INTERNALpERfEcTpERfEcT SURfAcEImpLANT pLAcEmENT pRocEdUREoSTEoTomE pRocEdURES

INTERNAL HEXEXTERNAL HEX

pERfEcT SURfAcE

ENDOPORE Insertion Technique

ENDOPORE Contents

Contents

3 Introduction

4 Product Descriptions

Endoporeimplantswithinternalconnectionforone-stagesurgery Endoporeimplantswithinternalhexforone-stageandtwo-stagesurgery Endoporeimplantswithexternalhexconnectionforone-stageandtwo-

stagesurgery

5 Surgical Instrumentation

EndoporeSurgicalKit EndoporeOsteotomeKit InstrumentCareandSterilization

6 Patient Selection

PatientRecordsandSelection ImplantIndications Contraindications

7 Pre-Surgical Considerations

8 One-Stage and Two-Stage Implant Placement Procedure Steps1to5

10 Endopore implants with Internal Connection, One-Stage Implant Placement Procedure Steps6to9

11 Endopore implants with Internal Hex and External Hex Connection, Two-Stage Implant Placement Procedure Steps6to9

12 Osteotome Procedures

ImplantPlacementProcedureUsingOsteotomes SequenceforOsteotomes ElevatingtheSinusFloorDuringImplantPlacement

18 Initial Healing Period and Postoperative Follow-Up

InitialHealingPeriod ImplantLoading Two-StageRe-EntrySurgery

19 Endopore Key Protocol Features for First and Second Stage Surgery

ENDOPOREIntroduction

Introduction to the ENDOPORE Dental Implant System

Ithasbeenmorethan20yearssinceresearchbeganattheUniversityofToronto,FacultyofDentistry,toseekoutalternativetechnologytothreadeddentalimplantsandsincethattime,theEndoporeDentalImplantSystemhasbeensuccessfullyusedinthetreatmentofthousandsofpatientsinover20countriestorestoreoralfunctionandestheticsandbringtothesepatientsagreatlyenhancedqualityoflife.

ThepurposeofthismanualistodescribethesurgicalprotocolsfortheEndoporeDentalImplantSystemusedina:

One-StageProcedure Two-StageProcedure OsteotomeProcedures

AwiderangeofprostheticoptionsisavailablefromInnovaforfunctionalandestheticrestorations.AdditionaloptionsareavailablefromAttachmentsInternational,anInnovasubsidiary,whichhasover25yearsofexperienceinrestorativedentistry.

ENDOPORE

4

Product Descriptions

Length

TC

Abutment Plattform

Diameter

Length

SCR

Diameter

Length

SCR

Diameter

Product Descriptions

TheEndoporeDentalImplantisatapered,truncatedtitaniumalloyconewithaporoussurface.Theporoussurfaceisachievedbysinteringsphericaltitaniumalloyparticlestotheimplantsubstrateforbonecontactandthree-dimensionalboneingrowth.Endoporeimplants,attachedcoverscrewsand

Endopore implants with internal connection for one-stage surgery

TheEndoporeImplantwithinternalconnectionisdesignedwithamorsetaperandiscurrentlyavailableinboth4.1mmand5.0mmdiameters,eachhavinga4.8mmwideabutmentplatform.Thisallowsboththe4.1mmandthe5.0mmdiameterimplantstoacceptthesamepros-theticcomponents.TheEndoporeimplantswithinternalconnectionareavailableinlengthsof5mm(forthe5.0mmdiameteronly),

7,9and12mm.Themachinedcoronalregionoftheimplantconsistsofa0.5mmsmoothcollar,andatransgingivalregionof1.8mmhigh.TheEndoporeimplantswithinternalconnec-tionarepackagedwithlightanddarkpurplecolourcodedlabelsthatidentifytheirdia-meters.Theimplantsareassembledwitha1.0mmhighcoverscrew.

TC Transgingival Collar

SCR Smooth Coronal Region

theirassociatedabutmentsaresuppliedsterile.Thepackagingshouldbeinspectedpriortoopening.Ifthereisanyindicationthatthepackagesealisbroken,theimplantmustnotbeused.Implantsmustnotbere-sterilised.

redlabeledboxes.Theseimplantshavea0.9mmhighx2.0mmflat-to-flathexandaUNFthread.

4.1mmdiameterimplantswiththeindustrystandardhexandthreadsarepackagedingreenlabeledboxes.Theseimplantshavea0.7mmhighx2.7mmflat-to-flathexandametricthread.

5.0mmdiameterimplantsarepackagedinturquoiselabeledboxes.Theseimplantshavea0.9mmhighx2.7mmflat-to-flathexandametricthread.

Endopore implants with internal hex for two-stage surgery

Endoporeimplantswithinternalhexaresuppliedinboth4.1mmand5.0mmimplantdiametersandavailableinlengthsof7mm,9mmund12mm.Thesmoothcoronalregion

oftheimplantconsistsofa2mmcollar.Alowprofilecoverscrewispackagedwitheachimplant.

Endopore implants with external hex conection for two-stage surgery

TheEndoporeImplantwithexternalconnectioniscurrentlyavailableinthreediameters:3.5,4.1and5.0mm;andfourlengths:5(forthe5.0mmdiameteronly),7,9and12mm.The4.1mmand5.0mmdiameterimplantsareavailableina1mmor2mmsmoothcoronalregion.Alowprofilecoverscrewisassembledwitheachimplant.Theimplantsareprovidedincolour-codedboxesrelatingtothediameterandthehexstyleofaparticularimplant:

3.5mmdiameterimplantsarepackagedin

BICORTICALENDOPORESurgical Instrumentation

Surgical Instrumentation

5

Endopore Surgical KitThebasicinstrumentationforplacingtheEndoporeImplantconsistsof:

Endopore Osteotome Kit

TheEndoporeOsteotomeKitconsistsof:threeend-cuttingosteotometips,bothstraightandoffsethandlestowhichthetipsareconnectedforuse,andasurgicalmallet.

Instrument Care and Sterilization

TheEndoporeDentalImplantSystemsurgicalinstrumentsmustbecleanedandsterilisedpriortoandfollowingtheirfirstandeveryuse.Immediatelyfollowingsurgery,theinstrumentsshouldbesubmergedinaninstrumentdisinfectantandthesurfaceofeachitemscrubbedwithasoftbrushtoremovealldebris.Specialattentionshouldbedirectedtotheinternallyirrigateddrills/burs.Dislodgeanydebrisfromtheirrigationopeningsorinsidetheshankofthedrill/bur.Theneachdrill/burshouldbeflushedgenerouslywithdistilledwater.

Theinstrumentsshouldthenbeplacedinanultrasonicunitfollowedbyrinsingwithdistilledwateranddrying.Itisacceptabletodrywithalintfreetowelbutissuggestedthattheinternallyirrigateditemsbeblowndrywithcompressedair.TheEndoporesurgicaltrayshouldbewipeddownwithdisinfectantthenrinsedwithwateranddried.Allitemsshouldbeinspectedandplacedintheappropriatepositioninthetray.Thenthetrayiswrappedorbagged,sealedandsterilisedbysteamautoclavingwithacompletedryingcycle.

Asurgicalmotorandhandpiecewithinternalandexternalirrigationcapabilitysuitableforimplantplacementarenecessary.

roundbur twistdrillsparallelingpins(occlusalguidepins) colour-codedimplantburs colour-codedtrial-fitgagesstainlesssteelpunchtip

straightoroffsetpunchhandle drillextension0.05hexdriver tipwrench mallet

ENDOPORE

6

Patient Selection

Patient Selection

Patient Records and Selection

Anypatientwithafullyorpartiallyedentulousmandibleormaxillacanbeconsideredforthistreatmentmodalityprovidedthattheyareingoodgeneralhealth(seeIndicationsandContraindications).Awell-preparedtreatmentplaniscriticalforimplantsuccess,includingbutnotlimitedto:

CompleteoralexaminationTreatmentofexistingpathologiespriortoimplantplacement

Radiographicassessment -Goodqualitypanoramicfilm -Appropriatelong-coneperiapicalfilms -Additionalspecialisedfilmsforthesite(s)

beingtreated:e.g.CTscans StudymodelsApre-surgicalprostheticguideusingthepatientsprosthesisornaturalteethasareferencesothattheimplantscanbeplacedinthemostsuitablelocationsduringthesurgery.

Theclinicianmustdetermineallpotentialrisksandthesuitabilityofthepatientforanimplantsupportedorimplantretainedrestoration.

Implant Indications

TheEndoporeDentalImplantisusedasanartificialtoothroottosupportaprosthesisinanedentulousorpartiallyedentulousmandibleormaxilla.

Pre-Surgical Considerations

Pre-Surgical Considerations

Endopore

7

Scalingandrootplaningonetofourweeksbeforesurgery.

Pre-operativeintra-oralandextra-oraldisinfectionofthesurgicalsite(s)withchlorhexidinemouthrinseorasimilarantiseptic.

Isolationofthesurgicalfieldwithsteriledrapesandgowns(OSHArecommendations).

Contraindications

EndoporeDentalImplantsshouldnotbeusedwithpatientswhohavecontraindicatingsystemicorlocaldiseasesincluding,butnotlimitedto:

Local contraindications

Oralinfectionsormalignancies

Activeperiodontaldisease

General medical contraindications

Blooddyscrasias

Uncontrolleddiabetes

Hyperthyroidism

Renaldisease

Uncontrolledhypertension

Liverproblems

Leukemia

Severevascularheartdisease

Hepatitis

Anyimmunosuppressivedisorder

Relative medical contraindications

Tobaccouse

Excessivealcoholconsumption

Poororalhygiene

Bruxism

Nailorpencilbiting

Tonguehabits

Anatomical contraindications

Insufficientridgedimensionstoaccommodateproperimplantplacement.Idealridgewidthisconsideredtobe6mmormore.

ENDOPORE

8

One-Stage and Two-Stage Implant Placement Procedure

Usethetwistdrillatadrillspeedof1000-1500rpmwithcopiousinternalandexternalsterilesalineirrigation.Thetwistdrillisindexedwithmarkingstocorrespondtothevariousimplantlengthsandisusedtocreateasiteoftheappropriatedepthfortheimplantstobeplaced.

Step 2

Elevateafull-thicknessmucoperiostealflaptoexposetheunderlyingbone.Theoptimalimplantsiteismarkedbyperforatingtheupperbonycortexusinga2.3mmroundburwiththepre-surgicalprostheticguideat1500-2000rpmwithcopiousexternalsalineirrigation.

Step 3

Aparallelingpin(occlusalguidepin)isusedtoverifytheappropriatealignmentwithadjacentteeth,opposingocclusionorotherimplants.Aradiographicimageisrecommended.

Step 1

One-Stage and Two-Stage Implant Placement Procedure, Steps 1 to 5

12 mm 9 mm 7 mm 5 mm

BICORTICALENDOPOREOne-Stage and Two-Stage Implant Placement Procedure

9

Whenthefinaldepthisreachedwiththetwistdrillandtheparallelingpinconfirmstheproperangulation,thesiteisexpandedwiththeappropriatesizedimplantburatadrillspeedof1000rpmwithcopiousinternalandexternalsterilesalineirrigation.

Exact site preparation is important, especially for tapered,self-seating implants.

Ifa5.0mmdiameterimplantisused,itisrecommendedtoexpandtheosteotomygraduallybyusinga4.1mmimplantburofthesamelength,asanintermediatebur.

Sharpbursandahighhandpiecetorquepotentialarecriticaltoavoidoverheatingofboneandburchatter;therefore,itisrecommendedtochangebursafterapproximately10uses,dependingonbonedensity.

Surgicalgauzefiberscancontaminatethesurfaceoftheimplantandincreasetheriskofimplantfailure;therefore,gauzeshouldnotbeusednearthesurgicalsiteorontheinstrumentsusedinthesitepreparation.

Step 5

Generouslyirrigatetheosteotomywithsterilesalinetoremoveanybonechipsbeforecheckingthesitewiththeappropriate-sizedtrial-fitgage.

The shoulder of the cone-shaped portion of the gage shouldbe flush with or just below the crestal bone level.

Thetrial-fitgagecanbeleftinthefirstsiteasaguidetohelpachieveparallelismwithotherimplants.Formultipleimplantsitesitisimportanttoensurethattheedge-to-edgeinter-implantdistanceisatleast2to3mmtoensureoptimalboneandsofttissue(includingpapillareformation).

Step 4

ENDOPORE

10

One-Stage Implant Placement Procedure

Theimplantisdrivenintoitsfinalpositionwithseveralfirmtapswiththepunchtipandmallet,resultinginatightfitoftheimplantintothebone.

Inallcases,theentireporous-surfacedregionoftheimplantandthe0.5mmsmoothcoronalregionmustbefullysubmergedinboneandtheimplantmustbeimmobile.

Step 7

Theimplantiscarefullyremovedfromthesterilepackaginganddelivereddirectlytothesiteusingtheattachedwhitedeliverytoolonly.Theimplantispressedintothebleedingsitewithmanualpressureandthedeliverytooldisconnectedfromtheimplantusingagentlerockingmotion.

Careshouldbetakentoavoidinadvertentcontactoftheporoussurfaceoftheimplantwithanythingpriortoitsfullseatingintothepreparedsite.Suchcontaminationcouldleadtoforeignbodyreactionandfailureoftheimplanttointegrate.

Thetappingactionofseatingtheimplantmayloosenthecoverscrew;thereforeitisimportanttotightenthecoverscrewusingthe0.05hexdriverandfingerpressure.

Atthispointtheimplantmustremainimmobile.

Step 6

Theflapmarginsarerepositionedandsuturedinatensionfreemanner.

Endopore implants with Internal Connection, One-Stage Implant Placement Procedure, Steps 6 to 9

Step 9

Step 8

PleasenotethefollowingstepsrefertotheEndoporeOne-Stageimplantplacementprocedure.

BICORTICALENDOPORETwo-Stage Implant Placement Procedure

11Theimplantisdriventoitsfinalpositionwithseveralfirmtapswiththepunchtipandmallet,resultinginatightfitoftheimplantintothebone.

Inallcases,theentireporous-surfacedregionoftheimplantandatleast1mmofthesmoothcoronalregionmustbefullysubmergedinboneandtheimplantmustbeimmobile.

Step 7

Theimplantiscarefullyremovedfromthesterilepackaginganddelivereddirectlytothesiteusingtheattachedwhitedeliverytoolonly.Theimplantispressedintothebleedingsitewithmanualpressureandthedeliverytooldisconnectedfromtheimplantusingagentlerockingmotion.Careshouldbetakentoavoidinadvertentcontactoftheporoussurfaceoftheimplantwithanythingpriortoitsfullseatingintothepreparedsite.Suchcontaminationcouldleadtoforeignbodyreactionandfailureoftheimplanttointegrate.

Step 8

Thetappingactionofseatingtheimplantmayloosenthecoverscrew;thereforeitisimportanttotightenthecoverscrewusingthe0.05hexdriverandfingerpressure.

Atthispointtheimplantmustremainimmobile.

Step 6

Theflapmarginsarerepositionedandsuturedinatensionfreemanner.

Endopore implants with Internal Hex/External Hex Connection, Two-Stage Implant Placement Procedure, Steps 6 bis 9

Step 9

PleasenotethefollowingstepsrefertotheEndoporeTwo-Stageimplantplacementprocedure.

ENDOPORE

12

Osteotome Procedures

Withitspress-fitdesign,highlyosteocon-ductivesurfaceandintegrationbyboneingrowthand3-dimensionalmechanicalinterlock,theEndoporeDentalImplantisappropriateforplacementusingosteotometechniques,especiallyintheposteriormaxillawherecancellousbone(TypesIII&

IVbone-AlbrektssonandZarb),i.e.,boneoflowerdensitybuthighvascularity,oftenpredominates.Indenserboneinthemaxilla(TypesI&II)andallsitesinthemandible,placementoftheimplantwithsurgicalbursisnecessary.

As with all dental implant procedures, sterile technique must be followed.

Step 1

Elevateafull-thicknessmucoperiostealflaptoexposetheunderlyingbone.Theoptimalimplantsiteismarkedbyperforatingtheupperbonycortexusinga2.3mmroundburwiththe

presurgicalprostheticguideat1500-2000rpmwithcopiousexternalsalineirrigation.

Step 2

Afterthecortexhasbeenperforated,the#1osteotometipattachedtoeitherastraightoroffsethandleisinsertedattheappropriateangulation(forlatercorrectimplantorientation)intothemarkedosteotomysite.Thesurgicalmalletisthenusedtodeliveraseriesoftapstotheendoftheosteotomehandletakingcaretomaintainthecorrectangulationoftheosteotome.

IftheboneisasexpectedofTypeIIIorIV,theosteotomewillquicklyadvanceintotheosteotomy,andthedevelopmentprogressoftheosteotomycanbemeasuredbyobservingtheosteotometipsdepthmarkings(5,7,9and12mm).Ifasimultaneoussinusfloorelevationisbeingdoneusingosteotomes,pleasesee

procedure,pages13to15.Ifrequired,anx-raycanbetakenatthispointtoverifythepositionandproperalignmentoftheosteotome.Todothis,thehandlecanbeunscrewedandremovedandtheosteotometipleftinsitufortheradiograph.

Ifconsiderableresistancetoosteotomeadvancementisexperienced,thetwistdrillmayberequiredtoestablishinitialpartialorcompletedepthfortheosteotomy.

Osteotome Procedures

Implant Placement Procedure Using Osteotomes

BICORTICALENDOPOREOsteotome Procedures

13

3.5 mm

9 mm Length

06-OT1 06-OT2 06M-9TFG/O

4.1 mm

7 mm Length

06-OT1 06-OT2 06-OT3 06-7TFG/O

4.1 mm

9 mm Length

06-OT1 06-OT2 06-OT3 06-9TFG/O

4.1 mm

12 mm Length

06-OT1 06-OT2 06-12TFG/O

5.0 mm

5 mm Length

06-OT1 06-OT2 06-OT306-7TFG/O

to 5 mm only06W-7TFG/Oto 5 mm only 06W-5TFG/O

5.0 mm

7 mm Length

06-OT1 06-OT2 06-OT3 06-7TFG/O 06W-7TFG/O

5.0 mm

9 mm Length

06-OT1 06-OT2 06-OT3 06-9TFG/O 06W-9TFG/O

5.0 mm

12 mm Length

06-OT1 06-OT2 06-OT3 06-12TFG/O 06W-12TFG/O

Theosteotometipsarelabeledas#s1,2and3and

haveincreasingtipdiameters.Allthreetipshave

horizontalmarkingsindicatingdepthsof5,7,9and12

mmcorrespondingtotheavailableEndoporeimplant

lengths.

Generallythethreetipsareusedinsequenceandonce

theappropriatedepthisreached,thetrial-fitgage

correspondingtotheimplantbeingplacedisconnected

toanosteotomehandleandusedasthefinalosteotome.

I Sequence for Osteotomes

579

12

579

12

579

12

tip#1 tip#2 tip#3

diameter

1.6 2.2 2.8

*Allmeasurementsareinmm

ENDOPORE

14

Osteotome Procedures

Whenthesitedepthhasbeenreachedwiththethree(ortwointhecaseofthe3.5mmx9mmand4.1mmx12mmimplantsitedevelopment)osteotometips,theappropriateEndoporetrial-fitgages*areusedasthefinalosteotometip.Thisgagehastheexactshapeandappropriatedimensionsfortheimplantbeingplaced,i.e.,itactsasanimplantreplica.NotethateachEndoporeimplanthasaspecificcorrespondingtrial-fitgagefoundintheEndoporesurgicalkit,andmustbeusedwiththesurgicalmallettocompletesitedevelopment.Careshouldbetakentoseethattheentireconicaltipofthetrial-fitgageisseatedinboneinordertoensurethattheimplantlaterwillbeseatedtothesamedegree.

*Asshowninthechartonpage13,ifa5.0mmdiameterimplantisbeingplaced,boththe4.1mmdiameterandthe5.0mmdiametertrial-fitgageswillbeneededtocompletetheosteotomy.Movingdirectlyfromthe#3osteotometiptothe5.0mmdiametertrial-fitgageisnotrecommendedasthisapproachcouldoverstresstheboneandresultindamagetothebuccalorpalatalcortices.

Step 4

Afterthe#1osteotometiphasreachedtherequireddepthfortheintendedimplantlength,theprocedureisrepeatedwithosteotomes#2and#3withtheexceptionofthe3.5mmx9mmand4.1mmx12mmEndopore.Intheseinstances,onlythe#1and#2osteotomeswillbeneededforsitedevelopment(Referencechartonpage13).

Pausingoccasionallyduringsitedevelopmentwithosteotomeswhileleavingtheosteotomesinthesiteallowssomestressrelaxationintheboneandmayreducetheriskoffractureofthebuccalorpalatalcorticalplates.

Step 5

Theimplantiscarefullyremovedfromthesterilepackaginganddelivereddirectlytothesiteusingtheattachedwhitedeliverytoolonly.Theimplantispressedintothebleedingsitewithmanualpressureandthedeliverytooldisconnectedfromtheimplantusingagentlerockingmotion.

Careshouldbetakentoavoidinadvertentcontactoftheporoussurfaceoftheimplantwithanythingpriortoitsfullseatingintothepreparedsite.Suchcontaminationcouldleadtoforeignbodyreactionandfailureoftheimplanttointegrate.

Step 3

BICORTICALENDOPOREOsteotome Procedures

15

Thetappingactionofseatingtheimplantmayloosenthecoverscrew;thereforeitisimportanttomanuallytightenthecoverscrewusingthe0.05hexdriverandfingerpressure.

Atthispointtheimplantmustremainimmobile.

Step 7

Theimplantisdriventoitsfinalpositionwithseveralfirmtapswiththepunchtipandmallet,resultinginatightfitoftheimplantintothebone.Inallcases,theentireporous-surfacedregionoftheimplantmustbesubmergedinbone(aroundtheentireperipheryoftheimplant).

Step 8

Theflapmarginsarerepositionedandsuturedinatensionfreemanner.

Step 6

Ifthereislessthan7mm(andaminimumof3mm)ofsubantralboneexistingbelowthesinusatanintendedimplantsiteandtheoperatorwishestoplacea7mmlongEndoporeimplant,thesinusfloormaybelocallyelevatedwiththeosteotometipsatthetimeofimplantplacementwiththefollowingproceduralmodifications.

Elevating the Sinus Floor During Implant Placement

Usingtheappropriatepre-operativeradiographs,theheightofsubantralboneattheintendedimplantsiteisdetermined.Withthisinformation,itwillbeknownhowdeeplythe#1osteotometipcanadvancewithoutcontactingtheactualsinusfloor.Generally,thisfirstosteotometipshouldbeadvancedwiththeaidofthesurgicalmallettoadepthabout1mmshortoftouchingthesinusfloor.Adistinctchangeinsoundandfeelwouldindicatethattheosteotomehasreachedthedensersinusfloor.Aperiapicalradiographmaybetakenatanypointinthissteptoverifythedepthofpenetrationoftheosteotometipinrelationtothesinusfloor.

Step 1

ENDOPORE

16

Elevating the Sinus Floor During Implant Placement

Step#1shouldberepeatedwiththe#2and#3osteotometips,i.e.,withsitedevelopmentstillstoppingshortofthesinusfloor.Aplugofautogenousbonewillhavebeencollectedandcompactedbytheosteotometipsattheapexofthispartiallydevelopedosteotomy.Oncethispartialdepth(i.e.,towithin~1mmofthesinusfloor)hasbeenachievedwiththe#3osteotometip,itisgenerallyrecommendedthataparticulategraftmaterialbeusedtosupplementtheautogenousboneplugthathasbeendevelopedattheosteotomyapex.Thisgraftmaterialshouldbegentlypackedintothesiteusingsteriletechnique,andatthispointthe#3osteotometipandsurgicalmalletusedtoupfracturethesinusflooratthesite.Careshouldbetakennottoadvancemorethan1mminsitedepthatthistimeinordertominimizetheriskofdamagingtheSchneiderianmembrane.

Step 3

Oncethesinusfloorhasbeenupfractured,itiswisetocheckvisuallytoensurethatthereremainsadefinitiveroofofgraftmaterialattheosteotomyapex.Ifanantralcommunicationhasbeenaccidentallycreatedbyadvancingtoofarapically,theprocedureshouldlikelybeabortedandappropriateactiontaken.

Ifasexpectedadefinitiverooftotheosteotomycanbeseen,sitedevelopmentshouldcontinuebyfirstaddingmoreoftheparticulategraftmaterial,compacteditgentlyandthenadvancingtoafurther1mmofosteotomydepthwiththe#3osteotometipandsurgicalmallet.Thiscycleofaddinggraftmaterialandadvancingafurther1mmshouldbecontinueduntilthefulldepthoftheimplantsite(generally7mmhasbeenreached).ItisNOTnecessarytouseanEndoporeimplantlongerthan7mmforthisapplication.UsingalongerimplantonlyincreasestheriskofSchneiderianmembranedamage.

Step 2

BICORTICALENDOPOREElevating the Sinus Floor During Implant Placement

17

Theimplantiscarefullyremovedfromthesterilepackaginganddelivereddirectlytothesiteusingtheattachedwhitedeliverytoolonly.Theimplantispressedintothebleedingsitewithmanualpressureandthedeliverytooldisconnectedfromtheimplantusingagentlerockingmotion.Careshouldbetakentoavoidinadvertentcontactoftheporoussurfaceoftheimplantwithanythingpriortoitsfullseatingintothepreparedsite.Suchcontaminationcouldleadtoforeignbodyreactionandfailureoftheimplanttointegrate.

Step 5

Oncethefulldepth(generally7mm)ofthesitehasbeenreachedinStep#3,theappropriatetrial-fitgage(seethechartonpage13)isusedasthefinalosteotometipandfullyseatedwiththesurgicalmallet.Onceseated,thetrial-fitgageshouldbesnugfittingandimmobileiftheimplantislatertobeproperlystabilized.

Step 6

Theimplantisdriventoitsfinalpositionwithseveralfirmtapswiththepunchtipandmallet,resultinginatightfitoftheimplantintothebone.Inallcases,theentireporous-surfacedregionoftheimplantmustbesubmergedinbone(aroundtheentireperipheryoftheimplant).

Step 4

Thetappingactionofseatingtheimplantmayloosenthecoverscrew;thereforeitisimportanttomanuallytightenthecoverscrewusingthe0.05hexdriverandfingerpressure.

Atthispointtheimplantmustremainimmobile.

Step 7

Step 8

Theflapmarginsarerepositionedandsuturedinatensionfreemanner.

ENDOPORE

18

Initial Healing Period and Postoperative Follow-up

Initial Healing Period

Anyinadvertentloadingoftheimplantshouldbeeliminated,especiallyduringthefirstweeksofhealinginordertoachieveoptimalosseointegration.

Ideally,noprostheticsshouldbewornduringtheinitialhealingperiodof7to10days.However,ifanoverdentureisindicated,itmustbegenerouslylinedwithasoftliner.

Thepatientshouldbeinstructedtofollowanappropriatedietdependentupontherangeandscopeofsurgery.

Thepatientshouldrinsegently(starting24hoursaftersurgery)withamouthrinsewhichdoesnotcontainalcohol,twicedailyuntilthewoundishealed.

Non-resorbablesuturesarenormallyremoved7to10daysaftersurgery.Regularofficevisitsarerecommended.

Implant Loading

Theminimumhealingperiod,priortothecommencementofprosthodonticworkfortheEndoporeimplantis10to14weeksintheanteriormandibleand16to20weeksinthemaxillaandposteriormandible.However,thetimeperiodisdependentonbonequality.

Thelongesthealingintervalswillbewheretheindirectsinuselevationhasbeendoneatthetimeofimplantplacementinsiteswheretheinitialboneheightwaslessthan5mmbelowthesinusfloor.

Initial Healing Period and Postoperative Follow-up

Two-Stage Re-Entry Surgery

1.Understerileconditionstheimplantcoverscrewisexposed,bytheuseofatissuepunchoraconservativeincision,andremovedusinga0.05hexdriverandfingerpressure.

2.Ahealingabutmentisplacedusingthe0.05hexdriver,tighteningonlywithfingerpressure.Thegingivaisthentightlysuturedaroundthehealingabutment.Whenusinganoverdenture,theprosthesisisagainrelievedovertheimplantsitesandlinedwithasoftliner.Careistakentoavoidsofttissueinsertionatthejunction.

3.Impressionsshouldbetaken4weeksafterre-entrysurgerytoallowtissuehealing.Forfixedprosthesis,theimplant(s)areprovisionallyloadedforaperiodof6to8weeks.Ifafterthe6to8weeksofprovisionalloadingtheradiographicboneheightsareunchanged,theclinicianmayproceedwiththefinalprostheticprotocol.(PleaseconsulttheInnovaProstheticManual).

BICORTICALENDOPOREEndopore Key Protocol Features for First and Second Stage Surgery

19

Endopore Key Protocol Features for Second Stage Surgery

Please note this page is only a reminder of key-points. We highly recommend to read the entire surgical manual before implant placement.

Endopore Key Protocol Features for First Stage Surgery

Do

Useahandpiecewithinternalandexternalsterilesalineirrigation

Usesharpburs Useaparallelingpin(occlusalguidepin)tocheckalignment

Expandosteotomygraduallybyfollowingbursequence

Ensurebleedinginosteotomysitetoallow3-dimensionalboneintegration

Irrigateosteotomysitewithsterilesalinetoevacuatebonechips

Ensurethatthetopofthetrial-fitgageisflushorjustbelowthecrestalbonelevel

Removetheimplantcarefullyfromthepackagingandcarryitdirectlyintothesurgicalsite

Drivetheimplantintoplacewithseveralfirmtapscreatingaverytightfit

Tightencoverscrewwithfingerpressureand0.05hexdriver

Assuretotalimmobilityofimplantattimeofplacement

Insureadequateocclusalloading

Avoid

Overheatingofbone Burchatter,deformedosteotomysite Undesiredimplantangulation Creatinganoversizedosteotomysitewhichwouldresultinpoorinitialimplantstability

Placingtheimplantinapoorlyvascularisedosteotomysitewhichmightresultinfailuretointegrate

Surgicalgauzearoundthesurgicalsite Under-seatingtheimplant Contaminationofthesurfaceandultimatefailuretointegrate

Rotationofimplant Useoftorquewrenchmightmobilizetheotherwisestableimplant

Rotatingimplantasitwillnotintegrate Avoidimplantoverload

Do

Exposeimplantwithsmallincisionortissuepunch

Removecoverscrewwith0.05hexdriverusingonlyfingerpressure

Placehealingabutmentwith0.05hexdriverusingonlyfingerpressure

Recordimpression4weeksafterre-entry,allowinggingivatoheal

Avoid

Fullthicknessflap

Useoftorquewrenchmightmobilisetheotherwisestableimplant

Useoftorquewrenchmightmobilisetheotherwisestableimplant

Recordimpressionbeforegingivahashealed

INTERNALpERfEcTpERfEcT SURfAcEImpLANT pLAcEmENT pRocEdUREoSTEoTomE pRocEdURES

INTERNAL HEXEXTERNAL HEX

pERfEcT SURfAcEENDOPORE Implant

Sybron Implant Solutions

ThedentalimplantplatformofSybronDentalSpecialties(SDS)bringstogetherthree(INNOVAORALTRONICSATTACHMENTS)organizationsthathavebeenleadersinimplantmanufacturing,designanddevelopmentsincetheinceptionofimplantdentistry.

Withourmostrespected,innovativeimplantsystemsPITT-EASY,andENDOPOREwearegivingyouaccesstoaworldofimplantsolutions.

Manufacturer:

Sybron Implant Solutions1717WestCollinsAvenueOrange,California92867UnitedStateswww.sybronimplants.com

Distributed by:

Sybron Implant Solutions GmbHJulius-Bamberger-Strae8a28279BremenGermanyPhone+4942143939-0Fax+49421443936www.sybronimplants.deinfo@sybronimplants.de

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07-0187:06/07