Northern Virginia Oral & Maxillofacial Surgery Associates

Implant CoordinatorProtocol and Guideline

The purpose of this manual is to serve as a guideline and assist with the Surgical Implant Coordinator position and administrative needs of Northern Virginia Oral & Maxillofacial Surgery Associates.

Prepared by: Yolimar Dick

Dental Implant.

A dental implant (also known as an endosseous implant or fixture) is a surgical component that interfaces with the bone of the jaw or skull to support a dental prosthesis such as a crown, bridge, denture, facial prosthesis or to act as an orthodontic anchor.

The basis for modern dental implants is a biologic process called osseo integration where materials, such as titanium, form an intimate bond to bone.

The implant fixture is first placed, so that it is likely to osseo integrate, then a dental prosthetic is added. A variable amount of healing time is required for osseo integration before either the dental prosthetic (a tooth, bridge or denture) is attached to the implant or an abutment is placed which will hold a dental prosthetic.

Success or failure of implants depends on the health of the person receiving it, drugs which impact the chances of osseo integration and the health of the tissues in the mouth.

The amount of stress that will be put on the implant and fixture during normal function is also evaluated. Planning the position and number of implants is key to the long-term health of the prosthetic since biomechanical forces created during chewing can be significant.

The position of implants is determined by the position and angle of adjacent teeth, lab simulations or by using computed tomography with CAD/CAM simulations and surgical guides called stents.

The prerequisites to long-term success of osseo integrated dental implants are healthy bone and gingiva. Since both can atrophy after tooth extraction pre-prosthetic procedures, such as sinus lifts or gingival grafts, are sometimes required to recreate ideal bone and gingiva.

The final prosthetic can be either fixed, where a person cannot remove the denture or teeth from their mouth or removable, where they can remove the prosthetic. In each case an abutment is attached to the implant fixture. Where the prosthetic is fixed, the crown, bridge or denture is fixed to the abutment with either lag-screws or cement. Where the prosthetic is removable, a corresponding adapter is placed in the prosthetic so that the two pieces can be secured together.

The risks and complications related to implant therapy are divided into those that occur during surgery (such as excessive bleeding or nerve injury), those that occur in the first six months (such as infection and failure to osseo integrate) and those that occur long-term (such as peri-implantitis and mechanical failures). In the presence of healthy tissues, a well-integrated implant with appropriate biomechanical loads can have long term success rates of 93 to 98 percent for the fixture and 10 to 15 year lifespans for the prosthetic teeth.

Medical Uses.The primary use of dental implants are to support dental prosthetics. Modern dental implants make use of osseo integration, the biologic process where bone fuses tightly to the surface of specific materials such as titanium and some ceramics. The integration of implant and bone can support physical loads for decades without failure.

For individual tooth replacement, an implant abutment is first secured to the implant with an abutment screw. A crown (the dental prosthesis) is then connected to the abutment withdental cement, a small screw, or fused with the abutment as one piece during fabrication. Dental implants, in the same way, can also be used to retain a multiple tooth dental prosthesis either in the form of a fixed bridge or removable dentures.

An implant supported bridge (or fixed denture) is a group of teeth secured to dental implants so the prosthetic cannot be removed by the user. Bridges typically connect to more than one implant and may also connect to teeth as anchor points. Typically the number of teeth will outnumber the anchor points with the teeth that are directly over the implants referred to as abutments and those between abutments referred to as pontics. Implant supported bridges attach to implant abutments in the same way as a single tooth implant replacement. A fixed bridge may replace as few as two teeth (also known as a fixed partial denture) and may extend to replace an entire arch of teeth (also known as a fixed full denture). In both cases, the prosthesis is said to be fixed because it cannot be removed by the denture wearer.

General Considerations.Planning for dental implants focuses on the general health condition of the patient, the local health condition of the mucous membranes and the jaws and the shape, size, and position of the bones of the jaws, adjacent and opposing teeth. There are few health conditions that absolutely preclude placing implants although there are certain conditions that can increase the risk of failure. Those with poor oral hygiene, heavy smokers and diabetics are all at greater risk for a variant of gum disease that affects implants called peri-implantitis, increasing the chance of long-term failures. Long-term steroid use, osteoporosis and other diseases that affect the bones can increase the risk of early failure of implants.

Main surgical procedures.

Placing the Implant.Most implant systems have five basic steps for placement of each implant:

1. Soft tissue reflection : An incision is made over the crest of bone, splitting the thicker attached gingiva roughly in half so that the final implant will have a thick band of tissue around it. The edges of tissue, each referred to as a flap are pushed back to expose the bone. Flapless surgery is an alternate technique, where a small punch of tissue (the diameter of the implant) is removed for implant placement rather than raising flaps.

2. Drilling at high speed : After reflecting the soft tissue, and using a surgical guide or stent as necessary, pilot holes are placed with precision drills at highly regulated speed to prevent burning or pressure necrosis of the bone.

3. Drilling at low speed : The pilot hole is expanded by using progressively wider drills (typically between three and seven successive drilling steps, depending on implant width and length). Care is taken not to damage the osteoblast or bone cells by overheating. A cooling saline or water spray keeps the temperature low.

4. Placement of the implant : The implant screw is placed and can be self-tapping, otherwise the prepared site is tapped with an implant analog. It is then screwed into place with a torque controlled drill at a precise torque so as not to overload the surrounding bone (overloaded bone can die, a condition called osteonecrosis, which may lead to failure of the implant to fully integrate or bond with the jawbone).

5. Tissue adaptation : The gingiva is adapted around the entire implant to provide a thick band of healthy tissue around the healing abutment. In contrast, an implant can be "buried", where the top of the implant is sealed with a cover screw and the tissue is closed to completely cover it. A second procedure would then be required to uncover the implant at a later date.

Timing of implants after extraction of teeth.

There are different approaches to placement dental implants after tooth extraction. The approaches are:

1. Immediate post-extraction implant placement.2. Delayed immediate post-extraction implant placement (two weeks to three

months after extraction).3. Late implantation (three months or more after tooth extraction).

There are also various options for when to attach teeth to dental implants,classified into:

1. Immediate loading procedure.2. Early loading (one week to twelve weeks).3. Delayed loading (over three months).

Healing time.For an implant to become permanently stable, the body must grow bone to the surface of the implant (osseo integration). Based on this biologic process, it was thought that loading an implant during the osseo integration period would result in movement that would prevent osseo integration, and thus increase implant failure rates. As a result, three to six months of integrating time (depending on various factors) was allowed before placing the teeth on implants (restoring them).

However, later research suggests that the initial stability of the implant in bone is a more important determinant of success of implant integration, rather than a certain period of healing time. As a result, the time allowed to heal is typically based on the density of bone the implant is placed in and the number of implants splinted together, rather than a uniform amount of time. When implants can withstand high torque (35 Ncm) and are splinted to other implants, there are no meaningful differences in long-term implant survival or bone loss between implants loaded immediately, at three months, or at six months.The corollary is that single implants, even in solid bone, require a period of no-load to minimize the risk of initial failure.

One-stage, two-stage surgery.After an implant is placed, the internal components are covered with either a healing abutment, or a cover screw. A healing abutment passes through the mucosa, and the surrounding mucosa is adapted around it. A cover screw is flush with the surface of the dental implant, and is designed to be completely covered by mucosa. After an integration period, a second surgery is required to reflect the mucosa and place a healing abutment.

In the early stages of implant development (1970−1990), implant systems used a two-stage approach, believing that it improved the odds of initial implant survival. Subsequent research suggests that no difference in implant survival existed between one-stage and two-stage surgeries, and the choice of whether or not to "bury" the implant in the first stage of surgery became a concern of soft tissue (gingiva) management.

When tissue is deficient or mutilated by the loss of teeth, implants are placed and allowed to osseo integrate, then the (gingiva) is surgically moved around the healing abutments. The down-side of a two-stage technique is the need for additional surgery and compromise of circulation to the tissue due to repeated surgeries.The choice of one or two-stages, now centers around how best to reconstruct the soft tissues around lost teeth.

Immediate placement.An increasingly common strategy to preserve bone and reduce treatment times includes the placement of a dental implant into a recent extraction site. On the one hand, it shortens treatment time and can improve esthetics because the soft tissue envelope is preserved. On the other hand, implants may have a slightly higher rate of initial failure. Conclusions on this topic are difficult to draw, however, because few studies have compared immediate and delayed implants in a scientifically rigorous manner.

Additional Surgical Procedure.

For an implant to osseo integrate, it needs to be surrounded by a healthy quantity of bone. In order for it to survive long-term, it needs to have a thick healthy soft tissue (gingiva) envelope around it. It is common for either the bone or soft tissue to be so deficient that the surgeon needs to reconstruct it either before or during implant placement.

Hard tissue (bone) reconstruction.

Bone grafting is necessary when there is a lack of bone. While there are always new implant types and techniques to allow compromise, a general treatment goal is to have a minimum of 10 mm in bone height, and 6 mm in width. Alternatively, bone defects are graded from A to D (A=10+ mm of bone, B=7–9 mm, C=4–6 mm and D=0–3 mm) where an implant's likelihood of osseo integrating is related to the grade of bone.

To achieve an adequate width and height of bone, various bone grafting techniques have been developed. The most frequently used is called guided bone graft augmentation where a defect is filled with either natural (harvested or autograft) bone or allograft (donor bone or synthetic bone substitute), covered with a semi-permeable membrane and allowed to heal. During the healing phase, natural bone replaces the graft forming a new bony base for the implant.

Three common procedures are:

1. The sinus lift.

2. Lateral alveolar augmentation (increase in the width of a site).3. Vertical alveolar augmentation (increase in the height of a site).

Soft Tissue (gingiva) reconstruction.

The gingiva surrounding a tooth has a 2–3 mm band of bright pink, very strong attached mucosa, then a darker, larger area of unattached mucosa that folds into the cheeks. When replacing a tooth with an implant, a band of strong, attached gingiva is needed to keep the implant healthy in the long-term. This is especially important with implants because the blood supply is more precarious in the gingiva surrounding an implant, and

is theoretically more susceptible to injury because of a longer attachment to the implant than on a tooth (a longer biologic width).

When an adequate band of attached tissue is absent, it can be recreated with a soft tissue graft. There are four methods that can be used to transplant soft tissue. A roll of tissue adjacent to an implant (referred to as a palatal roll) can be moved towards the lip (buccal), gingiva from the palate can be transplanted, deeper connective tissue from the palate can be transplanted or, when a larger piece of tissue is needed, a finger of tissue based on a blood vessel in the palate (called a vascularized interpositional periosteal-connective tissue (VIP-CT) flap) can be repositioned to the area.

Additionally, for an implant to look esthetic, a band of full, plump gingiva is needed to fill in the space on either side of implant. The most common soft tissue complication is called a black-triangle, where the papilla (the small triangular piece of tissue between two teeth) shrinks back and leaves a triangular void between the implant and the adjacent teeth. Dentists can only expect 2–4 mm of papilla height over the underlying bone. A black triangle can be expected if the distance between where the teeth touch and bone is any greater.

Recovery.

The prosthetic phase begins once the implant is well integrated (or has a reasonable assurance that it will integrate) and an abutment is in place to bring it through the mucosa. Even in the event of early loading (less than 3 months), many practitioners will place temporary teeth until osseo integration is confirmed. The prosthetic phase of restoring an implant requires an equal amount of technical expertise as the surgical because of the biomechanical considerations, especially when multiple teeth are to be restored. The dentist will work to restore the vertical dimension of occlusion, the esthetics of the smile, and the structural integrity of the teeth to evenly distribute the forces of the implants.

Prosthetic procedures for single teeth, bridges and fixed dentures.

An abutment is selected depending on the application. In many single crown and fixed partial denture scenarios (bridgework), custom abutments are used. An impression of the top of the implant is made with the adjacent teeth and gingiva. A dental lab then simultaneously fabricates an abutment and crown. The abutment is seated on the implant, a screw passes through the abutment to secure it to an internal thread on the implant (lag-screw). There are variations on this, such as when the abutment and implant body are one piece or when a stock (prefabricated) abutment is used. Custom

abutments can be made by hand, as a cast metal piece or custom milled from metal or zirconia, all of which have similar success rates.

The platform between the implant and the abutment can be flat (buttress) or conical fit. In conical fit abutments, the collar of the abutment sits inside the implant which allows a stronger junction between implant and abutment and a better seal against bacteria into the implant body. To improve the gingival seal around the abutment collar, a narrowed collar on the abutment is used, referred to as platform switching. The combination of conical fits and platform switching gives marginally better long term periodontal conditions compared to flat-top abutments.

Regardless of the abutment material or technique, an impression of the abutment is then taken and a crown secured to the abutment with dental cement. Another variation on abutment/crown model is when the crown and abutment are one piece and the lag-screw traverses both to secure the one-piece structure to the internal thread on the implant. There does not appear to be any benefit, in terms of success, for cement versus screw-retained prosthetics, although the latter is believed to be easier to maintain (and change when the prosthetic fractures) and the former offers high esthetic performance.

Implant Consultation.

This appointment is necessary and required prior to any implant appointment being scheduled.

At this point, the Oral Surgeon will discuss the patient’s potential for implant (s) and what is necessary in order to achieve patient’s functional and aesthetic needs. The patient will be given an estimate of cost and time frame in order to achieve final restoration.

Scheduling Implant Appointment.

This appointment is based on the patient’s estimate and the numbers # of implants to be placed and how much time the Oral Surgeon needs to place them including no side books.

Sometimes patients will need to be sedate for this procedures. Sometimes patients will also need to have extraction and / or bone grafts and / or sinus lift prior implant placement.

Implant Placement.

At this appointment, the patient will have the placement of implant (s) + / - bone graft, + / - sinus lift, + / - immediate temporary implant (s), and + / - temporary abutment (or Cover Screw) or in some cases the Oral Surgeon place a Healing Abutment if the surgical area is ready for a what they call Single Stage.

The appropriate amount of time should have been scheduled including no side books.

Flipper and temporary partial of full dentures should be in office at time of appointment.

Post Op Visits.

These are important for the Oral Surgeon in order to follow the patient’s healing process. Usually patients are seen 7 – 14 days following implant (s) placement. Occasionally, additional post op appointments are necessary due to patients need. It is important to have the patient seen prior to the Healing Abutment appointment.

Healing Abutment / Implant uncovering.

This appointment allows access to the implant by the restorative dentist and the Oral Surgeon. This appointment is usually schedule 3 months after the implant (s) placement.

Restorative by General Dentist.

Parts will have been delivered to General Dentist to make the final crown (s). They are usually determined by Oral Surgeon and General Dentist. Sometimes coordinated same day appointments are necessary. Usually, the patient will see the General Dentist 7 to 10 days after the Healing Abutment is placed. Final restoration depends on the General Dentist and the Lab used.

Final Post op Check.

This is a check for the Oral Surgeon to determine if final restoration is appropriate and the patient functions well with the new crown (s). This is usually scheduled after the patient has had a change to use the crown (s) for at least a couple of weeks.

Implant Consultation needs.

This is usual a 30 minute appointment.

Generally a panoramic x-ray is needed to determine patient’s needs and if patient is a good candidate, the Oral Surgeon will determine:

1) Does the patient need extraction (s)?If so,

a) Can this be done as same day as implant?b) Does patient need to heal 8 or more weeks post extraction prior to

implant placement?c) Does patient have an infection present?

2) Does Patient need a bone graft and need a healing time prior to implant placement?If so,

a) What kind of bone graft Donor bone Patient’s own bone

3) Does the patient need to have a sinus lift?4) If the patient can have an implant placement at any time:

Does the patient have? A previous missing tooth / teeth?

A deciduous tooth with little or no root structure? Replace an anterior tooth with small enough root space to

support an implant?5) Does the patient wish to have a flipper or temporary denture to wear

during the healing process?If so the patient will need to see the General Dentist for impressions so it will be ready and in office time of implant appointment.

6) Does the patient wish to have a temporary abutment for anterior Teeth?7) Does patient wish to haveimmediate temporary implant support a denture

while patient heals from extraction and implant placement?

Patients that have extractions + / - infection + / - bone graft and / or sinus lift prior to implant placement, or has a long time between extraction and implant placement, should consult the Oral Surgeon for re-evaluation. Another x-ray will be taken at this time.

The Oral Surgeon will prepare an estimate of cost and time frame in which the patient can expect to have the final restoration. Additional cost for abutments will be included on the estimate.

The estimate will then be gone over with the patient. At this time, the patient is advised of payment policy, if insurance covers implants and if preauthorization is necessary prior to scheduling patient’s appointment. At this time, Abutment costs should be stressed. They are not usually cover by insurance. They are not included in the implant cost. They are based on the Restorative Doctor needs and wants to restore implant (s) appropriately. They will be charge out at the abutment appointment because restoration plan by Restorative Doctor may not be known at time of implant insertion.

The patient can schedule the implant appointment if appropriate.

If the patient need extraction (s) or bone graft prior to implant (s) schedule that first. If flipper or immediate temporary denture needs to be here at the time of appointment either delivered by patient Restorative Doctor, schedule after you know when it will be available, otherwise patient will be without teeth for several days post extraction. The patient will need a follow up appointment in a two weeks after implant (s) placement.

Implant Placement Appointment needs.

What do you need?

Implant Tray +/- extraction instruments. Implant hand piece. Implant Placement kit (NOBEL OR BIOMET 3I). Implants. Healing Caps (also call: Cover Screw). Healing Abutments (if is a Single Stage). Saline irrigation. Antibiotic (patient have to take 4 pills before the surgery) remembers ask patient

if there is any allergies to any type of antibiotic). 2 35 cc syringe with blunt needles bent at an angle. Stainless steel cup for irrigation fluid. Sterile surgical gloves. Disposable suction tubing. #15 blade. Suture material. Mock letter to Restorative Doctor to be filed out during appointment. +/- Small measuring cup. +/- Bone graft material.

+/- 1 cc syringe with tip cut off. +/- Sinus lift instruments. +/- Osseo tomes. +/- Low speed with acrylic bur.

Implants required different kits in order to be placed and some need healing caps (Cover Screw) in addition to implant. Nobel Biocare have in a different package a separate healing cap (Cover Screw) Biomet 3I have the healing cap inside of the implant package.

Implant placement kits are brand and type specific.

They contain:

Drill bits of various sizes and widths. They are used in succession going from smallest to widest to achieve the correct size hole for the implant. They are either straight or tapered, therefore the correct kit is necessary.Certain kits have hollow drill bits that need to be cleaned out after each patient. (NOBEL Biocare).

Implant carriers. These fit into the implant and allow the Oral Surgeon to place the implant appropriately. Please note 3I has a separate carrier for the smaller 3.05 mm. It is important the right carrier is used. There is also a difference in internal and external hexed implants and what carriers are used.

Implant direction indicators.

Implant depth indicators.

Screwdrivers.

Hand torque wrench to finish implant placement.

It is important to maintain all of the kits by:

1) Replacing worn out drill bits.2) Replacing missing items.3) Make sure all drill bits and tools are stored in kit appropriately.4) Make sure all drill are in the proper size order.5) Make note on kit with autoclave tape if missing parts.6) Have back up for all drill sizes and implant carriers.

Implant System used in Northern Virginia Oral and Maxillofacial Surgery Associates

Nobel Biocare Overview.

Nobel Biocare is a world leader in the field of innovative implant-based dental restorations from single tooth to fully edentulous indications. They offer dental implant systems, high-precision individualized prosthetics and CAD/CAM systems, diagnostics, treatment planning, guided surgery solutions and biomaterials. They support customers throughout their professional and practice development. Their headquarters is in Zurich, Switzerland, and our shares are listed on the SIX Swiss Exchange.

Nobel Biocare Conical Connection.

Nobel Replace Conical Connection merges the original tapered implant body with a tight sealed connection, offering an esthetic solution for all indications. The implant body mimics the shape of a natural tooth root and is designed for high primary stability, making Immediate Function an option if indicated and desired. Nobel Replace Conical Connection is available with TiUnite on collar or 0.75 mm machined collar for different clinical needs and preferences.

Nobel Biocare Implant Diameters:

3 mm diameter (Color Code Pink)

3.5 X 8 mm

3.5 X 10 mm

3.5 X 11.5 mm

3.5 X 13 mm

3.5 X 16 mm

4 mm diameter (Color Code Yellow)

4.3 X 8 mm

4.3 X 10 mm

4.3 X 11.5 mm

4.3 X 13 mm

NobelReplace Platform Shift.

Nobel Replace Platform Shift is a variation of the popular Nobel Replace Tapered implant, offering an additional platform shifting feature, which is preferred by some due to its potential benefits in enhancing soft tissue volume. Nobel Replace Tapered has become one of the most preferred implant systems worldwide, not least due to its surgical -and prosthetic ease-of-use. It mimics the shape of a natural tooth root and is designed for high primary stability with all loading protocols. Nobel Replace Tapered is available with or without platform shifting.

5 mm diameter (Color Code Blue)

5 X 8 mm

5 X 10 mm

5 X 11.5 mm

5 X 13 mm

5 X 15 mm

5 X 16 mm

6 mm diameter (Color Code Green)

6 X 8 mm

6 X 10 mm

6 X 11.5 mm

6 X 13 mm

Nobel Biocare Implant Replacement Service.

The Implant Replacement Service (IRS) is a program that should be utilized for situations where the sterile barrier of the implant has been compromised (e.g., opened in error, dropped) or in cases where the implant was placed and promptly removed within 24 hours (e.g., failure to achieve primary stability, spinner).

To utilize this services we need to print legibly or fill Implant Replacement Service form out electronically; a printed hard copy must be returned with the implant(s).

Implant replacement: There is a maximum of 10 no-charge implant replacements per year.

The $100.00 per implant replacement fee will be charged once the maximum has been reached.

Shipping instructions:

1) Sterilize the implants to be returned. As part of the IRS program, final abutments not removed will not be replaced and cannot be returned.

2) Complete this form, print out, and enclose with returned product(s).

3) Please return in a traceable using FedEx services to the following address:

Nobel Biocare USA, LLC.,ATTN: Returns Department,

22715 Savi Ranch Pkwy., Yorba Linda, CA 92887

Implant Replacement Service

To avoid delays in processing please complete this form as thoroughly as possible, please print legibly.

Shipping Instructions:

1) Sterilize the implants to be returned. 2) Complete this form and enclose with return. 3) Please send return in a traceable manner (i.e. Fed Ex, UPS, etc.) to the following

address: Nobel BiocareAttn: Customer Service Unit 100, 9133 Leslie Street Richmond Hill, ON L4B 4N1

Name: ________________________________ Account Number: ______________________ Phone Number: ________________________ Fax Number: __________________________ Address: _________________________________________________________________________ City: ____________________Prov: _____ Postal Code: __________ Contact Person:___________________________________________________________________

Implant Replacement: There is a maximum of 10 no-charge implant replacements per year. The $100.00 per implant replacement fee will be charged once maximum has been reached.

All implant replacements must be within the same implant system, (i.e. Tapered Groovy for Tapered Groovy).

Returned Implants

Material # Lot/Batch # Qty Description _____________ _____________________________________________________________________ _____________ ______________________________________________________________________ _____________ ______________________________________________________________________ _____________ ______________________________________________________________________ _____________ ______________________________________________________________________ _____________ ______________________________________________________________________ _____________ ______________________________________________________________________ I accept the $100 per implant fee for this service and authorize this charge to my account. _______________________________ ______________ Signature Date The IRS program should be utilized for situations where the sterile barrier of the implant has been compromised or in cases where the implant was placed and promptly removed within 24 hours. F6-033 (10/11)

Nobel Biocare Product Complain.

How to report a product complaint?

The importance of required information

It is important to obtain all necessary information about the product event details to be able to perform a proper investigation.

The information is required for product development and for statistical analysis to ensure product safety. Additionally, it is needed for regulatory requirements as Nobel Biocare is a Medical Device manufacturer.

How to submit a product complaint?

When reporting a product complaint and requesting a replacement product, the entire complaint questionnaire must be completed.

The product must be returned to perform an adequate and relevant investigation.

If applicable, disinfect and autoclave the complaint products and label them accordantly.

Non-sterilized devices may be considered biological hazards.

If applicable, include x-rays/photos and other documentation.

Send the sterilized product(s) and original product investigation questionnaire to your:

Nobel Biocare USA, LLCAttn: Returns Department,

22715 Savi Ranch Parkway, Yorba Linda, CA 92887.

Do not hesitate to contact your Nobel Biocare USA representative if you have any concerns.

Costumer Service Phone Number: 1-800-322-5001

Complaint product sterilization instructions.

All complaint products retrieved from patient must be sterilized.

Disinfection: 70 % to 80 % aqueous ethanol rinse carefully and do not mechanically clean).

Sterilization: at 132–135 °C / 270–275 °F (max 137 °C / 279 °F) for a minimum of 3 minutes in sealed pouches indicating exposure.

Nobel Biocare Implant Inventory Form.

Northern VA OMS Associates - Woodbridge office

IMPLANTS SIZEExpecte

dQuantit

y Quantity

   Inventor

y on to    Level Hand Order

3 mm Conical        

REF 36699 3.5 X 8      

REF 36700 3.5 X 10      

REF 36701 3.5 X 11.5      

REF 36702 3.5 X 13      

REF 36703 3.5 X 16               

4 mm Conical        REF 36704 4.3 X 8      REF 36705 4.3 X 10      REF 36707 4.3 X 11.5      REF 36708 4.3 X 13      

REF 36843 PLATFORM SHIFT 4.3 X 11.5               

5 MM Conical        

REF 36710 5.0 X 8      

REF 36711 5.0 X 10      

REF 36712 5.0 X 11.5      

REF 36713 5.0 X 13      

REF 36714 5.0 X 16               

6 MM PLATFORM SHIFT        

REF 36901 6.0 X 8      

REF 36902 6.0 X 10      

REF 36903 6.0 X 11.5      

REF 36904 6.0 X 13      

Nobel Biocare Healing Abutment and Cover Screw Inventory Form.

Northern VA OMS Associates - Woodbridge office

COVER SCREW SIZEExpect

edQuant

ityQuant

ity

AND  Invent

ory on toHEALING ABUTMENTS   Level Hand Order

3 mm Conical COVER SCREW      REF 36649        

(NOBEL REPLACE) REF 29433                 

3 mm Conical HEALING ABUT.      REF 36639 3.6 x 3      REF 36640 3.6 x 5      REF 36867 3.6 x 7      REF 36641 5 x 3      REF 36642 5 x 5      REF 36868 5 x 7      

3 mm NobRpl        REF 29436 3.5 x 3      REF 29437 3.5 x 5      REF 33449 4.5 x 3      REF 33450 4.5 x 5      

                  

         4 and 5mm Conical COVER SCREW      

REF 36650        (NOBEL REPLACE) REF 29434        

4 and 5mm Conical HEALING ABUT.      REF36643 3.6 x 3      

REF 36872 3.6 x 7      REF 36645 5 x 3      REF 36646 5 x 5      REF 36873 5 x 7      REF 36647 6 x 3      REF 36648 6 x 5      REF 36874 6 x 7      

(NOBEL REPLACE) REF 33535 4.3 x 3      (NOBEL REPLACE) REF 33536 4.3 x 5      (NOBEL REPLACE) REF 33451 5.3 x 3      (NOBEL REPLACE) REF 33452 5.3 x 5      

         6 mm Conical COVER SCREW      

REF 29435        6 mm NOBEL REPLACE HEALING ABUT.      

REF 33453 5 x 3      REF 33454 5 x 5      REF 29446 6 x 3      REF 29447 6 x 5      

         6 mm Platform Shift COVER SCRTEW      

REF 30087        6 mm Platform Shift HEALING ABUT.      

REF 33457 7 x 5               

Nobel Biocare Restorative Parts Inventory Form.

Northern VA OMS Associates - Woodbridge office

Impression Coping SIZEQuantity

Quantity

GoldAdapt (UCLA)   on toImpression Coping (Lab Analog)   Hand Order

3 mm Conical Imp. Coping Open T.  REF 36258 3.6 x 10    REF 36260 3.6 x 14    REF 36261 5 x 14    

REF 33466 (Nobel Replace) 4 X 5           

3 mm Conical GoldAdapt (Lab Analog)    

REF 36838      REF 36728      

       3 mm Conical Impression Coping    

REF 29498 Nobel Replace      REF 3697      

       4 mm and 5 mm Imp. Coping Open T.    

REF 36262 3.6 x 14    REF 36265 5 x 10    REF 36264 5 x 14    REF 36267 6 x 10    REF 36266 6 x 14    

REF 33539 (Nobel Replace) 4.3    REF 33467 5.3    

       

4 mm and 5 mmGoldAdapt (Lab Analog)    

REF 36727      REF 36729      

REF 29010 (Nobel Replace)      REF 29011 (Nobel Replace)      

4 mm and 5 mm Impression Coping    

REF 36698      REF 29500 (Nobel Replace)      

5 mm WP Imp. Coping Open T.    REF 33468 (Nobel Replace) 5 mm    REF 29493 (Nobel Replace) 6 mm    

       

5 mm WPGoldAdapt (Lab Analog)    

REF 29014 (Nobel Replace)      REF 29015 (Nobel Replace)      

       5 mm WP Impression Coping    

REF 29502 (Nobel Replace)             

6 mm Imp. Coping Open T.    REF 30039 (Nobel Replace) 6.0 mm    REF 33469 (Nobel Replace) 6.0 / 7 mm    

       

6 mm GoldAdapt (Lab Analog)    

REF 29989 (Nobel Replace)      REF 29990 (Nobel Replace)             6 mm Impression Coping    REF 29995 (Nobel Replace)      

Nobel Biocare Contact Information.

Do not hesitate to contact your Nobel Biocare USA representative if you have any concerns.

Nobel Biocare Address.

Nobel Biocare USA, LLCAttn: Returns Department,

22715 Savi Ranch Parkway, Yorba Linda, CA 92887.

Costumer Service Phone Number: 1-800-322-5001

Biomet 3I Overview.

Biomet 3I is one of the leading companies in the oral reconstruction market. Of equal importance. Biomet 3I brings the same innovation, high standards and comprehensive approach to costumer service, dental practices and laboratory support and education. Biomet 3I pioneered the development of biologicalle driven implants, winning worldwide acclaim for the micro texture OSSEOTITE surface and then the nanoscaled, Bone Bonding Nanotite surface Implants. The tradition of implants innovation continues with the introduction of the 3I T3 Implant, a comtemporary hybrid that is designed for sustainanble aesthetics.

The 3i T3® Implant.

Designed To Deliver Aesthetic Results Through Tissue Preservation Contemporary Hybrid Surface.

Provided by a complex multi-surface topography.

Seal Integrity.

Provided by a stable and tight implant/abutment interface.

Integrated Platform Switching.

Provided by a medialized implant/abutment junction.

Biomet 3I Implant Diameter.

3 mm diameter (Color Code Pink)

3.25 X 8.5 mm

3.25 X 10 mm

3.25 X 11.5 mm

3.25 X 13 mm

4 mm diameter (Color Code Blue)

4 X 8.5 mm

4 X 10 mm

4 X 11.5 mm

4 X 13 mm

5 mm diameter (Color Code Yellow)

5 X 8.5 mm

5 X 10 mm

5 X 11.5 mm

5 X 13 mm

6 mm diameter (Color Code Green)

6 X 8.5 mm

6 X 10 mm

6 X 11.5 mm

6 X 13 mm

Biomet 3I Warranty.

Implant warranty benefits.

The doctor submitting a claim, upon review and approval by Biomet 3i, will receive a replacement implant equivalent to the implant placed in the surgical implant site(s).

All replacement implants will be Biomet 3i devices comparable to those used in the original “surgical procedure” (as defined below). Any requested product or service substitutions shall be at Biomet 3i discretion only. For purposes of this Warranty Program, “surgical procedure” is the clinical procedure (a) of preparing an osteotomy and inserting a dental implant(s) or (b) to reopen the osteotomy after implant(s) healing to place temporary or permanent components onto properly healed and integrated dental implants.

Eligibility.

To receive warranty benefits, the treating doctor(s) must: a. Notify Biomet 3i Warranty Administration within thirty (30) days of the incident. Notification is accomplished by submission of a properly completed Warranty Claim Form and return of the device(s) packaged and sterilized such to prevent loss from damage during shipment; b. Be current in all financial account activities with Biomet 3i; and c. Have installed the LODI implant covered by this Warranty Program in accordance with prescribed procedures and in accordance with accepted medical/dental practices.

Biomet 3I Complain Report.

BIOMET 3i Return/Exchange Policy.

Return Policy:

A purchaser may return any BIOMET 3I product within 90 days of the invoice date.  BIOMET 3i products returned within 60 days of the invoice date will be accepted without any re-stocking fee to the purchaser.

BIOMET 3i products returned between 61 and 90 days of the invoice date will be subject to a 15% restocking fee. A BIOMET 3i product will be accepted for return only if the BIOMET 3i product is:

1) Returned in its original, unopened package (including auto clavable products)

2) Received by BIOMET 3i within 90 days after the invoice date for that product

3) Returned freight is prepaid to:

4555 Riverside Drive, Palm Beach Gardens, Florida 33410,

(Attention: Returns Department) accompanied by the BIOMET 3i return authorization number provided by BIOMET 3i customer service department.

Purchaser should be advised that BIOMET 3i products not meeting the above criteria will not be accepted for return.

Exchange Policy:

 BIOMET 3i products may be exchanged within 180 days of the invoice date for other BIOMET 3i products of greater value within the same product family as determined by BIOMET 3i (ex. implant for implant, abutment for abutment, membrane for membrane), with the price differential paid by the purchaser. In both cases, the exchanged BIOMET 3i product must be:

1) Returned in its original, unopened package (including auto clavable products)

2) A currently offered BIOMET 3i product (discontinued product not included)

3) Returned freight is prepaid to:

4555 Riverside Drive, Palm Beach Gardens, Florida 33410

(Attention: Returns Department) and accompanied by the BIOMET 3i return authorization number provided by BIOMET 3i

customer service department.

Biomet 3I Implant Inventory Form.

Northern VA OMS Associates - Woodbridge office

IMPLANTS

Expected Quantity QuantityInventory on to

Level Hand Order

3.25        BOST 3285      BOST 3210      BOST 3211      BOST 3213      BOST 3215      

         4.1        

BOST 485      BOST 410      BOST 411      BOST 413      BOST 415      

         5.0        

BOST 585      BOST 510      BOST 511      BOST 513      BOST 515      

         6.0        

BOST 685      BOST 610      BOST 611      BOST 613      BOST 615      

Biomet 3I Healing Abutment Inventory Form.

Northern VA OMS Associates - Woodbridge office

HEALING   Expected Quantity QuantityABUTMENT   Inventory on to    Level Hand Order3.25        

IEHA 343      IEHA 344      IEHA 346      IEHA 353      IEHA 354      IEHA 356      IEHA 443      

4 444      IEHA 446      IEHA 453      IEHA 454      IEHA 456      IEHA 463      IEHA 464      IEHA 466      IEHA 473      IEHA 474      IEHA 476      

5.0        IEHA 553      IEHA 554      IEHA 563      IEHA 564      IEHA 566      IEHA 573      IEHA 574      IEHA 576      

6.0        IEHA 663      IEHA 664      

IEHA 673      

IEHA 674      

IEHA 676               

IMHA 32      ISMHA 33      

ISHA 42      Biomet 3I Restorative Parts Inventory form.

Northern VA OMS Associates

RESTORATIVE PARTS Expected Quantity QuantityInventory on to

Level Hand Order3.25        

Impression Copings IMIC33Analogs IMMILA

UCLA IMGUC1C   

4.1  Imp Coping (open tray 4x5) IIIC12

Analogs IILA20UCLA IGUCA1C

   5.0  

Imp Coping (open tray 5x6) IWIP56Analogs IILAW5

UCLA IWGA51C   

6.0  Imp Coping (open tray 6x7) IWIP67Imp Coping (open tray 6x7) IWIP66

Analogs IILAW6UCLA IWGA61C

      

Gold-tite screw IUNIHG                                    

Biomet 3I Contact Information.

Do not hesitate to contact your Biomet 3I representative if you have any concerns.

Biomet 3I Address.

4555 Riverside Drive, Palm Beach Gardens, Florida 33410

Surgical Implants Instruments.

Implant hand piece:

Drill attachments, commonly known as handpieces or contra angles, are vital to any dental operation. While air-driven or pneumatic handpieces are more traditional, electric (E-type) hand pieces provide the most torque and versatility for restorative, surgical/implant drilling, and endodontic treatments.

Sinus Lift Instruments:

An internal sinus lift is made through the maxillary jaw. This technique is often used when there is minimal bone shrinkage or when a single implant is placed. Furthermore, it is also recommended for increasing the density of poorly mineralized and relatively malleable bone via condensation, so that reliable results which remain stable long term can be achieved.

Osteotomes:

The osteotomes are designed for penetrating the sinus floor in a controlled manner and raising the mucous membrane, so that adequate amounts of bone augmentation material can be placed to ensure afterwards that the implant is retained firmly. Osteotomes are available in different diameters, for all common implant systems.

Sharp with cutting edges, concave, convex or pointed. Straight for anterior, bayonet shaped for posterior. With and without security stop screw. With depth markings, color coding to distinguish between the different shapes

and diameters.

Surgical Mallet:

The surgicalmallet is used along with a selected chisel tosplit teeth or reduce alveolar bone.

Periotome:

Periotomes are designed for separating the periodontal ligament from the tooth in preparation for a dental implant. After the periodontal ligament is cut and the tooth removed, the underlying bone structure remains intact, providing the necessary foundation for an implant supported replacement tooth.

Bone Profiler:

When performing single stage implant placement in conjunction with immediate fixed provisional restorations with screw retained abutments, it is often necessary to contour the crest of bone at the osteotomy site for proper seating of the abutment (s). Generally this step is needed when the implants are placed subcrestally or crestally, and when angled abutments are chosen to change the inclination of the implant (s).

Manual Torque Wrench Surgical:

A dental torque wrench or restorative torque wrench is a torque wrench used to precisely apply a specific torque to a fastener bolt for fixation of an abutment, dentures or prosthetics on a dental implant.

Bone Graft:

The most common use of bone grafting is in the application of dental implants to restore the edentulous area of a missing tooth. Dental implants require bones underneath them for support and proper integration into the mouth. People who have been edentulous (without teeth) for a prolonged period may not have enough bone left in the necessary locations. In this case, bone can be taken from the chin, from the pilot holes for the implants, or even from the iliac crest of the pelvis and inserted into the mouth underneath the new implant.

In general, bone graft is either used en block (such as from the chin or the ascending ramus area of the lower jaw) or particulate, in order to be able to adapt it better to a defect.

Dental bone grafting is a specialized periodontal procedure that has been developed to reestablish lost jawbone. This loss can be a result of dental infection of abscess, periodontal disease, or trauma. There are various reasons for replacing lost bone tissue and encouraging natural bone growth, and each technique tackles jawbone defects differently. Reasons that bone grafting might be needed include sinus augmentation, socket preservation, ridge augmentation, or regeneration.

Membrane:

A barrier membrane is a device used in oral surgery and periodontal surgery to prevent epithelium, which regenerates relatively quickly, from growing into an area in which another, more slowly growing tissue type, such as bone, is desired.

Absorbable Collagen:

The Absorbable Collagen is an absorbablecollagen sponge that is excellent for extraction andbiopsy sites, controls bleeding and stabilizesblood clots, protects wound bed, protects matrix for tissue ingrowth, absorbed in 10–14 days.

CollaTape Absorbable Collagen:

Collatape is a collagen wound dressing that is soft, white, pliable, nonfriable sponge used in dental surgery. Because of the coherent sponge structure, application of the dressings to the wound is easily controlled. The dressing retains their structural integrity even when wet. Can be used for minor oral wounds, closure of grafted sites, and repair of Schneiderian Membranes. Known to control bleeding and stabilize blood clots as well as protect the wound bed while accelerating the healing process.

Nobel Prosthetic Kit:

Complete set of components for tightening clinical and prosthetic screws to the correct torque value.

Screw Driver:

For tightening cover screws.

Implant Tracking System.

At tome of placement, you will need to record the implant, brand, type size and tooth #

This can be achieved by the following:

1) Paper tracking sheet done for each doctor separately, contains: Patient name. Date. Restorative Dentist. Tooth # for each tooth. Brand, type and size of implant for each tooth. Estimate time of Abutment Placement. Single stage. Healing Abutment brand and size.

Keep in a binder that is been identified with the Oral Surgeon name when page is filled for easy access.

2) Letter to Restorative Dentist based on mock letter include: Patient’s name. Date placed. Tooth # for each implant. Brand, type, size of each implant. Estimate when abutment due.

Once letter have been print, scan in patient chart with the implant tracking mock letter into the patient’s chart. Once letter has been mailed to Restorative Dentist write a note in patient’s chart with the day that the letter has been sent.

Implant Tracking System mock letter.

Today’s date:

Oral Surgeon:

Restorative Doctor: (First and last name)

Patient: (First and last name)

The following implant (s). Location (s), and size (s) were used:

Tooth Number: Implant Brand: Size mm:

The healing abutment will be placed approximately in 3 months from today (Month Only):

Single Stage: Yes No

If Yes, Please provide Healing Abutment information bellow:Brand: Size:

Today’s date:

Oral Surgeon:

Restorative Doctor: (First and last name)

Patient: (First and last name)

The following implant (s). Location (s), and size (s) were used:

Tooth Number: Implant Brand: Size mm:

The healing abutment will be placed approximately in 3 months from today (Month Only):

Single Stage: Yes No If Yes, Please provide Healing Abutment information bellow:

Brand: Size:

Today’s date:

Oral Surgeon:

Restorative Doctor: (First and last name)

Patient: (First and last name)

The following implant (s). Location (s), and size (s) were used:

Tooth Number: Implant Brand: Size mm:

The healing abutment will be placed approximately in 3 months from today (Month Only):

Single Stage: Yes No

If Yes, Please provide Healing Abutment information bellow:Brand: Size:

Implant Thank you letter single stage.

(Month, day and year)

Dr. (Restorative doctor last name and name)(Address)

RE: (Patient name and last name)

Dear Dr.(last name)

Thank you for referring (Patient last name) to our practice for surgical care. (Patient last name) was seen on (surgery day) for their implant procedure. The following implant location (s) and Healing Abutment size (s) were used:

(THIS IS AN EXAMPLE)

Tooth # Size Healing Abutment Brand#12 5 X 11.5 mm 5 X 3 mm Nobel Conical Connection

(Patient last name) surgery went very well, and I do not anticipate any complications.

I will personally available to you for the consultation concerning any aspect of this case.

Thank you for placing your confidence in my team.

Sincerely,

Dr. (Oral Surgeon name and last name)

Implant Thank you letter two stages / Delayed Exposure.

(Month, day and year)

Dr. (Restorative doctor last name and name)(Address)

RE: (Restorative doctor last name and name)(Address)

Dear Dr. (last name)

Thank you for referring (Patient last name) to our practice for surgical care. (Patient last name) was seen on (surgery day) for their implant procedure. The following implant location (s) were used:

(THIS IS AN EXAMPLE)

Tooth # Size Brand# 12 5 X 3 mm Nobel Conical Connection

(Patient last name) surgery went very well, and I do not anticipate any complications. I expect the healing abutment to be place sometime in: (3 months from today).

I will personally available to you for the consultation concerning any aspect of this case.

Thank you for placing your confidence in my team.

Sincerely,

Dr. (Oral Surgeon name and last name)

Follow up Visits.

Usually scheduled 7 – 14 post operatively. The Oral Surgeon evaluate the patient’s healing process.If healing ok, patient can be schedule for abutment appointment or if it was a Single Stage case patient can be schedule in 90 days. In 90 days appointment, Assistant should take a Panoramic X ray. With this radiograph the Oral Surgeon can see how the implant and the healing abutment has been integrated into the bone patient.

Assistant should record when patient’s need to come back, what will patient’s need for the next appointment.

For a Healing Abutment appointment patients will need:

Healing Abutment. Impression coping. Lab Analog. RESTORATIVE PARTS UCLA. Gold Tite (for Biomet 3I cases only).

Does patient need more than 30 minutes (more than 3 abutments?)Does patient need no side book (more than 5 abutments?)

If patient need another follow up appointment prior to abutment, schedule as a 10 minutes appointment.

Usually this is because the patient has experienced some complications post operatively or has had problem in the past, or lost an implant previously in same tooth area.

Patient should be advised to come earlier if complications arise prior next appointment.If patient ok, patient can be schedule and Oral Surgeon will advise what is needed for Abutment appointment.

Healing Abutment.

The healing abutment is placed after exposing the top of the dental implant. The healing abutment serves as a temporary replacement tooth during the healing period of the gums.

The gingiva heals and grows nicely around the implant abutment. Once the gums have healed and the dental implant is stable and osseo integrated with the bone, the healing abutment is removed and the dental implant is restored. At this point the gingiva will be esthetically surrounding the new dental implant crown as a result of the healing abutment that was placed there during the healing period.

Abutment / Uncovering Implant.

At this time the implant has had enough time to integrate into the bone, generally this is about 3 months after implant placement. The Implant Coordinator should have verified with Oral Surgeon and Restorative Dentist what will be used.

A letter to Restorative Dentist should have been sent shortly after the implant placement in order to allow the Restorative Dentist to respond with restoration plans.

Scheduling Healing Abutment Appointment.

Usually this is schedule 3 months after implant placement. Occasionally, this may be done earlier on patient’s needs. Not all of these will need parts for Restorative Doctors at that time. Additional healing will need to occur before patient is ready for restorative.

Generally 30 minutes is needed for 1 – 2 implants. Additional time may be necessary for additional implants.

If more than 2 healing abutment, check with Oral Surgeon to find out how much time is needed and if no side book are necessary especially if more than 5 healing abutments are to be placed.

Assistant should make sure scheduler is given proper information to schedule via note attached to chart or check in sheet. Scheduler should allow enough time for parts to be ordered. Generally most parts can be delivered in 3 days or overnight with extra cost for our Oral Surgeons.

However healing abutments parts are to be ordered the week prior, therefore abutment appointments should be schedule at least 1 – 2 weeks after final. Check unless otherwise by the Oral Surgeon.

Most shipping is within days, however some take longer. In other words even if you have the space tomorrow in the book to schedule the patient, do not schedule unless the parts are physically in the office.

If a patient insist on an earlier appointment, advises patient shipping cost may be added to treatment plan cost in order to accommodate them.

If patient must have appointment earlier due to being out of town or other personal obligations, it is at the Oral Surgeon to determine if shipping charges will be applied. If it is our error, patient is NOT charged for overnight charges.

If patient has an old implant or one not placed by us, they must be advised that we do not carry spare parts. We must verify the brand, type and size used before parts can be ordered. We will call them once the parts are available.

Healing Abutment placement.

What do you need?

Implant Completion Form: this form is been previously filled with the necessary restorative parts, implant brand and size information after the implant was placed for easy access in the Healing Abutment archive.

This form contains:

Date. Restorative Doctor Name, address and phone number. Patients name. Tooth Number. Implant Diameter. Healing Abutment. Restorative Options. Abutment tray, soft tissue tray or regular surgical tray with a small curette. Abutment kit appropriate for implant placed (Nobel Biocare or Biomet 3I). +/- Low speed hand piece with round acrylic bur.

If patient has healing abutments, parts can be delivered by patient. Parts will included Impression Coping, Lab Analog, +/- UCLA abutment +/- Gold Tite (just for Biomet 3I cases).

The Implant Coordinator will make sure the Restorative Dentist has the right tools for final restoration.

All parts should be recorded in the patient’s chart and in the Implant Completion Form and if patient will delivered parts to Restorative Dentist. Make sure to attached a copy of the final X ray with a copy of letter with implant and healing abutment size, brand, and tooth #

Implant Completion Form Biomet 3INorthern Virginia Oral and Maxillofacial Surgery Associates

Dentist:Address:

Phone:

Date:

Patient:

Tooth#

Implant Diameter

HealingAbutment

Tooth#

Implant Diameter

HealingAbutment

Restorative Options

Option 1: Encode healing abutment is in place (Impression of the healing abutment, no parts needed)

Option 2: Type of impression coping & lab analog has been sent:Pick Up Open Tray Lab Analog UCLA Gold Tite

Implant Completion Form Nobel Biocare

Northern Virginia Oral and Maxillofacial Surgery Associates

Dentist:Address:

Phone:

Date:

Patient:

Tooth#

Implant Diameter

HealingAbutment

Tooth#

Implant Diameter

HealingAbutment

Restorative Options

Option 1: Type of Impression Coping & Lab Analog has been sent:

Impression Coping Open Tray

Gold Adapt (UCLA) Implant Replica (Lab Analog)

Healing Abutment letter.

(Month, day and year)

Dr. (Restorative doctor last name and name)(Address)

RE: (Restorative doctor last name and name)(Address)

Dear Dr. (last name)

(Patient last name and first name)was seen in our office today for placement of the healing abutment (s). The following brand (s) and size (s) were used:

(THIS IS AN EXAMPLE)

Tooth # Healing Abutment Size Brand

Enclosed are the parts needed to restore the implant (s) and copy of the x-ray (s) taken of the healing abutment (s).

Please give us a call if you have any questions or concerns.

Sincerely,

Dr.(Oral Surgeon name and last name)

Restorative Parts

Impression Coping or Pick Up.

Impression copings are used by the dentist to replicate the position of the implant in thePatient’s mouth. The dentist screws the impression coping to the real implant and then,using a specific impression technique, takes an impression of the dentition. The impressiontechnique can be “open” or “closed”:

Biomet 3I Nobel Biocare (Pick-Up) (Impression Coping)

Open tray.

Open Traytechnique allows the dentistto remove the impression complete withimpression coping(s) from the patient’smouth by allowing external access to thecopings retaining screw(s) i.e. theimpression coping(s) remain fixed in theimpression material. The dentist is thenrequired to add the analogue(s) prior todispatching to the lab.

Closed tray.

Closed tray technique requires that thedentist first removes the impression thepatient’s mouth then unscrews theimpression coping(s) to remove themfrom the implant. The impressioncoping(s) are then placed back intoposition by the dentist in the impressionmaterial and the analogues are added prior to despatch.

Lab Analog or Implant Replica.

Analogues are used by laboratory technicians to replicate implants and their position in a patient’s mouth. A model of the patient’s dentition is castusing an impression. The analogue, screwed onto the impression coping, isset into the plaster model during casting.

Biomet 3I Nobel Biocare

(Lab Analog) (Implant Replica)

UCLA Or Gold Adapt.

Most implant systems have a “gold adapt” or “UCLA” type of abutment. These abutments have a plastic sleeve that the experienced technician can modify, and then cast, to accommodate a range of axial inclinations between implant and the overlying crown. This system allows the technician to create the best possible abutment to support the Doctor’s choice of restorative crown.

Biomet 3I Nobel Biocare

(UCLA) (Gold Adapt)

Gold Tite (Biomet 3I).

Gold Tite Screw increases implant / abutment clamping force by 113% versus a non coated screw. The patented Gold Tite surface lubrication allows the screw to rotate further, increasing the clamping force and maximizing abutment stability.

Nobel Biocare Color Code for accurate component identification.

Nobel Replace Conical Connection

Implants3.5 mm

Packaging Surgical Components

Implant Drivers Prosthetic Components

The color of the sticker in the top of the implant packaging cap represents the color code for the restoration of the tooth.

Implants 4.3 mm

Packaging Surgical Components

Implant Drivers Prosthetic Components

The color of the sticker in the top of the implant packaging cap represents the color code for the restoration of the tooth.

Implants 5.0 mm

Packaging Surgical Components

Implant Drivers Prosthetic Components

The color of the sticker in the top of the implant packaging cap represents the color code for the restoration of the tooth.

Implants 6.0 mm

Packaging Surgical Components

Implant Drivers Prosthetic Components

The color of the sticker in the top of the implant packaging cap represents the color code for the restoration of the tooth.

Biomet 3I Color Code for accurate component identification.

Implants 3 mm

Packaging Surgical Components

Implant Drivers Prosthetic Components

Implants 4 mm

Packaging Surgical Components

Implant Drivers Prosthetic Components

Implants 5 mm

Packaging Surgical Components

Implant Drivers Prosthetic Components

Implants 6 mm

Packaging Surgical Components

Implant Drivers Prosthetic Components

Surgical Implant Coordinator Responsibilities.

Ordering Implants. Ordering Healing Abutments. Ordering restorative parts. Inventory of implants, healing abutments, and restorative parts at list one a

months. Sending restorative doctor thank you implants letter and to scan on the patient

documents center for the office record. Sending healing abutment letter and to scan on the patient documents center for

the office record. Mailed or delivered restorative parts. Make sure the implants kits are completed. Make sure the implant drill and different components are in the correct order by

size and color in the implant kit. Make sure all the implant kit are sterilized following the sterilization rules for

each different company. Have a good relationship with referral doctors. Make sure to look at the schedule ahead at the time and be prepared with the

necessary inventory, X rays, bone graft material, surgical instruments, etc. for implant cases.

Make sure to always discuss the implant case with the oral surgeon before the surgery take place, that way the surgical room will be ready with the necessary instrumentation.

Make sure to have the implant models ready in every implant consultation room for the oral surgeon.

Follow the protocol to return failed and / or drop implants for each implant company.