3M ESPE MDI Mini Dental Implants Product Guide

123M ESPE MDI Mini Dental ImplantsProsthetic Flow Chart1.8 mm, 2.1 mm and 2.4 mm ImplantsCollared O-Ball ImplantsClassic O-Ball ImplantsCorresponds withLab Analog LAOBCorresponds withLab Analog 51181.8 mmdiameterOB-10OB-13OB-15OB-182.1 mmdiameterIOB-10IOB-13IOB-15IOB-1810 mm13 mm15 mm18 mm2.4 mmdiameter10 mm13 mm15 mm18 mmMOB-10MOB-13MOB-15MOB-181.8 mmdiameterS1810OBS1813OBS1815OBS1818OB2.1 mmdiameter10 mm13 mm15 mm18 mmS1810IOBS1813IOBS1815IOBS1818IOBCollared Square HeadImplantsCorresponds withLab Analog LASH10 mm13 mm15 mm18 mm2.4 mmdiameter1.8 mmdiameter2.4 13SH-15SH-1810 mm13 mm15 mm18 mmMSH-10MSH-13MSH-15MSH-18Collared O-Ball AnalogClassic O-Ball AnalogCollared Square Head AnalogLAOB5118LASHMetal 010351-01BlockoutShimO-Ball RestorativeCopingsO-Ball/Square Head allImmediateTemporizationCapS4118Waxing Coping

132.9 mm ImplantsTapered AbutmentImplantsO-BallImplants2.9 mmdiameter10 mm13 mm15 mm18 mm2.9 mmdiameter10 mm13 mm15 mm18 I-T15MII-T18Blockout ShimS1010Metal s0550-010351-01Tapered Abutment Restorative nCoping2923Tapered ntWaxingCoping2.9 mm Hybrid Lab AnalogMII-LAMDI 2.9 mm Hybrid Lab Analog KitsO-Ball Restorative .9 mm Hybrid Lab Analog Kit(O-Ball)MII-LA29212924MII-LAKT2.9 mm Hybrid Lab Analog Kit(Tapered Abutment)MII-LA29202923

143M ESPE MDI Mini Dental ImplantsImplant Surgical ProtocolsMandibular Denture StabilizationPreoperative PlanningAfter patient selection and evaluation protocols have been completed, the number of MDI implants required (minimum of four)is determined and thoroughly discussed with the patient. The patient’s lower denture is then fabricated or modified, followedby identification of appropriate implant sites. After site selection, the MDI implants should be placed at least 5 mm apart.For mandibular placement, the implants should be placed beginning at least 7 mm anterior to the mental foramen.1Site Preparation Entry points for each MDI implant are marked onthe patient’s tissue via bleeding points or a marker. The 1.1 mm Pilot Drill is delicately placed over the entrypoint and lightly pumped up and down until the corticalplate is penetrated. No incision is necessary in most cases. The average depth is one-third to one-half thethreaded length of the implant. Sterile irrigation isutilized throughout the drilling procedure. In extremely dense bone an extended penetrationmay be required. Optionally, a 1.3 mm MDI drill (S1013)may be necessary to further widen the drill channel.2Use of Finger Driver Open the MDI implant vial.** Carry implant to the site using the vial cap, or grasp thebody of the implant firmly with titanium locking pliers, andattach the Finger Driver to the head of the implant.(It has a friction grip o-ring and can be used as a carrier tothe patient’s mouth, as well as a beginning surgical driver.) After inserting the implant into the pilot opening throughthe attached gingiva, rotate clockwise while exertingdownward pressure. This procedure initiates the self-tapping process and isused until noticeable bony resistance is encountered. The pilot hole depth should never equal the lengthof the implant, as the tip of the drill is wider than thetip of the implant. Recommended motor RPM 1200 –1500S1011S0150**The 1.5 mm Disposable Tissue Punch canbe used to remove mobile mucosa.S9030OB-13**All MDI Implants are delivered sterile.

153Use of the Winged Thumb WrenchUse the Winged Thumb Wrench to thread the implant into placeuntil the wrench becomes difficult to turn.IMPORTANT: If no significant resistance is met during this mid-stage ofinsertion, the prognosis for the implant reaching its full potential is doubtful.The patient’s bone at this site possibly lacks the required density forpredictable success.S90324Use of the Ratchet or GraduatedTorque Wrench with Ratchet Adapter The Ratchet Wrench or Graduated Torque Wrenchwill then finalize the insertion process. Grasp the wrench (with the directional arrow facing clockwise)and engage the square neck of the Ratchet Adapter into thesquare opening of wrench. This final stage of MDI implant placement requires slow,carefully controlled ratchet turns. The ideal implant position allows the abutment headto protrude from the gingival soft tissue at its full lengthbut with no neck or thread portions visible.MDI TorqueRecommendations Do not exceed 45 Ncmduring implant placement. Advance the implant with the Torque Wrench to aminimum of 35 Ncm to allow immediate load. A minimum of 35 Ncmof resistance upon finalinsertion is recommendedfor immediate load. If a resistance of at least 35 Ncm cannot be reached a temporarysoft-loading without metal housings is recommended.CAUTION IN DENSE BONE: If torque exceeds 45 Ncm unscrew the implantand deepen the drill hole to 2/3 of implant length.S70078016801080705Final Implant PositioningA minimum of 4 MDI implants is required to stabilize a full lowerdenture.IMPORTANT: The removable o-ring attachments inside an over-denturewill not loosen an integrated MDI Implant. A loose implant is one that didnot fully integrate into the bone. The primary reason for non-integration isover-instrumentation of the bone. The MDI implant utilizes a fully self-tappingprotocol. It demands that the implant bite into the bone and advance itselffrom the initial point to completion. The procedure requires torquing forcesthat progress from the Finger Driver to the Winged Thumb Wrench to Ratchetor Torque Wrench with the Ratchet Adapter.Ideal Implant Position

163M ESPE MDI Mini Dental ImplantsImplant Surgical ProtocolsMaxillary Denture Stabilization1Site Preparation2Entry points are made with the Pilot Drill (Item S1011)by perforating the cortical plate.Use of the Finger DriverInsertion of the MDI implant begins with thevial cap and continues with the Finger Driveruntil more torque is necessary.2.4 mm diameter MDI implants require use of the1.1 mm Pilot Drill (Item S1011).2.9 mm diameter MDI implants require use of theDisposable Tissue Punch (Item S0150)* followed by theDrill Duo Kit (Item 2011D). Optionally, in dense bonea 2.0 mm MDI drill (2012-01) may be necessary to widenthe drill channel.S9030S1011S0150*2011D* The 1.5 mm Disposable Tissue Punch can be used to removemobile mucosa.MOB-13MII-OB13

173 Use of the Winged Thumb WrenchInsertion continues with the Winged Thumb Wrench.S90324Use of the Ratchet or GraduatedTorque Wrench with the Ratchet AdapterTo verify initial stability is sufficient for each implant, connectthe Graduated Torque Wrench and confirm at least 35 Ncm ofresistance.If there is less than 35 Ncm of resistance – which mightfrequently be the case in maxillar bone – a temporary soft-loadingwithout metal housings is recommended.IMPORTANT: If no significant resistance is met during thismid-stage of insertion, the prognosis for the implant reaching its fullpotential is doubtful. The patient’s bone at this site possibly lacks therequired density for predictable success.MDI TorqueRecommendations Do not exceed 45 Ncmduring implant placement. A minimum of 35 Ncmof resistance upon finalinsertion is recommendedfor immediate load.S7007801680705 Final Implant PositioningA minimum of 6 MDI implants are required tostabilize a full maxillary denture.IMPORTANT: The removable O-ring attachments inside an over-denturewill not loosen an integrated MDI implant. A loose implant is one that didnot fully integrate into the bone. The primary reason for non-integrationis over-instrumentation of the bone. The MDI implant utilizes a fullyself-tapping protocol. It demands that the implant bite into the bone andadvance itself from the initial point to completion. The procedure requirestorquing forces that progress from the Finger Driver to the Winged ThumbWrench to Ratchet or Torque Wrench with the Ratchet Adapter.6 Restorative ProtocolFor maxillary denture stabilization cases using MDI, a soft relinewithout metal housing attachments is recommended for the first4–6 months (see page 20 for Soft Reline Protocol). After osseointegration is complete, the denture can be retrofitted with metalhousings (see page 18 for Hard Pick-Up Protocol).

183M ESPE MDI Mini Dental ImplantsDirect Restorative ProtocolsSECURE Hard Pick-Up Protocol1Relieve denture to accommodate implants and metalhousings, creating individual holes or a trough.3Place Metal Housings on each implant and check for passive fitover shims. Place denture in patient’s mouth and check forpassive fit over implants and housings.2Trim Blockout Shims to appropriate length and placeone shim on each implant to block out undercuts.4Apply a thin layer of adhesive to the tissue-contactsurface of the denture.

1965Extrude SECURE Hard Pick-Up material directly onto MetalHousings and into the troughed denture.Seat denture in patient’s mouth and have patient applynormal bite pressure in centric occlusion and allow 7–9minutes for SECURE Hard Pick-Up material to set.Removable O-Ring (0550-01)housed inside metal housing.7DentureRemove denture and all blockout shims, trim and polish. Seat thefinal denture and inform the patient to keep the denture in place forthe first 48 hours after placement to prevent tissue overgrowth.SECURE Hard Pick-Up Kit8720SECURE Hard Pick-Up KitContents: 50 ml safety cartridge of hard pick-up material 10 ml adhesive Accessories8720

203M ESPE MDI Mini Dental ImplantsDirect Restorative ProtocolsSECURE Soft Reline ProtocolRecommended for maxillary cases. May be necessary when implantsare placed in softer bone in the mandible. Grind down denture base at least 1mm and relieve dentureto accommodate the prosthetic heads of each implant. Roughen the tissue-contact surface of the denture with anacrylic bur and degrease the surface with isopropyl alcohol. Apply a thin coat of adhesive. Extrude SECURE Soft Reline material onto the tissue-contactsurface of the denture. Place the denture in the patient’s mouth and ask patient toapply normal bite pressure in centric occlusion. Mix equal drops of glazing base and catalyst. Allow seven minutes for SECURE Soft Reline material to set. DO NOT remove the palate of a maxillary dentureduring this stage. Remove denture and trim excess material with fine scissors ora surgical blade. Use a brush to apply the mixture to the corresponding margins. Ask the patient to keep the denture in place for the first 48 hoursafter placement to prevent tissue overgrowth. Four to six months after soft load, the soft liner can bereplaced with a hard pick-up of the MDI Metal Housings (followinstructions for “SECURE Hard Pick-Up Protocol”) to increase thelevel of retention.SECURE Soft Reline Kit8120SECURE Soft Reline KitContents: 50 ml safety cartridge of soft reline material 10 ml glazing catalyst 10 ml glazing base 10 ml adhesive Accessories8120

21Indirect Restorative Protocol1Seating the CopingsSnap the O-Ball Impression Copings directly onto eachO-Ball MDI Implant.NOTE: Soft tissue may prevent full engagement of the coping on implantsseated too deeply into soft tissue. In such a case, it is recommended totake an impression of the O-Ball head of the implant without impressioncopings applied.2Seating the ImpressionStandard crown and bridge impression techniques are usedto pick up the impression copings, recording each implant’sposition easily and accurately. 3M ESPE Impregum PolyetherImpression Material is recommended for implant impressions.32921ImpressionCopingfor O-BallImplantsRemoval of the ImpressionOnce the impression has fully set, carefully remove the tray fromthe patient’s mouth and confirm all impression copings havebeen captured accurately in the impression.4Insertion of the Lab AnalogsThis step can be observed in the clinic or at the dental laboratory.Confirm the appropriate MDI Lab Analog will be inserted byreviewing the type of MDI O-Ball Implant used in the case. Usethe Collared O-Ball Analog (LAOB) any time Collared O-Ball MDIImplants are used. When Classic O-Ball MDI Impants are used,coordinate the case using Classic O-Ball Analogs (5118).Align the square neck of MDI Analog with the square openingat the base of the Impression Coping. Press the analog into thecoping until a snap fit is observed. Insert a lab analog into eachcoping and prepare the impression to be used to fabricate astone model.5Fabrication of the modelUse standard stone model fabrication techniques to form themodel. Once the stone has set completely, carefully remove theimpression from the model.LAOBMDI CollaredO-Ball Analog

223M ESPE MDI Mini Dental Implants2.9 mm Implant ProtocolsSurgical Protocol2.9 mm MDI implants are not recommended for placement in extremely dense (D1) or extremely soft (D4) bone.1Site Preparation1aProbe soft tissue at implant site and recordtissue thickness.1cCreate pilot hole using 1200 –1500 rpmand sterile irrigation.1bRemove soft tissue at implant site using the1.5 mm tissue punch.Soft Bone Drilling Protocol (D3 Bone)Entry divots are made with the Round Bur (included in item2011D). Then the 1.8 mm MDI drill (included in item 2011D)is used to perforate the cortical plate.Dense Bone Drilling Protocol (D2 Bone)Entry divots are made with the Round Bur. Pilot holes thenmade with the 1.8 mm Pilot Drill should have a depth equalto approximately ½ the length of the planned implant plusthe measurement of soft tissue thickness. Optionally, indense bone a 2.0 mm MDI drill (2012-01) may be necessaryto widen the drill channel. An endodontic stopper is helpfulin marking appropriate depth.Example: For a 13 mm implant in a site with 2.5 mm softtissue thickness, a pilot hole of approx. 9 mm is ideal(6.5 mm 2.5 mm 9 mm).2011D

23Implant Placement2Use of the Finger Driver3Insertion of the MDI implant begins with the vial capor with the Finger Driver and continues with the FingerDriver until more torque is necessary.Use of the Winged Thumb WrenchInsertion continues with

3M ESPE MDI Mini Dental Implants Prosthetics. 1325 2020 2012-01 Drivers, Wrenches, Ratchet Extension & Adapters Site Preparation 8010 8070 S0150 2020 S1013 S1011 2012-01 2000 2011D 1325 S015