Recomendados
Más contenido relacionado
La actualidad más candente
La actualidad más candente (20)
Destacado
Destacado (20)
Similar a Bio Horizons Internal
Similar a Bio Horizons Internal (20)
Último
Último (20)
Bio Horizons Internal
- 2. BioHorizons fue fundada en 1994 con la misión de introducir en el mercado un sistema de implantes dentales basado en la evidencia, que específicamente se adecuara a las distintas densidades óseas presentes en la boca. Desde entonces, hemos crecido hasta convertirnos, probablemente, en la compañía de reconstrucción oral más completa del mundo. Los tres principios: Ciencia, Simplicidad y Valor han sido la esencia que ha guiado toda nuestra oferta de productos.
- 10. Mayor superficie de contacto Rosca en “V” convencional El diseño de rosca cuadrada modificada de BioHorizons proporciona hasta 154% más superficie de contacto que otros implantes competidores de idéntico diámetro y longitud. Rosca cuadrada modificada
- 14. Más contacto hueso-implante en carga inmediata
- 15. Éxito en carga inmediata funcional y no funcional
- 16. Éxito en carga inmediata
- 19. Todos los componentes fabricados con aleación Ti-6Al-4V
- 26. 4 diámetros de implante - 3 plataformas protéticas z
- 33. Opciones y técnicas quirúrgicas
- 42. Caso ilustrativo cortesía del Dr. Jin Kim Esta presentación muestra la colocación y restauración de un implante BioHorizons Internal de 5.0mm en un alveolo rellenado con biomaterial tras una exodoncia.
- 55. Técnicas y Opciones Protéticas
- 80. Restauraciones tipo Corona & Puente
- 82. Aditamentos preparados en laboratorio
- 92. Restauraciones atornilladas a nivel del implante
- 95. Restauraciones de sobredentaduras con barra
- 98. Restauraciones con pilares de bola
Notas del editor
- Good evening, (afternoon or morning) my name is __________________ and I am your Product Support Specialists for BioHorizons Implant Systems. Today I am going to share with you the principles behind our Internal Hex connection implant. Before we get to the restorative benefits of the implant, let me tell you a little about us as a company.
- We were founded in 1994 with the mission of bring to market the first evidence-based dental implant system that specifically addressed the varying bone densities found in the mouth. We have grown to become the fastest growing oral reconstructive device company in North America. Our principles of Science, Simplicity and Value have driven all of our product offerings.
- We are actually a university “spin-off” company, as the core patents of our implant were developed at UAB. Our science based patents were developed on research done at UAB on how bone responds to mechanical load.
- We are the fasted growing oral reconstructive device company in North America, specializing in implant dentistry and tissue regeneration. We currently have sales in over 25 countries and have offices in Birmingham, AL, Toronto Madrid, and London. Our North American sales force has grown to over 40 Product Support Specialists in a very short period of time.
- Review product offerings
- Let’s review each of these areas.
- Most implant companies are offering some type of internally connected implant…..what sets BioHorizons Internal implant apart for the pack. Research provided us with the science to produce an evidence-based thread design with surface treatments for increased success. We have made every effort to simplify all aspects of implant therapy, and our commitment to providing the dental community with value has enabled us to design products with multi-use that reduces the cost of implant prosthetic components.
- The body of all BioHorizons implant have been designed to improve load transfer. In addition, this design increases the surface area of our implants significantly over all competitive designs. The improved histological response gives us a higher bone-to-implant contact, which increases the amount of reverse torque necessary to fracture the bone to implant bond. Our surface treatment options are proven to increase the osseoconductive surface of the implants, and of course, we manufacture all our products from the strongest titanium alloy.
- I just made some pretty aggressive statements out load transfer…I would like to show you the science behind the statements. We know that bone is strongest in compression and weakest when under shear forces. The University of Alabama’s research indicated that a modified square thread design maximized compressive load on the surrounding bone and reduces the destructive shear force by 10 times when compared to the conventional v-thread designs of other implant system. This is critical in compromised bone or areas where the use of a shorter implant is necessary.
- This unique thread design not only improves compressive load; it increases surface area as well. Our modified square-thread design provides up to 154% greater surface area than competitive implants of identical diameter and length.
- We have both human and animal histology indicating that we not only have bone growing into the depth of the thread, but the bone that is there is healthy lamellar bone.
- Results of our on-going multicenter clinical trial show 99.5% success rate and low crestal bone resorption independent of center, prosthesis design and bone type.
- The Journal of Periodontology published a paper in 2004 comparing the percentage of bone-to implant contact and reverse torque values of three thread designs used on implants. The conventional V-thread, used by 3i, Zimmer, and the Nobel Branemark implants show reverse torque Values of around 16 Ncm, with percentage of bone-to-implant contact of 60%. The reverse buttress thread, used predominately by Nobel on all of their Replace and Direct brand names has lower reverse torque values, which would be logical due to the lower percentage of bone-to-implant contact. But note the BioHorizons modified square thread design; the bone-to-implant contact is significantly greater, which increases the reverse torque values as well.
- The Journal of Periodontology published a paper in 2005 comparing the percentage of bone-to implant contact in immediately loaded implants that were retrieved from human patients. Note that BioHorizons modified square thread design showed the highest bone-to-implant contact 80.6%. It is important to not that the limited number of cases only allow us to make assumptions about the outcomes. This does not represent a prospective, controlled study.
- The Journal of Periodontology published a paper in 2003 showing follow-up of 646 implants of various systems. Each system performed well in the study with only 1.4% of the IFL failing, and 0.9% of the INFL failing. BioHorizons had 100% success in both implant and prosthesis survival (combined N = 242).
- Misch and Degidi followed 244 immediately and early loaded BioHorizons implants for 1 to 5 years. No implants or prostheses failed, and crestal bone loss was less than or equal to reported bone loss in conventional two-stage surgical approaches.
- We utilizes a biocompatible blast media (calcium phosphate) to provide surface roughness (Ra 75 μ m) on our implants. The blast media resorbs during the passivation process, resulting in an optimum roughness profile of a pure TiO2 (titanium oxide) surface with no surface contaminants. This surface has proven to be osseoconductive, creating a better bone to implant interface, as was demonstrated in reverse torque tests. Other roughening processes can leave a residue of silica or ceramic embedded in the titanium surface. This surface is available on all lengths and diameters of BioHorizons Implants.
- Hydroxylapatite (HA) is bio-active, and promotes rapid bone apposition to the implant. This extremely effective when dealing with the poorest of bone densities, as the implant becomes stable faster. There are, however, disadvantages to HA. If the HA coating is left above the bone it may collect plaque and bacteria more rapidly, making the colonization of bacterial more likely. HA coated implants should be used when the advantages outweigh the disadvantages. HA is available on all BioHorizons Internal implants.
- There are four grades of commercially pure titanium. The higher the number grade, the stronger the material as you can see from this chart. The largest implant company currently uses grade 2 because this is the grade which will allow them to use their current surface treatment. We chose to use Titanium Alloy due to it’s superior strength. You are offering your patients a lifetime treatment plan and must have products that can hold up to the rigors of a lifetime of eating!
- BioHorizons is committed to simplicity as well. We challenged the everyday annoyances you face in implant Prosthodontics with the determination to correct them.
- These are some of the things we have done. Let’s look at each of these specifically.
- Of all things, you want the connection between the implant and the prosthetic component to be easy to use and at the same time provide the strength necessary to withstand a lifetime of use. The lead-in bevel has many functions. Not only does it align the abutment and screw to seat properly, it also shield the abutment screw form lateral load, enhancing the strength of the connection. This bevel creates a biologic seal between the implant and the abutment, minimizing the micro-gap between the parts. Couple this with our precision machining you are assured a best fit and function of the components.
- When BioHorizons set out to develop an implant system around the implant body design at the University of Alabama, we looked at every area of concern within the discipline of implant dentistry. The inconvenience and wasted chair-time associated with screw loosing was paramount. So, our engineers started looking for a solution to this problem. What we found was a technology called Spiralock which was developed to address loosening and stripping of screws by vibration, shock, and temperature change. The secret to the Spiralock’s thread form is a 30 º “wedge” ramp cut at the root of the female thread. Under clamp load, the crests of the threads on any standard screw are drawn tightly against the wedge ramp. This design not only eliminates sideways motion that causes screw loosing but also distributes the threaded joint’s load throughout all engaged threads. Minimizing the occurrence of screws loosening will certainly simplify your life.
- In order to make prosthetic component selection simple, we have color coded all mating parts within the implant system. You will be able to tell at a glance the implant platform and the appropriate components to use for the restoration.
- You would not believe the number of times doctors have cross-threaded a screw when trying to “start” the screw into the implant. Our engineers have developed a guide pin which helps “center” the screw, making the job of starting screws very simple.
- And, we have an implant diameter for all clinical applications, with three prosthetic platforms.
- Because tooth contours and emergence profiles vary within the mouth, we made abutments with varying emergences so you could select what is best suited for the prosthesis planned. The 3inOne abutment has a flared (regular) emergence profile, and therefore healing abutments and impression copings used in conjunction with it will also be regular emergence. All prosthetic components are labeled with color-coded platform and emergence icons to for ease of use. When using either narrow or wide emergence abutments it is important to use the corresponding emergence healing abutments and impression copings.
- And last, but not least, we promise you value.
- In addition to giving you a lifetime warranty on our implant products, we give you a free abutment! Our implant is packaged as a complete restorative system. A gold-hued esthetic abutment comes with every implant.
- This Esthetic abutment has multi-purposes. First, your surgeon uses it to deliver the implant to the bone. He then sends you the abutment and abutment screw to use for both making impressions, as a temporary abutment, or as your final abutment. This adds up to savings from $150 to $250, when compared with other implant system. In addition, the taper on the abutment is optimal, so you have to do less modifications. The titanium nitride coating (gold color) has been added to enhance soft tissue esthetics.
- As I said, the free abutment may be used to make an impression in conjunction with the Ball-top screw. To accelerate treatment, an impression can be taken at the time of implant placement or at second stage surgery.
- Yes, unsurpassed value. There is a lifetime warranty on all implants and prosthetic components. If for any reason they must be removed, we replace them at no charge.
- Let’s take a look at the surgical techniques and options.
- You could not ask for simpler surgical kit. It follows the logical left-to-right progression and everything is color coded by diameter. The kit is complete! You can place any of the BioHorizons internal implants with this kit. Let’s go through the kit and identify it’s most unique benefits.
- Our starter drill is exceptional! The 1.8mm spade drill does not “walk” on the ridge and aggressively cuts dense bone. The incremental marks on the drill are from 7mm to 15mm.
- One of the most convenient aspects of our drilling system is our depth drills. The BioHorizons Internal implant is available in 4 different lengths; 9mm, 10.5mm, 12mm, and 15mm. So the surgical kit contains a set of depth drills, in 2.0mm and 2.5mm diameters, for each length of implant. The pre-set stops make osteotomy preparation much simpler. We also provide a set of depth drill without stops. So you receive a total of 5, 2mm depth drills and 5 2.5mm depth drills in the kit.
- Of course our kit has paralleling pins.
- And, to continue on the note of simplicity, our width increasing drills do not cut at the apex. They cut width only, so they will stop at the depth established by the depth drills. This provides you with an extra margin of safety when preparing your osteotomies.
- There is a crestal bone drill for each diameter of implant. They are used in dense cortical bone to prepare the crestal portion of the osteotomy to receive the implant without placing undo stress on the surrounding bone.
- We do provide bone taps for each diameter of implant. While our implants are self tapping, you may encounter dense bone that will require tapping. Our goal is to place the implant, minimizing undue stress on the surrounding bone. We want the kit to be complete so you can handle any situation that presents.
- You can place the implant the way you are most comfortable. The kit is complete with the appropriate tools fro handpiece placement, ratchet placement or hand placement. We also provide an insertion tool that streamlines the profile to the insertions when mesial/distal space is a problem.
- Now, let’s walk through a simple single tooth replacement.
- Dr. Kim grafted this site in December of 2004 and place the implant in February of 2005. We will go through the surgical and restorative phase of this patient.
- Note the nicely healed extraction site.
- Notice how Dr. Kim has made his incision to the lingual aspects of the ridge and has left the tissue undisturbed around the adjacent teeth. This flap design preserves papillae.
- The implant treatment planned is 9mm in length, so Dr. Kim uses the Depth Drills with a stop at 9mm.
- Many clinicians take and x-ray with a drill in place to verify angulations and proximity to adjacent anatomical structures.
- The osteotomy has been increased in diameter with the width increasing drills.
- Note the self-tapping geometry of the apical portion of the implant.
- Here we see the implant being threaded into the bone.
- The contrasting color between the gold hued esthetic abutment and the implant aids in precise placement.
- The abutment is removed. The insertion tool that I showed you earlier can be used to adjust the implant level if it deemed necessary.
- Healing abutments are selected based on the desired emergence profile of the final prosthesis and the tissue height.
- Here we see the post-op x-ray with the healing abutment in place. Dr. Kim has selected to do and one stage surgical protocol in this situation.
- Now, lets review the prosthetic techniques and options available with the BioHorizons Internal implant.
- Accurate impressions form the foundation for the restoration. Care must be taken to get it right the first time. Doing so will prevent the loss of time and money of expensive re-makes. Now, it looks from this list that you have to choose between 6 different impression techniques, but in reality you will only be confronted with two choices. A closed tray, indirect transfer or an open tray direct pick-up impression. Whether it is at the implant level or the abutment level is irrelevant at this point, as both techniques are clinically the same. The Prepared abutment impression and the ball abutment impressions are just like regular crown and bridge impressions.
- As you can see here, the prepared abutment is in the mouth and you just make an impression. You may or may not have to use retraction cord, it just depends on how sub-gingival your margin is. After you make the impression, you temporize the abutment, just as you would a prepared natural tooth.
- So, what is a closed tray indirect transfer impression. Well, it is probably the most used method currently being used in implant dentistry. The impression coping you use stays in the mouth after removal of the tray. It is then removed from the implant, and transferred to the impression, thus the name “Transfer”. You may use a stock tray, or if you wish, a custom tray. Some feel this is generally less accurate than direct pick-up methods, however I know clinitians who use this method most of the time. However, it is best suited for relatively few implants with reasonable draw. With the BioHorizons Internal implant you have two options for the impression coping: 3inOne Abutment with Ball-top Screw. Indirect Transfer Coping. This option allows the 3inOne Abutment to be used as a temporary during fabrication or preparation of a separate final abutment. Coping stays in the mouth after removal of the tray, is then removed from the implant, and transferred to the impression. Uses stock tray. Generally less accurate than direct pick-up methods. Best suited for relatively few implants with reasonable draw.
- So, lets see how this impression is made. Your patient will most likely present with a healing abutment in place. You will remove one at a time, replacing it with the selected impression coping. This is important! Immature soft tissue has a tendency to “slump”. By replacing the healing abutment with the impression coping minimizes this risk. It is generally easier to work from posterior to anterior.
- As a continuation on the subject of simplicity. I told you earlier that all parts are color coded. Well, we took it one step farther. There is a code on the superior surface of the healing abutment that gives you, the restorative doctor a lot of information. The “B” stands for blue, which would indicate you will be dealing with a 5.7mm platform. The “R” indicates the emergence is “regular”. And the “3” tells you how tall the healing abutment is. Now, you have knowledge of the tissue depth before you continue.
- After removing the healing abutment, the color coding comes into play. Blue indicates a 5.7 platform, green 4.5 and yellow 3.5.
- You could have selected either the free abutment coupled with a ball top screw or an impression coping to make your impression. You hand tighten the screws.
- Here you see that Dr. Kim has selected to use the free multi-purpose esthetic abutment coupled with a ball top screw as his impression coping. Note the flat side on the abutment. This flat side coincides with a flat of the six sided hex within the implant. So, what we will be transferring to our working model is the implant location and the hex orientation inside the implant. Dr. Kim positions the flat surface to the buccal for easier visual indexing in the impression. You will see what I mean in a moment. The hex hole on the top of the ball top screw is blocked out with wax.
- Here we see an illustration using both impression coping options. Block out access holes with wax. An x-ray would be taken prior to making the impression to insure the impression copings are seated completely. Express light or medium-bodied impression material around the copings. Record a full arch impression using medium or heavy-bodied impression material. Unscrew the copings after the tray has been removed. Immediately replace healing abutments to prevent soft tissue collapse.
- Here you see the transfer of the flat side of the free abutment in the impression.
- The impression coping in now removed for the mouth and assembled with the appropriate implant analog and then “transferred” back to the impression, aligning the flat of the impression coping to the flat within the impression.
- Here again is Dr. Kim’s case. De nuevo el caso del Dr. Kim.
- Now he is inserting the assembly back into the impression. Ahora está insertando la estructura de nuevo en la impresión.
- A working model is fabricated and mounted as per normal crown and bridge laboratory procedures. A soft tissue cast is recommended. This way, the laboratory never looses the landscape of the soft tissue while preparing the prosthesis, as they can easily lift and replace this soft material during fabrication of the crown. If the soft tissue cast were not made, the lab would have to remove the stone around the implant, thereby loosing soft tissue contours. Se fabrica y monta un modelo como para un puente y corona normal mediante procedimientos de laboratorio. Se recomienda un modelo de tejidos blandos. De esta manera, el laboratorio nunca pierde la perspectiva de los tejidos blandos mientras fabrican la prótesis pero también lo puede quitar y recolocar fácilmente durante la fabricación de la corona. Si no se hace el modelo de tejidos blandos, el labotario tendría que quitar la escayola alrededor del implante, perdiendo así el contorno de los tejidos blandos.
- Again, Dr. Kim’s clinical case. The abutment has been modified and is ready for the fabrication of the crown. We will return to this case for it’s completion in a few minutes. First I want to show you what an open tray, direct pick-up impression entails. Una vez más, un caso clínico del Dr. Kim. El aditamento se ha modificado y ya está listo para la fabricación de la corona. Volveremos a este caso en unos minutos para ver su resolución. Primero, quiero mostrarle lo que implica la impresión directa de cubeta abierta.
- With this method, the impression coping is “picked-up” within the impression. The screw that retains the coping is removed from the impression through a hole in the tray. This is considered the most accurate method of making an impression. Lets see how it’s done. Con esta técnica, el coping de impresión se “arrastra” con la impresión. El tornillo que retiene el coping se extrae de la impresión a través de un agujero en la cubeta. Se considera el método de toma de impresiones más preciso. Vamos a ver cómo se hace.
- Again, you remove the healing abutments as before in insert the direct pick-up impression copings. Note the length of the screw and the undercuts on the copings. These are designed to lock the coping within the impression material. Una vez más, extraiga los tapones de cicatrización como antes para la inserción de los copings de toma de impresión directa. Aprecie la longitud del tornillo y los cortes de los copings. Están diseñados para bloquear el coping dentro del material de impresión.
- A modified stock tray or a custom tray may be used. Access holes have been made to accommodate the screws. Se puede usar una cubeta estándar modificada o una cubeta hecha a medida. Los agujeros de acceso se han hecho para acomodar los tornillos.
- An x-ray should be taken prior to making the impression to insure the copings are seated completely. Impression material is syringed and a loaded tray is seated. Se debería tomar una radiografía antes de la toma de impresiones para asegurarse de que los copings están completamente asentados. Después se aplica el material de impresión con una jeringa y se asienta la cubeta cargada.
- After the material has set, the screws are removed through the tray. The impression is removed with the coping captured within the impression. Thus, the name “pick-up”. Cuando el material haya fraguado, se extraen los tornillos a través de la cubeta. Se extrae la impresión con los copings en su interior. De ahí el nombre de “pick-up”.
- Send all copings, abutments, screws and analogs to the lab with the impression, opposing model or impression, bite registration and shade. The laboratory will reassemble the analogs with the copings using the long screws and pour a stone model. Envíe todos los copings, tornillos y análogos al laboratorio con la impresión, los aditamentos, el modelo opuesto o su impresión, la mordida y el contraste. El laboratorio volverá a montar los análogos y los copings empleando los tornillos largos y vierta la escayola para el modelo.
- The laboratory model is fabricated as we discussed previously. El modelo del laboratorio se fabricado tal y como hemos expuesto anteriormente.
- There is virtually no limit to the options available with the BioHorizons internal implant. Virtualmente, no existe un límite para las opciones disponibles con el Sistema de implantes Internal de BioHorizons.
- For cement retained crown and bridge procedures you have a wide assortment of abutments to choose from. Of course, you will have the free gold-hued esthetic abutment that your surgeon sent you, but should it not fit into your restorative treatment plan, there is many others to choose from.
- Vamos a echar un vistazo rápido a las restauraciones mediante corona y puente
- If you wanted to prepare the abutment yourself, chair-side this would be your technique. Briefly describe.
- If the lab prepares the abutments, all you have to do is take an impression….they do the rest.
- After modifying the abutments, the lab uses normal laboratory techniques to fabricate a cement retained bridge…..describe steps..
- Continue to describe steps.
- Now, let’s look back at the completion of Dr. Kim’s case. You saw earlier that the abutment was modified.
- Dr. Kim’s laboratory provides him with an abutment seating jig. The acrylic jig is made to simplify the seating of the abutment in the mouth. Remember, the internal hex has 6 sides, so this abutment could be seated six different ways, but only one would be correct after it has been modified. The jig encapsulates the abutment, indexed to the adjacent teeth. Note there is an access hole for the abutment screw. To seat this correctly, all Dr. Kim has to do is remove the screw from the abutment on the lab model and pick the abutment/jig assembly off the model and go directly to the mount with it. He knows it is in it’s proper orientation when the abutment is seated and the jig indexes to the adjacent teeth. Now all he has to do is insert his abutment screw.
- Here you see the modified abutment and the finished crown.
- After seating the modified abutment and taking and x-ray to verify that it is seated completely, Dr. Kim torques the abutment screw with 30 Ncm of torque. He then fills the access hole with cotton and tops it off with what appears to be composite.
- He places a small amount of cement on the abutment and crown……
- And seats the crown. Care is taken to insure that all cement is removed from the sulcus. Occlusion is checked and adjusted under heavy bite force to harmonize load sharing between the implant and teeth. See how simple a single tooth replacement can be.
- This is the final x-ray.
- Of course there are other options…..let’s go through a few. First, let’s look at screw-retained.
- Whether it is single unit or multi-unit, you always start with either of the impression techniques we discussed earlier. In this case custom cast abutments are used by the laboratory to fabricate a screw retained three unit bridge. Our custom cast abutment is the same thing as what is commonly called the UCLA abutment.
- The framework is tried in and the veneering material is applied.
- There are a multitude of bar/overdenture treatments. But the one thing they all share is very simple. The bar either attaches directly to the implant or to an abutment for screw. The abutment for screw simply raises the bar to a higher level through the soft tissue. It is essential to use the corresponding components for each particular procedure since there is no cross-compatibility between part families.
- Your impression technique is the same for a bar direct to the implants as it was for the crown and bridge cases we looked at earlier. If you had chosen to use abutments for screw, you would have had the same impression technique choices, the difference being the abutments for screw would have been placed on the implants prior to making the impression. As you can see, you go through your normal denture techniques, with the exception that we are now connecting everything to the implants. After the denture set-up is complete and accepted, the bar is fabricated, using a matrix of the tooth positions.
- The bar is always tried in to insure it is passive in fit. If it is not passive it is sectioned and pick-up for soldering. After the bar is completed, the attachments are positioned and the denture if finished and delivered. Siempre se debe probar la barra para asegurar el ajuste pasivo. Si no ajusta, debe cortarse y extraerse para la soldadura. Después de que la barra esté terminada, los acoples se posicionan y la dentadura está terminada y se entrega.
- And then last, but not least, we have a ball abutment retained overdenture. Y por último, pero no por ello menos importante, tenemos la sobredentadura retenida por pilares de bola.
- With this treatment you have a choice of picking the attachments up chair-side or having the laboratory process them in the denture. For chair-side pick-up you do the following: A well-fitting denture is relieved to accommodate housings. Denture repair acrylic is placed around housings and in relieved areas. Denture is placed and acrylic is allowed to cure. Denture is now a tissue supported, implant-stabilized prosthesis
- Continue describing technique Continuar con la descripción de la técnica.
- So, why should you request the use of BioHorizons internal implant. Así que, por qué debería usted solicitar el uso del implante Internal de BioHorizons? We have developed and implant based on the science of how bone responds to load….this coupled with the simplicity and the value of the system means you minimize risks and maximize your time. Hemos desarrollado un implante basado en los fundamentos científicos de cómo un hueso responde a las cargas… Esto unido a la simplicidad y el valor del sistema significa que usted minimiza los riesgos y rentabiliza su tiempo.
- Questions and Answers Preguntas y Respuestas
- Thank you for your time and attention. Remember, I am always available to assist you with the clinical usage of our products. Gracias por su tiempo y atención. Recuerde, siempre estoy disponible para ayudarle con el uso clínico de nuestros productos.