SURGICAL STEPS

PREPARATION OF THE IMPLANT SITE

Blood chemistry and x-rays analysis, and any other tests the dental professional feels are necessary, are the first phase of any implant surgery.

After detaching the flap, create a niche with the triangular or the spherical milling tool and then use the Ø 2 pilot milling tool to prepare the implant bed down to the final depth (that is, down to the milling cutter stop).

If necessary, any unsatisfactory axial paths can be corrected in the next step.

Then the implant bed is to be widened (until the milling cutter stops) using the Ø 2.8 milling tool for Ø 3.25 implants, the Ø 3.2 milling cutter for Ø 3.75 implants, the Ø 3.4 milling cutter for Ø 4 implants and, finally, the Ø 4.2 cutter for Ø 5 implants.

Use the countersink to widen the Ø 3.75 and Ø 4 implants’ collar.

Finally, use a thread former mounted on the manual ratchet by means of a connector along the whole depth of the hole in the implant bed.

PACKAGING

The implant, complete with assembly device and cover screw, is supplied suspended from a stainless steel ring contained in a PMMA (polymethylmethacrylate) blister sealed into a sterile film.

Everything is then packed into a sealed box that guarantees an airtight closure. The blister containing the implant has a label with the device data.

The final package shall contain the blister with the implant and two adhesive labels which contain all relevant information and which the professional may use when updating the patient’s clinical record and give to the patient.

LABELLING

a) Manufacturer information

b) MDD CE symbol with the ID number of the certifying body.

c) Implant reference code

d) Implant diameter

e) Implant height

f) Implant lot number

g) Manufacturer’s data

h) RT® srl logo

i) 100% made in Italy

l) Blister contents description

m) Production date

n) Expiry date

o) Sterilised implant

p) Keep dry!

q) Warning! Please refer to the relevant documentation.

r) Do not re-use

s) Do not use if the package is damaged

t) Keep away from direct heat.

u) Implant diameter colour code used by RT® srl .

INSERTION OF THE DENTAL IMPLANT

Remove the sealing film from the first blister, which contains a second, smaller blister.

The film guarantees the sterility of the implant.

Remove the sealing film from the second blister, which contains the implant and the cover screw.

Open the blister just before the implant is to be put in place in the patient’s mouth.

Fasten the connector to the handpiece.

Use the connector on the handpiece to grasp the implant by its mounting device.

Lift the implant, which shall remain hanging from the connector fastened to the handpiece.(1)

Use the handpiece to insert the implant manually into its bed.

Push the implant in place by rotating the handpiece automatically clockwise (2).

When the implant reaches the bottom of the bone cavity, resistance shall increase significantly.

Place the square connector on the manual ratchet and then use it on the implant and, moving the ratchet slowly, bring the implant to its final position in the bone (3).

Remove the mounting device from the implant with the 1.2 mm manual hex key (4).

After inserting the implant, close and protect the hexagonal part of the implant with the cover screw (contained in the blister) to allow submucosal healing (5, 6). Submucosal healing is recommended when there are aesthetic considerations.

The surgeon shall be able to choose from all the existing soft tissue treatment options, thanks to a whole range of secondary healing components. The design guarantees a safe connection between the two components. Close the wound (7).

INSERTION OF THE HEALING SCREW

There are several secondary healing components available for each implant, which model the soft tisse during the transmucosal healing.

These components are recommended for intermediate use.

Open the wound.

Replace the cover screw for submucosal healing with the coping screw for transmucosal healing (8, 9, 10).

After the soft tissue has healed, the screw is removed to leave space for the appropriate temporary or final reconstruction.

IMPRESSION

Remove the coping screw (1).

Insert the Ø 3.75 transfer with the appropriate screw.

In this example, a transfer for the open tray technique is used (2).

The transfers screwed into the mount with the appropriate screws and the individual, perforated tray (open tray technique) (3) shall be used to get an impression (in plaster) that shall subsequently be created in the lab.

After fastening the analogs to the transfers anchored into the individual tray paste, the plaster shall be cast and,once hard, will show the impression, with the analogs showing the position and inclination of the implants placed in the patient’s mouth.

CHOISE OF THE PROSTHESIS ELEMENTS

ANALOG FOR PLASTER

Stainless steel analog to be embedded in the plaster (1), it is a true copy of the implant placed in the patient’s mouth.

Once the final models are ready, they are put in place in order to create the prosthesis.

CASTABLE

The castable abutment is made of plastic, has a cylindric shape with a flat reference face.

Its purpose is to create a suitable mesostructure for the superstructure or capsule. The dentist places the castable abutment on the model that contains the plaster analog, augments and shapes it with some modelling wax and, with the help of a wax milling bur, he shapes the stump, eliminating all existing undercuts.

The lost wax casting technique is used here; the plastic material the castable abutment is made of burns out completely, without leaving contaminating residue, and it is therefore possible to use all the metals that are suitable for dental works, even though titanium is the gold standard.

Screw in the castable device using the retaining screw.

STRAIGHT ABUTMENT

In the presence of decayed teeth or teeth with a damaged crown which need to be used as capsules or anchors for fixed partial dentures, it is often necessary to reconstruct the part of the tooth above the root with abutments of different kinds and materials.

In this way it is possible to place a fixed denture above the metal abutments (cemented fixed denture).

The fixed denture is anchored to the abutments with cement and cannot be removed by the patient. This is an example of a cemented fixed denture.

Screw in the titanium abutment using the retaining screw.

CAP SCREW

Removable dentures are fastened using ball screws. They are used for overdentures placed on implants and tissues, usually with two or more parallel implants (within 10°).

The ball screws provide a safe fastening and stabilise the overdenture.

Tighten the balls screw into the implant and mount the overdenture on the screw with the relevant Teflon (as shown in the example) or steel support caps.

SCREWED PROSTHESIS

The technology of these solutions is quite advanced.

In case of total edentulism (toothless arch), rather than placing a high number of implants (up to 10 for each arch) with a screwed in denture, which is quite difficult for the patient to care for and clean adequately, it is possible to place a denture on four to six implants in each arch.

The bar, made of different materials, is screwed on the implants with the retaining screws.

ANGLED JOINT

The angled joint is considered fundamental for the easy placement of dentures over implants with a very steep inclination.

Screw the joint on the implant with the relevant screw and then place the various parts of the dentures on it.

ANGLED CASTABLE

This is a castable spherical element on which another (inclinable) castable element can be fitted, with the possibility of rotating and inclining its as desired.

Fasten the inclinable castable abutment on the appropriate spherical element, adjusted to the appropriate angle, and fasten everything on the implant with the relevant hex key.

The hexagonal shape of the key allows the dentist to fix the castable element at different angles.

JOINT FOR SWITCHING CONNECTION

These elements are manufactured by RT®srl and are an innovative and practical idea.

These joints allow the dentist to change the connection between two implants.

In other words, if the dentist has an internal connection implant and an external connection denture, (which cannot be joined together), these joint can be used to connect them.

NONTRAUMATIC REMOVAL OF THE DENTAL IMPLANTS

Another of  RT®srl’s innovative ideas concerns the removal of an implant, which can be difficult because it might be difficult to identify its type and, consequently, to find the relevant compatible elements.

These extractors have a special threading, created specifically for this type of procedure, and are an excellent alternative to the trepan bur which notoriously also removes part of the bone in which the implant is integrated (1).

Our extractor is placed over the implant threading with a slight pressure, thus promoting its loosening with only a manual ratchet (2).