External Product Catalog & Surgical Technique Manual

CorporateOverview

ExternalSystemOverview

Product Catalog

Implants

HealingAbutmentsandCoverScrews

SurgicalKitandComponents

AncillarySurgicalInstruments

CollateralLiteratureandSupportMaterial

W&HSurgicalMotorsandAccessories

ProstheticOverview

ImpressionComponentOverview

3inOne andCeramicAbutments

EstheticAbutments(AngledandStraight)

AngledandStraightAbutments

ProfileandNon-hexedAbutments

CustomCastable(UCLA)Abutments

PEEKTemporaryandTitaniumTemporaryAbutments

Ball-topScrewsandIndirectTransferCopings

DirectPick-upCopings

ImplantAnalogsandScrews

AbutmentsforScrewandComponents

BallAbutmentsandComponents

ProstheticInstrumentation

PatientEducation

Surgical Manual

Introduction

ImplantSpecifications

SurgicalProtocols

ExternalImplantSpacing

RadiographicTemplate

SurgicalKit

SurgicalDrillsandInstrumentSequenceReview

OsteotomyInitializationandParallelPins

DepthandWidthIncreasingDrills

CrestalBoneDrillsandBoneTaps

ImplantPackaging/ImplantPick-up

ImplantPlacement/AbutmentRemoval

InsertionTools/CoverScrews/HealingAbutments

BoneProfilers/BurtestingGauge

SurgicalKitCleaning

DrillInstructionsforUse/Post-operativeInstructions/References

OrderingandWarrantyInformation/IconLegend

1

2-3

4

5

6-7

8-9

10-11

12-13

14-15

16-17

18

19

20

21

22-23

24

25

26

27

28-29

30-31

32-33

34

35

36

37

38-39

40

41

42-43

44-45

46-47

48-49

50-51

52-53

54-55

56

57

58-59

60-61

TABLEOFCONTENTS

No single implant design is perfect for every indication soBioHorizons lets clinicians choose the implant best suited to theirpreferencesandtheneedsoftheirpatients.Noothercompanyoffersmore choices of specialty implants, body shape, connection type,surfacetreatmentandrestorativepathsthanBioHorizons.

AllBioHorizonsimplantsandcomponentsareprecisionmanufacturedto the tightest mechanical tolerances in the industry. This yieldsproductswithaform,fitandfunctionyouwillappreciatethefirsttimeyoupickthemup.

Innovativeoptions...notcompromises

Patientsatisfaction:DeliveredHappy patients are the driving force of successful dental practices,and clinicians know they dont want implants; they want teeth. Buttraditionally,companieshaveonlyguaranteedtheirimplants!

Beginningin2008,1-unitto3-unitrestorationsmadeonourimplantsatselectlaboratoriesusinganapprovedtreatmentplanareguaranteed for life. If the prosthesis fails, BioHorizons covers the cost of thereworknoredtape,nosmallprint.

Thisisjustoneexampleoftheworld-class customer service youcanexpectfromBioHorizons.

BioHorizonsrecentlyintroducedLaser-Lok microchannelstothecollarsofitsinternally-connectedimplants.Laser-Lokisapatentedlaser-machinedsurfacetreatmentwithover15yearsofin vitro,animalandhumanstudies.Laser-Lokhasbeen shown throughSEManalysis andhumanhistology toinhibit epithelial downgrowth, achieve connective tissue attachment andretaincrestalbone.1

BioHorizons External has a long history of clinical success,includingexcellentmaintenanceofcrestalbone.2WearecurrentlyinvestigatinghowtheadditionofLaser-LoktoExternalmightfurtherenhancetheperi-implantboneandsofttissuecomplex,leadingtooptimalestheticoutcomes.Ifwecanfindawaytomakeagreatimplantevenbetter,restassuredwewill.

Committedtocontinualimprovement

external

Why pay for a prepable, gold-hued esthetic abutment if you dont have to?

EveryExternalimplantispackagedwitha3inOneAbutment,CoverScrewandAbutmentScrew.Most implantcompaniesmakeyoupayextraforaprepableestheticabutment.Usingthe3inOneAbutmentkeepsinventoryandoverheadcoststoaminimumandreducesthechanceofnothavingthecorrectcomponentstocompletethecase.

Gold-huedTiNcoatingforsofttissueesthetics

PatentedGuidePinsavestimeandeliminatescross

threading

Low-profileAbutmentScrewusesindustry

standard.050(1.25mm)hex

Spiralocktechnology

virtuallyeliminates

screwloosening

Prostheticplatform0.2mmwiderthanimplantbody

Stable1mmhighexternalhex

Statedimplantlength

Implantbodydiameter

0.5mmmachined

collar

Externalimplantsfeaturethetime-proven,biomechanicalsquarethreadwhichhasbeendemonstratedtoprovideincreased bone-to-implant contact and yield higher reverse-torque values.

Biomechanical Thread Form | Backed by Science

DegidiandPiattelli.Immediate Functional and Non-Functional Loading of Dental Implants: A 2- to 60-Month Follow-Up Study of 646 Titanium Implants. JPeriodontology2003;74:225-241.

NImplants NFailures %ImplantSurvival %ProsthesesSurvivalBioHorizonsImplants

126 0 100% 100%ImmediateFunctionalLoading

ImmediateNon-FunctionalLoading 116 0 100% 100%

V-thread Modified-square

15.586.07

65.469.64

23.179.68

74.378.63

ReverseTorqueValue(Ncm)

%Bone-to-ImplantContact

SteigengaJ,Al-ShammariK,MischC,NocitiFandWangH-L.Effects of Implant Thread Geometry on Percentage of Osseointegration and Resistance to Reverse Torque in the Tibia of Rabbits. JPeriodontology2004;75:1233-1241

MultiplestudieshavedemonstratedtheBioHorizonssquarethreadtobeextremelyreliableinimmediateloadingprotocols.Onestudy,summarizedbelow,followed242BioHorizonsimplantsthroughimmediatefunctionalandnon-functionalloading.

Crestal bone maintenance leads to success

A prospective,multicenter trial showed a 5-year cumulative success rate of 99.5% for 495 Externalimplantsin151patients.Therewerenosignificantdifferencesintheresultsbycenter,implanttype,bonedensity,areaof themouthorprosthesis type.Crestalbone loss fromprosthesisdelivery toone-yearfollow-upwasextremelylow(0.06mm),andactuallyturnedintobonegainatlaterfollow-upintervals.2

Radiographs of External implants in function for more than 6 years. Note that the crestal bone levels are maintained above the level of the first thread. Courtesy of Dr. Carl E. Misch.

Increased surface area for immediate loading success

Boneisstrongestincompressiveloading;weakestinshear.Externalssquare-threaddesignimparts10timeslessdestructivestressesattheimplant/boneinterfacethanconventionalv-threaddesigns,whilemaximizingcompressiveloadtransferandprovidingexcellentprimarystability.Theseattributeshavebecomeincreasinglyimportantwiththeemergenceofearlyandimmediateloadprotocols.3,4,5

Thesquare-threaddesignprovidesupto154%greatersurfaceareathanconventionalv-threaddesigns.Acomparativestudyofthreaddesigns(square-thread,v-threadandbuttressthread)concludedthatthesquare-threaddesignexhibitedsignificantlyhigherreversetorquevaluesandbone-to-implantcontactthantheotherthreaddesigns.6

Conventionalv-thread

BioHorizonssquare-thread

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products shown not to scale

Eachimplantispackagedwiththe3inOneAbutment,CoverScrewandAbutmentScrew.ChoiceofRBTorHAsurfacetreatment(except3.5mm:RBTonly).Orderbylengthanddiameter.TitaniumAlloy[Ti-6Al-4V].

Resorbable Blast Texturing (RBT)

Roughened TiO surface

Hydroxylapatite Coating (HA)High-density

crystalline coating

509D

505D

5D

55D

.5mm x 9mm

.5mm x 0.5mm

.5mm x mm

.5mm x 5mm

6009D

6005D

60D

605D

6009D

6005D

60D

605D

6.0mm x 9mm

6.0mm x 0.5mm

6.0mm x mm

6.0mm x 5mm

5009D

5005D

50D

505D

5009D

5005D

50D

505D

5.0mm x 9mm

5.0mm x 0.5mm

5.0mm x mm

5.0mm x 5mm

009D

005D

0D

05D

009D

005D

0D

05D

.0mm x 9mm

.0mm x 0.5mm

.0mm x mm

.0mm x 5mm

Diameter x Length

EXTERNALIMPLANTS

NA

NA

NA

NA

Implants

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0-60

0-60

0-606

0-50

0-50

0-506

Includedwitheachimplantsystem.Protectstheimplantsprostheticplatformduringsubmergedsurgicalhealing.Color-codedbyimplantdiameter.Hand-tightenwiththe.050(1.25mm)HexDriver.TitaniumAlloy[Ti-6Al-4V].

Usedfortissuehealingatsecond-stageuncoveryorasatransmucosalelementforsingle-stageprocedures.Color-codedbyimplantdiameter.Hand-tightenwiththe.050(1.25mm)HexDriver.TitaniumAlloy[Ti-6Al-4V].

.5mm Cover Screw

.0mm Cover Screw

5.0mm Cover Screw

6.0mm Cover Screw

0-900

0-900

05-900

06-900

0-0

0-0

0-06

-60

-60

-606

6.0mm x mm

6.0mm x .5mm

6.0mm x 6mm

-50

-50

-506

5.0mm x mm

5.0mm x .5mm

5.0mm x 6mm

-0

-0

-06

.0mm x mm

.0mm x .5mm

.0mm x 6mm

.5mm x mm

.5mm x .5mm

.5mm x 6mm

-0

-0

-06

0-0

0-0

0-06

HEALINGABUTMENTSANDCOVERSCREWS

HealingAbutments

CoverScrews

Straight Emergence Flared EmergenceImplant Diameter x Height

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60-500

External Surgical KitIncludesallinstrumentsshownonpages6-7.

-0

.0mm Starter Drill

-00

Drill Extender

-00

-00

Straight Parallel Pins (4perkit)

0 Angled Parallel Pins (2perkit)

-509

-505

-5

-55

-5

.5 x 9mm Depth Drill

.5 x 0.5mm Depth Drill

.5 x mm Depth Drill

.5 x 5mm Depth Drill

.5mm Depth Drill (withoutDepthStop)

-0

-

-7

-

-7

-5

.0mm Width Increasing Drill

.mm Width Increasing Drill


.mm Width Increasing Drill


5.mm Width Increasing Drill

60-00

Surgical Tray & Lid (without instruments)

SURGICALKITANDCOMPONENTS

ExternalSurgicalKit

IndividualSurgicalKitComponents

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.5mm Crestal Bone Drill

.0mm Crestal Bone Drill

5.0mm Crestal Bone Drill

6.0mm Crestal Bone Drill

.5mm D Bone Tap

.0mm D Bone Tap

5.0mm D Bone Tap

6.0mm D Bone Tap

-00

-00

5-00

6-00

-000

-000

5-000

6-000

.5mm Handpiece Adapter

.0/5.0/6.0mm Handpiece Adapter

-00

5-00

.5mm Ratchet Adapter

.0/5.0/6.0mm Ratchet Adapter

0-00

5-00

.5mm Implant-level Insertion Tool

.0mm Implant-level Insertion Tool

5.0/6.0mm Implant-level Insertion Tool

5-000

5-000

55-000

5-5

Hand Wrench

.050 (.5mm) Hex Driver

00-00

Ratchet & Hand Wrench Extender

00-05

Implant Spacer / Depth Probe

-00

Ratchet

0-000

SURGICALKITCOMPONENTS

IndividualSurgicalKitComponents

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50-000 Surgical Driver

Used to place implants in the osteotomy; particularly useful in the anterior.TheSurgicalDriverholds theRatchetAdapters that interfacewith the3inOneAbutment,aswellasBoneTapsandInsertionTools.Alsousedwiththe.050(1.25mm)HexDrivers(ref.300-350and300-351,soldseparately).

ExtendedShankDrills(not included in Surgical Kit)

-0

-507

-509

-505

-5

-55

-5

.0mm Starter Drill, Extended Shank

.5 x 7mm Depth Drill, Extended Shank


.5 x 0.5mm Depth Drill, Extended Shank

.5 x mm Depth Drill, Extended Shank


.5mm Depth Drill, Extended Shank

-0

-

-7

-

-7

-5

.0mm Width Increasing Drill, Extended Shank

.mm Width Increasing Drill, Extended Shank


.mm Width Increasing Drill, Extended Shank


5.mm Width Increasing Drill, Extended Shank

ExtendedShankDrillsare8mmlongerthanourstandarddrills.Theyprovide an intermediary increase in length between the standarddrillsusedalone,orwiththeDrillExtender(ref.122-100),whichadds16mmoflength.Thedepthmarksandcuttinggeometryareidenticaltoourstandarddrills.

SurgicalDriver(not included in Surgical Kit)

ANCILLARYSURGICALINSTRUMENTS

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AncillaryInstruments(not included in Surgical Kit)

-0 .0mm Lindemann Bone Cutter

Side-cuttingdrillusedtocorrecteccentricosteotomypreparations.

ForinstallationandremovalofCoverScrews,HealingAbutmentsandAbutmentScrews.Usewithlatch-typecontra-anglehandpieces:WS-75E/KMorsimilar.134-450is5mmlongerthanthe134-350.

-50

-50

.050 (.5mm) Handpiece Hex Driver

.050 (.5mm) Handpiece Hex Driver, Long

.5/.0mm Tissue Punch

5.0mm Tissue Punch

6.0mm Tissue Punch

External Bone Profiler, .5mm

External Bone Profiler, .0mm

External Bone Profiler, 5.0mm

External Bone Profiler, 6.0mm

Usedatimplantuncoverytocontourcrestalbonetoaccommodateabutmentswhentheimplant is subcrestal. For use in latch-type reduction handpieces. The Profilers internalgeometrymatchesthegeometryofthesurgicalCoverScrewwhichalignstheProfilerforpreciseremovaloftissuesurroundingtheplatform.

-

-

-5

-6

BioHorizonsTissuePunchesareusedinalatch-typehandpiecetoremovethesofttissuefromthecrestoftheridgepriortoosteotomypreparationinaflaplesssurgicalprocedure.

-0

-0

-0

ANCILLARYSURGICALINSTRUMENTS

0

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ExternalSurgical

L050 External Radiographic Implant Template (overlay) Designedtoaidtheclinicianinthepreoperativedeterminationofoptionsforimplantlengthanddiameter.Theclearoverlaytemplateshowsallsizesof BioHorizons External implants in 100% and 125% scale. Packagedwitheachnewsurgicalkit,butalsoavailableuponrequest.

L00

External Depth Mark and Drill Sequence Chart11x17(28cmx43cm)wallchartdetailstheDrillDepthMarksandrecommended sequence of use for the instruments found in theExternalSurgicalKit(ref.160-500).Packagedwitheachnewsurgicalkit,butalsoavailableonrequest.

External Surgical Kit Wall Chart11x17(28cmx43cm)wallchartdetailsthelocationofinstrumentsin the External Surgical Kit (ref. 160-500), as well as the referencenumberstoassistre-ordering.Packagedwitheachnewsurgicalkit,butalsoavailableuponrequest.

External - 7mm Length Implants Guides the clinician and laboratory through the nuances of placing andrestoring BioHorizons External 7mm length implants. Includes orderinginformationforimplants,2.0x7mmDepthDrillsandRadiographicTemplateswith7mmlengthimplants.NOTE: 7mm length implants are not available in all countries; please call for availability in your market.

L05BioHorizons External - 7mm Length Implants

L0

COLLATERALLITERATUREANDSUPPORTMATERIAL

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Regeneration Specialty CatalogOrderinginformationforAlloDerm,Grafton DBM,Mineross,Mem-Lok,AutoTacTitaniumtackingsystemandBoneFixationScrewKit.Awidearrayofboneandsoft-tissuegraftinginstrumentsarealsoshown.

ML00

ExternalProsthetic

RegenerationProductsandSpecialtyInstruments

BioHorizons External Impression Technique Guide

External Impression Technique GuideGuidestheclinicianandlaboratorythroughimpressionmakingtechniquesandprocedureswithBioHorizonsExternalimpressioncomponents.

ML007

Animated Restorative Technique GuideGuides the clinician and laboratory through impression making techniques andprosthetic/lab procedures with the BioHorizons 3inOne Abutment and Ball-topScrew,aswellasotherrestorativeprotocols.

MLV9

Animated Restorative Technique Guide

COLLATERALLITERATUREANDSUPPORTMATERIAL

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WH-ITC95

WH-95MC

WD-79M

WH-915One-pieceDisposableIrrigationSet(6pack)

ImplantMed915MotorCable-1.8meter

W&HEndoContra-angle2:1HandpieceWD-79NotincludedinStarterKit.2:1speed-reducingratio.UsedwithImplantMed915formechanicalrootcanalpreparation.

Re-order items:

WH-95 W&H ImplantMed 95 Starter Kit

WH 00 W&H ElcoMed SA-00 Professional Kit

Re-order items:

Maximummotor speed is 40,000 rpm. Themotor comeswith theWS-75 handpiece, bur testing gauge, (3)disposable irrigation assemblies, and service oil (shipped separately). The console has factory-programmedsettingsforendodonticfunctionswhenusedwiththeW&HEndoContra-angle2:1Handpiece.

Maximummotorspeedis50,000rpm.TheSA-200permitsthestorageoftorquecharacteristicsofatreatmentstage,whichcanthenbesavedonaDOCcardforarchivingpurposes.ThekitincludestheWS-75handpiece,(10)disposablespraytubes,burtestinggauge,irrigationspikeandserviceoil(shippedseparately).

WH-00PTWC

WH-00RPT ( PK)

WH-00INI

WH-00DOC

WH-00MC

PumpTube(190mm)withConnectors

ReplacementPumpTubes(190mm)(3pack)

INICards(3pack)

DOCCards(3pack)

ElcoMed200MotorCable-1.8meter

WH-ST (0 PK)

WH-CLP (0 PK)

WH-00PTWC

WH-00RPT (5 PK)

WH-00MC

WH-0MC

WH-0CLP (5 PK)

WH-0PTWC

WH-0RPT

WH-0ISAWRC

WH-0RC

WH-ISA

WH-ITWOS

WH-MD00

WH-OSC

WH-SP

GreenSingle-UseSprayTubes(10pack)

SetofSprayTubeClamps(10pack)

PumpTubewithConnectors(65mm)


ElcoMed100MotorCable-1.8meter

ImplantMed110MotorCable-1.8meter

SetofSprayTubeClamps(5pack)

PumpTube(85mm)withConnectors


IrrigationSpikeAssemblywithRollerClamp

FlowRegulatingRollerClamp

IrrigationSpikeAssembly(autoclavable)

IrrigationTubingw/oSpike(autoclavable)

MD-400ServiceOil-F1

OilSprayCap

SterilizationPlugforMotorCable

AllW&HMotors

ElcoMed100&200

ElcoMed100

ElcoMed100

ElcoMed100

ImplantMed110

ImplantMed110&915

ImplantMed110&915

ImplantMed110&915

ImplantMed110&915

ImplantMed110&915

AllW&HMotors

AllW&HMotors

AllW&HMotors

AllW&HMotors

AllW&HMotors

Ref. Code Description Motor Compatibility

W&HImplantMed915

W&HElcoMedSA-200

UniversalandLegacyRe-orderItems

W&HMOTORSANDACCESSORIES

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W&H :.7 Contra-angle Speed Increasing Handpiece 1:2.7speed-increasingratio-135,000rpmmaximum.Contra-angleHandpiecesuitableforhighspeedpreparationandtissueaugmentationprocedures.External irrigationport.Usesfriction-gripburs(1.6mm).

W&H 0: Contra-angle Handpiece WS-75 E/KMContra-angleHandpiecewithspeedreductionratioof20:1(2,500rpmmaximum).Equippedforbothinternalcooling&externalcooling.Push-buttonburrelease.Useslatch-typesurgicaldrillsandburs.

W&H : Straight Surgical Handpiece 1:1ratio-50,000rpmmaximum.Suitableforboneharvesting,thirdmolarextractionsandosteoplasty.Easilydismantledforcleaning.Uses45mmfriction-gripsurgicalburs(2.35mm).

S-

WS-75

WS-9

W&H : Contra-angle Surgical Handpiece1:2speedincreasingratio-80,000rpmmaximum.Suitableforsurgicalproceduressuchasbonesmoothing, thirdmolarextractionsandosteotomysitedrilling.Highprecisionbearingsensurethattheunitrunsvibrationfree.Usesfriction-gripsurgicalbursatleast65mmlong(2.35mm).

S-

Usedtoverifytheconditionoflatch-typeburs.Bursinproperconditionwillfitintolargerdiameterhole,butwillnotfitintothesmallerhole(markedred).Bursthatfaileitherofthesecriteriaareunfitforuse,andmaycausedamagetothehandpieceifused.

WH-BTG Bur Testing Gauge

IMPORTANT NOTE: W&H motors and handpieces are distinguished by their precision craftsmanship and reliability and are covered by a 1-year manufacturers warranty. Instructions for required cleaning and maintenance are outlined in each products

user manual, and adherence to these procedures is essential for proper function and longevity of the products. BioHorizons

assumes no liability for the failure of, or damage to, motors and handpieces that are not properly maintained or used contrary

to the instructions for use. Please contact your Product Support Specialist or Customer Care if you need additional information.

W&HElcoMedSurgicalHandpieces

BurTestingGauge

W&HMOTORSANDACCESSORIES

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Lab Modified Cement-retained

Custom Cast (UCLA) Screw-retained

Provisional Restorations

May also be modified chair-side.

Gold-base with burn-out plastic sleeve. Non-hex-engaging abutments are only for multiple-unit prostheses.

AbutmentsforCement-retentionPages -

CustomCastableAbutmentsPages -

PEEKAbutmentsPage

Cement-orscrew-retained

TitaniumTemporaryAbutmentsPage

Screw-retained

IMPLANT-LEVELFIXEDPROSTHETICOVERVIEW

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Implant-level Cast Bar or Hybrid (Fixed-detachable)

Abutment for Screw-level Cast Bar or Hybrid (Fixed-detachable)

BallAbutmentsPage 0

Abutment-retained Overdenture, Tissue-supported

AbutmentsforScrewPage

REMOVABLEANDHYBRIDPROSTHETICOVERVIEW

CustomCastableAbutmentsPages -

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Ball-top Screw Closed-tray Transfer

Implant-level Open-tray Pick-up

Impression coping remains in mouth when impression tray is removed. Coping is transferred from the patient and indexed into the impression after assembly with an Implant Analog.

Impression coping is picked-up in the impression. An implant analog is attached to the incorporated coping before the stone model is created.

IndirectTransferCopingsPage 5

DirectPick-upCopingsPage 6

Direct Abutment Impression (Crown & Bridge-type)A crown & bridge impression is made of a seated abutment and a stone model is created. The abutment remains in place during laboratory fabrication of the final prosthesis.

Implant-level Closed-tray Transfer (Non-hex engaging)Impression coping remains in mouth when impression tray is removed. Coping is transferred from the patient and indexed into the impression after assembly with an Implant Analog.

IndirectTransferCopingsPage 5

Multiple-unitsonly

IMPRESSIONCOMPONENTOVERVIEW

AbutmentsforCement-retentionPages -

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Abutment for Screw-level Closed-tray Transfer

Abutment for Screw-level Open-tray Pick-up

AbutmentforScrew-levelIndirectTransferCopings

Page 9Impression copings remain in mouth when the tray is removed. Copings are transferred from the patient and seated in the impression after assembly with Abutment for Screw Analogs.

Impression copings are picked-up in the impression. Abutment for Screw Analogs are attached to the incorporated copings and a stone model is poured.

BallAbutmentImpressionComponentsPages 0-

Ball Abutment Closed-tray TransferAn impression is made of the seated Ball Abutments which remain in place when the tray is removed. Ball Abutment Analogs are seated in the impression and a stone model is poured.

AbutmentforScrew-levelDirectPick-upCopings

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IMPRESSIONCOMPONENTOVERVIEW

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6.25mm

1.5mm

5.2mm

5.75mm4.5mm

8mm

.5mm 3inOne Abutment

.0mm 3inOne Abutment

5.0mm 3inOne Abutment

6.0mm 3inOne Abutment

Forcement-retained,single-ormultiple-unitprosthesesIncludesAbutmentScrew(130-300or140-300,finaltorque:30Ncm)UsedwithBall-topScrewasaclosed-tray,hexed-timedimpressioncopingGold-coloredTitaniumNitride[TiN]coatingfortissueestheticsTitaniumalloy[Ti-6Al-4V]

0-

0-

05-5

06-6

5.25mm

6 8 10 15

3.2mm3.2mm3.2mm2.9mm

.5mm Ceramic Abutment

.0mm Ceramic Abutment

5.0mm Ceramic Abutment

6.0mm Ceramic Abutment

Forsingle-ormultiple-unitprosthesesintheanteriorestheticzoneIncludesAbutmentScrew(130-400or140-400,usedonlywithExternalCeramicAbutments,finaltorque:30Ncm)

Yttria-stabilizedZirconia[ZrO2]

-5

-5

5-5

6-5

7.7mm

2.0mm

6.6mm5.1mm

5

7mm*

5.6mm

5mm

5 5 8


RESTORATIVECOMPONENTS

3inOneAbutmentsforCement-retainedRestorations

CeramicAbutmentsforEstheticZoneRestorations

*Previous versions of these abutments were 10mm high. Reduce as necessary using a low-speed handpiece at 15,000-20,000 RPM with a ceramic trimming wheel. Dipping both the wheel and abutment in water at frequent intervals during modification will help minimize heat generation.

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1mm

15

3mm

1515

.5mm Angled Esthetic Abutment

.0mm Angled Esthetic Abutment

5.0mm Angled Esthetic Abutment

Forcement-retained,single-ormultiple-unitprosthesesIncludesAbutmentScrew(130-300or140-300,finaltorque:30Ncm)Gold-coloredTitaniumNitride[TiN]coatingfortissueestheticsTitaniumalloy[Ti-6Al-4V]

-

-

5-

9mm

.5mm Straight Esthetic Abutment

.0mm Straight Esthetic Abutment

5.0mm Straight Esthetic Abutment

Forcement-retained,single-ormultiple-unitprosthesesIncludesAbutmentScrew(130-300or140-300,finaltorque:30Ncm)Gold-coloredTitaniumNitride[TiN]coatingfortissueestheticsTitaniumalloy[Ti-6Al-4V]

-

-

5-

1mm

6.5mm

3mm

5.9mm5.8mm

9mm

6.5mm5.9mm5.8mm


AngledEstheticAbutmentsforCement-retainedRestorations

StraightEstheticAbutmentsforCement-retainedRestorations

0

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.5mm Angled Abutment

.0mm Angled Abutment

5.0mm Angled Abutment

Forcement-retained,single-ormultiple-unitprosthesesIncludesAbutmentScrew(130-300or140-300,finaltorque:30Ncm)Titaniumalloy[Ti-6Al-4V]

-00

-00

5-00

1mm

17

3.7mm

11mm

4.2mm 5.2mm

20 20


.5mm Straight Abutment

.0mm Straight Abutment

5.0mm Straight Abutment

-0

-0

5-0

4mm

10mm

3

3.7mm 4.2mm 5.2mm

4 8


AngledAbutmentsforCement-retainedRestorations

StraightAbutmentsforCement-retainedRestorations

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.5mm Profile Abutment

.0mm Profile Abutment

5.0mm Profile Abutment


-

-

5-

3mm

5.8mm

12mm

6.8mm 7.4mm

4mm

Forcement-retainedmultiple-unitprostheses(finaltorque:30Ncm)Bestsuitedforrestorationsrequiringonlyminorintra-oralmodificationOne-piece,non-hexengagingabutmentTitaniumalloy[Ti-6Al-4V]

.5mm Abutment for Cement, Non-hexed

.0mm Abutment for Cement, Non-hexed

5.0mm Abutment for Cement, Non-hexed

-0

-0

5-0

4

3.7mm

8mm

4.2mm 5.2mm

6 9.5


ProfileAbutmentsforCement-retainedRestorations

AbutmentsforCement-retainedRestorations-Non-hexed

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Forsingle-ormultiple-unitscrew-retainedorcustomabutmentcement-retainedrestorations

IncludesAbutmentScrew(130-300or140-300,finaltorque:30Ncm)Goldalloybase(60%Gold,20%Palladium,19%Platinum,1%Iridium)withDelrinburn-outsleeve

Dimensionsshownbelow

.5mm Plastic Custom Castable Abutment, Hexed

.0mm Plastic Custom Castable Abutment, Hexed

5.0mm Plastic Custom Castable Abutment, Hexed

6.0mm Plastic Custom Castable Abutment, Hexed

-7

-7

5-7

6-7

Forsingle-ormultiple-unitscrew-retainedorcustomabutmentcement-retainedrestorations

IncludesAbutmentScrew(130-300or140-300,finaltorque:30Ncm)Delrinburn-outsleeveDimensionsshownonoppositepage

.5mm Gold/Plastic Custom Castable Abutment, Hexed

.0mm Gold/Plastic Custom Castable Abutment, Hexed

5.0mm Gold/Plastic Custom Castable Abutment, Hexed

6.0mm Gold/Plastic Custom Castable Abutment, Hexed

-7

-7

5-7

6-7

HexedandNon-hexedGold/PlasticCustomCastableAbutmentsshareidenticalexternalgeometry.

6.75mm

1mm

6.0mm4.5mm

12mm

5.0mm

5mm (top of alloy base)


CustomCastable(UCLA)Abutments-Hexed

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.5mm Gold/Plastic Custom Castable Abutment, Non-hexed

.0mm Gold/Plastic Custom Castable Abutment, Non-hexed

5.0mm Gold/Plastic Custom Castable Abutment, Non-hexed

6.0mm Gold/Plastic Custom Castable Abutment, Non-hexed

.5mm Plastic Custom Castable Abutment, Non-hexed

.0mm Plastic Custom Castable Abutment, Non-hexed

5.0mm Plastic Custom Castable Abutment, Non-hexed

6.0mm Plastic Custom Castable Abutment, Non-hexed

-0

-0

5-0

6-0

Formultiple-unitscrew-retainedorcustomabutmentcement-retainedrestorations

IncludesAbutmentScrew(130-300or140-300,finaltorque:30Ncm)Delrinburn-outsleeveDimensionsshownbelow

-

-

5-

6-

Formultiple-unitscrew-retainedorcustomabutmentcement-retainedrestorations

IncludesAbutmentScrew(130-300or140-300,finaltorque:30Ncm)Goldalloybase(60%Gold,20%Palladium,19%Platinum,1%Iridium)withDelrinburn-outsleeve

Dimensionsshownonoppositepage

HexedandNon-hexedPlasticCustomCastableAbutmentsshareidenticalexternalgeometry.

6.75mm

0.5mm

5.75mm4.2mm

12mm

4.75mm


CustomCastable(UCLA)Abutments-Non-hexed

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.5mm PEEK Temporary Abutment

.0mm PEEK Temporary Abutment

5.0mm PEEK Temporary Abutment

6.0mm PEEK Temporary Abutment

Forcement-orscrew-retainedprovisionalrestorations(upto30days)IncludesAbutmentScrew(130-300or140-300,hand-tighten)DirectCopingScrews(purchaseseparately,page27)maybeusedtomaintainscrewaccessholeduringfabricationofscrew-retainedprovisionalrestorations

PEEK(PolyEtherEtherKetone)material

7-000

7-000

75-000

76-000

6.5mm

3.0mm

6.0mm4.75mm

4

8mm

5.5mm

5mm

5 5 7


0.5mm

4.2mm

9mm

4.75mm 5.75mm

.5mm Titanium Temporary Abutment, Hexed

.0mm Titanium Temporary Abutment, Hexed

5.0mm Titanium Temporary Abutment, Hexed

-5

-5

5-5

Forsingle-unit(hexed)ormultiple-unit(non-hexed)screw-retainedprovisionalrestorationsIncludesAbutmentScrew(130-300or140-300,hand-tighten)DirectCopingScrews(purchaseseparately,page27)maybeusedtomaintainscrewaccessholeduringfabricationofscrew-retainedprovisionalrestorations

TitaniumAlloy[Ti-6Al-4V]

.5mm Titanium Temporary Abutment, Non-hexed

.0mm Titanium Temporary Abutment, Non-hexed

5.0mm Titanium Temporary Abutment, Non-hexed

-

-

5-


PEEKTemporaryAbutments

TitaniumTemporaryAbutments

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.5mm Ball-top Screw

.0/5.0/6.0mm Ball-top Screw

-5

-5

The Ball-top Screw MUST be used with

a 3inOne Abutment to serve as an

indirect transfer coping

11mm

3mm

8mm

4mm

5

3.7mm

10mm

4.2mm 5.2mm

5 7

Onlyusedforclosed-tray,non-hexedtransferswhenthefinalrestorationistobeamultiple-unit,non-hexengaging,screw-retainedprosthesis,orformakingimpressionsforfabricationofacustomimpressiontray

Hand-tightenmanuallyorwiththe.050(1.25mm)HexDriverTitaniumAlloy[Ti-6Al-4V]

.5mm Indirect Transfer Coping, Non-hexed

.0mm Indirect Transfer Coping, Non-hexed

5.0mm Indirect Transfer Coping, Non-hexed

-00

-00

5-00

IMPRESSIONCOMPONENTS

Ball-topScrewforIndirectTransfer

IndirectTransferCopings(ClosedTray)-Non-hexed

Usedwiththe3inOneAbutmentasanimpressioncopingforclosed-trayindirecttransfers

Screwsfor3.5mmimplants(213-235)areyellow(anodized)Screwsfor4.0/5.0/6.0mmimplants(214-235)aresilver(un-anodized)Hand-tightenmanuallyorwiththe.050(1.25mm)HexDriverTitaniumAlloy[Ti-6Al-4V]

6

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Direct Pick-up Copings (Open Tray) - Non-hexed

Usedtomakeanopen-tray,implant-level,hexed-timedimpressionPackagedwiththeextendedDirectCopingScrew(243-320or244-320)TitaniumAlloy[Ti-6Al-4V]

Usedtomakeanopen-tray,implant-level,non-hexedimpressionPackagedwiththeextendedDirectCopingScrew(243-320or244-320)TitaniumAlloy[Ti-6Al-4V]

-

-

5-

6-

.5mm Direct Pick-up Coping, Non-hexed

.0mm Direct Pick-up Coping, Non-hexed

5.0mm Direct Pick-up Coping, Non-hexed

6.0mm Direct Pick-up Coping, Non-hexed

.5mm Direct Pick-up Coping, Hexed

.0mm Direct Pick-up Coping, Hexed

5.0mm Direct Pick-up Coping, Hexed

6.0mm Direct Pick-up Coping, Hexed

-

-

5-

6-

6.2mm

5mm

3.7mm

11mm

4.2mm 5.2mm

6mm

17mm

2.5mm


DirectPick-upCopings(OpenTray)-Hexed

DirectPick-upCopings(OpenTray)-Non-hexed

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Packagedwithallimplantsandtwo-pieceabutmentsScrewsfor3.5mmimplants(130-300)areyellow(anodized)Screwsfor4.0/5.0/6.0mmimplants(140-300)aresilver(un-anodized)Utilizesthe.050(1.25mm)HexDriver(finaltorque:30Ncm)TitaniumAlloy[Ti-6Al-4V]

PackagedwithallDirectPick-upCopingsScrewsfor3.5mmimplants(243-320)areyellow(anodized)Screwsfor4.0/5.0/6.0mmimplants(244-320)aresilver(un-anodized)Maybeusedextrascrewlengthisneeded,ortomaintainscrewchannelduringfabricationofscrew-retainedprovisionalprostheses

Utilizesthe.050(1.25mm)HexDriver.Hand-tightenortorqueto30Ncmdependingonapplication


.5mm Direct Pick-up Screw

.0/5.0/6.0mm Direct Pick-up Screw

-0

-0

.5mm Abutment Screw

.0/5.0/6.0mm Abutment Screw

0-00

0-00

RepresentstheExternalimplantinalaboratory-fabricated,implant-levelstonemodel

Color-codedbyimplantbodydiameterTitaniumAlloy[Ti-6Al-4V]

.5mm Implant Analog

.0mm Implant Analog

5.0mm Implant Analog

6.0mm Implant Analog

9-000

9-000

95-000

96-000


DirectCopingScrews

AbutmentScrews

ImplantAnalogs

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UsedtoretainbarsorprosthesesfabricatedfromthePlasticCopingsforAbutmentforScrew.Utilizesthe.050(1.25mm)HexDriver.Finaltorque:30Ncm.TitaniumAlloy[Ti-6Al-4V].

.5mm Abutment for Screw, mm collar


.5mm Abutment for Screw, 5mm collar



.0mm Abutment for Screw, 5mm collar

5.0mm Abutment for Screw, mm collar

5.0mm Abutment for Screw, mm collar

5.0mm Abutment for Screw, 5mm collar

5-0

5-0

5-05

5-0

5-0

5-05

55-0

55-0

55-05

Burn-outcoping(matrix)forAbutmentforScrew.Maybetrimmedforheight.CopingScrewsmustbepurchasedseparately(below).Delrin.

.5/.0mm Plastic Coping, Abutment for Screw (5 pack)

5.0mm Plastic Coping, Abutment for Screw (5 pack)

5-0

55-0

Usedinthelabwhenalongerscrewisdesired.UsedonlywiththeAbutmentforScrew.Hand-tightenortorqueto30Ncmdependingonapplication.TitaniumAlloy[Ti-6Al-4V].

Long Bar Retention Coping Screw, Abutment for Screw (5 pack)

-Short Bar Retention Coping Screw, Abutment for Screw (5 pack)

-0

5.2mm

12mm

-500 (2.7mmhigh)

5-0 55-0

3,4or5mm

4.2mm

1.25mm

3.7mm

4.2mm

4.2mm 5.2mm

5.2mm

4.2mm

4.5mm

ABUTMENTSFORSCREWANDCOMPONENTS

AbutmentforScrew

PlasticCopings,AbutmentforScrew

Screws,AbutmentforScrew

Formultiple-unitrestorationsincluding:abutment-levelscrew-retainedrestorations,castalloybarsforoverdenturesandfixed/detachable(hybrid)restorations

PackagedwiththeCoverCap(224-500)SeatusingtheappropriateHexAdapter,AbutmentforScrew(purchasedseparately,page29)


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PackagedwithallAbutmentsforScrew.Hand-tightenwith.050(1.25mm)HexDriver.TitaniumAlloy[Ti-6Al-4V].

-500 Cover Cap, Abutment for Screw

Usedtomakeadirectpick-upimpression(open-tray)attheabutmentlevel.Packagedwiththerequiredscrew.UsedonlywiththeAbutmentforScrew.TitaniumAlloy[Ti-6Al-4V].

Usedtomakeanindirecttransfer(closed-tray)impressionattheabutmentlevel.UsedonlywiththeAbutmentforScrew.TitaniumAlloy[Ti-6Al-4V].

UsedtorepresenttheAbutmentforScrew/Implantassemblyintheworkingcast.Notforusewithimplant-levelimpressions.TitaniumAlloy[Ti-6Al-4V].

.5/.0mm Analog, Abutment for Screw

5.0mm Analog, Abutment for Screw

5-600

55-600

RequiredforplacementofAbutmentforScrew.MaybedrivenbyeitherHandWrench,TorqueWrenchorAS123HandUnit.

.5/.0mm Hex Adapter, Abutment for Screw

5.0mm Hex Adapter, Abutment for Screw

0-0

05-0

.5/.0mm Indirect Transfer Coping, Abutment for Screw

5.0mm Indirect Transfer Coping, Abutment for Screw

5-00

55-00

.5/.0mm Direct Pick-up Coping, Abutment for Screw

5.0mm Direct Pick-up Coping, Abutment for Screw

-

5-

ABUTMENTFORSCREWCOMPONENTS

DirectPick-upCopings,AbutmentforScrew

IndirectTransferCopings,AbutmentforScrew

Analogs,AbutmentforScrew

CoverCap,AbutmentforScrew

HexAdapter,AbutmentforScrew

0

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2,4or6mm

3.5mm

2.5mm

3.7mm 4.2mm 5.2mm

5.9mm

2.6mm5mm

5.5mm

3.2mm

O-Ring Attachment SetO-Ringencapsulator2ProcessingO-rings2ClinicalO-rings

60-00

StandardO-ringattachmentforprocessingintodenture.

O-Ring Encapsulator Femalereceptacleprocessedintodenture.Titanium.2perpackage.

60-00

Clinical O-RingUsedforclinicalapplications.Silicone.12perpackage.

60-0

Processing O-RingUsedforlabprocessingapplications.Buna.12perpackage.

60-0

.5mm Ball Abutment, mm Collar


.5mm Ball Abutment, 6mm Collar



.0mm Ball Abutment, 6mm Collar

5.0mm Ball Abutment, mm Collar

5.0mm Ball Abutment, mm Collar

5.0mm Ball Abutment, 6mm Collar

6-00

6-00

6-006

6-00

6-00

6-006

65-00

65-00

65-006

BALLABUTMENTSANDCOMPONENTS

BallAbutments

O-ringAttachmentSystem

Forretentionoftissue-supportedoverdenturesUsewiththeBallAttachmentorO-ringAttachmentsystemRecommendedforrelativelyparallelimplantsSeatwith.050(1.25mmHexDriver(finaltorque:30Ncm)TitaniumAlloy[Ti-6Al-4V]

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60-00

60-500

.5/.0mm Ball Abutment Analog ( pack)

5.0mm Ball Abutment Analog ( pack)

Set of toolsInsertSeatingTool,ReamerandParallelingTool.

BCS

TheBallAttachmentsystemoffersseveraladvantagesovertraditionalO-ringattachments.Itrequireslessmesial/distal/buccal/lingualspaceandoffersfourdifferentlevelsofretention.Thenylonretentioninsertscanbechangedchairside.

Pink Nylon Insert Clinicaluse.2perpackage.SoftRetention:2.3lb/875g

White Nylon Insert Clinicaluse.2perpackage.StandardRetention:3.3lb/1250g

Yellow Nylon Insert Clinicaluse.2perpackage.ExtraSoftRetention:1.4lb/525g

Black Nylon Insert LabProcessingandChair-sideDenturePick-up.2perpackage.

Green Nylon Insert Clinicaluse.2perpackage.ElasticRetention.

BCIG

BCIB

BCIY

BCIW

Directional RingsUsedforobtainingparallelism.0,7and14rings.Setof3.

BCDR

BCIP

Castable Ball Pattern Burn-outcomponentforfabricationofacustombarwithballattachments.Not recommended for use with O-Ring Attachments.2ballsperpattern.

BCIST Paralleling ToolAlaboratorytoolusedonasurveyortopositionandwaxcastableballsonabar.

ReamerUsedtoadjustretentionofnyloninserts.

BCR

BCPTInsert Seating ToolUsedtoseatnyloninsertsinattachmenthousings.

BCCBP

BCAHT

Includes:(1)TitaniumHousing,(3)FemaleNylonInserts-white(moreretention),pink(lessretention),black(labprocessing)and(1)ProtectiveDisk(ref.BCPD,protectstissueduringimpressionmakingordenturepick-up)

BCAS Ball Attachment Set

BALLABUTMENTCOMPONENTS

BallAttachmentSystem

BallAbutmentAnalogs

Attachment Housings - TitaniumForResinpickuporSoldering.2perpackage.

UsedtorepresenttheBallAbutment/Implantassemblyintheworkingcast.OnlyusedinconjunctionwithBallAbutments.TitaniumAlloy[Ti-6Al-4V].

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Hand WrenchUsedondriveendofAS123HandUnit.AlsofitsindividualHexDrivers/AdaptersandBoneTaps.

00-00

0 Ncm Torque WrenchUsedtodelivertorquetoprostheticcomponents.

00-070

00-00 AS Hand UnitProvidesimprovedvisionandeasyaccesstoprostheticcom-ponentsinposteriorregionsofthemouth.HandWrenchandDriversmustbepurchasedseparately.

Mayalsobepurchasedaspartofthe320-000CompleteProstheticInstrumentationSystem(seeabove).

Prosthetic Sterilization Tray (not shown)Autoclavabletrayforprostheticinstrumentation(includedwiththe320-000and320-101).

Complete Prosthetic Instrumentation System (shown)Includes:AS123HandUnit/HandWrench/30NcmTorqueWrench/.050(1.25mm)HexDriver,Regular/.050(1.25mm)HexDriver,Long/HexAdaptersforAbutmentforScrew/RatchetExtender/SterilizationTray.

0-000

.050 (.5mm) Hex Driver Regular or LongUsedtodriveallsurgicalandprostheticcomponentswiththeexceptionoftheAbutmentforScrew.

00-50 (regular)

00-5 (long)

6.25mm12.5mm

0-0 Basic Prosthetic Instrumentation Kit (not shown)Includes:HandWrench/30NcmTorqueWrench/.050(1.25mm)HexDriver,Regular/.050(1.25mm)HexDriver,Long/RatchetExtender/SterilizationTray.

ProstheticInstrumentationSystem

RequiredforplacementofAbutmentforScrew.MaybedrivenbyeitherHandWrench,TorqueWrenchorAS123HandUnit.

0-0

05-0

.5/.0mm Hex Adapter, Abutment for Screw

5.0mm Hex Adapter, Abutment for Screw

PROSTHETICINSTRUMENTATION

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IMPAH Abutment Clamp

Usedtoholdtwo-pieceabutmentsduringdeliveryandtighteningoftheAbutmentScrew.AbutmentClamp

ExternalImplantAnalogHandles

ForinstallationandremovalofCoverScrews,HealingAbutmentsandAbutmentScrews.TheHandpieceHexDriversareusedwithlatch-typecontra-anglehandpieces.TheHandpieceHexDriver,Long(134-450)is5mmlongerthanthestandardversion(134-350).

5-5

-50

-50

.050 (.5mm) One-piece Hex Driver

.050 (.5mm) Handpiece Hex Driver

.050 (.5mm) Handpiece Hex Driver, Long

Clean-outTapTools

HexDrivers

.5mm Implant Clean-out Tap Tool

.0/5.0/6.0mm Implant Clean-out Tap Tool

Abutment for Screw Clean-out Tap Tool

Usedtore-threadExternalimplantsorAbutmentsforScrewwheretheinternalthreadshavebecomedamaged.RequiresastandardsurgicalRatchet(130-000)orHandWrench(300-400)asadrivemechanism.

-00

-00

-70

UsedtoholdExternalabutmentsforchairsideorlaboratorypreparation,thesehandlesmimictheimplant/analoghexgeometry.AbutmentsaresecuredtothehandlewiththestandardAbutmentScrew.Comesinthreeplatformsizes:3.5,4.0mmand5.0/6.0mm.

.5mm Implant Analog Handle

.0mm Implant Analog Handle

5.0/6.0mm Implant Analog Handle

9-00

9-00

95-00

ANCILLARYPROSTHETICINSTRUMENTATION

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ML0 Patient Education Tooth Replacement with Dental Implants posterThis2-sidedlaminatedpostervisuallyoutlinestheadvantagesofimplanttherapycomparedtotraditionaltreatmentmethods.Onesidefocusesontoothreplacementoptions,whiletheoppositesidecontainsinformationonbonelossandhowdentalimplantscanhelppreservebone.Twopostersperpackage.24x36(61cmx91cm).

Five Implant Acrylic ModelThislife-sizedmodelallowsthecliniciantoillustrateimplantplacementofBioHorizonsimplants.Clearacrylicallowstheimplantstobeviewedinrelationtoadjacentteeth.Callforavailability.

MPSA

ML0 Patient Education Dental Implants - the tooth replacement solutionThishigh-qualityflipbookhelpstheimplantcandidateunderstandtherationaleandtheadvantagesofimplanttherapycomparedtotraditionaltreatmentmethods.Themessagefocusesonthepositivesofimplantsandtheirabilitytogreatlyreducethebonelossassociatedwithedentulism.Manytreatmentoptionsaredetailedtoaidtheclinicianindescribingaprocedure.9x6(23cmx16cm).

ML00

ML0

ML09

MLD0 Patient Education Soft tissue grafting with AlloDerm Thisbrochurehelpspatientswithrecedinggumtissueand/orsensitiverootsunderstandthebasicscience,safety,andbenefitsoftissuegraftingwithAlloDermRegenerativeTissueMatrix.8.5x3.5(21.5cmx8.7cm).

Patient Education Rebuilding and maintaining bone Thisbrochureexplainsthebenefitsandbasicscienceofboneregenerationanditsrelationshiptoimplanttherapy.8.5x3.5(21.5cmx8.7cm).

Patient Education Stabilizing dentures using dental implantsThisbrochurehelpsthedenturewearerunderstandtherationaleandtheadvantagesofdenturestabilizationwithimplants.8.5x3.5(21.5cmx8.7cm).

Patient Education Tooth replacement with dental implants Thisfour-foldbrochurehelpstheimplantcandidateunderstandtherationaleandtheadvantagesofimplanttherapycomparedtotraditionaltreatmentmethods.Themessagefocusesonthepositivesofimplantsandtheirabilitytogreatlyreducethebonelossassociatedwithedentulism.8.5x3.5(21.5cmx8.7cm).

External x Patient Education Model This4-timesscalemodelincludestheImplant,Abutment,AbutmentScrew,Ball-topScrew,HealingAbutment,CoverScrew,ImplantDriverandHexDriver.Excellentfordemonstratingimplantcomponentstothepatient.Callforavailability.

MXIM

PATIENTEDUCATIONMATERIAL

5


This Surgical Manual serves as a reference for using BioHorizons External implants and surgical instruments. Its sole

intentionistoprovideinstructionsontheuseofBioHorizonsproducts.Itisnotintendedtoprovideinstructiononmethods

orproceduresfordiagnosis,treatmentplanning,orplacementofimplants;nordoesitreplaceclinicaltrainingoraclinicians

bestjudgmentregardingtheneedsofeachpatient.BioHorizonsstronglyrecommendsappropriatetrainingasaprerequisite

fortheplacementofimplantsandassociatedtreatment.

The procedures illustrated anddescribedwithin thismanual reflect idealized patient presentationswith adequate bone

andsofttissuetoaccommodateimplantplacement.Noattempthasbeenmadetocoverthewiderangeofactualpatient

conditionsthatmayadverselyaffectsurgicalandprostheticoutcomes.Clinicianjudgmentasrelatedtoanyspecificcase

mustalwayssupersedeanyrecommendationsmadeinthisoranyBioHorizonsliterature.

BeforebeginninganyimplantsurgicalprocedurewithBioHorizonsimplants:

Designasurgicaltreatmentplantosatisfytheprostheticrequirementsofthecase.

ReadandunderstandtheInstructionsforUsethataccompanytheproducts.

Cleanandsterilizethesurgicaltrayandinstrumentsperinstructions.

Becomethoroughlyfamiliarwithallinstrumentsandtheiruses.

StudySurgicalKitlayout,color-codingschemeandiconography.

TreatmentPlanning

Theimplantteamshouldbeinagreementandincommunicationthroughoutallstagesoftherapy.Thepatient,therestorative

andsurgicaldoctors,aswellasthedentallaboratoryshouldunderstandandagreeuponthetreatmentplan.Thetreatment

planshoulddeterminethedesign,numberandpositionoftheimplants.

DiagnosticCasts

Mountedstudycastsandadiagnosticwax-uparethefoundationfordeterminingimplantposition. SurgicalGuideTemplates

Oncethediagnosticwax-upisfinalized,therestorativedoctorordentallaboratoryfabricatesthesurgicalguidetemplate.

Thisguideindicatestothesurgeontheimplantpositionthatoffersthebestsupportfortheprosthesis,aswellasoptimal

estheticsandhygienerequirements.Thesurgicalguidealsoprovidesinformationaboutthetoothandsupportingstructures

thathavebeenlost.

LaboratoryGuideTemplates

Amatrixofthediagnosticwax-upmayalsobeutilizedbythelaboratorywhendevelopingthefinalprosthesis.Thematrix

actsasaguideforpositionandcontouroftheprosthesis.

SURGICALM

ANUAL

EXTERNALSURGICALMANUAL-INTRODUCTION

6


6


SURGICALMANUAL

Packagedwith3inOne Abutment,AbutmentScrewandCoverScrew

Machinedcollar:0.5mmhigh

Bodydiameters:3.5mm/4.0mm/5.0mm/6.0mmImplantlengths:9mm/10.5mm/12mm/15mmProstheticplatforms0.2mmwiderthanimplantbody

ChoiceofRBTorHAsurface(HAnot offered on 3.5mm implants)

TitaniumAlloy(Ti-6Al-4V)

Minimum ridge width

Implant body Diameter

Hex flat-to-flat measurement

Implant body lengths

Minimum mesial /distal space

Apical diameter

Prostheticplatform diameter

Allspacingrecommendationsgivenwithinthisliteraturearegeneralguidelines.Cliniciansmustapplytheirbestjudgementastowhethertheseguidelinesareappropriateforindividualpatientpresentations.

IMPLANTSPECIFICATIONS

3.5mm

9.0mm

9mm10.5mm12mm15mm

6.2mm

3.0mm

6.0mm

8.0mm

2.5mm

8.0mm

5.2mm

9mm10.5mm12mm15mm

3.0mm

5.0mm

7.0mm

2.1mm

7.0mm

4.2mm

9mm10.5mm12mm15mm

2.7mm

4.0mm

6.0mm

2.0mm

6.5mm

3.7mm

9mm10.5mm12mm15mm

2.4mm

3.5mm

5.5mm

7


7


SURGICALM

ANUAL

Two-stage Surgery was the original protocol developed for placingmoderndentalimplants.Theimplantisplacedbelowthesofttissueandprotectedfromocclusalfunctionandotherforcesduringosseointegration.Alow-profileCoverScrewisplacedontheimplanttoprotectitfromtheingressofsofttissue.

Following osseointegration, a second surgery exposes the implant anda transmucosalHealingAbutment isplaced toallowsoft tissuehealing.Prostheticrestorationbeginsaftersofttissuehealing.

Single-stageSurgery leavestheimplant/abutmentconnectionexposedto theoralcavityviaa removableHealingAbutment.Thiseliminates theneedforasecondsurgerytoexposetheimplant.Althoughtheimplantisnotinocclusalfunction,someforcescanbetransmittedtoitthroughtheexposedtransmucosalelement.

Prosthetic restoration begins following osseointegration of the implantandsofttissuehealing.

Single-stageSurgerywithNon-functional ImmediateTeeth providesthe patient a non-occlusal provisional prosthesis early in the treatmentplan. An abutment is placed on the implant at or shortly after surgery,andaprovisionalrestorationissecuredtoitwithtemporarycement.Theprovisionalcanhelpcontourthesofttissueprofileduringhealing.

Single-stageSurgerywithImmediateFunctionmaybepossibleingoodquality bonewheremultiple implants exhibiting excellent initial stabilitycanbesplintedtogether.Splintingimplantstogethercanofferasignificantbiomechanical advantage over individual, unsplinted crowns. Cliniciansmust evaluate the mitigating patient factors in each case to determinewhetherimmediatefunctionisappropriate.

HealingAbutmentasatransmucosalelement.

CoverScrewinasubmergedsurgicalprotocol.

Non-functionalprovisionalprosthesis.

Splintedprosthesisinimmediatefunction.

Non-functionalImmediateRestoration

Single-stageSurgery

Two-stageSurgery

ImmediateFunctionalRestoration

SURGICALPROTOCOLS



SURGICALMANUAL

SpacingconsiderationsforBioHorizonsExternalimplants:

Properspacingisessentialforesthetics,bonemaintenanceandhygieneconsiderations

Maintainaminimumof1.5mmfromadjacentteeth(contactatcresttotheedgeofimplant)

Maintain3.0mmedge-to-edgespacingbetweenadjacentimplants

Watchfortoothrootstippedorangledbeyondthecontactregionofthecrown

Minimumspacingguidelinesareillustratedbelow(figures rounded up to the next 0.1mm)

1.5mm

3.3mm

Osteotomycenter3.3mmfromadjacenttooth

3.0mm

7.5mm

Theosteotomycenter-to-centermeasurementrequiredtomaintaina3.0mmedge-to-edgespacingbetweenExternalimplantsisderivedusingthefollowingcalculation:[sumof2implantbodydiameters]+3.0mm.Thetablebelowliststhepermutations.

1.5mm

3.5mm


1.5mm

4.0mm


Measurementisdependentonthetwoimplantbodydiameters.

5.0mm implant.0mm implant.5mm implant

Theosteotomycenterpointrequiredtomaintaina1.5mmimplant-to-toothspacingisderivedusingthefollowingcalculation:[implantbodydiameter]+1.5mm.ThemeasurementsforthefourExternalimplantbodydiametersareshownbelow.

1.5mm

4.5mm


6.0mm implant

.5mm

.0mm

5.0mm

6.5mm

6.8mm

7.3mm 8.0mm

7.0mm

7.5mm

5.0mm.0mm.5mm

6.0mm 7.8mm 8.5mm8.0mm

6.0mm

9.0mm

bodydiameter

IMPLANTSPACINGCONSIDERATIONS

5.0mm implant .0mm implant

9


9


SURGICALM

ANUAL

Probetipmeasuresosteotomydepth.

Purpose:Multi-functioninstrumentforintraoralmeasurements.

2.0mmprobetipmeasuresosteotomydepthinmillimeterincrements

Fivecentimetergraduatedruleronshaft

Endmeasuresimplant-to-implantspacing,mesial/distalandbuccal/lingual

Aidsimplantplacementadjacenttoanexistingtooth

Therectangularendofthetoolprovidesintraoralmeasurementsofbuccal/lingualandmesial/distalspace.

7mm

9mm

11mm

13mm

15mm

10mm

12mm

14mm

16mm

Usingtherectangularendasshownagainstanexistingcrowncenterstheosteotomyapproximately4.25mmfromthecontact.

Usefulformarkingcenter-to-centerimplantspacingontheridgepriortomultipleimplantplacement.

Center-to-centerimplantspacing

~4.25mm

IMPLANTSPACER/DEPTHPROBE

0


0


SURGICALMANUAL

All implantsareshownat100%scaleand125%scale (forpanoramic radiography).Themagnification factorofpanoramicradiographytypicallyrangesfrom115%to135%.

5mmcircularrepresentationsareshownat100%and125%fortheradiographicballtechnique.Thistechniqueusesradiographicmarkingballsembedded inaplastic templateprior to radiographicexaminationof thepatient.Thesemarkingballswillbevisibleontheradiographicimage.

Measurements can be taken to determine themagnification factor of the radiograph and help the practitioner accuratelydeterminetheamountofavailableboneforimplantplacement.Thefollowingexampleshowsthecalculationofamagnificationfactorandthesubsequentdeterminationofavailableboneabovethemandibularcanal:

Step1.Theradiographicmarkingballhasaknowndiameterof5mm.

Step2.Themeasured(apparent)diameterofthemarkingballontheradiographis6mm.

Step3.Themagnificationfactoriscalculatedas:65=1.2or120%.

Step4.Themeasured(apparent)distanceontheradiographbetweenthecrestoftheridgeandthesuperioraspectofthemandibularnervecanalis15mm.

Step5.Theactualdistancebetweenthecrestoftheridgeandthemandibularcanalwouldbecalculatedas:15mm1.2=12.5mm.

ExternalRadiographicTemplateREF#L0250Actualsize8.5x11(21.5cmx28cm)

Purpose:Aidsclinicianinpreoperativedeterminationofoptionsforimplantlengthanddiameter.

A mm margin of safety should be factored into any treatment plan adjacent to a vital anatomic structure.

RADIOGRAPHICTEMPLATE



SURGICALM

ANUAL

External Implant Color-code

TheExternalSurgicalKitusesan intuitive layouttoguidethesurgeonthroughthe instrumentsequence.Thesequencebegins intheupper left handcornerandworks left-to-right and thendown.Color-coded lines, instrumentsandgrommets further aid ininstrumentselectionandidentification.

Priortouse,cleanandsterilizethesurgicaltrayandinstruments(seepage57)andstudytheSurgicalKitlayout,color-codingandiconography.Surgicalassistantsshouldalsobethoroughlyfamiliarwithallinstrumentsandtheiruses.

4.0mmimplantbody

5.0mmimplantbody

6.0mmimplantbody

3.5mmimplantbody

3.5 4.0 5.0 6.0

SURGICALKIT



SURGICALMANUAL

ThedepthmarksareconsistentthroughouttheStarterDrill,DepthDrillsandWidthIncreasingDrills.Thethickbandsareeachonemillimeterwide.Thinlinesareusedtomark7mmand11mm.

Peri-operativeoral rinseswitha0.12%ChlorhexidineDigluconatesolutionhavebeenshown tosignificantly lower theincidenceofpost-implantationinfectiouscomplications.8Apreoperative30-secondrinseisrecommended,followedbytwicedailyrinsesfortwoweeksfollowingsurgery.

Drillingmustbedoneunderaconstantstreamofsterileirrigation.Apumpingmotionshouldbeemployedtopreventover-heatingthebone.Surgicaldrillsandtapsshouldbereplacedwhentheyareworn,dull,corrodedorinanywaycompromised.BioHorizonsrecommendsthereplacementofdrillsafter12to20osteotomies.9ADrill-usageTrackingChartisavailablefromBioHorizonstoaidofficesinarchivingthisimportantinformation.

Thereisariskofinjurytothemandibularnerveassociatedwithsurgicaldrillinginlowerposteriorregions.Tominimizetheriskofnerveinjury,itisimperativetheclinicianunderstandthedrilldepthmarkingsinordertocorrelateimplantlengthwiththeactualdrillingdepthtoproducethedesiredverticalplacementoftheimplant.

ThedescriptionsoftheDrillsinthisliteraturearespecifictotheExternalSurgicalKit(ref.160-500)andDrillspurchased after June 30, 2007. If you possess previous BioHorizons Surgical Kits or Drills, please refer toimportantInstructionsforUseonpage58.

14mm

10mm

12mm

15mm

11mm

13mm

7mm

9mm

TheSurgicalDrillsincludedintheExternalSurgicalKitareexternallyirrigatedanddesignedtobeusedatspeedsof850-2,500rpm7withsteadysterileirrigation.Reduceddrillspeedmaybedesiredinsofterboneorasdrilldiameterincreases.

DrillingConsiderations

SURGICALDRILLS



SURGICALM

ANUAL

Depth Drill Sequence (in average bone density)

5.0mm implant body

.0mm implant body

.5mm implant body

Crestal Bone Drills

(site specific)

Bone Taps(site specific)

6.0mm implant body

Width IncreasingDrill Sequence

(in average bone density)

Handpiece/Ratchet Adapters and

Insertion Tools

INSTRUMENTSEQUENCEREVIEW



SURGICALMANUAL

Purpose:Extendlengthoflatch-typedrillsandburs.

Adds16millimeterstooveralllengthofdrillsandburs

Providesaccessbetweenlongcrowns

Internalgeometryengagesdrillslatchgeometry

Compatiblewithlatch-typehandpieces,bursanddrills

Chisel-tipdesigneliminatesskatingonosseouscrest

Initiatesosteotomytoplanneddepth

PreparessiteforParallelPins

Purpose:Initiateosteotomy.

OSTEOTOMYINITIALIZATION

2.0mmStarterDrills

DrillExtender

StandardLengthDrill

ExtendedShankDrill

DrillExtenderwithStandardLengthDrill

+8mm

+16mm

5


5


SURGICALM

ANUAL

ParallelingPinsmaybeusedfollowingthe2.0mmStarterDrilltoevaluateanychangesneededtoimproveimplantangulationandposition.TheParallelingPinsareprovidedbothstraightandwitha20angle.ThelargeendoftheParallelingPinmaybeusedaftertheosteotomyisenlargedto2.5mm.

RadiographicevaluationoftheosteotomysproximitytoadjacentanatomycanbemadeusingthePinsasreference,howeverthelevelofradiographicmagnificationmustbetakenintoaccount.Dividethefeaturesapparentlengthontheimagebytheknownactuallengthtocalculatethemagnificationfactor(apparentlengthactuallength=magnificationfactor).

Byexample:iftheshankmeasures10.5mmontheradiograph,themagnificationfactoris:10.59=1.16or116%.ThereforeiftheParallelPinappearsontheradiographtobe4.0mmawayfromastructure,theactualdistanceis4.0mm1.16,or3.4mm.

Providedstraightandwitha20angle

Usedafter2.0mmStarterDrilland2.5mmDepthDrills

9mmshankforradiographicevaluationofproximitytoadjacentanatomy

Hubdiameteris4.0mm

Purpose:Evaluationofosteotomypositionandangle.

Theradiographicmagnificationfactorisderivedbycomparingtheapparentlengthontheradiographtotheknownactuallength.

9.0mm

2.0mm

2.5mm

9.0mm

Hub4.0mm

0.5mm

.0mm

PARALLELPINS

6


6


SURGICALMANUAL

Efficientcuttinggeometrycollectsboneforautografting

Offeredwithandwithoutlength-specificstops

UseDrillwithoutdepthstopwhencounter-sinkingimplant

2.5mmDepthDrillsareusedtoincreaseand/orsetthedepthandwidthoftheosteotomyfollowinguseofthe2.0mmStarterDrill.Theymayalsobethefirstdrillsusedtosettheosteotomydepthforimplantplacementinanextractionsocket.Therearefour2.5mmDepthDrillswithfixedDepthStopscorrespondingtothestandardplacementdepthsoftheimplants,aswellasonedrillwithoutadepthstop.

Depth Stop Drills - Fixedcircularringsactasstopstopreventdrillingbeyondthepre-determineddepth(9mm,10.5mm,12mmor15mm).Thesedrillsshouldnotbeusedwhensubcrestalplacement(counter-sinking)oftheimplantsprostheticplatform/CoverScrewisplanned.Preparationtothefulllengthpermittedbyadepthstopallowsplacementofthecorrespondingimplantasshownabove.Foraddedreferencethesedrillshavestandarddepthmarkingsbelowthestop.

Depth Drill without Stop - Thisdrillhasdepthmarksrangingfrom7mmto15mm(seepage42).Theclinicianmustmanuallystopthedrillattheplanneddepthbasedonthedepthmarksontheshaft.Thisdrillshouldbeusedifallorpartoftheimplantsprostheticplatform/CoverScrewwillbeplacedsubcrestal.

Purpose:Increaseosteotomydepthfollowinguseofthe2.0mmStarterDrill.

2.5x12mmDepthStopDrill

2.5mmDepthDrillwithoutStop

12mmlongExternalImplant

2.5MMDEPTHDRILLS

7


7


SURGICALM

ANUAL

Depth-markedforreference.Non-endcuttinggeometryforaddedsafety

Efficientcuttinggeometrycollectsboneforautografting

Color-codedbythesmallestdiameterimplantbodywithwhichitisused

3.0mm

Purpose:Incrementallywidenstheosteotomywithoutcreatingexcessiveheat.

WidthIncreasingDrillsareusedtoincrementallywidentheosteotomyafterthedepthhasbeenestablishedwitha2.5mmDepthDrill.Thegradualremovalofbonereducesheatgenerationinthesurroundingtissue.Thecuttingflutesextendthelengthofthedrillbodyandcollectbonethatmaybesavedforintraoperativegraftingprocedures.

TheWidthIncreasingDrillsfeatureahighlyefficientcuttinggeometry.Thedrillslackend-cuttinggeometry,therebycreatingabuilt-instopindensebonethatcanassistthesurgeonbypreventingosteotomypreparationbeyondtheplanneddepth.

Variations inbonedensityorpossiblevoidsrequiresurgeonstoobservethedrillsdepthmarkingsastheprimarydeterminantofdrillingdepth,ratherthanrelyingexclusivelyonthenon-endcuttinggeometrytostopthedrill.

IfaWidthIncreasingDrillfailstoreachtheplanneddepthasshownbythedepthmarks,usethe2.5mmDepthDrilltore-establishthedepthandrecommencetheWidthIncreasingSequencewiththe3.0mmWidthIncreasingDrill.

3.4mm 4.4mm3.9mm 5.4mm4.9mm

WidthIncreasingSequencefor3.5mmImplantBody




3.0-5.4MMWIDTHINCREASINGDRILLS



SURGICALMANUAL

TopofCoverScrewlevelwiththeosseouscrest

Prostheticplatformlevelwiththeosseouscrest

CrestalBoneDrillspreparedensecrestalbonetoreceivetheimplantsflaredcrestmodule.Thecrestmoduleistheareabeneaththeprostheticplatformandabovetheimplantthreads.Thesedrillsaretypicallynotusedinsiteslackingcorticalboneatthecrest.

ThereareseveralsignificantcuttinglevelsontheCrestalBoneDrills(seetopright).Implantplacementatlevelsbetweenthoseshowninthetwoexamplesaboverequirethesurgeontouseaproportionatelyappropriateamountofthecuttinggeometry.

PreparingtoLevel1allowsplacementoftheprostheticplatformlevelwiththecrest(Example1).

PreparingtoLevel2allowsplacementoftheCoverScrewlevelwiththecrest,provided the osteotomy has been prepared to accommodate the additional depth(Example2).

Purpose:Preparesdenseosseouscresttofacilitatepressure-freeseatingoftheflaredcrestmodule.

Example2.Preparationtocuttinglevel2

Example1.Preparationtocuttinglevel1

Level2

Level1

SiteSpecific.Indicatedwhendensecorticalboneispresentatcrest

Roundednon-cuttinghubcentersdrillinosteotomy

UsedfollowingthefinalWidthIncreasingDrillforeachimplant

850-2,500rpmwithsteadyirrigation.7

Cuttinglevels

CRESTALBONEDRILLS

9


9


SURGICALM

ANUAL

SiteSpecific.Nottypicallyusedinsoft(D3-D4)bone

30rpmorless10

Finalosteotomypreparationinstrumentpriortoimplantplacement

SquaredriveshaftinterfaceswithRatchetandHandWrench

Theosteotomyshouldbetappedindensebonetopreparethesitetoaccepttheimplantsthreadswithoutcreatingexcessivepressure.TheuseofaBoneTapmayalsobe indicated in lessdensebonewhenoneormoresidesof theosteotomy is incontactwithalateralplateofcorticalbone.

TheBoneTapsmaybedrivenwitheitheraHandpiece(Fig.1),Ratchet,HandWrenchorbytheBioHorizonsSurgicalDriver(purchasedseparately,ref.150-000).TheRatchetandHandWrenchExtender(Fig.2)maybeusedwhenadditionallengthisneeded.

PlacethetipoftheBoneTapintotheosteotomy,applyfirmapicalpressureandbeginrotatingslowlyinaclockwisedirection(30rpmor less is recommended).Whenthethreadsengage,allowthetapto feedwithoutexcessivepressure.Toremove,rotatetheBoneTapinacounter-clockwisedirection,allowingittobackoutoftheosteotomy.DonotpullontheBoneTaptoremoveitfromthesite.

Priortopublicationofthisliterature,BioHorizonsExternalImplantswereofferedinmultiplethreadpitches:D2,D3andD4.CliniciansplacingpreviouslypurchasedD2threadformimplantsinsitesrequiringtappingmustusethecorrespondingD2BoneTaps(availablethroughBioHorizonsCustomerCare).

TheD3BoneTapsprovidedintheExternalSurgicalKitMAYbeusedtopreparesitesforD4implants,aswellasD3implants.However,D3BoneTapsMAY NOTbeusedtopreparesitesforD2implants.

Purpose:Preparesdensecorticalboneforimplantthreads.

Figure .Handpiece

Figure .Ratchet&Extender

9mm

11mm

13mm

15mm

10mm

12mm

14mm

DetailofBoneTapdepthmarks

BONETAPS

50


50


SURGICALMANUAL IMPLANTPACKAGING

Bodydiameterandsurfacetreatmenticon Implantsurfacetreatment

anddimensions

PartNumber

LotNumber

ExpirationDate

External Hex

Implant System

L0123 Rev C

BioHorizons Implant Systems, Inc. Birmingham, AL 35244 USA

Implant Diam

eterThreadform

Se

e In

stru

ctio

ns fo

r Use

Insid

e

external

REF

LOT

Rx Onlydo not re-use

gamma irradiatedSTERILE R

expires

0473

YYXXXXX

YYYY-MM

manufacture dateYYYY-MM

4012D3External Hex Implant4.0 x 12mmD3 Threadform, RBT

External Hex Implant

4.0 x 12m

m, RBT

D3

4.0

BioHorizonsExternal implantsareprovided indouble-layerpackaging(asdepictedbelow).Acardboardsleeveprotectsablisterpackthatcontainstheimplantinasterileinnervial.Onlythesterileinnervialshouldbeintroducedintothesterilesurgicalfield.Theblistertraylidhasmultiplepeel-and-sticklabelsforaffixingtothepatientschart.Whenthelidoftheblistertrayisremoved,theimplantvialisexposedandmaythenbeplacedinthesterilefield.Whileholdingthevialinanuprightfashion,removethecapbyrotatingitinacounter-clockwisedirection.Theimplantcanthenberemovedfromthevialbyengagingthepremounted3inOneAbutmentwiththeappropriateAdapter.

External Hex Implant System

L0123 R

ev C

Bio

Horizons Im

pla

nt S

yste

ms, In

c. B

irm

ingham

, A

L 3

5244 U

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Implant Diameter Threadform

See Instructions for Use Inside

extern

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REF

LOT

Rx

Onl

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re-u

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gam

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STER

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0473

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man

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4012

D3

Exte

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Hex

Impl

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4.

0 x

12m

mD

3 Th

read

form

, RB

T

External Hex Implant 4.0 x 12mm, RBT

D34.0

External Hex

Implant System

L0123 Rev C


Implant Diam

eterThreadform

Se

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Insid

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external

REF

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expires

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4.0 x 12m

m, RBT

D3

4.0

External Hex

Implant System

L0123 Rev C


Implant Diam

eterThreadform

Se

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Insid

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external

REF

LOT



expires

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4.0 x 12m

m, RBT

D3

4.0

External Hex

Implant System

L0123 Rev C


Implant Diam

eterThreadform

Se

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Insid

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external

REF

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expires

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4.0 x 12m

m, RBT

D3

4.0

External Hex

Implant System

L0123 Rev C


Implant Diam

eterThreadform

Se

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stru

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Insid

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external

REF

LOT



expires

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4.0 x 12m

m, RBT

D3

4.0

5


5


SURGICALM

ANUAL

ThedimpleontheAdaptersalignwithanyofthefourexternalflats

ontheabutment.

Abutment-levelAdaptersengagethe3inOneAbutmentsexternalsquare.

IMPLANTPICK-UP

Premounted3inOneAbutmentservesasthesurgicaldrivemount

O-ringsecuresimplantwhileitiscarriedtoosteotomy

Electrichandpieceormanualinsertionoptions

30rpmorless10

Purpose:Engagesthe3inOneAbutmentallowingtheimplanttobedrivenintotheosteotomy.

HandpieceandRatchetAdaptersengageExternalimplantsviathesquareonthecoronalaspectofthe3inOneabutment.RemovethecapfromtheinnervialandseatthechosenAdapter.RemovetheimplantfromthevialandcarryittotheosteotomyontheAdapter,takingprecautionsnottotouchtheimplantsurfaceduringthetransfer.

Placetheapexoftheimplantintotheosteotomy,applyfirmapicalpressureandbeginrotatinginaclockwisedirection(30rpmorless).Oncetheapicalthreadsengagethebone,allowtheimplanttofeedwithoutexcessivepressure.

Overtighteningthe implant intheosteotomymaycauseosseousmicrofractureorpressure-inducednecrosisoftheadjacentbone.ManualseatingviatheAdapterforRatchetmaybedesiredtogainatactilesenseoffinalimplantplacement.Iftoomuchresistanceisfeltduringinsertion,removetheimplantandrevisetheosteotomywiththeappropriateCrestalBoneDrillorBoneTapasdeemednecessarytoreduceinsertiontorque.

HandpieceandRatchetAdapters(Abutment-level)

5


5


SURGICALMANUAL

ThestatedlengthofBioHorizonsExternalimplantsismeasuredfromtheapexoftheimplanttothetopoftheprostheticplatform(seepage2).Theplacementlevelshouldbedrivenbytheprostheticnecessitiesofeachcase.Contributingfactorsinclude:availableinter-occlusalspace,softtissuethicknessandplannedprosthesistype.

Preparingtheosteotomytothestatedimplantlength(e.g.10.5mmdeepfor10.5mmlengthimplants)allowsplacementoftheprostheticplatformlevelwiththecrest(shownatright). Iftheprostheticplatformistobecountersunkbelowthecrest,acorrespondingincreaseoftheosteotomydepthisrequired.

Cliniciansmay opt to leave a portion of the 0.5mmmachined collar and/or crest modulesupracrestal,ifdoingsodoesnotcompromisetheimplantsinitialstabilityandadequatesofttissuecoverageexists.Itisnotrecommendedtoplaceimplantsinafashionthatleavessurfacetreatedareas(RBT/HA)exposedtotheoralcavity.

IMPLANTPLACEMENT

ImplantPlacement

HexDrivertipdetail:Taperhelpssecurecomponents

HexDriverandAbutmentScrew/ComponentEngagement

ThetipsofBioHorizonsHexDriversareslightlytaperedtoallowafriction-fitengagementofmatingscrewsandcomponents.Thetaperallowsscrewstobecarriedtotherestorativesiteonthehexdriver.However,whilethetaperenhancesclinicalutility,itrequiresthedriverbeengagedtothefulldepthofthehexholebeforetorqueisapplied.Failuretofullyengagethehexmaycausestrippingofeitherthedriverorthescrew.Aglovedfingermaybeplacedonthetopofthedrivertoprovideapicalpressuretokeepthedriverfullyengaged.

Useofmagnificationmayberequiredtoverifytheabsenceofforeignmaterialinthehexhole.Ifaprovisionalprosthesiswasinplacepriortofinaltorquedelivery,removeallmaterialusedtoblockout thescrewaccesschannelprior toseatingthedriver.Adentalprobeorsimilarinstrumentmaybeusefulforremovingimpediments.

Properengagementminimizeslikelihoodofcomponentstripping.

Incompleteengagementincreaseslikelihoodofcomponentstripping.

5


5


SURGICALM

ANUAL

Toremovethe3inOneAbutmentengagetheAbutmentScrewwiththe.050(1.25mm)HexDriver,apply firmapicalpressure to theHexDriverandrotatecounter-clockwiseuntilthescrewiscompletelydisengagedfromtheimplantbody.The3inOneAbutmentmaythenberemoved.

Insoftbone,orwhenthe implant lacks initialstability,anAbutmentClamp(ref. IMPAH,soldseparately)shouldbeusedtograsptheoutsideoftheabutmenttoprovidecounter-torqueduringlooseningoftheAbutmentScrew.

The 3inOne Abutment (and Abutment Screw) should be sanitized following standardclinicalprotocolandretainedwiththepatientschart.Itcanlaterbeusedintheimpressionmakingprocedureandasatemporaryorfinalabutmentforcementretention.

Thelongestflatsurfaceontheexternalaspectofthe3inOneAbutmentisindexedtooneofthesixflatsoftheimplantsexternalhexagon.Inmostcasesoneofthehexflatsshouldbeorientedtothefacialaspect,as itallowsforangulationcorrectionwithstockangledabutments.Placingthe longflatof the3inOneAbutmenttothefacialalso leavesmoreroomforporcelaininthatareaonthefinalprosthesis.

The implants rotational position can be adjusted followingremoval of the 3inOne Abutment using the Implant-levelInsertionsToolsasdescribedonpage54.

ABUTMENTREMOVAL

3inOneAbutmentRemoval

HexOrientation

5


5


SURGICALMANUAL

PackagedwitheachimplantinthesterileinnervialHand-tighten(10-15Ncm)11utilizing.050(1.25mm)HexDriver

Color-codedbyimplantbodydiameter

Purpose:Protectsprostheticplatformintwo-stage(submerged)surgicalprotocols.

Removethe3inOneAbutmentandthoroughlyirrigatetheinsideoftheimplanttoremovebloodandotherdebris.UnscrewtheCoverScrew(includedineach implantvial) fromitsholderandscrewit intothe implantusingthe .050(1.25mm)HexDriver.Followingplacementof theCoverScrew, thesurgicalsiteshouldbe irrigatedandthesoft tissueadapted inanormalsurgicalfashion.TakeprecautionstopreventtheCoverScrewfrombeingaspiratedbythepatient.

INSERTIONTOOLS/COVERSCREWS

CoverScrews

Maybeusedfollowingremovalofthe3inOneAbutment

Offersanarrowerpathofinsertionandbetterclearancethanthe

3inOneAbutment/Abutment-levelAdapteroption

SquaredriveshaftinterfaceswiththeRatchetandHandWrench

Therotationalposition(hexflatorientation)ortheplacementlevelofExternalimplantscanbeadjustedwiththeInsertionToolsfollowingremovalofthe3inOneAbutment.

MatetheappropriateInsertionToolwiththeexternalhexoftheimplantandlightlyscrewintoplace.EngagetheInsertionToolwitheithertheRatchetorHandWrenchandrotatetheimplanttotherequiredposition.

Purpose:Engagesexternalhexallowingimplantspositiontobeadjustedintheosteotomy.

InsertionTools(Implant-level)

55


55


SURGICALM

ANUAL Selectbyheightandemergenceprofile(seebelow)Hand-tighten(10-15Ncm)11utilizing.050(1.25mm)HexDriver

Color-codedbyimplantbodydiameter Encodedforeasyintraoralidentification,forexample: x .5indicates.0mmimplantdiameterx.5mmhigh

Purpose:Transmucosalelementforsingle-stagesurgicalprotocolorforsofttissuehealingperiodfollowingsecond-stageuncovery.

HealingAbutmentsareplacedafteruncoveryinatwo-stagesurgicalprotocol,orin lieuofaCoverScrewinasingle-stage(non-submerged)protocol.ExternalHealingAbutmentsarespecifictoeachofthefourimplantbodydiametersandcomeinthreeheights(3mm,4.5mmand6mm)withthechoiceofstraightorflaredemergenceprofiles.Theheightshouldbechosensothatitextendsapproximately1mmthroughthesofttissue.

Following seating, irrigate the surgical site and adapt the soft tissue in normal surgical fashion. A gingivectomyor apicallypositionedflaptechniquemaybeusedtoreducethesofttissuethicknessandtodecreasesulculardeptharoundtheimplant.ThesuturegrooveontheHealingAbutmentmaybeusedtoapicallypositionthesofttissueflap.TakeprecautionstopreventtheHealingAbutmentfrombeingaspiratedbythepatient.

FlaredEmergenceProfileHealingAbutmentsshouldbeusedwheneveruseofanabutmentwithaflaredmarginisplannedandmesial/distalspacepermits.Theflaredprofilecontoursthetissueawayfromtheimplantprostheticplatformandallowseasierseatingofflaredabutments.FlaredEmergenceProfileHealingAbutments are approximately1mmwider than theprostheticplatformof thecorrespondingimplant.

Straight Emergence Healing Abutments have the same diameter as thecorresponding implantplatform.Proper seatingof the3inOneAbutment andother flared emergence abutmentsmaybedifficult if the Straight EmergenceHealingAbutmentisused.Inthesecases,the3inOneAbutmentshouldnotbeused as an impression coping. All other BioHorizons impression copingswillworkforthesecases.Besurethatthecopingusedisappropriateforthespecificcase(hexedornon-hexed).

StraightEmergenceProfile

FlaredEmergenceProfile

HEALINGABUTMENTS

HealingAbutments

56


56


SURGICALMANUAL

Also called a Go /No-GoGauge, theBur TestingGauge is used to verify thedimensionalaccuracyofdrill shanksof latch-typeburs.Burs inproper conditionWILL fit into the largerdiameterhole,butWILL NOT fitintothesmallerhole(markedred).

Bursthatfaileitherofthesecriteriaareunfitforuseandmaybecomestuckinthehandpieceifused.Thegauge is includedwithallW&Hstarterpackages,andmayalsobeorderedfrompage13.

BoneProfilersremoveandcontourexcessboneandsofttissuefromtheareaoftheprostheticplatformpriortotheseatingofahealingorprostheticabutment.ThereisaspecificBoneProfilerforeachofthefourimplantbodydiameters.

ThesurgicalCoverScrewalignstheBoneProfilerandprotectstheimplantfromdamage.TheProfilerisusedinalatch-type,reductionhandpieceundercopiousamountsofsterileirrigation.Followingremovaloftheexcessboneandsofttissue,unscrewtheCoverScrewfromtheimplantandseatthechosenprostheticcomponent.

DonotusetheBoneProfilerwithouttheCoverScrewinplacetoprotecttheimplantbodyandprostheticplatform.

BoneProfilersarenotincludedintheExternalSurgicalKit,butmaybepurchasedseparately(seepage9).

Compatiblewithlatch-type,speed-reducinghandpieces

850-2,500rpmdrillspeedwithsteadysterileirrigation7

Color-codedbyspecificimplantbodydiameter

Purpose:Removeandcontourexcessboneandsofttissuefromtheareaoftheprostheticplatform.

ANCILLARYINSTRUMENTS

BoneProfilers

BurTestingGauge

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APPENDIX

SurgicalKitCleaning

ExternalSurgicalKits(ref.160-500)areprovidednon-sterileandmustbecleanedandsterilizedbeforethefirstandeachsubsequenteachuse,inaccordancewiththeappropriateInstructionsforUse(ref.L0202P).Removeinstrumentsfromthepackageanddiscardpackingmaterialspriortocleaning/sterilization.Double-checkinstrumentstoensuretheirfunctionalitypriortosurgery.VerifythedimensionalaccuracyofdrillshanksusingaBurTestingGauge(oppositepage).

Cleaningwithhydrogenperoxideorotheroxidizingagentswilldamagethesurfaceofinstruments.

1.DisassembletheSurgicalKitandwashthetrayusingabroadspectrumcleaning/disinfectingagentsuchasHu-FriedyEnzymaxorequivalent.Rinsethetraywithwateranddrythoroughly.

2.Placetheinstrumentsinabeakerofdetergentsolutionandsonicatefor10minutes.Rinsethoroughly.3.Removeanyvisibledebrisfromtheinstrumentswithasoftbristlebrush.Rinsethoroughly.4.Rinseinstrumentswithisopropylalcoholtoremoveanysoapresidueandminerals(importanttohelppreventcorrosion).5.Blotinstrumentswithalint-freetowelandallowthemtoairdrycompletely.6.Returninstrumentstotheappropriatelocationinthesurgicaltray.7.Wrappingthekitinstandardapprovedsterilizationwrap,useoneofthreequalifiedsteamsterilizationcycles: a.PrevacuumSteam:132C(270F)forfiveminutesminimum. b.GravitySteam:132C(270F)forthirtyminutesminimum. c.GravitySteam:121C(250F)forfiftyminutesminimum.8.Dryfor20to50minutesasneeded.

Propertesting,cleaningandcalibrationofsterilizationequipmentmustbedoneatregularintervalstoensurethatunitsareinproperworkingorder.Equipmentoperatingconditionsvaryanditistheresponsibilityofeachdentalofficetoensurethatpropersterilizationtechniqueforinstrumentationisfollowed.

Prior tosurgery,cliniciansmayopt to layout instruments in thesterilefield in theorderofuse, tohelpensurecorrectprogressionthroughthesurgicalsequence.Itisrecommendedtohaveback-upsteriledrillsavailablepriortobeginningasurgicalprocedure.

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SURGICALMANUAL

StarterDrillRef.122-1032.5mmDepthDrillsRef.122-225,122-12509,122-12512and122-12515WidthIncreasingDrillsRef.122-230,122-232,122-237,122-242,122-247and122-252

Thedesignanddiameter(2.0mm)ofthenewStarterDrillobviatestheneedfor2.0mmDepthDrillSeries(122-220,122-12009,122-12012and122-12015),andthereforetheyhavebeenremovedfromthedrillingsequence.

BioHorizonsrecommendsagainst intra-operativecomminglingofthepreviousandnewdrilldesigns,asdoingsomayresultinaninaccurateosteotomydepth.However,clinicianjudgmentasrelatedtoanyspecificcaseortheuseofanyinstrumentalwayssupersedesanyrecommendationsmadeinthisoranyotherBioHorizonsliterature.

PreviousandNewDesignDrillsmaybedifferentiatedbycomparisonofthecuttingflutes.Theflutesonthepreviousdesignstopbelowthedepthmarks.NewDesignDrillshavecuttingflutesthatextendthroughtheDepthMarks(seeDiagramA).PleaseconsultyourBioHorizonsProductSupportSpecialistorCustomerCareifyouareuncertainofwhichdesigndrillsyouhave.

In July 2007 BioHorizons introduced a new surgical drill design in the External Surgical Kit (ref. 160-500). The following information applies only to clinicians with earlier External Surgical Kits which were provided with the previous design drills. It is important that clinicians be able to distinguish between previous and new drill designs.Affected drills include:

Previous design

New design

CuttingFlutesextendthroughtheDepthMarks

CuttingFlutesendbelowtheDepthMarks

DiagramA.Differentiatingbetweendrilldesigns

APPENDIX

ImportantInformationRegardingPreviousExternalSurgicalKits(ref.160-500)

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1.HumanHistologicEvidenceofaConnectiveTissueAttachmenttoaDentalImplant.MNevins,MLNevins,MCamelo,JLBoyesen,DMKim.International Journal of Periodontics & Restorative Dentistry. Vol. 28, No. 2, 2008

2.AProspectiveMulticenterClinicalInvestigationofaBone-QualityBasedImplantSystem.KlineR,HoarJ,BeckG,HazenR,ResnikRandCrawfordE.Implant Dentistry, 224-234, Vol. 11 No. 3, 2002

3.Five-YearProspectiveStudyofImmediate/EarlyLoadingofFixedProsthesesinCompletelyEdentulousJawswithaBoneQuality-BasedImplantSystem.MischCEandDegidiM.Clinical Implant Dentistry and Related Research, 17-27, Vol. 5 No. 1, 2003

4.ImmediateFunctionalandNon-FunctionalLoadingofDentalImplants:a2-to60-MonthFollow-UpStudyof646TitaniumImplants.DegidiMandPiattelliA. J Periodontology 2003;74:225-241

5.Non-FunctionalImmediateTeethinPartiallyEdentulousPatients:APilotStudyof10ConsecutiveCasesUsingtheMaestroDentalImplantSystem.MischCE.Compendium Special Issue, 25-36, 1998

6.EffectsofImplantThreadGeometryonPercentageofOsseointegrationandResistancetoReverseTorqueintheTibiaofRabbits.SteigengaJ,Al-ShammariK,MischC,NocitiFandWangH-L,J Periodontology 2004;75:1233-1241

7.DensityofBone:EffectonSurgicalApproachandHealing.CEMisch.Contemporary Implant Dentistry. Second Edition. Mosby: St. Louis, 1999. 371-384.

8.TheInfluenceof0.12%ChlorhexidineDigluconateRinsesontheIncidenceofInfectiousComplicationsandImplantSuccess.LambertP,MorrisHandShigeruO.J Oral Maxillofac Surg, 1997, 55:25-30 Suppl 5

9.Heatproductionby3implantdrillsystemsafterrepeateddrillingandsterilization.ChaconGE,BowerDL,LarsenPE,McGlumphyEA,BeckFM. J Oral Maxillofac Surg. 2006 Feb;64(2):265-9

10.RootFormSurgeryintheEdentulousMandible:StageIImplantInsertion.CEMisch. Contemporary Implant Dentistry. Second Edition. Mosby: St. Louis, 1999. 347-369.

11. Implantabutmentscrewtorquegeneratedbygeneraldentistsusingahanddriverinalimitedaccessspacesimulatingthemouth.E.Hill,S.PhillipsandL.Breeding. J. of Oral Implantology. 2007 Vol. 33(5):277-279

APPENDIX

References

Aperiodofunloadedhealing isoftenrecommended,dependingon individualpatienthealingratesandinitial implantstability.Eachcasemustbeindependentlyevaluated.Thisunloadedhealingperiodallowsforintegrationbet

Documents

External Product Catalog & Surgical Technique Manual