casting waxes

1. GOOD MORNING

2. Recent Advances in
Implants
Dr. Sanket Rane

3. Contents
• Introduction
• Advanced diagnostic methods
• Advances in implant materials.
• Advanced surgical techniques.
• Changing concepts in implant dentistry.
• Conclusion.

4. INTRODUCTION
• The idea of permanently being able to replace teeth has been
a desire of civilizations since the days of the Egyptians.
• First implant- copper peg- 3000 yrs ago.
• Central America- Replacing lost teeth with animal ones.
• Finally, in the mid-1960's, Dr. Branemark in Sweden
discovered that titanium would fuse to bone…..
• Advent of computerized tomography (CT).

5. Classification
• Advances in diagnostic imaging
– Zonography
– Cone beam Computed tomography(CBCT)
– Microtomograph
– Multi slice helical CT
– Dentascan
– Interactive CT

6. • Advances in implant design
– Mini implants
– Transitional implants
– One-piece implants.
• Advances in Implant materials
-Ceramics
-Carbon and polymers
- Hyrdoxyapatite
- Bone morphogenic proteins
- Plasma spraying

7. • Advances in implant design and surface in
commerically available brands:
– Biohorizon
– Nobel biocare
– Astra tech
– Straumann

8. • Softwares simplifying treatment planning and
surgical procedures
– Simplant
– NobelGuide
– NobelClinician
– Image guided surgeries
CAD/CAM in implant dentistry.
Changing concepts in implant dentistry
-All on 4 concept
-Tooth in an hour concept
-Rescue implant concept

9. ADVANCES IN IMAGING/
DIAGNOSTIC MODALITIES
• ADVANCES IN PANORAMIC IMAGING
• ZONOGRAPHY
• A modification of the panoramic x-ray machine for making
cross sectional images of the jaws.
• The tomographic layer is approximately 5mm.
• For appreciation of spatial relationship between the critical
structures and the implant site.

10. Zonography
• Limitations:
• Tomographic layers relatively thick .
• Adjacent structures blurring and superimposition.
• Not useful for determining the differences in bone density or
for identifying disease at implant site.

11. Tomography
• Tomography is the generic name
formed by the greek words
‘tomo’(slice) and ‘graphy’(picture).
• Enables visualization of a section of
patient’s anatomy by blurring other
regions above and below the site of
interest.
• For dental implant patients, high
quality complex motion tomography is
required.

12. Computed tomography (CT)
• Computed tomography (CT) is a digital and mathematical
imaging technique that creates tomographic sections.
• With latest CT scanners, images with sectional thickness of
0.25 mm can be obtained .
• This can be useful for determining the implant site in terms of
bone density, and location to adjacent anatomic structures.

13. Recent advances in
Computed Tomography(CT)
• Cone beam CT:
• It uses a cone beam and reconstructs the image in any
direction using special software.
• It gives all the information of a CT but, at 1/8th the radiation
dose and at a lower cost.

14. • Software is used to display and visualize the anatomy
in a way that is clinically meaningful.
• The manufacturers of CBCT scanners offer software that is
capable of multiplanar reformations .
• Third-party software …….
Simplant……..

15. SAGGITAL CT AXIAL CT
CROSS SECTIONAL VIEW OF MAXILLA AND MANDIBLE

16. Recent advances in
Computed Tomography(CT)
• Microtomograph:
• Modification of CT, it is specially useful in acquiring serial
sections of bone implant interface.
• Multi slice helical CT:
• The rapid volumetric data acquisition. The speed was further
increased by multislice CT, and offers higher accuracy of
images as compared to CT.

17. Dentascan
• DentaScan imaging
provides programmed
reformation, organization
and display of the
imaging study.

18. • The radiologist simply indicates the
curvature of the mandibular or
maxillary arch
• The computer is programmed to
generate referenced cross sectional
and tangential/panoramic images of
the alveolus along with 3-D images of
the arch.
• The cross sectional and panoramic
images are spaced 1mm apart and
enable accurate preprosthetic
treatment planning.

19. Limitations
• 1. Images may not be of true size and require compensation
for magnification.
• 2. Determination of bone quality requires use of the
imaging computer or workstation.
• 3. Hard copy dentascan images only include a limited range
of the diagnostic gray scale of the study.
• 4. Tilt of the patients head during the examination is critical

20. Interactive computed tomography(ICT)
• This technique enables
transfer of the imaging study
to the clinician as a computer
file….
• The clinician’s computer
becomes a diagnostic
radiologic workstation with
tools……….

21. • An important feature of ICT is
that the clinician and radiologist
can perform “electronic surgery”
(ES)……
• With an appropriately designed
diagnostic template, ES can be
performed to develop the
patient’s treatment plan
electronically in 3 dimensions.
• ES and ICT enable the
development of 3 dimensional
treatment plan…..

22. • Transfer of the plan to the patient
at the time of surgery can be
accomplished by……
• It can also be accomplished by the
production of the computer
generated, three-dimensional
stereotactic surgical templates
from the digital ICT and ES data.

23. Limitations of ICT:
• Refinement and exact orientation of the implant positions is
difficult and cumbersome.
• Executing the plan may be difficult for the surgical team.

24. ADVANCES IN IMPLANT MATERIALS,
FORM, SHAPE AND
SURFACE TOPOGRAPHY
• Mini implants/transitional implants.
• One -piece implants
• Modifications in surface topography(coatings)
• Materials used for fabrication of implants.

25. MINI IMPLANTS
• Mini dental implants (MDIs) are small
diameter dental implants.
• Are sometimes referred to as SDIs
(small diameter implants), as well as
NDIs (narrow body implants).
• Diameter less than three millimetres
(3mm.)

26. MINI IMPLANT DESIGN
• Diameter of 1.8mm to 2.9mm.
• Various lengths.
• Multiple tip, thread, body and head designs are available
• Thread designs vary from thin to thick and thread spacing is
also variable.
• Square, rectangular, or o-ball heads are common.

27. MINI IMPLANT -indications
• Endentulous patients that have loose
lower dentures.
• Where extensive surgery required
for conventional implants is
contraindicated due to medical or
age constraints.
• Healing time is decreased.
• Lower costs

28. • Fixed crown and bridge….
• Proper case selection is critical but the
available literature has demonstrated
success that rivals standard implants.
• Transitional stabilization

29. PROCEDURE
• Available in 6 lengths: 6, 8, 10,13, 15 & 18
• Typically inserted directly through the overlying gums and into
the bone beneath
• No need to surgically cut and raise flap
• A single minimally invasive surgery is needed for insertion of
MDI implants
• Immediate loading done due to self tapping design.

30. PROCEDURE
• Each of the tiny implants is
held in finger driver that
inserts the implant and also
acts as screw driver.
• Next a winged wrench is used
to tighten the implant
• Possible to provide mini
implant treatment in single
dental office visit.

31. TRANSITIONAL IMPLANTS
• Diameter ranges -1.8 to 2.8
mm
• Length -7mm to 14mm.
• Fabricated with pure titanium
in a single body with treated
surface.
• Primary function is to absorb
masticatory stress during
healing phase

32. Advantages
• Provisionalisation of fully and partially edentulous jaws
• Undisturbed healing of bone grafts
• Immediate loading not possible but patient insists for fixed
transitional prosthesis
• Effective way to generate aesthetic transitional appliances
• Allows evaluation of phonetics and function.
• Cost effective.

33. Contraindications
• Depth of supporting bone is less than 10mm with insufficient
cortical bone to provide implant stabilization.
• Patients with excessive bruxism.
• When placement of sufficient number of transitional implants
is not possible…..
• Should be used with caution : Placed 1.5 to 2.5 mm from
definitive implants….

34. COMMERCIALLY AVAILABLE
TRANSITIONAL IMPLANT SYSTEMS
• Immediate Provisional Implant System –IPI (Nobel Biocare)
• Modular Transitional Implant System -MTI (Dentatus)
• TRN/ TRI Implants (Hi Tec implants)

35. ONE PIECE IMPLANTS
• Abutment and implant body in one piece
and not separate
• Material: Titanium Alloy – Ti-6Al-4V
• Diameter: 3.0mm Lengths: 12, 15 and 18mm.
• Maximum Strength - Minimum Profile.
• Minimal Surgery - Maximum Esthetics.
• Availability : Biohorizon 3.0 , Nobel direct ,
Zimmer’s one piece implant.

36. INDICATIONS
• The long-term treatment of missing
maxillary laterals and mandibular incisors.
• For treatment of spaces that cannot be
handled with larger two-piece implants….
• Also used for overdentures.

37. Biologic width Around One- And Two-Piece
Titanium Implants.
Hermann J. S, Cochran D. L., Buser D., Schenk R. K. and Schoolfield J. D
• Histometrically examined peri-implant soft tissue dimensions
• Conclusion: Gingival margin (GM) is located more coronally
and Biologic Width (BW) dimensions are more similar to
natural teeth around one-piece nonsubmerged implants
compared to either two-piece nonsubmerged or two-piece
submerged implants.
Clinical Oral Implants Research 2001, 12: 559–571.

38. SURFACE MODIFICATIONS
• Increase possibility of rigid fixation
• Promote higher percentage of bone – implant contact
• Proven to increase bone bonding strength
Three general techniques used to modify surfaces:
- Add material,
- Remove material
- Change the material already present.

39. Addition
• Thick coatings - sol-gel and plasma-spraying
• Thin film coatings (sub-micron) - vapor deposition
techniques, where the coating material condenses onto a
surface from a vapor.
• The three basic vapor deposition techniques are:
i. evaporation,
ii. sputtering and
iii. chemical vapor deposition.

40. Removal of material from surfaces
• Glow discharge treatment
• Sputter-etching.

41. • Changed without addition or removal of material by use of
laser and electron beam thermal treatments.
• Ion implantation can be used to add material to surfaces,
modify coatings, and change microstructures

42. Surface modification for
metallic implants
• These treatments include passivation, anodization, ion
implantation, and texturing.

43. PASSIVATION
• Purpose: enhancing the oxide layer present and creating a
surface less likely to break down and release metallic ions in
service.
• Passivation of a surface with the action of an electric current
is known as ANODIZATION….resulting in much thicker oxide
layers…..
• IMPORTANT for highly roughened surfaces, since the
increased surface area has the potential for greater release of
metallic ions into the surrounding tissue.

44. • Surface texturing of an implant is done to increase the surface
area and provide a greater potential for interlocking with
bone.
• Blasting with aluminum oxide or other ceramic particulate
materials, plasma spraying with titanium and acid etching.
• Recently, a resorbable ceramic-blasting material has been
developed…….

45. Ceramic implant surface
• High-strength ceramics used for
implants are very inert in the
body and exhibit minimal ion
release.
• Aluminum oxide is regarded by
many as the standard inert
material……..

46. • The ionic ceramic surface is in a high
oxidation state, thermodynamically stable
and hydrophilic
• Minimal ion release has been noted for
aluminum oxide or zirconium oxide under
normal conditions.
• Coatings may also include biologic coatings
such as proteoglycans, bone morphogenic
proteins and growth factors

47. Zirconia
• Zirconia (Zr02) is a ceramic material used
in implantology because:
• Biocompatibility(bio inert)
• Esthetics (because its colour is similar to the teeth), and
• Mechanical properties, which are better than alumina.
• High resistance to corrosion, flexion, and fracture
• Contact with bone and soft tissue similar to that observed in
titanium implants
• It can be used to produce a entire implant or as a coating.

48. Carbon and
Polymeric implant surfaces
• Carbon has been shown to exhibit an inert and biocompatible
surface when exposed to blood or tissue.
• The carbon structure used for dental implants is known as
turbostratic and is a modified graphite structure.
• Polymeric surfaces are not commonly seen for dental
implants.
• Designed to act as a shock absorber, but this polymeric
element requires periodic replacement due to wear.

49. Surface enhancers
• Bioactive surface coating
Plasma spray - titanium
- hydroxyapatite
• Sand blasted
• Acid etched

50. Hydroxyapatite
• Properties of HA composites is highly dependent on the
particle size and morphology of the HA filler.
• HA of sufficient fineness should be developed.
• RF induction suspension plasma spraying with a wet
suspension of HA.

51. NanoTite ion beam modification of
titanium surface
• Modified with a thin 1 micron thickness of calcium phosphate
with HA- like chemistry for bone enhancement
Ion beam deposition

52. Loaded HA Coated And Grit Blasted Titanium
Implants
Block MS, Finger IM, Fontenot MG, Kent JN
• Comparative study of bone response to HA-coated titanium
surface and two titanium surfaces.
• He found that bone formation and maturation clearly
occurred at a faster rate and earlier periods on HA coated
implants than on non-coated implants, they are stable both in
vivo and in vitro.
• He concluded that HA-coated dental implant results in
superior bone bonding, earlier biointegration, and better
maintenance of crestal bone than titanium surfaces.
Int J Oral Maxillofac Implants 1989,4:219-225

53. Red Blood Cell And Platelet Interaction With
Titanium Implant Surfaces
• The influence of the micro-roughened surface, produced by
dual acid-etching (DAE) of machined commercially pure
titanium, on initial blood cell/implant interactions .
• Micro-roughened DAE implant surfaces showed, qualitative,
more platelets than machined surfaces, while the textured
glass surfaces demonstrated increased platelet aggregation.
• They believed that these early blood cell/implant interactions
may play a key role in the osteoconduction stage of peri-implant
bone healing response to micro-roughened implants.
Clini Oral Implants Res 2000,Dec 11(6);530-9
Park JY, Davies JE

54. The Advantages Of Coated Titanium Implant Prepared
By Radiofrequency Sputtering From Hydroxyapatite
David R. Cooley, Adrian F. Van Dellen DVM, John O. Burgess and A. Stewart Windele
• Investigated and compared the healing rates of bone around
commercially pure titanium implants and titanium implants
sputter-coated from a hydroxyapatite target.
• Histologic analysis of the bone-implant interface
demonstrated that coated implants had nearly twice the
percentage of direct bone contact compared with non coated
implants.
• Accelerate the healing of bone at the implant interface.
J Prosth Dent 1992(1);93-100

55. Bone Reaction Adjacent To Microplasma Sprayed Capo4
Coated Oral Implants Subjected To Occlusal Load, An
Experimental Study In The Dog ; Short Term Results
R. Junker , P. J. D. Manders , J.Wolke , Y. Borisov and J. A. Jansen
• Investigated, in a mandibular dog model, bone biological
properties and the occlusal loading effects of titanium
implants provided with newly developed microplasma-sprayed
CaP coatings.
• Functional loading of MPS CaP coatings induces a favorable
bone response.
Clinical Oral Implants Res 2010

56. Bone Formation Of Titanium Porous Oxides
(TiUnite ) Oral Implants In Type IV Bone
Huang YB, Xiropaidis AV, Sorensen RG, Albandar JM, Hall J, Wikesjo UM
• Evaluated the local bone formation and osseointegration at
TPO- modified implants in type IV bone.
Result-
TPO surface possesses a considerable osteoconductive
potential promoting a high level of implant osseointegration
in type IV bone in the posterior maxilla
Clinical Oral Implant Res 2005, Vol 16 Issue 1 ;105-111

57. TO BE CONTINUED.....

59. Advances in commercially available
implant systems
• Biohorizon
• Nobel biocare
• Astra tech
• Straumann

60. BIOHORIZON IMPLANT SYSTEM
• LASER- LOK TECHNOLOGY
• Unique surface characteristics
• Laser-Lok microchannels is a series of cell-sized
circumferential channels that are precisely created using laser
ablation technology.
• Extremely consistent microchannels that are optimally sized
to attach and organize both osteoblasts and fibroblasts.
• Includes a repeating nanostructure that maximizes surface
area and enables cell pseudopodia and collagen microfibrils to
interdigitate with the Laser-Lok surface.

61. • Biologic response :
• The inhibition of epithelial downgrowth and the attachment of
connective tissue (unlike Sharpey fibers).
• This physical attachment produces a biologic seal around the
implant that protects and maintains crestal bone health.
• More effective than other implant designs in reducing bone
loss.

62. • Different than other surface treatments
• Virtually all dental implant surfaces on the market are grit-blasted
and/or acid-etched.
• These manufacturing methods create random surfaces that
vary from point to point on the implant……..
• The clinical advantage
• The Laser-Lok surface has been shown in several studies to
offer a clinical advantage over other implant designs to
reduce bone loss by 70% .

63. • Latest discoveries
• Laser-Lok abutments
• Create a biologic seal.

64. NOBEL BIOCARE SYSTEM
NobelReplace™ Tapered Groovy
implant
• NobelReplace™ Tapered Groovy implant is shaped to
resemble a tooth root.
• New and unique grooved threads implant.
• Since bone forms more rapidly in the grooves, the Groovy
implants integrate faster
• Tapered design makes surgical procedure exceptionally simple
and predictable – especially for immediate placement after
extraction.

65. INDICATIONS
• For immediate placement after extraction.
• Whenever immediate or early loading is applied.
• The Groovy implants are preferred over models without the
groove in soft bone conditions.

66. Advantages of groove pattern
• Faster integration with grooves
• Bone formed preferentially within the grooves, compared to
other parts of the implant
• Enhanced osseoconductive properties of the grooves and a
guiding effect on bone forming cells
• Up to 30% increase in stability……
Scanning electron
microscopic
images of TiUnite®
implant with
a groovy at the thread
flank.

67. NobelReplace™ Tapered Groovy implant on the
collar
• Grooves extended to the collar of most new implants so they:
• Increase surface area
• Increase area for bone to-implant contact

68. The NobelSpeedy™ implant
• Features:
• Parallel walled implant
• Slightly tapered design
• TiUnite® surface provides accelerated
osseointegration over machined surface
implants .
• Narrow tip makes it perfect for flapless
surgery
• Primary stability at time of implant
placement.
• Shortening treatment time and speeding
recovery.

69. • NobelSpeedy™ implant for flapless surgery
• The innovative head design makes this implant ideal for
flapless surgery.
• Head is the same diameter as the implant body…
• Inspection of the bone margin is impossible when working
flapless……
• Preventing the use of countersinks preserves cortical bone.

70. • NobelSpeedy™ implant for Immediate
Function
• The innovative implant tip is sharp so the implant works as an
osteotome…….
• This feature allows variable, and if needed, extensive under-preparation
of the site.
• The resulting higher initial stability, especially in soft bone,
supports immediate function.
• The sharp tip also secures a smooth insertion…….

71. • Since the implant cuts through any bone quality it's especially
suitable for grafted bone.
• The bone graft can be of various density levels, and the
ability to under-prepare gives the necessary flexibility when
preparing the grafted site.
• The implant will cut even in under-prepared block graft sites.

72. • NobelSpeedy™ implant -esthetics
• The parallel-walled body and innovative head of
NobelSpeedy™ secures flexibility in the final vertical position
of the implant, which is important for the emergence profile.
• It provides the possibility to increase torque and place the
implant further down without repeating the drilling
procedure.
• Especially important when working with internal connection
implants where only 3 positions allow optimal esthetics.

73. NobelSpeedy™ Replace
• Narrow Tip ,Sharper Chamfers
• Internal Abutment Connection
• Slightly Tapered
• TiUnite® all the way up
• Extremely Short Drill Protocol
• Grooves on threads
• Increased initial stability in soft bone

74. NobelSpeedy™ Groovy
• Same benefits as NobelSpeedy™
Replace.
In addition:
• External Abutment Connection
• Including Shorty implant
NobelSpeedy™ Shorty (7mm)

75. NobelActive™ Implant
• NobelActive™ implants don't cut
through bone like conventional implants,
they gently press through it like a
corkscrew.
• This bone condensing capability delivers
high initial stability.
• The narrow neck is designed to preserve
marginal bone and promote long-lasting
soft tissue stability.

76. • The self-drilling ability of NobelActive™ implants allows it to
be inserted into sites prepared to a reduced depth.
• This is useful where sites are close to vital anatomical
structures: the mandibular nerve canal or the maxillary sinus,
and nose cavity.
• Operator can be confident of accurate placement while having
a minimally invasive procedure.

77. NobelActive™-Advantages
• Potentially fewer drilling protocol steps, depending on bone
density and quantity .
• Minimal osteotomy with minor trauma to bone and
surrounding tissues .
• High stability in fresh extraction sites and sites with thin sinus
floors.
• Immediate placement in the esthetic region, even when
buccal bone plate is very thin
• Excellent stabilization in wide sockets…..

78. • Excellent stabilization in soft bone…
• Adjustment to small changes for parallelism – using the self-drilling
capacity…..
• A narrow neck designed to preserve marginal bone.
• Grooves on threads and scientifically proven Tiunite™ surface

79. NobelSpeedy™ Shorty
• Shorty implant (7mm)
• Narrow Tip
• Slightly Tapered
• Grooves on threads
• The implant for flapless surgery
• Extremely Short Drill Protocol
• Immediate Function
• Increased initial stability in soft bone
• Optimal Emergence Profile and Esthetics
• TiUnite® 'all the way up'

80. NobelPerfect™
• NobelPerfect™ is a unique, anatomically designed implant for
esthetically demanding areas from premolar to premolar.
• The interproximal bone may be preserved ……………
height discrepancy between the facial and interproximal…
• The anatomic design and the unique implant surface,
TiUnite™, give esthetic support and an effective barrier
against the oral cavity.

81. • Scalloped bone apposition area follows
three-dimensional osseous contours.
• Scalloped soft tissue apposition area
allows for the development of the biologic
width around the entire neck of the
implant.
• Scalloped prosthetic table follows three-dimensional
soft tissue topography.

82. The NobelPerfect™ One-Piece implant
• The NobelPerfect™ One-Piece implant is
machined from a single piece of titanium…..
• The scalloped TiUnite surface contour at the
implant neck follows the same principles as for
the original NobelPerfect™.
• The One-Piece design allows placement
flexibility of the implant…
• With this design, the soft tissue is supported
entirely by the implant body, irrespective of the
shape of the osseous ridge.

83. NobelDirect Implant
• The NobelDirect Groovy implant features a revolutionary new
one-piece design that is
• user-friendly,
• cost-effective,
• biologically sound and
• esthetically stable.
• The implant is machined from a single piece of titanium,
incorporating both the implant body and an integral fixed
abutment.

84. NobelGuide™ Zygoma Implant
• Using Brånemark System® Zygoma implants with
NobelGuide™ enables use of CT scan data as the basis for
surgical planning in a 3D computer environment.
• From computer-based planning…one or two Surgical
Templates, depending on the nature of the case….flapless
surgery.
• Immediate Function

85. Astra Tech implant system
• OsseoSpeed™ -chemically modified titanium surface,
• Providing unique nano scale topography,
• Stimulates early bone healing and speeds up the bone healing
process.
• The result of the micro-roughened titanium surface treated
with fluoride is increased bone formation and stronger bone-to-
implant bonding.

86. Astra Tech implant system
• MicroThread™
• The neck of Astra Tech implants are
designed with MicroThread that has
minute threads that offer optimal load
distribution and lower stress values.

87. Astra Tech implant system
• Conical Seal Design™ a strong and
stable fit
• Conical connection below the marginal bone
level transfers the load deeper down in the
bone…….
• Reduces peak stresses and thereby
preserves the marginal bone.
• Seals off the interior of the implant from
surrounding tissues, minimizing micro-movements
and micro-leakage.

88. • Simplifies maintenance and ensures reliability in all clinical
situations.
• The tight and precisely fitting implant-abutment relation......
• The abutment is self-guiding and the installation procedure is
non-traumatic, eliminating the risk of bone damage.

89. • Connective Contour
• The Connective Contour™ is the unique
contour that is created when you connect
the abutment to the implant.
• This contour allows for an increased
connective soft tissue contact zone both
in height and volume…
• Sealing off and protecting the marginal
bone.

90. Straumann SLActive implant
• Chemical modification to
a sandblasted, large-grit,
acid-etched (SLA)
implant surface.
• Hyrdophilicity
• Protein adsorption

91. • Enhanced osteoblast activity
within the first weeks
• Enhanced angiogenesis and
bone healing within the first
days after contact with the
new surface.

93. • More bone apposition
on surface
• Higher implant stability .

94. Advantages
• This surface reduced the average healing time from 12 weeks
(TPS surface) to only 6-8 weeks.
• Molecular optimization and the substantial reduction of the
average healing time from 6-8 weeks to 3-4 weeks,

95. Straumann Roxolid Implant
• Roxolid® is a homogenous metallic alloy composed of the
elements titanium and zirconium.
• Higher tensile strength compared to pure titanium.
• Important when small diameter implants are chosen due to
their reduced size.
• Roxolid® and SLActive® combine high strength with excellent
osseointegration.
• Roxolid® implants have been used where
3.3mm titanium implants
previously were not suitable.

96. SURGICAL GUIDES
• Surgi Guides are computer-generated drilling guides that are
fabricated through the process of stereolithography.
• The SurgiGuide concept is based on the presurgical treatment
planning using SimPlant software for ideal implant
positioning.
• These successive diameter surgical osteotomy drill guides may
be either bone, teeth, or mucosa-borne.

97. • Surgi Guides have metal cylindrical
tubes that correspond to the number of
desired osteotomy preparations and
specific drill diameters.
• The diameter of the drilling tube is
usually 0.2mm larger than the
corresponding drill, thus making angle
deviation highly unlikely.

98. Steps in using SIMPLANT software
Step 1
The scan
• Connect to the Dental Planit button in
your SimPlant GO software to start a
case.
• A radiolucent bite index used to
stabilize jaws at the time of scanning.
• Create an open bite with no overlap in
the horizontal plane.

99. Steps in using SIMPLANT software
Step 1
The scan
• Digital information on the desired tooth-setup
is obtained via the wax-up created
on the plaster model.
• When your patient has been scanned,
your image conversion provider takes an
optical scan of the plaster model and
wax-up and integrates them with the
scanning images.

100. Steps in using SIMPLANT software
• The image conversion saves you valuable
time and ensures that the CT images are
easy to read.
• Exact tooth information – no scatter
artefacts.
• Desired tooth setup – via the plaster model
wax-up (optional).
• Soft tissue information – be able to
measure mucosa thickness.
• Indication of the alveolar nerve –result is
EASY verification.
• Exact sinus information – 3D
representations included.

101. Steps in using SIMPLANT software
• Step 2
• The planning in SimPlant®
• SimPlant file.
• 3D representations of
patient’s anatomy, alveolar
nerve, sinuses, plaster model
and desired tooth setup.
• Plan and communicate

102. Steps in using SIMPLANT software
• Step 3
• The SurgiGuide®online order
• The high resolution optical scan of the
plaster model in SimPlant is used to
design a perfectly fitting SurgiGuide.
• Specialized design team reviews and
designs a custom made SurgiGuide
which is fabricated with high precision
3D printing process.

103. Steps in using SIMPLANT software
• Step 4
• Surgery
• SurgiGuide is delivered
with the drilling and
installation protocol.
• Disinfect the SurgiGuide
before surgery

104. NobelGuide
• NobelGuide is a complete
treatment concept for
• Diagnostics,
• Prosthetic-driven treatment
planning and
• Guided implant surgery – for
a single missing tooth to an
edentulous jaw.

106. NobelClinician Software
• NobelClinician Software is the next generation software for
• Digital diagnostics and
• Treatment planning.
• Through various pre-defined workspaces any DICOM file can
be reviewed and analyzed.
• NobelClinician Software facilitates team collaboration and
comes with an unparalleled ease of use.

107. • NobelClinician
Software supports
the NobelGuide
concept.
• 3D radiographic
data

108. CAD/CAM in implant dentistry
• Uses
• Used in designing of prosthesis
• Used in milling /fabrication of prosthesis(framework)
• For milling of abutments.
• Advantages:
• Superior fit
• Less degree of rotational freedom so more accurate implant
abutment connection.

109. CAD/
CAM
system
Provider Implant restoration
type
Restoration
material
Procera Nobel
Biocare
Abutments
Fixed partial
denture
frameworks
Milled bars
Titanium
Alumina
Zirconia
Atlantis Astra
Tech
Abutments Titanium
Titanium with gold
coating
Zirconia
Encode Biomet 3i Abutments Titanium
Titanium with gold
coating

110. CAM
StructSURE
Biomet 3i Milled bars Titanium
CARES Straumann Abutments Titanium
Zirconia
Etkon Straumann Frameworks
Abutments
Zirconia
Titanium
BioCad BioCad
Medical
Abutments
Milled bars
Titanium

111. CAD/CAM Custom Implant
Abutment Systems
• The Procera system (Nobel
Biocare) :
• Custom abutments in titanium,
alumina, and zirconia.
• A master cast is developed after
making an implant-level
impression.
• Scanned and the custom abutment is
designed by a 3d cad pro-gram.

112. • A machined base cylinder is
screwed to the implant analog and the abutment is waxed up.
• The pattern is then removed from the master cast and scanned
by the Procera scanner.
• The design is sent to the production facility for the abutment
fabrication.
• The abutment can be further digitized, and finally a titanium or
ceramic coping is
produced using the same system.

113. CAD/CAM Custom Implant
Framework System
• Procera implant partial
prostheses are available in
zirconia or titanium.
• CAD/CAM custom Procera
partial prostheses are screw-retained
implant-supported
restorations that can be used
with a wide range of
implant systems.

114. • The zirconia implant prosthesis is available at the implant level,
while the titanium implant prosthesis is available at the implant
and abutment levels .
• Using acrylic resin, a framework pattern is fabricated
directly on temporary implant cylinders.
• The acrylic resin framework pattern is then laser scanned, and
the framework is milled in a CNC-milling machine with 5
degrees of freedom.

115. • CAM StructSURE
precision milled bars
(Biomet 3i)
• Hader and Dolder designs for
over-denture bars and primary
bars and in fixed hybrid designs.
• Technician does not need to wax
or resin design the framework;
instead, the design is made on-screen
with a sophisticated
software program.

116. • The Etkon system can
produce frameworks up
to16 units from a variety of
materials, such as zirconia
and titanium.

117. Newer concepts in
implant dentistry
• All on four
• Rescue implant concept
• Teeth in an hour concept

118. ALL ON FOUR -Maxilla and mandible
• The All-on-4 for edentulous jaws has
been developed to maximize the use
of available bone and to allow for
Immediate Function
• Using only four implants in
edentulous jaws…..

119. • All-on-4 using
conventional flap
procedure with
traditional planning
and a standardized
All-on-4 Guide for
predictable and
optimal positioning
of the implants.

120. • All-on-4 with NobelGuide using
flapless technique, computer-based
planning and a customized Surgical
Template to correctly drill and
position the implants.

121. Zygoma implants
• The zygomatic implant is an alternative to bone grafting in
extremely resorbed maxilla.
• With extremely resorbed maxillas, fixed prosthesis can be
provided with four zygomatic implants.
• Either a conventional two stage procedure or a one-stage
surgical procedure or flapless guided surgery with Nobelguide
and immediate function.

122. Zygoma implants
• The four zygomatic implants procedure results in
• Less morbidity,
• Shorter delays between anatomical reconstruction and
functional rehabilitation
• Provide immediate or early loading with immediate function.
• Four zygomatic implants and a fixed bridge seem to be a
valuable technique for the rehabilitation of extremely
resorbed maxillas.

123. Teeth in an hour concept
• With conventional treatment…..
• Teeth-in-an-Hour™ allows the possibility to provide patients
fixed, well-functioning, and esthetic prostheses on implants in
less than an hour.
• With flapless technique…..with greatly reduced healing time,
no temporaries and no significant pain or swelling.
• With the NobelGuide system, allows replacing missing teeth
with permanent dental implants – easily, quickly and
comfortably.

124. CONCLUSION

125. References
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126. References
• 6. Christensen, GJ; Swift, Edward J. (2008). "Mini implants: Good or bad
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127. References
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128. References
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129. Thank you