OCO Biomedical Presents The Next Generation of Endosseous

Implants

RestoringRestoringOCO BiomedicalOCO BiomedicalDental Implant Dental Implant

SystemsSystems

[[RESTORATIVE PROCEDURE RESTORATIVE PROCEDURE AND LAB TECHNIQUEAND LAB TECHNIQUE]]

I-Mini, ISI Complete One-piece, I-Mini, ISI Complete One-piece, TSI & ERI Two-piece Dual StabilizationTSI & ERI Two-piece Dual Stabilization™™ Implants Implants

May 3, 2023

THE DIRECT TECHNIQUETHE DIRECT TECHNIQUE

The ISI Complete and TSI Immediate Load Dental Implant System

ISI Complete• Direct restorative only because it is a one-

piece implant and abutment• Temporized and load/function after being

placed

TSI (or ERI) with solid abutment

• Two-piece implant with Morse taper lock• 6-8 Position indexed interface• TSI can be restored by either the Direct or

Indirect Methods• All Two-piece abutments have 6 or 8

position indexing

Available: Three + Restorative Systems

• 1 Direct and 2 Indirect and 3 modified indirect

• The Conventional Two-piece Abutment System

• Shielded margin abutment

• 6-8 position indexed interface

80%+ of cases can be loaded immediately and put in function after placement!

TRIP: Tissue Retraction Impression Pickup For Direct Restorative Technique

For straightabutments

For offsetabutments

Dual Stabilization® Implant System

• TSI Abutments

IOT / O-Ball Parallel Wall (Indexed)

15 degree Offset C&B

Straight Skirted& Offset Skirted &Soon, scalloped-

contoured

Healing Cuffs

UMA UMA Healing Cuff

TSI C&B Taper/ Straight

ScallopedSkirted

Abutments

Indexed & Non-Indexed Waxing

Sleeves

Fixed CB Solid Abutments (4mm, 5.5mm, & 7mm heights)

IOT Over Denture Abutments (0mm, 2mm, 3mm, & 4mm heights)

Locator Abutments (.07mm, 2.0mm, 3.0mm, 4.0mm, 5.0mm, & 6.0mm heights)

Shielded Abutments (straight & 15degree offset) Long & Short Available

Pedestal Abutments (Straight & Offset)

• The ISI Implant 1 to 2 months after placing

• The ISI & TSI with solid abutment use the same direct method

Ready to restore

ISI & TSI Implant Restoration: Direct Method

• Snap the TRIP (tissue retraction impression pickup) onto the Implant collar to prepare it for taking the impression

ISI & TSI Implant Restoration: Direct Method

• Make sure the TRIP displaces the gingiva and snaps over the top of the collar of the implant

ISI & TSI with Pedestal Abutments Implant Restoration: Direct Method

TRIP Impression

• Inject medium bodied impression material into the top of the TRIP until it flows from vents

• Cover the impression pickup (TRIP) by flooding the area around it with medium body impression material

Cover the TRIP

• With heavy body or putty, complete the impression using a standard or triple-tray

Complete the Impression

• When set, remove tray• The TRIP is picked up into the

impression

Remove the Tray

• Use the solid analog when the abutment is not modified

• Use the Margin Analog (MA) when the abutment is modified

Modified vs. Non-Modified Abutments

• The lab model with the solid brass analog is used when the abutment is not modified

• The Margin Analog (MA) is used when the abutment is modified vertically or for the TSI with an offset abutment

Lab Models

• Fill MA with hard implant stone, epoxy die material, composite, etc.

• Pour the rest of the impression with die stone

Lab Models

Margin Analog Example

Tissue Retraction Impression Pickup Snapped over the

abutment

Take an impression

Indexing will be captured in the impression

Using the margin analog tool, gently dab the margin analog

into the impression

The lab will pour in Polyurock and it will harden to replicate the abutment

• The Acrylic Coping (AC) is used under temps for perfect marginal fit and as a base for wax-up prior to casting the metal coping for the final crown

Acrylic Coping (AC)

Acrylic Coping (AC)

• Wax-up & casting on working and tissue model using the AC as a base for a perfect marginal fit

• AC to final PFM crown

Acrylic Coping (AC)

• Final restoration completed and cemented into place with an excellent fit and emergence profile

• Precision fit comes from the machining of the AC to match the margin at the implant abutment interface

• Easier than conventional crown procedures and construction

Final Restoration Complete

Oops – implant placed out of alignment? Or need to accommodate anatomy or emergence profile?

TRIPTRIPOFF-SETOFF-SETTRIPTRIP

Alignment Correction

• Use the 2 piece off-set abutment to align and the off-set trip for the impression

• The TSI Two-piece implant must be used

• The top of the off-set TRIP is perpendicular to the implant

• Straight pressure retracts the tissue and easily snaps over the top of the collar and around the margin with clearance for the off-set abutment

Alignment Correction: Offset TRIP

• The mal-aligned implant is now aligned with other ISI or TSI implants with one piece straight abutments or adjacent natural teeth

Alignment Correction

• Inject medium or regular bodied impression material over and around the abutments

TRIP Impression

• Snap the straight and off-set TRIPs over the abutments until you feel the ends stop firmly on the top of the collar of the implants

TRIP Impression

• Flood the area around the trips with more medium bodied impression material

• Then complete the impression using heavy bodied or putty

Complete the Impression

Pull the Impression

• Pull the impression• Snap in a solid analog and a two-piece analog

Working Model

• On an anterior tooth, the straight abutment may be out of alignment with the other teeth

• Put in an offset abutment• Take your impressions

Anterior alignment : TSI, ERI Implant

Model

• Create the soft tissue model by putting soft tissue material around the analog

• Fill the rest of the model with die stone• Then the crown is made on the model

Case Example: Simple Direct Restoration of an ISI, One-Piece and TSI with a Solid Abutment

Pre-op

Surgical removal and grafting

6 wks postop

4 mo postop

Ceka Bond (from Preat) placed on threads of the solid, C&B abutment

Solid abutment threaded into TSI Implant

Abutment torqued to 30 N/cm

TRIPS (Tissue Retraction Impression Pickups) “snapped” over the abutments onto the implant’s margin.

Flood Impression material through the occlusal opening and out the vents of the TRIP

TRIPS are pulled out into the impression perfectly capturing the margin and indexing

of the implant/abutment

Solid Analog Modified to match the vertical height on the abutment of the implant

Analogs engaged in the Impression

Models poured, trimmed, ACs placed on analogs, crowns cast, porcelain added and finished. Easier than a conventional crown!

Crowns cemented

Finalized case. Total lab fee $410.00 - $50.00 implant surcharge. The

surcharge was Removed

Restoring a 15 yr old case

TSI Implant Restoration: Example Cases

ISI & TSI Implant Restoration: Example Cases

ISI & TSI Implant Restoration: Example Cases

ISI & TSI Implant Restoration: Example Cases

Upper and lower Restored

But, Did She Like It, NO!Could Not Be Cleaned To Her Satisfaction ; so

Porcelain trimmed to make cleansable and softgingival prosthesis constructed

Case finalized and cleansable

• Chris – ready for the final restoration• Placing the offset TRIP to make sure it fits and snaps into

place

ISI & TSI Implant Restoration: Example Cases

• Cover the abutment with medium body impression material

ISI & TSI Implant Restoration: Example Cases

• Then flood the area with the impression material

ISI & TSI Implant Restoration: Example Cases

• A triple tray filled with heavy body or impression putty and the impression taken

ISI & TSI Implant Restoration: Example Cases

• Bottom of the TRIP penetrating out of the impression• Shows the depth of the top of the lingual side of the

implant

ISI & TSI Implant Restoration: Example Cases

Information: Margin Analog (MA)

• The Margin Analog (MA) used for offset abutments and modified straight abutments using the direct technique

• Engage the non-beveled end• Tool used to snap the MA into

the TRIP

• With the tool, snap the MA into the TRIP and fill it with acrylic, composite material or any flowable crown build-up material

Placing the MA

The Finished PMF Crown

Upper First MolarUpper First Molar

Upper First MolarUpper First Molar

Upper First Molar - SeatedUpper First Molar - Seated

Splinting Natural and Implant Supported Crowns

Use an Interlock , Small , Round, With No Stops. Allows Vertical Movement on Natural Tooth

Prepped Natural Tooth and Implants

Cemented Natural tooth and Implant Crowns

Completed Case

ISI & TSI Restorative Components For The Direct Technique

Tissue Retraction Impression Pickup (TRIP)

For straightabutments

For offsetabutments

Margin Analogs (MAs)

• Simple restorative procedures requiring minimal tools and components

Acrylic Coping (AC)

MA Placement Tool

One- and Two-Piece Analogs

RESTORATIVE PROCEDURE RESTORATIVE PROCEDURE AND LAB TECHNIQUEAND LAB TECHNIQUE

TSI/ERI Two-piece Dual StabilizationTSI/ERI Two-piece Dual Stabilization™™ Implants and Implants and the assortment of accessorythe assortment of accessory

Abutments that are modified, fitted, and made Abutments that are modified, fitted, and made ready along with the restoration by the dental ready along with the restoration by the dental

laboratory, to be delivered laboratory, to be delivered

[[The Indirect Technique – TSI &ERIThe Indirect Technique – TSI &ERI]]

Natural Contour Esthetic Abutment

Restoring Central Incisor with a Restoring Central Incisor with a 3mm Healing Cuff 3mm Healing Cuff

3mm Healing Cuff Removed 3mm Healing Cuff Removed

Placing the Impression CopingPlacing the Impression Coping

The IC is engaged by threading in the ball impression The IC is engaged by threading in the ball impression screw by hand or with a .050 hex driverscrew by hand or with a .050 hex driver

With the tip removed, Inject Medium Body Impression With the tip removed, Inject Medium Body Impression Material Around the IC and BallMaterial Around the IC and Ball

Complete the Impression with HeavyComplete the Impression with HeavyBody Material in a Triple or Standard TrayBody Material in a Triple or Standard Tray

Snap on the TSI AnalogSnap on the TSI Analog

If the I-TRIP is not removed with the impression, snap it into the TSI Analog, and then place both pieces into the boldly indexed impression area.

Snap Into The ImpressionSnap Into The Impression

Pour and Articulate a Soft Tissue Pour and Articulate a Soft Tissue ModelModel

Place a 2, 3, 4 or 5 mm Soft Tissue Healing Cuff to Maintain Place a 2, 3, 4 or 5 mm Soft Tissue Healing Cuff to Maintain the Emergence Profile the Emergence Profile

The Dental Lab Shapes, Sizes andThe Dental Lab Shapes, Sizes andParallels the Selected Abutment(s)Parallels the Selected Abutment(s)

With the Abutments Shaped, the Restoration(s) is Completed on the Soft Tissue With the Abutments Shaped, the Restoration(s) is Completed on the Soft Tissue ModelModel

With the Healing Cuff Removed, the Indexed Abutment(s) With the Healing Cuff Removed, the Indexed Abutment(s) are Positioned with the Locking Screw – 20 n/cmare Positioned with the Locking Screw – 20 n/cm

The Final Restoration(s) is CementedThe Final Restoration(s) is Cementedto Place and the Case is Finalizedto Place and the Case is Finalized

Conventional Construction of a Zirconium Core Crown total cost: $189.00

Open Tray Impression Open Tray Impression TechniqueTechniquefor the ERI or TSI Dental for the ERI or TSI Dental ImplantsImplantsUsing an impression coping and TSI/ERI Using an impression coping and TSI/ERI AnalogsAnalogs

Two ERI Implant Placed (Central Incisors)

Engage the Natural Contour Esthetic Abutments and Ball Impression Screws

Glob around abutments and screws with medium body impression material

Fill the tray with hard body impression material and take an impression

Remove the ball impression screws and abutments and thread them into corresponding TSI/ERI analogs

Snap the abutments and analogs into the impression as indexed

Place healing screws in ERI or use two more abutments and make Temps

Final Crowns

Tissue needed to be trimmed away

Abutments are torqued to 25 N/cm

[[Custom Abutment Custom Abutment ProcedureProcedure]]

ERI (or TSI) Dental Implant placed further than 15 degrees out of parallel

1mm healing collar is engaged for a period of healing

Remove the healing collar after implant integration

The Biotorq driver engages with the custom abutment and is used to fixate the abutment into

the implant

Biotorq Driver Custom Abutment Driver and Abutment engaged

Biotorq Driver threads in the fixed Custom Abutment

Torque the abutment to 30 N/cm

Engage the UCLA Impression pickup and position the flat side facially

Using the Thumb Knob and .050 hex driver, thread the ball impression screw into the UCLA Impression Pickup

Flood medium body impression material around the UCLA Impression Pickup

Use hard body impression material in the tray

Flat side of Impression Pickup is formed in the impression

Remove the UCLA Impression Pickup from the Custom abutment (in the mouth) and engage it to the Custom Abutment Analog

Warning!Do not remove the Custom Abutment or change its indexing. This abutment is to remain permanently

fixated into the implant

Snap the UCLA Impression Pickup and the Custom Abutment Analog into the impression

Match the flat side on the abutment to the flat side in the impression

Hand tighten Custom Abutment healing collar over the custom abutment with the same Thumb Knob and .050 hex driver

Impression with Custom Analog and Impression Pickup in place

Octa Waxing Sleeve used by lab for custom abutment

[[O-BALL OVERDENTURE O-BALL OVERDENTURE RESTORATIONSRESTORATIONS]]

Using the Dual StabilizationUsing the Dual Stabilization®® Implant SystemImplant System

Ready to Restore• 4-on-the-Floor™

Placement Technique: Four to six ISI Complete® (or 3.0mm I-Mini) One-Piece O-Ball or TSI/ERI Two-Piece (with O-Ball Abutments) Implants places (2 in lower anterior and 2 in lower quads) in the mandible.

• Have a good, new denture made with proper plane of occlusion and esthetics.

Step 1: For TSI, Attach O-ball Abutments

• For the TSI Implant, screw the O-Ball Abutments into implant bodies with O-Ball Driver (Cat# 0076 or 0076S).

Step 2: Take Impression• With ISI or ISD One-Piece

O-Ball Implants in place, or TSI Two-Piece Implants in place with O-Ball Abutments, take an impression directly of the O-Ball Attachment/ Abutment, or with female caps and O-rings in place (if driving square is sub-gingival).

Step 3: Full Arch Impression

• Use medium bodied impression material around the O-Ball Attachments and record a full-arch impression with standard (heavy) body material.

Step 4: Analogs

• Snap O-Ball analogs into the impression (in female caps if are used) and forward to the laboratory.

Step 5: Temporary Retention

• For the ISI or ISD One-Piece O-Ball Implants or the TSI Two-Piece Implants in place with O-Ball Abutments, use soft denture liner (PermaSoft) for denture retention while the new denture is being created or prior to final reline.

• Excavate the original denture and fill with soft denture liner.

Step 6: Lab Model

• The laboratory pours a working model using the O-Ball Analogs.

• For a new denture or reline, use a sound, previously constructed denture.

Step 7: Final Denture

• The laboratory will incorporate the O-ring encapsulators into the new denture or reline.

Step 8: Final Seating

• Seat new denture.• Final restoration is

complete.• After seating, if the

denture is too tight, the lumen of the O-ring can be enlarged by opening with a #6 Round Bur

In less than 2 weeks the healing looks great and he’s ready for a reline and the final female attachments

X

• The abutments are flooded with medium body impression material and the TRIPs snapped to place

• Do not use self curing acrylic to place attachments in the denture

Impression and TRIPs

The relieved denture is put to place and the patient guided into occlusion

O-ball analogs placed into denture with impression

Analogs in model on reline jig female attachments are now placed on the analogs before processing

Finished Denture after Reline

Dentures in place and ground into occlusion

Flanges are trimmed and the size of the denture is minimized

I-Mini IOT Restoration Case

O-Ball Overdenture: creating a Chrome framework

Snap Caps (with O-rings) on to O-balls. Take an impression if deep in tissue.

Do not place caps in impression (have lab pour model)

The lab will create a cast chrome cobalt framework to be incorporated for the model

The lab will incorporate the framework into the denture

Thank You Questions?

Q&A