Surgical Manual - Mavraidopoulos.gr
Surgical manualASTRA TECH Implant System EV
The ASTRA TECH Implant System EV is designed for easeof use and versatility in providing treatment solutions foryour implant patients.The foundation of this evolutionary system remains theunique ASTRA TECH Implant System BioManagementComplex, which has been proven to predictably providelong-term marginal bone maintenance and esthetic results.
CONTENTSIntroduction – ASTRA TECH Implant System EVDrilling protocol and bone classificationImplant assortmentImplant size/tooth positionInterface connectionTray conceptColor coding445568Treatment planningPre-operative proceduresClinical application910Implant site preparationSurgical components and instruments overviewImplant packaging and handlingDrilling protocolExpanded drilling protocolOsteotomy preparationSpongious bone preparationCortical bone preparationOptional bone preparationStep-by-step implant placementOne-stage surgical protocolTwo-stage surgical protocolStep-by-step implant placement, 6 mmTorque Wrench – surgical handlingTorque guideCleaning and ces35This manual is designed for use by clinicians who have undergone at least basicsurgical and in-clinic implant training. Staying current on the latest trends andtreatment techniques in implant dentistry through continued education is theresponsibility of the clinician.All products may not be regulatory cleared/released/licensed in all markets.Please, contact the local DENTSPLY Implants sales office for current productassortment and availability.To improve readability for our customers, DENTSPLY Implants does not use or inbody copy. However, DENTSPLY Implants does not waive any right to the trademarkand nothing herein shall be interpreted to the contrary.Product illustrations are not to scale.3
IntroductionDrilling protocol and bone classificationThe density and orientation of trabeculae in spongiousbone differs from patient to patient and from location tolocation. These variations can create differences in perceivedresistance when preparing the implant site. The marginalcortical bone, however, is most often homogeneous in qualitybut may vary in thickness from case to case, which requiresadaptive preparation methods.As a result, a unique and simple drilling protocol has beendeveloped to allow for preferred primary stability of theimplant: O ne standard procedure that produces a 0.5 mm underpreparation relative to the implant body diameter. F ollowed by two options for preparation of the corticalbone based on bone thickness which gives an underpreparation of 0.3 or 0 mm relative to the implantdiameter in the marginal part. I n situations when a wider osteotomy preparationis needed, apically and/or along the implant body,additional drills are available for further, optionalosteotomy preparation.Thin cortical bone(less than 2 mm)Spongious boneThick cortical boneThere is one drilling protocol recommended for preparation of the spongiousbone with two options for the cortical bone.Implant assortmentOsseoSpeed EV implants are available in a versatile rangeof shapes, diameters and lengths for all indications, includingsituations with limited space and/or bone quantity.StraightConicalSpecific colors have been assigned to the different implantabutment connection sizes, which are consistently usedthroughout the system and identified by symbols and colors.4Ø 3.0Ø 3.6Ø 4.2Ø 4.8Ø 5.4GreenPurpleYellowBlueBrown
IntroductionImplant size/tooth positionThe design philosophy of the ASTRA TECH Implant System EVis based on the natural dentition utilizing a site-specific,crown-down approach supported by an intuitive surgicalprotocol and a simple prosthetic workflow.Implant-abutment interfaceconnectionThe OsseoSpeed EV implant has a unique interface forone-position-only placement for ATLANTIS patient-specific,CAD-CAM abutments. The interface also allows forthe flexibility of six-position indexing of prefabricatedabutments, while index-free abutments can be seated inany rotational position.OsseoSpeed EVAbutment placement optionOne-position-onlyATLANTIS patient-specific, CAD/CAMabutments will seat in one position only.Six positionsIndexed abutments will seat in sixavailable positions.Multiple considerations are required for each individual tooth, the supportneeded for the final restoration in the particular position, soft-tissue healing,and implant design and size. The illustration indicates the recommendedimplant sizes in relation to the natural dentition, provided there is sufficientbone volume and space in relation to adjacent dentition.Index freeIndex-free abutments will be seated in anyrotational position.5
IntroductionTray conceptThe tray layout and components are organized to support theuser throughout the entire surgical procedure. The tray designeliminates the need for rubber grommets for holding drills andinstruments, which simplifies the cleaning process.The layout is printed on the overlay, which is snapped ontothe tray base. This solution offers the possibility of adaptingthe tray’s contents according to individual preferences.Tray logicsThe color-coded tray has a drill marking system forease of use and effective handling throughout the procedure,based on the following principles:LidOverlay A ll drills for spongious preparation are color-coded whiteand marked with drill number 1–6 on the drill shaft. A ll drills for the cortical bone preparation are color-codedaccording to the implant and marked with either an A or Bfor straight implants, or A/B for conical implants. T he drills for optional osteotomy preparation are colorcoded according to the implant and marked with V or X.Tray baseBase shield I n addition to the diameter, all drills shafts are marked witha number for easy identification and reference.Spongious bone preparation162345Cortical bone preparation– straight implants6ABABAA-6 mmCortical bone preparation– conical implantsBB-6 mmAOptional preparationBA/BVX
IntroductionOverlay 1Streamlined content for the most commonly usedstraight implants.Overlay 2Designed to accommodate the complete range ofdiameters for straight and conical implants.Overlay 3Supports the full implant assortment including short andOsseoSpeed Profile EV implants.7
IntroductionColor codingThroughout the ASTRA TECH Implant System EV, markings,color coding and geometrical designs simplify the correctidentification of corresponding components.Ø 3.0Ø 3.6Ø 4.2Ø 4.8Ø 5.4Each implant-abutment connection size is identified by aspecific color, which is used consistently throughout thesystem. The color is applied directly to components andinstruments, as well as on packaging and informationalmaterial, where appropriate.GreenPurpleYellowBlueBrownThe following components and/or packaging arecolor-coded:Healing componentsAbutment screws for all two-piece abutmentsPackaging for components on implant-levelLaboratory components on implant-levelImpression components on implant-level8
Treatment planningPre-operative proceduresPre-operative examinationThe pre-operative examination should include a generalevaluation of the patient’s health and clinical and oralradiographic examinations. Particular attention should begiven to mucous membranes, jaw morphology, dental andprosthetic history, and signs of oral dysfunction.SIMPLANT 16, the computerguided implant treatmentsoftware, can be used for theASTRA TECH Implant System EVto ensure accurate planningfor optimized implant position andplacement.Radiographic analysis should be used to evaluate bonetopography of the residual alveolar process. The initialradiographic evaluation, together with the clinicalexamination, is the basis for determining whether or nota patient is a candidate for implant treatment.Even though the final treatment approach may be determinedat the time of surgery, consider the following based on thequality of supporting bone and expected initial stability of theimplant(s):If the patient is found to be suitable, a more thoroughclinical examination of the area for treatment and theopposing jaw should be performed. Any local pathologyin the jaws should be treated before implant placement.Pre-operative planningPre-operative planning should be based on the expectedrestorative treatment outcome. The ASTRA TECH ImplantSystem EV assortment is designed to meet the prostheticneeds for the tooth replacement planned. The prostheticversatility in materials, designs and sizes is aligned withthe implant for support of the tooth replacements in thedifferent positions in the jaw.To achieve the expected outcome, treatment planningshould include all stages of the procedure, from healingtime and components to provisional and final restorations.Models mounted on an articulator give information of therelationship between the jaws and teeth. A diagnosticwax-up with the missing teeth replaced provides importantinformation in the planning phase. Based on analysis andevaluation of the occlusal table, forcedistribution and preferred sites for theimplants, an optimal plan canbe achieved. The transparentRadiographic Implant Guidesdisplaying implants indifferent magnifications ishelpful in planning optimalposition, direction andimplant size. One- or two-stage surgical procedure Immediate or early loading protocol Expected healing time before loadingWhen the prerequisites for immediate loading cannot be met,an early loading protocol (at least six weeks healing period)may be considered.In all situations, bone quality and quantity, primary stabilityachieved, design of restoration, and loading conditionsshould be carefully examined and assessed by the clinicianwhen determining time to loading of implants for eachindividual case.Before treatment begins, the patient should be informed aboutthe results of the pre-operative examination and given a clearexplanation of what is entailed by the planned treatment,including the expected outcome, maintenance requirementsand risks involved.9
Treatment planningClinical applicationOsseoSpeed EV implants are indicated for immediateplacement in extraction sites and/or in partially orcompletely healed alveolar ridges using a one- ortwo-stage surgical procedure.Implants with the OsseoSpeed surface are especiallyindicated for use in soft bone applications where implantswith other surface treatments may be less effective.ImplantshapeBased on mechanical strength considerations, it isrecommended to always place the widest implant possibleGeneral clinicalapplicationStraightSuitable in themajority of situations.For replacement of maxillary lateral andmandibular central and lateral incisorswhen there is not enough space for awider implant.Used in situations with limited bone volume orspace between adjacent teeth, where a 4.2 mmimplant is judged to be too wide.ConicalIn situations wherelimited bone volumeand a larger prostheticplatform is preferred.N/AN/APrecaution: When treatment planning for implant with 6 mm length considerthe widest possible implant, a two-stage surgical approach and splinting ofimplants. Closely monitor the patient for peri-implant bone loss or change in theimplants’ response to percussion. If the implant shows greater than 50% boneloss or mobility, consider possible removal of implant.10OsseoSpeed EV implants can be used in an immediateloading protocol. However, for single-tooth replacement insoft bone or when using a 6 mm implant, where primaryimplant stability may be difficult to maintain, immediateloading may not be appropriate and thus not recommended.
Treatment planningfor the edentulous space. This is particularly important in theposterior regions of the jaws where loading forces are highand considerable bending moments could be generated.In all cases, it is important to consider loading conditionswhen determining the number and spacing of implants.Suitable in the majority of situations.Used in situations with enough bonevolume.Suitable in situations with wide ridgesand large edentulous spaces.Suitable in situations with limited bonevolume where a 3.6 mm implant diameteris the choice but where a larger prostheticplatform is preferred.Suitable in situations with bone volumewhere a 4.2 mm implant diameter isthe choice but where a larger prostheticplatform is preferred.N/A11
Implant site preparationSurgical components and instruments overviewImplant sites are prepared in a step-by-step procedureusing different diameter drills, instruments and verificationtools, ensuring an efficient and atraumatic preparation.All drilling in the bone should be performed at a maximumof 1500 rpm using profuse external irrigation with a salinesolution. An intermittent drilling technique will help preventheating of the bone and create a pumping effect for efficientremoval of bone tissue.ASTRA TECH Implant System EV drills: Excellent cutting properties Laser-etched depth indication lines Sterile packaging Multiple-use* with option for single-use In addition to the diameter, all drills shafts are marked witha number/letter for easy identification and reference Color-codedPackagingPick-upGuide Drill EV / Precision Drill EV Open the package. Engage the drill with the contra angle.Used for marking and creating a startingpoint. Pour the blister onto a sterile area. Secure the drill by squeezing the blister. Expose the drill shaft by bending backthe top of the blister.* All drills except Precision Drill EV can be used forapproximately ten cases. They should be carefullycleaned and sterilized after each surgery andreplaced as soon as a decrease in their cuttingefficiency is observed.12Note: The Precision Drill EV is an extremelysharp, single-use-only drill and shouldnever be handled manually once out of itspackage.
Implant site preparationDrill packaging**Patent pendingBA B12345A6Spongious bone preparationCortical bone preparation– straight implantsCortical bone preparation– conical implantsTwist Drill: Used for initial preparation andevaluation of the bone 1 .Used for the preparation of the cortical layerto reduce pressure in the bone around theimplant neck.Used for the preparation of the cortical layerto reduce pressure in the bone around theimplant neck. Color: corresponds to implantApical border of the indication line indicatesthe minimum depth needed to fit the implant.A In thin cortex, drill to the apical borderof the depth indication line.B In thick cortex, drill to the full depth ofthe depth indication line.Make sure enough depth is provided for theentire implant.Step Drill: Used for site preparation – allowsfor a stepped osteotomy that providesguidance during the drilling process2 – 6 . The stepped osteotomy designensures proper preparation of the marginalbone for implant placement, while achievingthe preferred level of primary stability. Color: white Markings: diameter and drill number Length: available in short (6–13 mm) andlong (6–17 mm) Markings: diameter and drill letter A – thin cortical bone 2 mm B – thick cortical bone 2 mm Length: one optionNote: There are separate cortical drillsspecific for the 6 mm implant.AB6 mm6 mm Color: corresponds to implant Markings: diameter and drill letter Length: one option13
Implant site preparationSurgical components and instruments overview6 mm3.0 mm6 mm145.4 mmV-Twist Drill (optional)– extra apical preparationX-Step Drill (optional)– extra body preparationDirection Indicator EVFollowing opening of the marginal corticallayer with cortical drill A , B or conicaldrill A/B , the V drill can be used to widenthe apical part of the osteotomy.Following opening of the marginal corticallayer with cortical drill B or conical drillA /B , the X drill can be used to widen theremaining osteotomy below.Used for visualizing the position anddirection of the prepared osteotomy. Color: corresponds to implantNote: for conical implants, this colorrefers to the implant body diameter. C olor: corresponds to implantNote: for conical implants, this colorrefers to the implant body diameter. Markings: diameter and V Markings: diameter and XA laser marking indicates the 6 mm depth.The flange (collar) of the instrument indicatesthe smallest (3.0) and greatest (5.4) implantplatform size. Length: 6–17 mm. Length: 6 –13 mm.The narrow end is used after drill 1and the wider end is used after drill 3 .Direction Indicator EV is equipped with ahole for attaching a safety thread.
Implant site preparation17 mmDrilling depth15 mmThe drilling depth is measured from the widest part of thedrill tip up to the indication line. Length, available in short(6 –13 mm) and long (6–17 mm).13 mm11 mm9 mm8 mm6 mmAdditional tip depth is maximum 1.0 mm regardless of thedrill diameter. 1 mm6 mm5 mm4 mm3 mm2 mm0 mmDrill Extension EVImplant Depth Gauge EVImplant Driver EVUsed for extending the length of a drill shaft.Used for measuring the depth of theimplant site. Markings: corresponds to the implantlengths 6 –17 mmUsed for picking up and installing theimplant in the prepared osteotomy. TheImplant Driver EV can engage into any ofthe six positions of the implant. The bodyof the driver has a hexagonal geometrywith dimples.Note: To facilitate optimal placement ofpre-designed abutments, align one of thedimples buccally.Note: Drill Extension should not be usedin combination with torque transferringinstruments, such as implant drivers.Ensure sufficient irrigation when using thedrill extension.The other end of the gauge can beused as a measuring probe. Markings: 0–15 mmNote: The depth gaugeis designed with waist tofacilitate the identificationof the 13–15 mm marking.The reference point (“0”) of the depthmarkings is the intended bone level, i.e.,the lowest point of the bevel. Color: corresponds to implant Markings: depth and diameter Length: two options15
Implant site preparationImplant packaging and handlingThe packaging includes a 2D barcode for simplified inventorycontrol.PackagingImplant containerImplant pick up Packages contain protective blisters thathold the components. Open the blister package. A ttach the appropriate Implant Driver EV tothe contra angle or Surgical Driver Handle.Labels Three peel-off labels are provided forthe patient’s treatment record and forcommunicating with the restorative team.16 P our the sterile inner container onto asterile area. R emove the cap from the containerusing a twisting motion to expose thetop of the implant.Note: Marked with implant size and length
Implant site preparationa)b)Implant pick upAttach the Implant Driver EVManual implant pick up Make sure that the implant driver is fullyseated into the implant (a). A ttach the Implant Driver EV by pressing itfirmly into the Surgical Driver Handle EV.The driver is correctly seated when thecolor coded marking is just in contact withthe handle. Use the Implant Driver EV together withSurgical Driver Handle EV to pick up theimplant. Press downwards to activate the carryingfunction before picking up the implant (b). When picking up the implant from theinner container, do not use excessivepressure.17
Implant site preparationDrilling protocol for OsseoSpeed EV – straightA1OPTIONAL2A -Cortical Drill EV Ø2.5/2.71 -Twist Drill EV Ø1.92 -Step Drill EV Ø1.9/2.5BV -Twist Drill EV Ø 2.5B -Cortical Drill EV Ø2.5/3.0X -Step Drill EV Ø 2.5/2.85A1OPTIONAL3A -Cortical Drill EV Ø3.1/3.31 -Twist Drill EV Ø1.93 -Step Drill EV Ø2.5/3.1BV -Twist Drill EV Ø 3.1B -Cortical Drill EV Ø3.1/3.6X -Step Drill EV Ø 3.1/3.45A1Guide Drill EVPrecision Drill EV3OPTIONAL4A -Cortical Drill EV Ø3.7/3.91 -Twist Drill EV Ø1.93 -Step Drill EV Ø2.5/3.1BV -Twist Drill EV Ø 3.74 -Step Drill EV Ø3.1/3.7B -Cortical Drill EV Ø3.7/4.2X -Step Drill EV Ø 3.7/4.05A13OPTIONAL5A -Cortical Drill EV Ø4.3/4.51 -Twist Drill EV Ø1.93 -Step Drill EV Ø2.5/3.1BV -Twist Drill EV Ø 4.35 -Step Drill EV Ø3.7/4.3B -Cortical Drill EV Ø4.3/4.8X -Step Drill EV Ø 4.3/4.65A135OPTIONAL61 -Twist Drill EV Ø1.93 -Step Drill EV Ø2.5/3.1A -Cortical Drill EV Ø4.9/5.1BV
Surgical manual ASTRA TECH Implant System EV. The ASTRA TECH Implant System EV is designed for ease of use and versatility in providing treatment solutions for your implant patients. The foundation of this evolutionary system
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