RBBMacchu Picchu. The lost city of the Incas Cuzco-Perù RBBSong: “Tribute to Ayacucho” . Interpret: Dr. Raul Garcia Zarate

COLEGIO ODONTOLÒGICO

REGIONAL DE LIMA

Programa Acadèmico Anual

Prof. Ricardo Benza Bedoya

RBB

Sistema de Implantes

Biohorizons

RBB

OBJETIVOS1.Comprender las

generalidades del sistema de implantes biohorizons

2.Explicar las innovaciones màs importantes del sistema de implantes biohorizons

“Quien tiene muchos vicios, tiene muchos amos.”Plutarco

6

Key features and benefits

• Proprietary Laser-Lok® microchannels†

• Anatomically tapered implant body

• Patented reverse buttress threads‡

• Proven internal hex connection

• Titanium alloy

†Laser-Lok design patent #6,454,569 and 6,419,491‡Reverse Buttress thread design patent #5,964,766

7

Resorbable blast texturing (RBT)

• Highly complex surface texture

• Increasedstability and osseointegration*

• Biocompatible resorbableblast media

*Sawase T, Wennerberg A, Hallgren C, Miuyamoto I, Albrektsson T: Atomic force microscopic study of commercially available implant abutments. Clin Implant Dent Rel Res 1(2):92-97, 1999.

8

Reverse buttress threads

• Wide, flat leading edge• Increased surface area• Improved axial load

distribution• Improved primary stability

Patent# 5,964,766

9

Anatomically Tapered

• 1-2mm of taper based on implant diameter

• Ideal profile for constrained spaces

• Improved primary stabilityApical 6mmtapered

10

Non-Laser-Lok (left) vs. Laser-Lok (right) 80 newton side load

Courtesy of Jack Ricci, PhD, NYU

11

Thread Design

• Defines the interaction between the implant and bone macrostructure

• “Machine screw” thread versus “wood screw” thread: – Machine screw thread: Screw and substrate have the

same or similar mechanical properties.– Threads are small, closely packed, and v-shaped.– Wood Screw: Screw and substrate are different

materials (substrate has lower stiffness).– Threads are larger, with larger pitch.– Threads designed to dig into the substrate.

Courtesy of Jack Ricci PhD (NYU)

12

Thread Design• “Wood screw” thread designed for axial compression

C

F

boneReverse buttress design has larger, deeper thread, and a lower surface face designed to provide compressive force rather than shear force.

S

Square thread similar

Courtesy of Jack Ricci PhD (NYU)

13

Laser-Lok® microchannels

• Controls epithelial downgrowth

• Attaches and retains crestal bone

Patent# 6,454,569 & 6,419,491

14

Old and New Microtextures

Machined surface RBT

Courtesy of Jack Ricci PhD (NYU)

15

Biologic width around natural teethminimal dimension – 3mm

1mmSulcus

1mmEpithelialAttachment

1mmConnectiveTissue

16

Biologic width around traditional implants

Tissue levelat the time

of placement

Bone levelat the time

of placement

Microgap

Is there a better way?

17

Tapered Internal with Laser-Lok

18

Laser-Lok – proprietary

• Only surface of its kind– Microgrooved surfaces for

mechanical stability

• Patented

• FDA cleared claims– Inhibit epithelial

downgrowth

– Attach/retain crestal bone

19

• Microgrooved surfaces produced from silicon wafer templates.

• Microgrooves inhibited colonization and caused directional colony formation (Contact Guidance).

• Optimal groove size for inhibition of fibroblast colonization was 6-12 µm width and >2 µm height.

Ricci JL, Charvet J, Frenkel SR, Chang R, Nadkarni P, Turner J, Alexander H: Bone Response to Laser Microtextured Surfaces. In: Bone Engineering, edited by JE Davies, Em2 Inc., Toronto, Ont. Canada, Chapter 25, 282-294, 2000.

In vitro studies of cell response to surface microtexture: cells on controlled microtextures

Courtesy of Jack Ricci, PhD, NYU

20

Supracrestal biologic widthwith Laser-Lok

Laser-Lok

microchannels

random

roughenedsurface

Tissue levelat the time

of placement

Bone levelat the time

of placement

21

GOAL: complete case management

SURGERY• CT• Intra-oral scanning• Surgical planning software• Surgical Guide• Instruments

IMPLANT• Biomechanically enhanced design• Surgical planning software

ABUTMENT• CAD/CAM• Restorative planning software • Standard and esthetic

CROWN• CAD/CAM• Restorative planning software• Traditional lab processes

23

Laser-Lok clinically supported – in vitro

1. 3-12µm microgeometries vs. random blasted surfaces

2. 1¾-12µm microgrooves, controlled

3. 2-12µm linear grooves vs. diamond patterns, controlled

4. 8 & 12µm parallel grooves vs. square posts, controlled

5. 8 & 12µm parallel grooves vs. square posts, controlled

6. 8 & 12µm microgrooves vs. random blasted surfaces

• Suppress fibrous encapsulation• Inhibit cell growth• Cell orientation & organization• Directed tissue response• Cellular contact guidance

HBE cell colony on smooth and MG8 surfaces

MG8 surface

Smooth surface

Human Bronchial Epithelial (HBE) Cells

Ricci

Courtesy of Jack Ricci, PhD, NYU

24

Laser-Lok clinically supported – human

1. Immediate, provisional load histology

2. Immediate, provisional load histology with sinus graft

3. Clinical, radiographic and histologic evaluation of hard and soft tissue attachment

4. Prospective, controlled, multi-center (37 mos. follow-up)

5. Prospective, randomized vs. Nobel and 3i (3 year follow-up)

• No epithelial downgrowth• Strong bone integration• Reduced crestal bone loss

Courtesy of Jack Ricci, PhD, NYUCourtesy of Jack Ricci, PhD, NYU

25

Placement levels

• May be placed either crestal or supracrestal• Laser-Lok is a transition zone for uneven ridges

Supracrestal(machined and

8 micron Laser-Lok)

CrestalUneven ridge

26

Instrument sequenceCrestal Bone Drills

and Bone Taps(Site-specific)

2.0mm

Starter Drill

2.5mm

Depth Drill

Width Increasing

Drills

Abutment-level Driver

Depth Gauge

27

1mm high silver bands determine crestal and supracrestal placement

SupracrestalPlacement

CrestalPlacement

Drill toleading

edge

Drill totrailingedge

28

Silver bands defined on drill wall chart and in the Surgical Manual (L0603)

29

Depth verification

• Verify osteotomy depth

• Manually insert Depth Gauge

Width Increasing Drill

DepthGauge

12mm Implantwith Laser-Lok

30

Bone Taps

• Usage dependent on clinical assessment

• Prepares sites with dense cortical bone

• One Bone Tap for each body diameter

31

Crestal Bone Drills (for dense bone)

Example 2 (Crestal). Full cutting geometry used.

Implant platform level with osseous crest

Example 1 (Supracrestal). Only partial cutting geometry used.

1mm left above osseous crest

32

Abutment-level drivers

• 3inOne Abutment serves as surgical mount

• Interfaces withsquare drive

• Pick-up directlyfrom vial

• Drivers for both Handpiece and Ratchet are included

33

Implant-level drivers

• May be used following removal of 3inOne Abutment

• Color-coded by prosthetic platform

• Drivers for both Handpiece and Ratchet are included

34

Healing Abutments

• 3 heights (1, 3, 5mm)• 3 Emergence

– Narrow– Regular and – Wide Emergence

• Suture groove to apically position tissue

35

Simple Solutions Healing Abutments

• Used when a Simple Solutions restoration is planned

• Develops soft tissue emergence• Order by platform and collar

height

36

“Platform Switching

Microgap

Courtesy of Craig Misch, DMD

37

Immediately loaded, maxilla, 2 years

Courtesy of Cary Shapoff, DDS (CT)

38

Laser-Lok case: Stuart Froum, DDS, NYU

Pre-op

2 ½ years post-op

At placement

39

Courtesy ofCraig Misch, DMD

40

Comprehensive portfolio

Implants

Prosthetics

Soft & Hard Tissue

41

Restorative options

• Simple Solutions Restorations• Traditional implant-level restorations• Implant-supported overdentures• Implant-stabilized overdentures

42

Proven internal hex connection

• Supported by a comprehensive line of internally hexed prosthetics

43

Restorative options

• Simple Solutions restorations• Traditional implant-level restorations• Implant-supported overdentures• Implant-stabilized overdentures

44

45

Simple Solutions concept• Cement-retained restorations in a minimal number of visits• Pre-tapered abutments designed to be restored without

additional preparation• Patients can wear a tooth-colored healing cap over the

abutment while the laboratory fabricates the final prosthesis

1. Seat SimpleSolutions Abutment

2. Make closed-tray,pick-up impression

3. Seat FinalRestoration