1.

• If orthopedic and neurosurgeons doing hip replacement and spinal fusion have patients in function the same day, why should dental implants take3 to 6 monthsbefore function?

OCO Biomedical technology has made it a reality with the next generation of dental implants!

The OCO DUAL STABILIZATION Line of Dental Implants, bioengineered to encourage bone growth

2.

The 1938 Adams patent covers the general form of all of todays classic two-stage root form dental implants

Not even industry leaders have innovated or made any major improvements since the original 1938 patent was issued

1938 Adams 3. 1938 Adams patent for a two-stage endosseous root form implant Classic two-stage dental implants covered by the 1938 Adams patent

Examples of classic two-stage dental implants based on the 71 year old Adams U.S. patented technology:

Two-Stage Dental Implant Examples 4. Pinkie Adams 1938 Patent 1938 Adams patent for a two-stage endosseous root form implant

One company, for example, claims 40 years of inventions and technological advances:

Evolution of threaded implants, not muchchange until introduction of dual-stabilization 5. The ISI Complete ,TSI, and The ERIImmediate Load capableDual-StabilizationDental Implant System In 2002 OCO Biomedicalintroducedthe next generation of endosseous implants: July 20, 2010 Patent Pending 6. OCO Biomedicals Dual Stabilization Line designed to grow bone by compressing it with tension For a Predictable Immediate Load or 2 stage conventional Dental Implant Placement: 7. Product Overview Dual Stabilizationand how it works July 20, 2010 8. The Next Generation inImplant Technology

Dual Stabilization implant design:

• Creates a true mechanical lock at the top and bottom of the implant, ensuring immediate stability and superior osseointegration

• Durable, high-quality, immediate-performance implant and temporary crown in less than an hour in most cases.

Bull-Nose/ Auger Tip 9. OCO Biomedical Developed Many Changes ISI & TSI: Dual Stabilization for True Immediate Load Bull Nose Tip

The unique tip locks the apex of ISI Complete and TSI in medullar bone

1

Select surface treatment at tip: Apical portion of implant is not grit blasted to preserve cutting edge

Auger like thread pattern condenses bone after implant bottoms out by pulling it up and around the tip stimulating bone growth with tension

10. High-Powered Images Show the Superior Features of the ISI Complete & TSI Dental Implant and the Cortico-Thread & Taper locking the top

32x machined perio collar surface

Lighter grit blasted cortico-thread

High power illustrates fine machining of implant threads

10C um sem of proprietary surface treatment

Most porous in the industry

2 11. Advantages of OCOISI, TSI , andERIImplants

Innovator in Immediate Load/ Function Implant Technology: introduced in 2002

• Competitors re-engineering existing systems and force a larger implant into a smaller diameter hole. Or, a thread which increases in thickness along the long axis of the implant. Result, bone compression

• OCO system developed dual stabilization; unique bull nosed tip pulls bone from beneath the implant up around the tip(tension) which encourages bone growth. The wide diameter top with cortico treads locks the top at the crest of the ridge. Thus; eliminating a fulcrum along the body of the implant.

12. Advantages (contd)

Easy to use/learn system & instrumentation

Conventional flap & reflection or Single stage, flapless surgical procedure in less than 30 min

• Reduced patient chair time

• Increased patient satisfaction

• Why? No pain or swelling!

Extremely high success rate

• Unchallenged successes history, not one reported case of crestal bone loss or cupping since introduction!

Designed and manufactured in the USA

13. 2 Bio Horizon implants placed in upper and 2 OCO Biomedical TSI implants in lower 6 yrs ago s 14. Dual Stabilization Implant System

ISI Complete One-Piece Implant

• Crown & Bridge or O-Ball overdenture prosthetic options

• Diameters: 3.25, 4.0 & 5.0 mm

• Lengths: 8, 10, 12, 14 & 16 mm

• Complete system including implants, instrumentation, prosthetics and direct restorative components

• Now available, theLocatorfor over dentures

15. Dual Stabilization Implant System

TSI Two-Piece Implant System

• Variety of prosthetic options:

• • O-Ball/IOT, Straight C&B, Offset, Paralleled Wall, Pedestal, Skirted and other abutments

• Diameters: 3.25, 4.0 & 5.0 mm

• Lengths: 8, 10, 12, 14 & 16 mm

• Complete system including implants, instrumentation, prosthetics and restorative components

• Can be restored using direct or indirect technique with a very large variety abutment options

16. The Economical I-Mini & Micro mini Implant Systems for Economical DentureStabilization & Long Term Fixed Support

I- Mini : 3mm Mini Implant

Introduced 2002

• Crown & Bridge or O-Ball/IOT & prosthetic options

• Diameter: 3.0 mm

• Lengths: 10, 12 & 14 mm

• Complete system including implants, instrumentation, prosthetics attachments and restorative components

• Soon to be released, the Locator over- denture attachment & 8mm length

• Also, Micro Mini : 2.2mm @ 2.4mm Diam

17. Diagnosis and treatment planning

Medical and dental history

How did the patient loose the tooth or teeth

Pano or cone-beam cat scan x-ray

Study models

Model mapping on areas to be treated if needed

Identify bone type and density

Evaluate available bone in areas to be treated

Inform before you perform

Evaluate the patient expectations

Can you meet those expectations

Can anyone achieve the expectations

Encourage the patient to get a second or third opinion and estimate

18.

Evaluate study model for ridge width, alignment of adjacent teeth, if a dental implant can be placed using uncomplicated techniques.

19.

Section the model through the edentulous area and after estimating gingival thickness, map it.

20. Mount study models, mounted. A must for treatment planning andCase Presentation 21. Study models, mounted. A must for treatment planning andCase Presentation 22. Edentulous Mandible An immediate denture placed 17 yrs ago July 20, 2010 23. Pantographic X=Ray, a must for any implant case.Is there abundance of bone? 24. Model of lower, sectioned at the center and mapped 25. Zoll bone width measuring device 26. Bone Densities July 20, 2010 27. Anterior Bone Qualities

Lekholm and Zarbs four bone qualities for the anterior region of the jaws:

• Quality 1:Composed ofhomogenous compact bone

• Quality 2:Thick layer of cortical bone surrounding dense trabecular bone.

• Quality 3:Thin layer of cortical bone surrounded by dense trabecular bone of favorable strength.

• Quality 4:Thin layer of cortical bone surrounding a core of low-density trabecular bone.

D1 D3 D2 D4 28. General Bone Densities

Bone Density Classification by Misch & Judy

D2 D1 D4 D3 Bone Density Description Tactile Analog Typical Anatomical Location D1 Dense Cortical Oak or maple wood Anterior mandible D2 Porous cortical and coarse trabecular White pine or spruce wood Anterior mandible Posterior mandible Anterior maxilla D3 Porous cortical (thin) and fine trabecular Balsa wood Anterior maxilla Posterior maxilla Posterior mandible D4 Fine trabecular Styrofoam Posterior maxilla 29. Basics for fixed: 4 Main buttresses for fixed or implant supported teeth Ideal minimum Implant diameter Minimum implantlength 10 to 12 mm 30. A Dental Implant is not a natural tooth root

Vertical tooth movement: 25 to 100 m

Vertical Implant movement: 0 to 10 m

Proprioception: Tooth yes

Implant - no

Horizontal flex: Tooth yes

Implant - no

31. So, if not following the buttress parameters and ignoring the physical properties: 32. Edentulous upper left quadrant: Ideal implant placement 4.0mm bicuspid areas 5.0 mm 1 stmolar area 4 or 5mm 2 ndmolar 33. Bi-Lateral lower edentulous: R- normal ridge, L- narrow ridge TreatmentR- Ideal, 5.0mm atMolar, 4mm for bicuspids L- Narrow ridge- compromise, 2 3.25 At molar.3.25 in bicuspid Areas. Prosthesis, splinted crowns No wider than bicuspids,Lighter occlusion and noLateral interferences. 34. Edentulous upper and lowerTreatment: Stabilize lower dentureEconomy: I-Mini Implants

4 on the floor

3.0mm I-Mini implants

Placed between mental foramina

X X FOR A SIMPLE OVERDENTURE NEVER PLACE IMPLANTS IN THEPOSTERIOR REGION 35. To maximiseTo maximize A-P place markers in the denture, take a pano and establish the location of the mental foraminaOI IO 36. Implants placed and at least 3mm anterior to the mental foramina 37. Edentulous upper and lowerTreatment: Stabilize lower dentureOr, if the residual ridgePermits: moderate height,Wide ridge 4 to 6 standard sized 3.25 or 4mm Implants placed between the mental foramina,2 - 4.0 mm 2 3.25 mm Never! 2 Implants inCuspid Areas Crates a fulcrum The denture will rock 38. Edentulous upper and lowerTreatment: Stabilize lower dentureOr, if the residual ridgePermits:Tall, med width OR: 5 or 63.25 mm implantsbetween the mental foramina 39. Five implants placed comfortably in the safety zone by placing markers in denture first 40. Post- OpPano 41. In less than 2 weeks the healing looks great and hes ready for a reline and the final female attachments 42. Flanges are trimmed and the size of the denture is minimized 43. The Chronic Perio Patient Presents for Implants 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54. Simple Central Incisor Replacement 5 Years after Ortho 55. 56. 57. 58. 59. 60. 61. 62. 63. 64. 65. 66. 67. 3 Months after Home Treatment, Deep Scaling &Extractions 68. 69. 70. 71. 72. 73. 74. 75. 76. 77. 78. 79. 80. 81. 82. 83. 84. 85. 86. 87. 88. 89. 90. 91. 92.

Ask, How was the tooth lost?

Why did this patient loose his lower central incisor? 93.

The 3.0 diameter / 16mm lengthI-Mini(ISD) implant was placed and put into immediate function

Immediate Function 94.

Temp in place and put in immediate function without bonding to adjacent teeth

Time: 35 minutes

Immediate Function 95.

Extreme lower level tongue thrust:

8 lb pressure x2/ minute by day, X1 per min at night

Cause of tooth loss 96.

Final restoration in place

Implant with crown still in function

3 years post-op

Final Restoration in Place 97.

After 3 years, no appreciable bone loss

And theISI Completestill firm and functional

After 3 Years No Bone Loss and Stable 98. 8-6-096years post-op 99. IMMEDIATE PLACEMENT PROTOCOL AND PROCEDURE ISI Complete One-piece, TSI & ERI Two-piece Dual Stabilization Implants July 20, 2010

Two Musts:

Break through cortical bone lining the socket in the alignment of the implant to be placed

Set depth with pilot drill 2mm beyond apex of the removed tooth root

100. Establishing the path of implant insertion after removing the tooth or tooth roots 101. With a high speed drill, always break through the cortical bone lining the socket wall in the direction of implant alignment Use a # 8 surgical or XXL straight fissure burr/ water cooling only, no air 102. Use the pilot drill in the surgical HP aligned and go to the final depth 103. Select the implant diameter by placing the final drill into the socket. It must not drop more that half the selected length 104. Drill with osteotomy former to the final depth established by the pilot Drill 105. Implant placed with grafting material, if dual stabilization is present, ISI can be used. If not, a TSI must be used 106. An emergency visit for a loose UL Cuspid 107. UL Cuspid has a RCT With a post and core. Fractured root 108. 109. 110. 111. 112. 113. 114. 115. 116. 117. Impression taken the day the fractured root was removed and implant placed 118. 119. 120. 121. 122. 123. Temp placed the same appointment, Patient left the office with a tooth 124. 125. 126. 127. Zirconium core tried-in a month later 128. 129. 130. Final crown seated, note the emergenceprofile 131. 132. Case finalized 133. Patient: 87 yr old Female FriendFull lower, all remaining teeth to be removed 134. First surgery, all fractured teeth removed, implants immediately placed and voids grafted 135. All lower teeth removed, voids grafted and implants placed immediately using single stage flapless procedure in edentulous areas 136. Lower temp in place 137. Final PFM final splint. Stress breakers on distal of cupids and dove tail on LL 2 ndBi 138. Full upper and fixed lower 139. My 88 yr old friend no longer fears the horrors of a lower denture 140. Crown needed on # 31, large filling breaking down. Why not fill space with a simple pontic? 141. 3 Unit bridge? Then followed by constant pain, solution: RCT # 20 142. Pain persists, referred to endodontist 143. Bridge removed, molar sectioned and removed. Grafting and immediate placement of 5.0 X 10 TSI Implant 144. 4.0 X 12mm ISI placed at 30. Sutures removed , abutment and temp placed after 3 weeks 145. 6 Months post op, healing complete and 3 removed and grafted. 146. Healing after extracting # 3 with socket lift and bone grafting with pericardium barrier membrane 147. Teeth to be removed, 3 and 5. On which can an immediate implant be placed? 148. 1 stbicuspid removed buy teasing out with straight elevator and focepts 149. Root is not bifurcated and divergent, narrow and ideal for immediate placement 150. Place final drill to be used into socket, if half or less should bottom out to determine implant diameter to be used 151. Break through the cortical bone at the tip of the socket 152. Use the pilot drill to the final depth, in this case, 2mm beyond 153. Place colletape and bone into socket in case sinus was perforated and to fill gaps in final osteotomy 154. Use osteotomes to condense grated bone and open center for the implant 155. Driving the implant into the socket 156. Implant placed 157. Temp in place 158. Root tip and implant, sinus at the tip 159. Socket of 3 was elevated with a large osteotome, grafted, opening covered with pericardium and sutured 160. Implant placed in 5 and socket elevation and grafting on 3 to place a 5 X10mm Implant later 161. 5.0 X 10mm TSI placed 3 Mo Later 162. Thank You Questions? Q&A OCO Biomedical is a debt-free Company serving the dentalImplant Communitysince 1976