1. July 23, 2009 The ISI Complete™ , TSI, and Soon Be Released ERI Immediate Load Dental Implant System OCO Biomedical introduced the next generation of endosseous implants: Patent pending

2. Diagnosis and treatment planning Medical and dental history How did the patient loose the tooth or teeth Pano or cone-beam cat scan x-ray Study models Model mapping on areas to be treated if needed Identify bone type and density Evaluate available bone in areas to be treated Inform before you perform Evaluate the patient expectations Can you meet those expectations Can anyone achieve the expectations Encourage the patient to get a second or third opinion and estimate

3. Evaluate study model for ridge width, alignment of adjacent teeth, if a dental implant can be placed using uncomplicated techniques.

4. Section the model through the edentulous area and after estimating gingival thickness, map it.

5. Mount study models, mounted. A must for treatment planning and Case Presentation

6. Mount study models, mounted. A must for treatment planning and Case Presentation

7. July 23, 2009 Edentulous MandibleAn immediate denture placed 17 yrs ago

8. Pantographic X=Ray, a must for any implant case. Is there abundance of bone?

9. Model of lower, sectioned at the center and mapped

10. July 23, 2009 Bone Densities

11. Anterior Bone Qualities Lekholm and Zarb’s four bone qualities for the anterior region of the jaws: Quality 1: Composed of homogenous compact bone Quality 2: Thick layer of cortical bone surrounding dense trabecular bone. Quality 3: Thin layer of cortical bone surrounded by dense trabecular bone of favorable strength. Quality 4: Thin layer of cortical bone surrounding a core of low-density trabecular bone. D1 D2 D3 D4

12. General Bone Densities Bone Density Classification by Misch & Judy D2 D1 D4 D3

13. Basics for fixed: 4 Main buttresses for fixed or implant supported teeth Ideal minimum Implant diameter Minimum implant length 10 to 12 mm

14. A Dental Implant is not a natural tooth root Vertical tooth movement: 25 to 100 mµ Vertical Implant movement: 0 to 10 mµ Horizontal flex: Tooth –yes Implant - no Proprioception: Tooth – yes Implant - no

15. So, if not following the buttress parameters and ignoring the physical properties:

16. Edentulous upper left quadrant: Ideal implant placement 4.0mm bicuspid areas 5.0 mm 1st molar area 4 or 5mm 2nd molar

17. Bi-Lateral lower edentulous: R- normal ridge, L- narrow ridge Treatment R- Ideal, 5.0mm at Molar, 4mm for bicuspids L- Narrow ridge- compromise, 2 3.25 At molar. 3.25 in bicuspid Areas. Prosthesis, splinted crowns No wider than bicuspids, Lighter occlusion and no Lateral interferences.

18. Edentulous upper and lower Treatment: Stabilize lower denture Economy: I-Mini Implants 4 on the floor 3.0mm I-Mini implants Placed between mental foramina X X FOR A SIMPLE OVERDENTURE NEVER PLACE IMPLANTS IN THE POSTERIOR REGION

19. To maximise To maximize A-P place markers in the denture, take a pano and establish the location of the mental foramina I O O I

20. Implants placed and at least 3mm anterior to the mental foramina

21. Edentulous upper and lower Treatment: Stabilize lower denture Or, if the residual ridge Permits: moderate height, Wide ridge Never! 2 Implants in Cuspid Areas 4 to 6 standard sized 3.25 or 4mm Implants placed between the mental foramina, Crates a fulcrum The denture will rock 2 - 4.0 mm 2 – 3.25 mm

22. Edentulous upper and lower Treatment: Stabilize lower denture Or, if the residual ridge Permits: Tall, med width OR: 5 or 6 3.25 mm implants between the mental foramina

23. Five implants placed comfortably in the safety zone by placing markers in denture first

24. Post- Op Pano

25. In less than 2 weeks the healing looks great and he’s ready for a reline and the final female attachments

26. Flanges are trimmed and the size of the denture is minimized

27. July 23, 2009 IMMEDIATE PLACEMENT PROTOCOL AND PROCEDURE ISI Complete™ One-piece and TSI Two-piece Dual Stabilization™ Implants

28. Establishing the path of implant insertion after removing the tooth or tooth roots

29. With a high speed drill, always break through the cortical bone lining the socket wall in the direction of implant alignment Use a # 8 surgical or XXL straight fissure burr/ water cooling only, no air

30. Use the pilot drill in the surgical HP aligned to the final depth

31. Select the implant diameter by placing the final drill into the socket. It must not drop more that half the selected length

32. Drill with osteotomy former to the final depth established by the pilot Drill

33. Implant placed with grafting material, if dual stabilization is present, ISI can be used. If not, a TSI must be used

34. Q&A Thank You Questions? OCO Biomedical is a debt-free Company serving the dental Implant Community since 1976