Dental Implants

Speaker

Rob Dunn

I qualified in 1967 from Manchester with a Bachelor dental Surgery.  I was awarded a Diploma in General Dental Practice by the Royal College of Surgeons in London in 1992, and am a member of the International Team for Implantology .

IMTEC MDI™ Surgical Protocol

Preoperative Planning

After patient selection and evaluation protocols have been completed, the number of MDI implants required is determined and thoroughly discussed with the patient. The patient’s lower denture is then fabricated or modified, followed by identification of appropriate implant sites. After site selection, the MDI implants should be placed approximately 5-8mm apart. For mandibular placement, the implants should be placed beginning at least 7mm anterior to the mental foramen.

Entry points & use of the Pilot Drill

Entry points for each MDI implant are marked on the patient’s tissue via bleeding points or a marker. The Pilot Drill is delicately placed over the entry point and lightly pumped up and down until the cortical plate is penetrated. No incision is necessary. The average depth is one-third to one-half the threaded length of the implant. Sterile irrigation is utilized throughout the drilling procedure. In extremely dense bone an extended penetration may be required. The pilot hole depth should never equal the length of the implant, as the tip of the drill is wider than the tip of the implant.

Use of the Finger Driver

for implant insertion
Open the MDI implant vial.* Grasp the body of the implant firmly with titanium locking pliers. Next, attach the titanium Finger Driver to the head of the implant. (It has a friction grip o-ring and can be used as a carrier to the patient’s mouth, as well as a beginning surgical driver.) After inserting the implant into the pilot opening through the attached gingiva, rotate clockwise while exerting downward pressure. This procedure initiates the self-tapping process and is used until noticeable bony resistance is encountered.

Use of the Winged Thumb Wrench

The Winged Thumb Wrench is designed to deliver a greater amount of torque. Use it to thread the implant into place until the wrench becomes difficult to turn.

Use of the Ratchet or Adjustable Torque Wrench to finalize the insertion process

The Ratchet Wrench or Extended Range Adjustable Torque Wrench and Ratchet Adapter will then finalize the insertion process. To utilize, grasp the wrench (with the directional arrow facing clockwise) and insert the ball and o-ring of the Ratchet Adapter into the bottom of the opening of the wrench. The final stage of MDI implant placement requires small, incremental, carefully controlled ratchet turns for final seating. The ideal length allows the abutment head to protrude from the gingival soft tissue at its full length but with no neck or thread portions visible. The implant can then be ratcheted until it demonstrates a rock-like integration of at least 30- 35 Ncm, which will then allow it to be immediately loaded.

MDI Torque Recommendation:

• IMTEC does not recommend
exceeding 50 Ncm during
implant placement.
• IMTEC recommends immediate
load of implants only when at
least 30–35 Ncm of resistance is met upon insertion.


Thick Tissue
IMPORTANT: The removable o-ring attachments inside an over-denture will not loosen an integrated MDI Implant. A loose implant is one that did not fully integrate into the bone. The primary reason for non-integration is over-instrumentation of the bone. The IMTEC Sendax MDI Implant utilizes a fully self-tapping protocol. It demands that the implant bite into the bone and advance itself from the initial point to completion. The procedure requires torquing forces that progress from Finger Driver to Winged Thumb Wrench to Ratchet or Torque Wrench.
Collared MDI Implant,
Standard

IMTEC MDI™ Prosthetic Protocols

SECURE™ Hard Pick-Up Protocol

For this step the clinician has the option to excavate 5mm openings or bur a complete trough in the denture as shown in the diagram below.
• Relieve denture to accommodate implants and metal housings. A
• Trim Blockout Shims to appropriate length and place one shim on each implant.
• Place metal housing on each implant and check for passive fit over shims. C
IMPORTANT: This is a critical part of the protocol. The Blockout Shim is placed over the exposed head of the MDI Implant to prevent pick-up material from curing to the implant. 19 Orders and Customer Service: 800-879-9799 or 580-223-4456 Domestic Fax: 800-986-9574 or 580-223-4561 www.imtec.com Copyright 2008 IMTEC, a 3M Company
• Place denture in patient’s mouth and check for passive fit over implants and housings.
• Apply a thin layer of SECURE Adhesive to the tissue born surface of the denture.
• Extrude SECURE Hard Pick-Up material directly onto metal housings and into the troughed denture.
• Seat denture in patient’s mouth and have patient apply normal bite pressure in centric occlusion. D
• Allow 7-9 minutes for SECURE Hard Pick-Up material to set.
• Remove denture and all blockout shims, trim and polish. E
• Seat the final denture and inform the patient to keep the denture in place for the first 48 hours after placement to prevent tissue overgrowth.
IMTEC MDI™ Prosthetic Protocols
SECURE™ Soft Protocol

Recommended for maxillary cases. May be necessary when implants are placed in
softer bone in the mandible.
• Grind down denture base at least 1mm and relieve denture to accommodate the prosthetic heads of each implant. A
• Roughen the tissue-born surface of the denture with an acrylic bur and degrease the surface with isopropyl alcohol.
• Apply a thin coat of SECURE Soft Adhesive.
• Extrude SECURE Soft Reline material onto the tissue-born surface of the denture.
• Place the denture in the patient’s mouth and ask patient to apply normal bite pressure in centric occlusion.
• Allow seven minutes for SECURE material to set.
• Remove denture and trim excess material with fine scissors or a surgical blade.
• Mix equal drops of SECURE Glazing Base and Catalyst.
• Use a brush to apply the mixture to the corresponding margins.
• DO NOT remove the palate of a maxillary denture during this stage.
• Ask the patient to keep the denture in place for the first 48 hours after placement to prevent tissue overgrowth.
• Four to six months after soft load, the soft liner can be replaced with a hard pick-up of the MDI metal housings (follow instructions for “IMTEC SECURE Hard Pick-Up Protocol”) to increase the level of retention.
• A progressive or immediate removal of the palate of a maxillary denture can be done at this stage of treatment.
For this step the clinician has the option to excavate 5mm openings or bur a complete trough in the denture as shown in the diagram below.