Esthetic Abutments and Ball Impression Screws

Glob around abutments and screws with medium body impression material

Fill the tray with hard body impression material and take an impression

Remove the ball impression screws and abutments and thread them into corresponding TSI/ERI analogs

Snap the abutments and analogs into the impression as indexed

Place healing screws in ERI or use two more abutments and make Temps

Final Crowns

Tissue needed to be trimmed away

Abutments are torqued to 25 N/cm

[Custom Abutment Procedure]

ERI (or TSI) Dental Implant placed further than 15 degrees out of parallel

1mm healing collar is engaged for a period of healing

Remove the healing collar after implant integration

The Biotorq driver engages with the custom abutment and is used to fixate the abutment into the implant

Biotorq Driver

Custom Abutment

Driver and Abutment engaged

Biotorq Driver threads in the fixed Custom Abutment

Torque the abutment to 30 N/cm

Engage the UCLA Impression pickup and position the flat side facially

Using the Thumb Knob and .050 hex driver, thread the ball impression screw into the UCLA Impression Pickup

Flood medium body impression material around the UCLA Impression Pickup

Use hard body impression material in the tray

Flat side of Impression Pickup is formed in the impression

Remove the UCLA Impression Pickup from the Custom abutment (in the mouth) and engage it to the Custom Abutment Analog

Warning!
Do not remove the Custom Abutment or change its indexing. This abutment is to remain permanently fixated into the implant

Snap the UCLA Impression Pickup and the Custom Abutment Analog into the impression

Match the flat side on the abutment to the flat side in the impression

Hand tighten Custom Abutment healing collar over the custom abutment with the same Thumb Knob and .050 hex driver

Impression with Custom Analog and Impression Pickup in place

Octa Waxing Sleeve used by lab for custom abutment

[O-BALL OVERDENTURE RESTORATIONS]

Using the Dual Stabilization Implant System

Ready to Restore
4-on-the-Floor Placement Technique: Four to six ISI Complete (or 3.0mm I-Mini) OnePiece O-Ball or TSI/ERI Two-Piece (with O-Ball Abutments) Implants places (2 in lower anterior and 2 in lower quads) in the mandible. Have a good, new denture made with proper plane of occlusion and esthetics.

Step 1: For TSI, Attach O-ball Abutments

For the TSI Implant, screw the O-Ball Abutments into implant bodies with O-Ball Driver (Cat# 0076 or 0076S).

Step 2: Take Impression

With ISI or ISD One-Piece O-Ball Implants in place, or TSI Two-Piece Implants in place with O-Ball Abutments, take an impression directly of the O-Ball Attachment/ Abutment, or with female caps and O-rings in place (if driving square is subgingival).

Step 3: Full Arch Impression

Use medium bodied impression material around the O-Ball Attachments and record a full-arch impression with standard (heavy) body material.

Step 4: Analogs
Snap O-Ball analogs into the impression (in female caps if are used) and forward to the laboratory.

Step 5: Temporary Retention

For the ISI or ISD OnePiece O-Ball Implants or the TSI Two-Piece Implants in place with O-Ball Abutments, use soft denture liner (PermaSoft) for denture retention while the new denture is being created or prior to final reline. Excavate the original denture and fill with soft denture liner.

Step 6: Lab Model

The laboratory pours a working model using the OBall Analogs. For a new denture or reline, use a sound, previously constructed denture.

Step 7: Final Denture

The laboratory will incorporate the Oring encapsulators into the new denture or reline.

Step 8: Final Seating

Seat new denture. Final restoration is complete. After seating, if the denture is too tight, the lumen of the O-ring can be enlarged by opening with a #6 Round Bur

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

Impression and TRIPs

The abutments are flooded with medium body impression material and the TRIPs snapped to place Do not use self curing acrylic to place attachments in the denture

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

I-Mini IOT Restoration Case

O-Ball Overdenture: creating a Chrome framework

Snap Caps (with O-rings) on to O-balls. Take an impression if deep in tissue.

Do not place caps in impression (have lab pour model)

The lab will create a cast chrome cobalt framework to be incorporated for the model

The lab will incorporate the framework into the denture

Q&A

Thank You
Questions?