Bicon Surgical PDF

Simple. Predictable. Profitable.
Bicon Surgical Manual

Dear Colleagues:
Since 1985, many of the procedures and techniques depicted in the
following pages have been successfully utilized by Bicon clinicians.
However, as any experienced dentist knows, there are many ways
of achieving a particular result and by no means are the depicted
techniques the only way of providing for your patients needs.
Clinicians for whom the Bicon system is a new experience should be
impressed with the fexibility, forgivingness and facility with which Bicon
implants can be placed and restored simply even in challenging
clinical situations.
Bicons benefcial surgical attributes include: sub-crestal placement of
implants, harvesting of bone with slow-speed osteotomy preparation
without irrigation, and the use of narrow and short implants to avoid
vital structures. These clinical benefts are directly related to the
implants elegant plateaued design, which provides cortical-like bone
around the implant with central vascular systems. The implants sloping
shoulder provides sufcient space for the interproximal papillae, which
are crucial for gingivally aesthetic restorations. The implants 1.5 locking
taper connection provides for 360 of universal abutment positioning
prior to its engagement and is also proven to be a bacterial seal.
Hopefully, with the depicted techniques, you will enjoy the benefts
of the Bicon system, such as never again having to apologize to your
patients for a dark metallic gum line even when an implant is less than
ideally positioned.
Sincerely,

Vincent J. Morgan, D.M.D.
Bicon 501 Arborway Boston, MA 02130 tel: (800) 88-BICON or (617) 524-4443 www.bicon.com
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Table of Contents
Pre-Surgical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-7
Measurement of Bone. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Bone Classication. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Implant Size Selection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-5
Surgical Template Fabrication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-7
Instrumentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-17
Instrument Descriptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-17
Surgical Placement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-32
Flap Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Pilot Drill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22-23
Latch Reamers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Hand Reamers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Implant Insertion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26-27
Two Stage Surgical Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-29
Immediate Stabilization and Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30-31
One Stage Surgical Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33-49
Pilot Drill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Latch Reamers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Template Fabrication. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Two Stage Surgical Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37-38
One Stage Surgical Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39-40
Two Stage Mandibular Ridge Split . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Internal Sinus Lift . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Lateral Sinus Lift. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Handpiece Maintenance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Abutment Measurement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Non-Shouldered Abutments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46-47
Stealth Shouldered Abutments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48-49
Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step
Page 1
Pre-Surgical
Page 2
Pre-Surgical: Measurement of Bone
Keys to Success
Examine patient with mouth closed to ascertain if there is enough inter-occlusal space for the intended prosthesis.
A frenectomy may be advisable, to improve the soft tissue environment around the intended prosthesis.
Computer Aided Tomography (CAT scan), although usually not necessary, can be of value in determining the best
implant placement sites where there is minimal bone or concern as to the exact location of anatomical structures.
Care must be taken to avoid the inferior alveolar nerve and the mental
foramina in the premolar region, since the mandibular nerve is often inclined
coronally in this area.
Care must be taken to avoid the penetration of the submandibular fossa which
is located below the mylohyoid line, and particularly the sublingual space in
the anterior mandible where the sublingual artery is located. Inadvertent
penetration of these lingual plates may be avoided by appropriately directing
the pilot bur and reamer burs toward the buccal and monitoring the area with
digital contact while drilling.
The location of the maxillary sinus and nasal floor must be positively identified
to avoid their inadvertent penetration with a reamer or an implant.
In general, 2.0mm of bone should separate the apex of the implant osteotomy
and the mandibular canal.
2.0mm
Mylohyoid
Line
Submandibular
Fossa
Page 3
Pre-Surgical: Bone Classication Type I-IV
Description
Recommended
Implant Surface Integration Time Bone Type
Dense Cortical
Flute of a 3.5mm reamer
bur flled with bone and
minimal blood
HA
Integra-Ti*
TPS
Approximately
16 weeks
Type I
Porous Cortical and
Course Trabecular
bur flled with blood
wetted bone
HA
Integra-Ti*
TPS
Approximately
10 weeks
Type II
Description
Recommended
Porous Cortical and
Fine Trabecular
bur only partially flled
with blood wetted bone
HA Approximately
10-12 weeks
Type III
Description
Recommended
Fine Trabecular
bur devoid of bone
HA Approximately
16-20 weeks
Type IV
Description
Recommended
*Since 1985, each Bicon implant has been grit blasted with alumina and passivated in a nitric acid solution. Bicon formerly
referred to this controlled surface as Uncoated; however, this controlled surface will now be referred to as Integra-Ti.
Page 4
Pre-Surgical: Implant Size Selection
Implant Size Selection
The appropriate implant length and width depends upon the available bone and the expected occlusal loads.
In general, choose the widest but not necessarily the longest implant possible.
Panoramic and periapical radiographs as well as diagnostic models and a clinical examination are used to determine
if enough mesio-distal space and vertical bone height exist to place a Bicon implant safely and appropriately in a
proposed site.
A transparent ruler or an implant radiograph overlay, which depict implant outlines of actual size and 125% of actual
size, is helpful in selecting an appropriately sized implant. Since radiographs are not necessarily precise representations,
knowledge of their magnification must be considered while using them to determine an appropriately sized implant.
Keys to Success
The 3.5mm diameter implants are generally for mandibular anterior teeth. If practical, their use should be
avoided for maxillary anterior and all posterior teeth.
The 5.0 x 8.0mm and the 6.0 x 5.7mm implants are capable of supporting any tooth in the dental arch.
From the canine posteriorly, if practical, place one implant per tooth being replaced.
Consider using HA coated implants in poor quality or grafted bone.
It is advisable to have at least 1.0mm of bone around the implant. Therefore, an advisable bone width is 5.5mm
to comfortably accommodate a 3.5mm implant, unless ridge splitting or grafting techniques are employed to
widen the site.
In the anterior maxilla, it is advisable to place 4.5mm wide or wider implants, especially when the use of an
angled abutment is intended.
The width of the alveolar bone may be assessed with a periodontal probe or caliper. It is advisable to have 1.0mm
of bone around an implant for a long-term favorable prognosis.
For maxillary anterior implants, always anticipate the potential need for ridge splitting or bone grafting
techniques.
4.5 x 8mm 5 x 8mm 5 x 8mm 4 x 11mm 3.5 x 11mm 4.5 x 8mm 5 x 8mm 5 x 8mm 4 x 11mm 3.5 x 11mm 6 x 5.7mm 6 x 5.7mm
0 1 2 3 4 5 6 7 8
1/8 inch
1mm
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
(100%SCALE)
(125%SCALE)
260-103-005 R0904
The Bicon Implant Ruler
The Bicon Implant Overlay
3.5mm 4.0mm 4.5mm 5.0mm 6.0mm
4.5mm x 8.0mm or Wider
4.0mm x 11mm or Wider
4.5mm x 8.0mm or Wider
4.5mm x 8.0mm,
5.0mm x 6.0mm,
or Wider
5.0mm x 8.0mm
or 6.0mm x 5.7mm
3.5mm x 11mm or Wider
5.0 x 6.0mm or Wider
4.5mm x 8.0mm,
5.0mm x 6.0mm,
or Wider
5.0mm x 8.0mm
or 6.0mm x 5.7mm
Page 5
Pre-Surgical: Implant Size Selection
Implant Size Recommendations: The following chart contains recommendations only. Actual clinical conditions and
the clinicians assessment are the main criteria for choosing the size of an implant for a particular area.
3.5 x 14 3.5 x 11 3.5 x 8 4 x 14 4 x 11 4 x 8 6 x 8 4.5 x 11 4.5 x 8 5 x 8 5 x 11 6 x 5.7 5 x 6
Maxilla
Mandible
Page 6
Pre-Surgical: Surgical Template
Surgical Template
Accurate placement of any implant requires the awareness of its intended prosthetic restoration. Mounted study casts
and a diagnostic wax-up of the teeth to be replaced are usually necessary for the fabrication of a surgical template
that will aid the dentist in the appropriate placement of an implant. Although the location and availability of bone
will dictate the ultimate trajectory of the pilot drill, clinicians should strive to stay within 10 of the ideal position and
trajectory of the intended prosthesis.
Vacuum Formed Template
After making an impression and subsequent cast of the
diagnostic wax-up of the intended restoration, a vacuum
formed template is prepared on the cast from thin template
stock which is commonly used for the chairside fabrication of
transitional restorations. A hole is drilled in the middle of the
incisal or occlusal surface of the template in the location of
the intended tooth. The vacuum formed template, if possible,
is trimmed to include at least one tooth distal and three or
four teeth mesial to the area of the intended replacement.
Template from Stone Model
1 Using a duplicated stone model of the
diagnostic wax-up, draw a line through the
incisal edge and occlusal surfaces of the teeth
and another line in the center of each tooth
to be replaced, intersecting the incisal or
occlusal line.
2 Remove the lingual half of the teeth to be
replaced.
3 Mold acrylic onto the lingual aspect of the
model up to the level of the central fossa or
incisal edge of the teeth to be restored.
4 Cut a 2.0mm wide groove in the acrylic
corresponding to the middle of each intended
tooth to be replaced.
2
Remove lingual half
3
Mold acrylic Cut 2.0mm groove
1
Stone model
4
Page 7
Keys to Success
The trajectory of the pilot bur will be the trajectory of the implant and the trajectory of a straight abutment.
The nal implant osteotomy, to the extent possible, should be centered in the middle of the intended prosthetic tooth.
An appropriate mesio-distal positioning of a pilot osteotomy is more critical than a slightly o axis trajectory.
Both the vacuum formed and palatal templates are placed in cold sterilization prior to their being used to facilitate
achieving an appropriate trajectory for the pilot bur.
Pre-Surgical: Surgical Template
Template determines mesio-distal positioning. Availability of
bone determines final bucco-lingual angulation.
Trim excess incisal length to prevent interference
with head of handpiece.
Fabrication of Palatal Template from Existing Prosthesis
1
Insert denture into alginate in
denture duplicator.
Apply separating medium. Fill other side with alginate. Close and allow alginate to set.
2 3 4
5
Open and remove denture. Fill alginate mold with acrylic. Close and allow acrylic to polymerize. Open and remove duplicated prosthesis.
6 7 8
9
Draw a line in the middle of each tooth and a line
representing greatest concavity on the tissue side.
10
Cut a 2.0mm wide groove in center of each tooth
joining the lines representing the middle of each
tooth and greatest concavity of the tissue side.
11
Remove the buccal acrylic along the slope joining
the two lines representing the middle of each
12
0 15
13
For larger edentulous areas, fabricate a palatal template by using an existing removable prosthesis. When fabricating the
palatal template, the buccal aspect is inclined from the incisal edge or central fossa of the proposed teeth back to the crest
of the alveolar ridge, which is represented on a duplicated prosthesis as the greatest concavity on the alveolar ridge side of
the prosthesis.
Page 9
Instrumentation
Page 10
Instrumentation: Descriptions
The Bicon Surgical Kit
Pilot Drill
The pilot drill was designed to prepare the initial pilot
osteotomy and to establish the osteotomys trajectory.
Latch Reamers
The latch reamers were designed to prepare an osteotomy
and to harvest autogenous graft material without irrigation at
a maximum speed of 50 RPM. Three lengths are available to
accommodate a variety of clinical situations.
Page 11
Paralleling Pins
The paralleling pins were designed as an aid
to properly align the pilot osteotomies and
subsequently the implants.
Latch Reamer Extension
The latch reamer extension was designed to lengthen a latch
reamer to facilitate access when adjacent teeth interfere with
the handpiece head. If the latch reamer is not fully engaged in
the latch extension prior to being used, the latch reamer may
become stuck or permanently damaged in the latch reamer
extension.
Implant Inserters/Retrievers
The inserters/retrievers were designed for use with
either a threaded knob or a threaded straight handle to
assist in the placement and retrieval of certain implants
depending upon the clinical situation. It is essential for
a clinician to understand how an implant is disengaged
from the inserter/retriever instrument prior to using it
intra-orally.
Page 12
Healing Plug Removal Instruments
The removal instruments were designed to facilitate
the removal of the healing plug from the implants well
during the uncovering procedure of an implant.
Hand Reamers & Hand Reamer Extension
The hand reamers were designed to be used with a threaded
straight handle to manually prepare an osteotomy.
The hand reamer extension was designed to give a clinician
more access when the interproximal space or opposing dentition
interfere with the handpiece head by converting the hand reamers
to a latch style.
Page 13
Sulcus Reamers
The sulcus reamers were designed to remove any soft
tissue or bone above the implant that could prevent the
locking taper engagement of an abutment into the well of
the implant.
Guide Pins
The standard and extended guide pins were designed
(depending upon an implants depth) to be used as a
guide for sulcus and impression reamers as well as for
tissue punches. They may also be used to assist in the
evaluation of how well an implant has osseointegrated.
The extended guide pins are used with deeply positioned
implants and long-shafted abutments.
Implant/Abutment Seating Tips
The seating tips were designed for use with a threaded
straight or oset handle to facilitate the proper seating
of an implant or an abutment. When using the implant
seating tips, it is imperative that the seating tips be fully
seated into the well of the implant to avoid causing
distortion of the well during their use, which could
subsequently prevent the complete locking taper
engagement of an abutment.
Impression Reamers
The impression reamers were designed to remove any soft tissue or
bone above the implant well that could interfere with the proper
seating of an impression post.
Page 14
Sinus Lift Osteotomes
The sinus lift osteotomes were designed for use with
a threaded straight handle to make a greenstick
fracture of the sinus foor during an internal sinus lift
procedure.
Bone Expanders
The bone expanders were designed to assist in the formation of an
osteotomy while using an expanding bone technique.
Page 15
Threaded Chisels
The threaded chisels were designed for use with
a threaded straight handle to split and widen thin
alveolar ridges to allow for the insertion of implants
and/or interpositional bone grafts.
Open Well for Storage
This additional storage space was designed for accessory
items such as instruments and abutments.
Page 16
Instrumentation: Tray Contents
Top Tray
Threaded Straight Handle
The straight handle was designed to be used with all threaded
instrumentation: hand reamers, sulcus reamers, inserters/retrievers,
tissue punches, osteotomes, chisels, bone expanders, seating tips and
impression reamers.
Threaded Oset Handle
The oset handle was designed for use with implant and abutment
seating tips when direct access is not possible.
Surgical Mallet
The surgical mallet was designed to be used with the threaded straight
or oset handles for the seating of implants and abutments. It may also
be used during ridge splitting and internal sinus lift procedures.
Dappen Dish
The dappen dish was designed to collect autogenous bone.
Bottom Tray
The bottom tray was designed for the storage of accessory items as well
as for the 18:1 and 400:1 handpieces. Handpieces are sold separately
from the surgical kit.
Page 17
Instrumentation: Tray Contents
Middle Tray
Abutment Shoulder Depth Gauge
The abutment shoulder depth gauge was designed to facilitate the
measuring of the soft tissue height above an implant for the selection
of an abutment with an appropriate shoulder height.
Removal Wrench
The removal wrench was designed to loosen hand reamers, osteotomes,
chisels and bone expanders from a threaded straight handle or a
threaded knob.
Bone Depth Gauge/Bone Plugger
The bone depth gauge was designed to facilitate the measuring of
the osteotomys depth. The bone plugger was designed to compress
autogenous bone graft material over the shoulder of the implant.
Bottom Tray
The bottom tray was designed for the storage of accessory items as well
as for the 18:1 and 400:1 handpieces. Handpieces are sold separately
from the surgical kit.
Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step Step by Step
Page 19
Surgical Placement
Page 21
Surgical Placement: Flap Design
Flap Design
After appropriate local anesthesia, either an envelope or broad based pedicle flap is raised. In both designs, the crestal incision should
be palatal or lingual to the actual crest of the ridge.
Broad Based Pedicle Type Flap
The broad based pedicle flap is recommended for use in the posterior part of the mouth for two stage surgical placements and for
narrow ridges. This flap consists of two near parallel incisions and one transverse incision lingual to the crest of the ridge. This flap can
be easily modified for the one stage or immediate stabilization and function techniques.
1
Edentulous area
2
Incisions
3
Flap reflection
Semi-Lunar Type Flap
The semi-lunar flap is recommended for the one stage surgical technique, the immediate stabilization and function technique and for
aesthetic areas. This flap consists of a pedicle flap based on the lingual or palatal aspect of the ridge. Caution is advised when using
the semi-lunar flap, since visualization of the implant site is limited to only the crestal aspect of the bone. As a result, inadvertent buccal
or lingual fenestrations are more likely to occur when using the semi-lunar flap.
1
Incision
2
Flap reflection
3
Retraction suture
Page 22
Surgical Placement: Pilot Drill
Pilot Drill
The pilot osteotomy should be positioned
in the center, when possible, of the
edentulous space of the proposed tooth
and with the same trajectory as that of the
intended prosthesis.
1 Using a surgical template, an 18:1 reduction
handpiece, and a 2.0mm pilot drill, make
the initial penetration into the ridge at
approximately 1,100 RPM with external sterile
irrigation. The pilot bur must completely
penetrate the crestal cortex.
2 After half the necessary depth is achieved,
remove the pilot drill and insert a paralleling
pin into the newly formed osteotomy
to assess the positioning and trajectory
of the preliminary pilot osteotomy. Use
intermittent pumping actions to clean
bone from the pilot drill flutes.
3 Place the vacuum formed template over a
paralleling pin to confirm the appropriateness
of the preliminary osteotomy. It is still
possible to change the positioning and
trajectory of the osteotomy, if necessary.
4 If the trajectory is appropriate, continue
drilling with the pilot drill to the depth
marking, which will allow for the chosen
implant to be seated below the bone. For
aesthetic areas, the implant should be placed
5.0mm below the buccal gingiva.
5 If multiple implants are being placed,
paralleling pins should be inserted
consecutively into the completed pilot
osteotomies to facilitate the establishment
of the trajectory of the pilot drill for the
preparation of subsequent osteotomies.
1b
Penetrate crestal cortex
2
Insert paralleling pin
3
Assess positioning and trajectory
5
1a
Use surgical template
Assess trajectory
2.0mm
7.0mm to
8.0mm
5.7/6.0mm Implant Lengths
Drilling Depth:
Drilling Depth: Drilling Depth:
Drilling Depth:
2.0mm
11mm
8.0mm Implant Lengths
2.0mm
14mm
11mm Implant Lengths
2.0mm
17mm
4a
Ideal drilling depth for different implant lengths
Crestal Cortex
Page 23
Old Pilot Drill vs. New Pilot Drill
Prior to using a pilot drill, it is imperative
that its markings are identified and
understood. No assumption should be
made about the height of the first marking.
Special Considerations
Maxillary Anterior Extraction Site
1 Initially drill into the palatal wall of the socket
more perpendicularly than the proposed
trajectory of the intended restoration.
2 Immediately upon the pilot drills engagement
of the bone, change the drills trajectory to be
more parallel with the adjacent teeth and the
proposed restoration.
Special Considerations: Pilot Drill
11mm
8mm
6mm
NEW!
14mm
Old New
2 1
Initial trajectory Change trajectory
1
Uneven bone levels
2
Sulcus reamer
Uneven Crestal Bone
1 To prevent the inadvertent displacement of
a reamer bur, uneven levels of bone must be
leveled at the pilot osteotomys orifice.
2 Rotate a sulcus reamer as a planisher on a
2.0mm guide pin inserted into the 2.0mm
pilot osteotomy. Alternatively, use a round bur
to even the bone level around the orifice of
the pilot osteotomy.
Page 24
Surgical Placement: Latch Reamers
2
Harvest autogenous bone
3
1
Initial 2.5mm latch reamer
2.0mm
8.0mm
5.7/6.0mm Implant Lengths
4.0
2.0mm
11mm
8.0mm Implant Lengths
4.0
2.0mm
14mm
4.0 2.0mm
17mm
4.0
Drilling Depth:
Drilling Depth: Drilling Depth:
Drilling Depth:
4
Keys to Success
To facilitate removal of the reamer from
the osteotomy, continue rotating the
reamer while it is being withdrawn.
In very dense bone, it may be necessary
to use the 2.5mm and 3.0mm latch
reamers at a speed of approximately
1,100 RPM with external sterile irrigation
to prepare an osteotomy.
Avoid clogging the reamer utes with
bone shavings since the bony walls of
the osteotomy may become overheated
due to friction.
Using latch reamer burs in excess of 50
RPM may result in overheated bone and
the subsequent failure of the implant to
osseointegrate.
Irrigation is not recommended since it
dilutes the blood in the socket and in the
harvested autogenous bone, which may
inhibit healing.
It is not necessary to use all reamers
in creating an osteotomy. One must
only nish the osteotomy with the nal
reamer and a reamer that is 0.5mm
smaller than the nal reamer. For
example, when drilling to a width of
5.0mm one must nish the osteotomy
with 4.5mm and 5.0mm reamers.
2.5mm 3.0mm 3.5mm 4.0mm 6.0mm 5.5mm 5.0mm
14mm
11mm
8.0mm
Latch reamers with newest measurements
17mm
4.5mm
6.0mm
Latch Reamers
During the preparation of an osteotomy,
the latch reamers should be rotated at a
maximum of 50 RPM without irrigation.
The 400:1 handpiece will provide sufficient
speed reduction and increased torque to
appropriately prepare an osteotomy.
1 Using the 400:1 reduction handpiece and
a 2.5mm latch reamer, widen the pilot
osteotomy. It is best to use a two handed
drilling technique where one hand guides the
drill while the other applies apical pressure.
2 Place harvested autogenous bone,
intermittently removed from the flutes of the
reamer burs, into a silicone dappen dish for
later use.
3 The reamers are used sequentially beginning
with a 2.5mm diameter and ending with the
diameter of the intended implant. The newest
reamers have horizontal markings at 6.0, 8.0,
11, 14 and 17mm, whereas older reamers may
have different markings. It is imperative
that the depth indicators on the latch
reamers are identified prior to surgery.
No assumptions should be made about
the height of the first marking on any
latch reamer.
4 Drill to the depth that will allow the chosen
implant to be seated below the bone. For
aesthetic reasons the implant should be
placed 5.0mm below the buccal gingiva.
Page 25
Surgical Placement: Hand Reamers
Hand Reamers
1 The threaded straight handle in conjunction
with the 2.5mm hand reamer may be used
to enlarge a pilot osteotomy. A two handed
technique should also be used with this
manual drilling method. One hand will rotate
the straight handle, while the other feels and
monitors the bone plates.
2 Place harvested autogenous bone in the
silicone dappen dish for later use.
3 The hand reamers are used sequentially to
widen and in some situations to deepen an
osteotomy to the size of the intended implant.
Hand reamers are marked horizontally at 6.0,
8.0, 11, 14 and 17mm.
4 Drill to the depth which will allow for the
chosen implant to be seated below the bone.
For aesthetic reasons, the implant should be
placed 5.0mm below the buccal gingiva.
2
Harvest autogenous bone
1
Thread hand reamers
Keys to Success
Hand reamers oer greater control
for the preparation of maxillary
osteotomies. They help to ensure
avoiding inadvertent penetration
of the sinuses, nasal oor and walls
of the osteotomy.
The use of hand reamers facilitates
the clinicians perception of the
harder cortical layers of bone
before they are penetrated.
Since hand reamers have only
one cutting surface, they allow
for cutting only the palatal side
of an osteotomy while expanding
the buccal wall in the opposite
direction.
Irrigation is not recommended since
it dilutes the blood in the socket
and in the harvested autogenous
bone, which may inhibit healing.
3
Hand reamers
2.0mm
8.0mm
$RILLING$EPTH $RILLING$EPTH
5.7/6.0mm |mplant Lengths
2.0mm
11mm
2.0mm
14mm
llmm |mplant Lengths
$RILLING$EPTH
2.0mm
17mm
8.0mm |mplant Lengths
l4mm |mplant Lengths
$RILLING$EPTH
17mm
14mm
11mm
8.0mm
6.0mm
Hand Reamer Markings
4
6.0mm 4.0mm 5.5mm 3.5mm 5.0mm 4.5mm 3.0mm 2.5mm
8.0mm
11mm
14mm
17mm
6.0mm
Page 26
Surgical Placement: Implant Insertion
Option 1: Healing Plug Inserter
1 Prior to the seating of an implant, the integrity
of the osteotomys bony structure should
be thoroughly assessed with a curette while
the bone shavings are being completely
removed from the osteotomy.
2 Confirm the prepared sockets depth with a
depth gauge. If the site is not deep enough
for placement of an implant 5.0mm below
the crest of the buccal gingiva, make the
necessary depth changes with a pilot drill and
latch or hand reamers. Do not flush a socket
to remove blood.
3 The implants sterile blister pack is dropped
onto a sterile tray prior to removing its tyvek
backing before the implants inner packaging
is cut with a pair of scissors.
4 Grasp the healing plug inserter with gloved
fingers or forceps. Using the healing plug
inserter, insert the implant into the blood
filled osteotomy. Note: The implant should
not touch anything prior to being placed
and rotated into the prepared bleeding
socket. The implant should be wet with
blood during seating.
5 The implant may be more definitively seated
into an osteotomy by using a seating tip
with the straight or offset handles. The
implant may be tapped with the healing plug
inserter in place, or directly into the well of
the implant. Use the 2.0mm implant/angled
abutment seating tip when tapping on a
healing plug inserter or a 2.0mm implant
well. Use the 3.0mm implant seating tip when
tapping directly into a 3.0mm implant well.
Note: Care must be taken to assure
that the seating tip is fully seated in an
implant well prior to tapping to avoid
distortion of the well, which could
subsequently prevent the complete
locking taper engagement of an
abutment.
2
Verify socket depth
3b
Open implant package
3a
Implant in packaging
1
Curette osteotomy
5a
5b
Keys to Success
The implant seating tips must be completely positioned into the well of the implant prior to the application of any
seating or moving force. Inappropriately applied force could distort the implants well which may prevent the complete
engagement of the implants locking taper connection.
The implant is designed to be initially twisted into an osteotomy prior to any seating tap.
5c
Seat implant
4
Insert implant
2.0mm Implant/
Angled Abutment
Seating Tip
3.0mm Implant
Seating Tip
Seating Tip with Threaded Straight Handle
Threaded Oset Handle
Threaded Straight Handle
11mm
2.0mm
11mm
2.0mm
Page 27
Surgical Placement: Implant Insertion
Option 2: Implant Inserter
The inserter/retriever instruments can be
used to either insert an implant into an
osteotomy with a turning and pushing
motion or to remove an implant from
its osteotomy with a turning and pulling
motion.
1 Prior to the seating of an implant, the integrity
of the osteotomys bony structure should
be assessed with a curette while the bone
shavings are being completely removed.
2 Check the prepared sockets depth with a
depth gauge. If the site is not deep enough
for placement of an implant 5.0mm below
the crest of the buccal gingiva, make the
necessary depth changes with a pilot drill and
latch or hand reamers. Do not flush a socket
to remove blood.
3 The implants sterile blister pack is dropped
onto a sterile tray prior to removing its tyvek
backing before the implants inner packaging
is cut with a pair of scissors.
4 Remove the implants black healing plug
inserter while holding the implant in its sterile
bag prior to inserting the appropriate implant
inserter/retriever into the well of the implant.
5 Select the inserter/retriever by matching the
diameter of the instrument with the diameter
of the implant well. Attach a threaded
knob or the threaded straight handle to
the inserter/retriever. It is essential for a
clinician to understand how an implant
is disengaged from the inserter retriever
instrument prior to using it intra-orally.
6 Insert the implant into the osteotomy and
rotate the inserter/retriever assembly while
pressing it apically. To disengage the implant
from the inserter/retriever, hold the assembly
while turning the central knob counter
clockwise, which will then push the implant
off the inserter/retriever instrument.
2
Verify socket depth
1
Curette osteotomy
4
Remove healing plug
6
Insert implant
5b
3.0mm
Long
2.0mm
Long
3.0mm
Standard
2.0mm
Standard
5a
Inserter/retriever
3b
Open implant package
3a
Implant in packaging
11mm
2.0mm
11mm
2.0mm
Page 28
Surgical Placement: Two Stage Surgical Technique
Two Stage Surgical Placement
1 The plastic healing plug is trimmed smoothly
either intra-orally or extra-orally with healing
plug cutters or a pair of scissors to the level
of the crest of the ridge to minimize mucosal
irritation during healing.
2 The space around the top of the seated
implant is covered with the autogenous
bone particles that were harvested from the
flutes of the reamers during the osteotomy
site preparation. Alternatively, if necessary,
a grafting material may be used in lieu of
autogenous bone. Do not submerge the
plastic healing plug too deeply, since
it may be difficult to locate after the
implant has osseointegrated.
3 The mucoperiosteal flaps are approximated
with sutures.
Note: Care should be taken to insure that
closure is achieved to prevent seepage of oral
fluids into the implant site and the loss of
grafted particles from the site. Membranes may
facilitate site closure.
1b
Insert trimmed healing plug
Autogenous bone
3
Approximate with sutures
1a
Trim healing plug
Keys to Success
Use HA treated implants for sites with poor quality bone.
Repair any penetration or fenestration of the osteotomy with a bone
graft either with or without the use of a membrane.
Avoid transmucosal loading of the newly placed implant.
Provide appropriate antibiotic coverage after implant placement.
If there is only lateral movement of the implant after an appropriate
period of healing, it may indicate the need for additional healing time.
However, apical mobility of the implant usually indicates a failure of
the implant to osseointegrate.
To facilitate the seating of angled abutments, use a sulcus reamer that
is one size larger than the actual abutment diameter.
Cover with autogenous bone
2a 2b
Two Stage Surgical Uncovering
After a minimum of two to four months of
healing, the implant is surgically uncovered.
1 Locate the black healing plug. In non-
aesthetic areas, a slightly lingual or
palatal crestal incision is made with only
enough periosteal reflection to expose
the black healing plug. For aesthetic
areas, the incision should be semi-lunar.
2 Remove the black healing plug by pressing
the healing plug removal instrument into
its center hole and using a simultaneous
twisting and pulling motion or a continuous
twisting motion until the plug is dislodged.
Alternatively, other dental instruments such a
#110 endodontic reamer, scaler, or round bur
may be used to remove a healing plug.
3 Insert an appropriately sized guide pin
corresponding to the implants 2.0 or
3.0mm well diameter to ascertain the
implants osseointegration by evaluating
its mobility. Mobility may indicate non-
osseointegration.
4 If the implant is deeply placed, the use of an
extended guide pin may be necessary. Its use
will prevent the unnecessary removal of bone
over the implant.
5 Remove any bone which may prevent the
seating of the intended impression post by
using the appropriately sized impression
reamer. Attach the impression reamer to a
threaded handle or knob. Insert the assembly
onto the appropriate guide pin seated in
the implant well and rotate while applying
apical pressure, which will shape the bone to
accommodate the desired impression post.
6 Remove any bone or soft tissue which
may prevent the seating of the intended
abutment by using an appropriately sized
sulcus reamer. The diameter of the sulcus
reamer corresponds to the diameter of the
intended abutment. Attach the sulcus reamer
to a threaded straight handle or knob. Insert
the assembly onto the appropriate guide pin
seated in the implant well and rotate while
applying apical pressure, which will shape the
bone to accommodate the desired abutment.
Note: To facilitate the seating of angled
abutments, use a sulcus reamer that is one size
larger than the actual abutment diameter.
Page 29
Surgical Placement: Two Stage Surgical Technique
Two Stage Surgical Uncovering
After a minimum of two to four months of
healing, the implant is surgically uncovered.
1 Locate the black healing plug. In non-
aesthetic areas, a slightly lingual or
palatal crestal incision is made with only
enough periosteal reflection to expose
the black healing plug. For aesthetic
areas, the incision should be semi-lunar.
2 Remove the black healing plug by pressing
the healing plug removal instrument into
its center hole and using a simultaneous
twisting and pulling motion or a continuous
twisting motion until the plug is dislodged.
Alternatively, other dental instruments such a
#110 endodontic reamer, scaler, or round bur
may be used to remove a healing plug.
3 Insert an appropriately sized guide pin
corresponding to the implants 2.0 or
3.0mm well diameter to ascertain the
implants osseointegration by evaluating
its mobility. Mobility may indicate non-
osseointegration.
4 If the implant is deeply placed, the use of an
extended guide pin may be necessary. Its use
will prevent the unnecessary removal of bone
over the implant.
5 Remove any bone which may prevent the
seating of the intended impression post by
using the appropriately sized impression
reamer. Attach the impression reamer to a
threaded handle or knob. Insert the assembly
onto the appropriate guide pin seated in
the implant well and rotate while applying
apical pressure, which will shape the bone to
accommodate the desired impression post.
6 Remove any bone or soft tissue which
may prevent the seating of the intended
abutment by using an appropriately sized
sulcus reamer. The diameter of the sulcus
reamer corresponds to the diameter of the
intended abutment. Attach the sulcus reamer
to a threaded straight handle or knob. Insert
the assembly onto the appropriate guide pin
seated in the implant well and rotate while
applying apical pressure, which will shape the
bone to accommodate the desired abutment.
Note: To facilitate the seating of angled
abutments, use a sulcus reamer that is one size
larger than the actual abutment diameter.
1b
Lingual crestal incision
2a
Implants with healing plugs
in place
2b
Healing plug removal
instrument in use
1a
Edentulous implant site
3
Use appropriate guide pin to evaluate osseointegration
6
Use appropriate sulcus reamer(s) prior to abutment seating
There Should be
No Movement
4
Guide pin and extended guide pin
4b 5
Impression reamer
2.0mm 3.0mm
5.0 5.0
6.5 6.5
6.5
Page 30
Surgical Placement: Immediate Stabilization and Function
The Immediate Stabilization and Function technique is a predictable treatment
regardless of the quality of bone or the initial stability of the implant in the
osteotomy. The only criterion for success of this treatment (in addition
to the normal implant placement techniques) is the chairside prosthetic
stabilization of the implant with a transitional prosthesis. The prosthesis
must be stabilized by bonding it to adjacent teeth or to other implants during
the period of osseointegration. A close working relationship between the
surgical and restorative dentist must be present for successful treatment with
a compliant patient who will monitor and attempt to preserve the immobility
of the transitional prosthesis.
Protocol for Immediate Stabilization and Function Technique for a Single Tooth and Multiple Teeth:
Materials
HA coated implants (recommended)
Stealth shouldered abutments
Tall and short acrylic sleeves
Vacuum-formed template of intended
transitional prosthesis
Transitional crown bonding materials
Transitional crown composite material:
Integrity by Dentsply and/or
DiamondCrown by DRM
Reinforcing ber (not necessary if
Integrity or DiamondCrown material
is used in su cient bulk)
3
Insert implant
4
Determine shoulder height
5
Confirm shouldered abutment
1
Extract tooth
6
Assemble acrylic sleeve
Immediate Stabilization and
Function Technique
1 Extract tooth and/or prepare osteotomy in
conventional manner.
2 Prior to preparing the osteotomy, etch and
prepare the adjacent teeth or crowns for
bonding.
3 Insert appropriate implant so that it is at
least 5.0mm below the buccal soft tissue.
Harvested bone may be placed over the
implant prior to removal of the black healing
plug or the inserter/retriever.
4 Use shoulder depth gauge to determine the
appropriate shouldered abutment height.
The 5.0 x 4.0mm or the 4.0 x 3.5mm
shouldered abutments are usually the
appropriate abutments to be utilized. If
shrinkage of tissue were to occur during the
healing phase, a shorter abutment height
may be used for the final prosthesis for a
subgingival margin.
5 Choose appropriate shouldered abutment
width based on the anatomy of interproximal
papillae. Abutments and acrylic sleeves
should be wide enough to support
the interproximal papillae without
encroaching upon the papillae.
6 Based on anatomical space considerations
assemble a tall or short acrylic sleeve to the
abutment intra-orally or extra-orally.
2
Etch/prepare adjacent teeth
Page 31
Surgical Placement: Immediate Stabilization and Function
Immediate Stabilization and
Function Technique (cont.)
7 Place selected shouldered abutment into
implant with finger pressure only for
fabrication of a transitional stabilization
prosthesis.
8 Inject transitional crown material around the
acrylic sleeves to make an acrylic strut or
bridge between the adjacent teeth.
9 Place a reinforcing fiber such as Connect
by Kerr into lingual aspect of template to
strengthen the transitional prosthesis. The
reinforcing ribbon is usually not necessary
when using sufficient bulk of Integrity
or DiamondCrown for the transitional
prosthesis.
10 Place transitional crown material into the
occlusal half of vacuum formed template and
insert the template over the acrylic sleeves
and strut intra-orally to form the transitional
prosthesis.
11 Remove template and polish transitional
prosthesis leaving interproximal extensions for
stability.
12 Place polished transitional prosthesis onto
abutment to confirm fit and occlusion. Usually,
no cement is required between the prosthesis
and the abutments, since the transitional
prosthesis snaps onto the abutments.
13 Bond transitional prosthesis to adjacent teeth
in a secure manner to stabilize the transitional
restoration. Alternatively, if care is taken, the
prosthesis may be bonded directly onto the
adjacent teeth without being removed for
polishing, especially for a single implant when
DiamondCrown is used as a veneer over the
adjacent teeth.
14 IMPORTANT: Admonish patient that it is
of paramount importance that there be
NO movement of the bonded transitional
prosthesis. Have patient return for
additional bonding, if any movement of
the transitional prosthesis is perceived.
15 After a minimum of 10 weeks of healing, the
transitional prosthesis may be removed and
the implants may be restored in the intended
manner.
16 Final restorations and radiograph of Integrated
Abutment Crowns.
Note: Statistically, a 2.0mm diameter abutment
post will move 0.1mm into the well of an implant
from its initial insertion to its being denitively
seated, and a 3.0mm abutment will move
0.25mm. It is advisable to have a compliant
patient who will monitor the site for mobility.
9
Place reinforcing fiber
10
Vacuum formed template
11
Remove prosthesis
8
Inject transitional crown material
12
Place polished prosthesis
13
Bond transitional prosthesis
14
Transitional prosthesis
7
Place with finger pressure
15
Transitional prosthesis after 10 weeks
16
Final restorations
Page 32
Surgical Placement: One Stage Surgical Technique
One Stage Surgical Technique
1 Insert the implant using a seating tip or an
inserter/retriever.
2 Place a temporary abutment into the clean
dry well of the implant. The temporary
abutment should be wide enough to
support the interproximal papillae without
encroaching upon them. The temporary
abutment must have sufficient length
to provide support for the soft tissue
and short enough so that it does not
interfere with the temporary prosthesis.
3 Using the straight or offset driver and
a seating tip, lightly tap the temporary
abutment into place. Use caution to avoid
seating the implant farther into the osteotomy
than the desired depth. If necessary, contour
any excess tissue.
4 It may be necessary to approximate the
mucoperiosteal flaps with sutures.
Note: The osteotomy must be wide enough
at the crest to allow for the full seating of the
temporary abutment; counter sinking may be
achieved by using a latch, hand or sulcus reamer
to widen the orifice of the osteotomy.
2
Insert temporary abutment
3a
Tap temporary abutment
3b
Seated temporary abutments
4
1
Insertion
Sutured flaps
Keys to Success
The temporary abutment should be the same or smaller diameter of
the intended nal abutment in order to yield the proper aesthetic
contouring of the soft tissue.
Avoid placing pressure from the tongue on the temporary abutments
and implants.
Do not use the one stage surgical procedure with a removable
transitional, full or partial overdenture.
If necessary, contour temporary abutments to provide space for the
formation of interproximal papillae.
Page 33
References
Page 34
References: Pilot Drill
Pilot Drill
Pilot Drill Warning
It is imperative that the depth indicators on the 2.0mm Pilot Drill are
identified prior to surgery. No assumptions should be made about the
height of the first marking on the pilot drill.
11mm
8mm
6mm
NEW!
14mm
Old New
Newest Latch Reamer Measurements with Corresponding Implant Examples
Page 35
References: Latch Reamers
Latch Reamers with Newest Measurements
Latch Reamer Warning
The reamers are used sequentially beginning with a 2.5mm diameter
and ending with the diameter of the intended implant. The newest
reamers have horizontal markings at 6.0, 8.0, 11, 14 and 17mm, whereas
older reamers may have different markings. It is imperative that the
depth indicators on the latch reamers are identified prior to surgery. No
assumptions should be made about the height of the first marking on
any latch reamer.
Latch Reamers
5.0mm 3.5 x 14 5 x 11 5 x 8 4.5mm 4.0mm 3.5mm 3.0mm
14mm
11mm
8.0mm
17mm
5 x 6 5.5mm 6.0mm
6.0mm
2.5mm
2.5mm 3.0mm 3.5mm 4.0mm 6.0mm 5.5mm 5.0mm
14mm
11mm
8.0mm
17mm
4.5mm
6.0mm
Page 36
References: Template Fabrication
0 15
Template determines mesio-distal positioning
and availability of bone determines final bucco-
lingual angulation.
5
0 15
Use vacu-press template and actual
abutment to confirm restorability of
osteotomy site.
6
Fabrication of Palatal Template from Diagnostic Model
Fabrication of Palatal Template from Existing Prosthesis
Place acrylic onto the lingual aspect
of the trimmed model.
3
Prepare vertical groove in
center of each tooth position to
accommodate 2.0mm pilot drill.
4
Make impression of edentulous ridge
and prepare diagnostic wax-up.
1
Duplicate model and remove
lingual cusps to central fossa.
2
1
Insert denture into alginate in Lang duplicator. Apply separating medium.
2
Fill other side with alginate.
3
Close and allow alginate to set.
4
Fill alginate mold with acrylic.
6
Close and allow acrylic to polymerize.
7
Open and remove duplicated prosthesis.
8 5
Open and remove denture.
9
Draw a line in the middle of each tooth and a line
representing greatest concavity on the tissue side.
10
Cut a 2.0mm wide groove in center of each tooth
joining the lines representing the middle of each
11
Remove the buccal acrylic along the slope joining
the two lines representing the middle of each
12
Trim excess incisal length to prevent interference
with hub of handpiece.
0 15
Template determines mesio-distal positioning and availability
of bone determines final bucco-lingual angulation.
13
Page 37
References: Two Stage Surgical Technique
Two Stage Surgery Implant Insertion Technique
Extraction
site
Narrow
keratinized
tissue
Wide
keratinized
tissue
Flap Designs
1
Drill 2.0mm pilot hole with external
irrigation to a depth 2.0mm-5.0mm
deeper than chosen implant.
2
Use paralleling pins to facilitate alignment
when placing multiple implants.
3
Place abutment into pilot hole and confirm
appropriateness with a vacu-press template.
4
Widen socket with reamer burs without
irrigation at a maximum of 50 RPM.
5
Harvest bone debris from reamer
flutes and socket.
6
Remove implant from plastic bag.
7
Seat implant by tapping gently on healing
plug or directly into the implant well.
8
Cut healing plug.
9
Place harvested bone graft over
shoulder of implant.
10
Close and wait a minimum of nine weeks
for osseointegration.
11
Page 38
References: Two Stage Surgical Technique
Insert chosen abutment.
7
Two Stage Surgery Implant Uncovering Technique with Non-Shouldered Abutment
Two Stage Surgery Implant Uncovering Technique with Temporary Abutment
Expose the implant in aesthetic areas
with a semilunar crestal incision.
1
Place guide pin to check integration
and angulation.
4
Flush and dry implant well and
proceed to step 7 or to 6a below.
6
Inject acrylic around emergence cuff
or temporization sleeve and into vacu-
press template.
10
Remove excess bone with sulcus reamer corresponding to the
chosen abutment with either threaded knob or straight handle. Use
extended guide pins for long shafted abutments.
5
Use a 60 beaver blade or any blade to
make split thickness buccal flap.
2
Wait for soft tissue healing prior to
taking final impression.
13
Place template to form
temporary crown.
11
Remove and polish acrylic confluent with emergence cuff or
temporization sleeve to form sulcus.
12
Use a template to confirm appropriateness of abutment prior to
engagement of locking taper connection, then tap on abutment
in long axis of abutment shaft to engage locking taper.
8
Remove healing plug with a healing plug
removal instrument or small forceps.
3
Place temporary abutment.
6a
Allow for soft tissue healing before proceeding with
step 2 of one stage uncovering technique.
6b
Place an acrylic emergence cuff or temporization
sleeve and modify, if necessary.
9
Page 39
References: One Stage Surgical Technique
One Stage Surgery Implant Insertion Technique
Extraction
site
Narrow
keratinized
tissue
Wide
keratinized
tissue
Flap Designs
1
Remove black healing plug.
6
Insert implant with abutment
into socket.
8
Replace black healing plug with
appropriate temporary abutment.
7
Countersink socket orifice 1.0mm-2.0mm.
5
Widen socket with successively wider reamer burs
without irrigation at a maximum of 50 RPM.
4
Place abutment into pilot hole and
confirm with vacu-press template.
3
Trim tissue if necessary.
9
Drill 2.0mm pilot hole with external
irrigation to a depth 2.0mm-5.0mm
deeper than chosen implant.
2
Page 40
References: One Stage Surgical Technique
One Stage Surgery Implant Uncovering Technique with Non-Shouldered Abutment
Allow a minimum of nine weeks for
osseointegration.
1
Inject acrylic around emergence cuff or
temporization sleeve and into vacu-press stent.
8
Place template to form
temporary crown.
9
Remove and polish acrylic confluent with
emergence cuff or temporization sleeve
to form sulcus.
10
Remove temporary abutment
without anesthesia.
2
Place guide pin to check
integration and angulation.
3
Flush and dry implant well.
4
Insert abutment.
5
Use a template to confirm appropriateness of
abutment prior to engagement of locking taper
connection, then tap on abutment in long axis
of abutment shaft to engage locking taper.
6
Place an acrylic emergence cuff or
temporization sleeve and modify, if necessary.
7
Page 41
References: Two Stage Mandibular Ridge Split
Two Stage Mandibular Ridge Split Technique
Coronal view of mandible.
1
Close for three or four weeks to re-establish
blood supply to the cortical bone.
4
Lateral view of two thin vertical osteotomies
and a wider horizontal osteotomy.
3
Buccal cortex is outfractured as
wider reamer burs are used.
6
Insert implant into a widened ridge
apical to the horizontal osteotomy.
7
Allow a minimum of four months for
osseointegration.
8
Without reflecting the buccal periosteum,
drill a 2.0mm pilot hole to a depth below
the horizontal osteotomy.
5
Make a full thickness flap and a narrow crestal
osteotomy. Make a wider horizontal osteotomy
3.0mm above the mandibular canal.
2
Page 42
References: Internal Sinus Lift
Internal Sinus Lift Technique
Internal Sinus Lift Technique - One Stage Alternative
3b
Close and wait a minimum of four
months for osseointegration.
Close and wait a minimum of four
months for osseointegration.
7
Place bone graft material
over shoulder of implant.
6
Tap directly on
temporary abutment.
3a
Tap implant into socket elevating sinus
floor. When beveled edge is at crest,
implant is at proper depth.
4
Prepare osteotomy to sinus floor.
1
Greenstick fracture sinus floor
with narrower osteotome.
2
Place bone graft material
into socket.
3
Insert and cut healing plugs.
5
Page 43
References: Lateral Sinus Lift
Possible Complication: Small Perforation
Possible Complication: Large Perforation
Lateral Sinus Lift Technique with Floor Augmentation
Large perforation of membrane.
1
2
Drill suture retention holes.
3
Lateral view of suture retention holes.
4
Suture resorbable membrane in place.
Trans-illuminate sinus to identify
osteotomy outline.
1
Elevate sinus floor keeping curette
in contact with bone.
3
Prepare osteotomy with external irrigation.
Inferior cut should be at level of sinus floor.
2
Small perforation of membrane.
3a
Cover small perforation with
resorbable membrane.
3b
After closure wait six months
prior to placing implants.
5
Place graft material under elevated
sinus membrane.
4
Final closure of graft under
resorbable membrane.
7
Place graft material under membrane.
6 5
Coronal view of membrane in place.
Page 44
References: Handpiece Maintenance
Handpiece Considerations
The 400:1 handpiece has su cient torque to cut through bone at 50 RPM.
The 18:1 handpiece is designed to be used with the pilot drill at ~1,100 RPM with external irrigation.
Irrigation is not necessary at speeds of 50 RPM or lower.
Failure to observe speed limitation may result in burned or overheated bone which could result in substantial bone
necrosis.
The 20,000 RPM Air Motor attaches to conventional four hole dental tubing and is an alternative to the electric drill unit.
Air pressure of at least 80 PSI is recommended to drive the air motor with su cient torque in dense bone.
Proper maintenance of handpieces is crucial for long term success of handpieces.
Do not exceed 132C (275F) when sterilizing.
In order to prevent discoloration and/or damage to the plating of the handpieces from chemicals that are not
su ciently cleaned from other instruments, do not autoclave the handpieces with other instruments.
Always check the handpiece for any abnormal vibration, heating, noise, or sluggish operation. If any abnormality is
noticed, cease the use of the handpiece.
Handpiece Maintenance
Cleaning and Lubrication
Clean and lubricate the contra-angle handpiece after each use.
Attach the metal spray nozzle into the back of the handpiece and insert the pana spray into the metal spray nozzle.
(Figure 1)
Spray for approximately 2 seconds
Disassemble the head from the handpiece using the supplied wrench. (Figure 2)
Spray into the head. (Figure 3)
Assemble the head to the handpiece sheath in the reverse order of disassembly. Make sure that the two keys at the
union nut align with the slots in the sheath and tighten the union nut.
Wipe the assembled handpiece clean.
Sterilization
The 400:1 and 18:1 handpieces are autoclavable.
Wipe any debris o with an alcohol-soaked cloth.
Lubricate the handpiece using spray lubricant. Insert the handpiece into a sterilizing pouch and seal it.
Autoclave for 15 minutes at 132 C (275 F). Do not set the sterilizer temperature above 132 C (275 F).
To expel excess oil, operate the handpiece before using it intra-orally.
Figure 3 Figure 2 Figure 1
Figure 1
Page 45
References: Abutment Measurement
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Page 46
References: Non-Shouldered Abutments
Non-Shouldered Abutments and Prosthetic Components
4.0 x 6.5mm
Restorative/Laboratory Kit
260-140-465
5.0 x 6.5mm
260-150-465
5.0 x 5.0mm
260-150-450
3.5mm
Temporization Sleeve (2)
260-135-165
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3.5 x 6.5mm
260-135-465
3.5mm Diameter
2.0mm Post
4
.
0

x

6
.
5

0
2
6
0
-
1
4
0
-
0
0
2
4
.
0

x

1
0

1
5
2
6
0
-
1
4
0
-
1
1
5
4
.
0

x

1
0

0
2
6
0
-
1
4
0
-
1
0
1
4
.
0

x

6
.
5

2
5
2
6
0
-
1
4
0
-
0
2
5
4
.
0

x

6
.
5

1
5
2
6
0
-
1
4
0
-
0
1
5
4
.
0

x

6
.
5

0
2
6
0
-
3
4
0
-
0
0
1
4
.
0

x

6
.
5

1
5
2
6
0
-
3
4
0
-
0
1
5
4.0mm Diameter
4.0 x 10mm
260-140-410
4.0mm
260-140-165
5.0mm
260-150-165
Indirect Abutment Level Impression
Modifed and unmodifed
color-coded impression sleeves
are defnitively seated on their
corresponding abutments.
Impression material is injected
around the impression sleeves
for the making of an abutment
level transfer impression.
Acrylic impression sleeves withdrawn in impression
material prior to impression being sent to
the laboratory.
Soft tissue material being injected
around impression sleeves and
abutment transfer dies.
Notes: Snap-on sleeves are only specic for abutment diameter. Abutment height is not a criterion for proper selection of snap-on sleeves. Transfer dies correspond to exact diameter and height of abutment placed.
Because of machining tolerances, acrylic sleeves may not reach the height of contour for some angled abutments.
6.5mm Height 6.5mm Height
10mm Height
3
.
5

x

6
.
5

0
2
6
0
-
1
3
5
-
0
0
1
3
.
5

x

6
.
5

2
5
2
6
0
-
1
3
5
-
0
2
5
3
.
5

x

6
.
5

1
5
2
6
0
-
1
3
5
-
0
1
5
2.0mm Post
3.0mm Post
6.5mm Height
6.5mm Height
5.0mm Height
2.0mm Post
5.0mm Height
3.0mm Post
6.5mm Height
6.5mm Height
5.0mm Height
6.5mm Height
10mm Height
6.5mm Height
4
.
0

x

1
0

1
5
2
6
0
-
3
4
0
-
1
1
5
4
.
0

x

1
0

0
2
6
0
-
3
4
0
-
1
0
1
10mm Height
Page 47
References: Non-Shouldered Abutments
Non-Shouldered Abutments and Prosthetic Components
5.0 x 12mm
260-150-412
5.0 x 10mm
260-150-410
5.0 x 6.5mm
260-150-465
7.5 x 8.0mm
260-175-480
7
.
5

x

8
.
0

0
2
6
0
-
3
7
5
-
8
0
1
7
.
5

x

8
.
0

1
5
2
6
0
-
3
7
5
-
8
1
5
7.5mm Diameter
6
.
5

x

5
.
0

0
2
6
0
-
1
6
5
-
0
5
0
6
.
5

x

5
.
0

1
5
2
6
0
-
1
6
5
-
0
5
5
6
.
5

x

6
.
5

0
2
6
0
-
1
6
5
-
0
0
1
6
.
5

x

6
.
5

1
5
2
6
0
-
1
6
5
-
0
1
5
6
.
5

x

5
.
0

0
2
6
0
-
3
6
5
-
0
5
0
6
.
5

x

5
.
0

1
5
2
6
0
-
3
6
5
-
0
5
5
6
.
5

x

6
.
5

0
2
6
0
-
3
6
5
-
0
0
1
6
.
5

x

6
.
5

1
5
2
6
0
-
3
6
5
-
0
1
5
6.5mm Diameter
5
.
0

x

1
2

1
5
2
6
0
-
1
5
0
-
2
1
5
5
.
0

x

1
2

0
2
6
0
-
1
5
0
-
2
0
1
5
.
0

x

1
0

1
5
2
6
0
-
1
5
0
-
1
1
5
5
.
0

x

1
0

0
2
6
0
-
1
5
0
-
1
0
1
5
.
0

x

1
2

0
2
6
0
-
3
5
0
-
2
0
1
5
.
0

x

1
2

1
5
2
6
0
-
3
5
0
-
2
1
5
5.0mm Diameter
6.5 x 6.5mm
260-165-465
6.5 x 5.0mm
260-165-450
5.0mm
260-150-165
6.5mm
260-165-165
7.5mm
260-175-165
Direct Abutment Level Impression
Non-shouldered abutment being
prepared with a #1557 carbide bur.
Two prepared non-shouldered
abutments.
Impression material being injected
around non-shouldered abutments.
Full arch impression.
Notes: Snap-on sleeves are only specic for abutment diameter. Abutment height is not a criterion for proper selection of snap-on sleeves. Transfer dies correspond to exact diameter and height of abutment placed.
Because of machining tolerances, acrylic sleeves may not reach the height of contour for some angled abutments.
12mm Height
10mm Height
6.5mm Height
2.0mm Post
3.0mm Post
12mm Height
6.5mm Height
3.0mm Post 3.0mm Post
8.0mm Height
6.5mm Height
5.0mm Height
6.5mm Height
5.0mm Height
2.0mm Post
12mm Height
6.5mm Height
10mm Height
5.0mm Height
6.5mm Height
8.0mm Height
5
.
0

x

1
0

1
5
2
6
0
-
3
5
0
-
1
1
5
5
.
0

x

1
0

0
2
6
0
-
3
5
0
-
1
0
1
10mm Height
Page 48
References: Stealth Shouldered Abutments
5.0mm
Stealth Shouldered Abutment System
Aluminum Oxide Sleeves
One-Piece Acrylic Sleeves
3.5 x 7.0mm 4.0 x 7.0mm
Abutment Shoulder Gauge
5.0mm
Short
5.0mm
Tall
4.0mm
Short
4.0mm
Tall
3.5mm
5.0 x 10.0mm 5.0 x 7.0mm
3.5mm 4.0mm
Stealth Shouldered Abutments with a 2.0mm Post
Abutment Transfer Dies*
5.0mm
Plastic*
5.0mm
Brass
4.0mm
Plastic*
4.0mm
Brass
3.5mm
Plastic*
*NOTE: Plastic transfer dies should not be used with metal castings.
Page 49
References: Stealth Shouldered Abutments
Stealth Shouldered Abutment System
5.0mm 4.0mm
Abutment Shoulder Gauge
Stealth Shouldered Abutments with a 3.0mm Post
4.0 x 7.0mm 5.0 x 10.0mm 5.0 x 7.0mm
Aluminum Oxide Sleeves
One-Piece Acrylic Sleeves
5.0mm
Short
5.0mm
Tall
4.0mm
Short
4.0mm
Tall
Abutment Transfer Dies*
5.0mm
Plastic*
5.0mm
Brass
4.0mm
Plastic*
4.0mm
Brass
*NOTE: Plastic transfer dies should not be used with metal castings.
501 Arborway
Boston, MA 02130 USA
tel: (800) 88-BICON (617) 524-4443
fax: (800) 28-BICON (617) 524-0096
web: www.bicon.com
e-mail: support@bicon.com
Copyright 2005 Bicon R0605 260-103-001

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