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PRODUKTE 2016


PRODUKTE 2016 Implantat Systeme AnyRidgeÂŽ MiNiTM MegaGen Kit Digitaler Workflow Regeneration Instrumente & Materialien

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Herzliche Grüsse von Ihrem MegaGen Team MegaGen bietet für Ihre Patienten sowie für Sie als Anwender Produkte, die einen echten Mehrwert schaffen. Sehr geschätzte Kunden, liebe Interessenten, Die Firma MegaGen wurde im Jahre 2002 durch Herrn Dr. Park in Südkorea gegründet und ist bis heute in 48 Ländern weltweit vertreten. Das Unternehmen steht für innovative Produkte, die dem Anwender Mehrwerte bei der Verarbeitung und Behandlung bieten. Unter diesem Aspekt wurde auch das aktuelle Fokusprodukt AnyRidge-lmplantatsystem entwickelt und 2012 in den Markt eingeführt. Durch dieses außergewöhnliche Implantat-Konzept wurde die internationale Marktbekanntheit von MegaGen enorm gesteigert. Unser wichtigstes Anliegen innerhalb unserer Unternehmung ist es, hochwertige sowie innovative Produkte an Spezialisten zu vermitteln und diese mit bestem Kundenservice und entsprechenden Weiterbildungskonzepten zu unterstützen. Gerne steht Ihnen unser Verkaufsteam persönlich zur Verfügung und berät Sie über die Vorteile unserer Produkte. Gerne können Sie unseren eShop jederzeit besuchen unter www.imegagen.de besuchen.

Ihr MegaGen-Team


MegaGen Geschichte Ein kurzer Ablauf

2002

28.04. Zulassung für die Produktion medizinischer Geräte (Korea Food & Drug Administration: Nr. 1621). 07.08. Aufnahme der Tätigkeit als Co-Chief Director, Ryoo, Kyung-Ho. 01.09. Durchführung eines Projekts im Zusammenhang mit dem TBI Geschäft (Ministerium für Handel, Industrie und Energie).

2003

30.05. Zusammenschluss mit MINEC Co., LTD. 02.09. U.S. FDA-Zulassung für das Intermezzo Implantat-System. Nr. K051018. 21.12. Zertifizierung ISO9001/13485 DNV (Nr. 2005-OSL-AQ-0376).

2005

22.02. KGMP. 02.04. U.S. FDA-Zulassung für das Rescue External Implant System Nr. K063216. 10.04. CE-Zertifizierung für chirurgisches Instrument. 11.04. CE-Zertifizierung für das EZ Plus Implantat System & Rescue Implantat System. 2007 18.05. U.S. FDA-Zulassung für das EZ Plus Implantat-System. Nr. K070562. 12.07. Änderung des Firmennamen von MegaGen Co., Ltd. in MegaGen Implant Co., Ltd. 30.11. Als überlegene Exportfirma ausgezeichnet (Bürgermeister von Gyeongsan). 28.12. Gewinn des ersten Preises im Bereich kleiner und mittelständischer Unternehmen (Gouverneur von Gyeongbuk).

2004

27.02. Als Venture Industry ernannt (041327035-1-0034). 01.03. Innovation Technology Assignment für kleine und mittelständische Unternehmen. 14.07. Zertifizierung Government Industry Auxiliary Research Institute (ID Nr.20041761/ MegaGen Corp). 09.09. ISO9001/2000 (Nr. 12 100 23436 TMS).

2006

10.01. U.S. FDA-Zulassung für das ExFeel Implant System Nr. K052369. 08.03. CE-Zertifizierung für das ExFeel Implantat System / Intermezzo Implantat System. 13.04. U.S. FDA-Zulassung für das Intermezzo Fixture Nr. K053354. 19.04. U.S. FDA-Zulassung für das Rescue Implant System Nr. K053353. 09.06. Ausgewählt als Inno-Biz (Nr. 6535-0617). 11.09. Lizenz erhalten, eine Organbank einzuführen (Korea Food & Drug Administration: Nr. 88).

2008

11.04. U.S. FDA-Zulassung für das Rescue External Implant System (Länge 5,0, 6,0 mm) Nr. K073058. 13.05. Gewinn der SMBA Administrator-Auszeichnung beim nationalen Wettbewerb der mittelständischen Unternehmen 2008. 29.05. Gewinn des Verdienstpreises beim First Day of Medical Appliances (Minister-Preis des Ministeriums für Soziales und Gesundheit). 02.06. Zum vielversprechenden exportierendem mittelständischen Unternehmen ernannt (Daegu Gyeongbuk Export Support Center). 26.06. Ausgewählt als „Kibo A+ Mitglied“ des Kibo Technologiefonds. 15.08. U.S. FDA-Zulassung für das Rescue External Implant System (Länge 5,0, 6,0 mm) Nr. K081302. 22.10. Lobende Erwähnung des Premierministers bei der “Best Venture Enterprise 2008”. 23.10. Ausgewählt als einer der Kandidaten für den Preis des Premierministers im Bereich Product Rescue auf der 9. Großausstellung innovativer Technologien mittelständischer Unternehmen. 31.10. Gewinn der Auszeichnung durch das Ministerium für Wissenswirtschaft bei der großen Ausstellung der Korea Enterprise Stiftung 2008. 02.12. Gewinn der "5 Millionen Dollar Export Tower Prize" am 45. Handelstag. 03.12. Gewinn des ersten Gyeongbuk Gouverneur Preis im Daegu Gyeongbuk Venture Industry 2008. 12.12. Zum "Next Generation World Best Product Company 2008" gewählt (Ministerium für Wissenswirtschaft), ausgewählt als Gyeongbuk PRIDE Produkt (mit einem Zahnimplantat-System).

2010

20.04. Registriert als Gyoung-Pook Patent STAR Company [Po-Hang Industrie- und Handelskammer]. 02.07. U.S. FDA-Zulassung für Bone Plus BCP [Nr. K090950]. 05.08. U.S. FDA-Zulassung für das Lateral Sinus Graft-System [Nr. 3005554774]. 14.12. [Auszeichnung] Präsident Kwang-Bum Park erhält den Großen Preis 2010 für Intellectual Property Management. 29.12. Als führende Firma in der Beschäftigungsförderung ausgezeichnet [Regierung der Gyeongbuk Provinz]. 30.12. [Auszeichnung] Ausgezeichnet mit dem Großen Preis für Beschäftigungsförderung [Regierung der Gyeongbuk Provinz].

2012

17.01. MegaGens Anyridge Implantatsystem mit dem IR52 Jang Young Shil Preis ausgezeichnet. 30.01. Marke Anyridge beim japanischen Patentamt registriert. 07.04. MegaGen Paradigm 2012, Einführung der neuen Oberflächenbehandlung Xpeed und des Implantatsystems AnyOne. Entwicklung auf Basis des T.O.P.- Konzepts. Ankündigung des innovativen DDX-Service für digitale Zahnmedizin. 09.11. MegaGen organisiert ein internationales Symposium in Jeju 2012. 9.-10.11., Jeju Shilla Hotel. 25.12. MEGAGEN TOWER geöffnet (Gangnam Filiale).

2014

31.03. Straumann investiert in MegaGen. 01.04. MEG-Inject, Gewinner des Red Dot Award 2014. 13.04. MegaGen Symposium in Seoul 2014, 13.04.2014, Auditorium, COEX. 04.08 MegaGen unterzeichnet ein Memorandum of Understanding (MOU) mit Straumann und Daegu Metropolitan City. 28.09 MegaGen Meg-Serie gewinnt Convergence Federation Prime Minister‘s Award für kleine und mittlere Unternehmen.

14.01. Ausgewählt als „Leading Technology Venture Company“ (mittelständischer Unternehmen). 27.02. Als führendes Unternehmen für Beschäftigung ausgewählt (Vereinigung mittelständischer Unternehmen). 2009 30.04. Als "Guaranteed by KOTRA" ernannt (KOTRA Gütesiegel). 30.06. Als führendes Unternehmen für künftige Bio-Technologie-Zahnimplantat- Entwicklung durch die koreanische Regierung ernannt. 02.09. Auszeichnung durch den Premierminister von Korea für “Innovative Technology Show 2009” (Produkt: Bone Plus: Bio-Material). 03.02. [Zertifizierung] U.S. FDA-Zulassung für Ball Abutment-System [Nr.K101890]. 16.03. [Auszeichnung] Verleihung des Ministry of Knowledge & Economics Award am 2011 Chamber’s Day. 19.05. [Auszeichnung] Verleihung des Prime Ministry Award auf dem 46. Koreanischen INVENTION DAY. 23.06. [Ausstellung] Teilnahme an der SIDEX 2011 (Seoul International Dental Exhibition). 01.07. [Bildung] Jährliches MINEC-UCLA Meeting 2011 auf Hawaii. 20.07. [KFDA] Registrierung prothetisches Kit & Komponenten (Abdruck, Halterungsentferner). 29.07. Verleihung des “Expert Leading Company“-Zertifikats [IBK Bank]. 10.08. [Produkt] Spezifikationscode am Pfosten aller festen Abutments hinzugefügt. 22.08. [Produkt] Zusätzliche 1mm Höhe für Octa-Abutment für geringe 2011 gingivale Höhe. (Referenzcode: AANOAF0010). 09.09. [Zertifizierung] CE-Zulassung für das AnyRidge Internal Implant System. [Halterung, Abutment: 71220-2010-CE-KOR-NA Rev 6.0/ chirurgisches Instrument: 2243-2007-CE-NOR Rev 2.0]. 15.09. [Produkt] Komplette Entwicklung des Bone Expander Kit für die "ridge splite" Technik des AnyRidge-Systems. 29.09. [Zertifizierung] Erneuerung der ISO 9001: 2008 / ISO 13485: 2003-Zertifizierung. [Zertifikat-Nr. 30098-2008-AQ-KOR-NA]: Zertifizierung für das Qualitätsmanagement-System zur Herstellung dentaler Implantatsysteme und Biomaterialien. 13.10. [Ausbildung] MINEC-IRAN als offizielle Filiale von MINEC international zugelassen. DDS, MSc Maziar Shahzad Dowlatshahi als Präsident von MINEC-IRAN beauftragt. 11.11. [Symposium] Das 9. Internationale MegaGen-Symposium in Mailand. 13.12. MegaGen erhält den Hauptpreis des 11. Daegu-Gyeongpook Hightech-Venture Award. 21.12. [Auszeichnung] MegaGen Implantat mit dem 10 Millionen Export Tower auf dem 48th Daegu-Gyongbook Trade Day ausgezeichnet. 30.12. 2011 Year-End Ceremony im CINUS Theater. 22.02. Auszeichnung des Korea Health Industry Development Institute. 2013 18.03. AnyRidge erhält Zulassung in Russland. 27.03. Daegu-Kyeongbuk Region Auszeichnung für mittelständische Verwaltung. 28.05. Herausragendes mittelständisches Unternehmen, Auszeichnung des Handelsministeriums und des Energieministers. 14.09. MegaGen Symposium in Russland 2013. 14.-15.09., Moskau, Russland. 07.11. Das 10. Jahrestreffen des MegaGen International Symposium Evidences & Challenges with Masters, 7.-8. Nov. 2013 / Hotel Shangri-La, Bangkok, Thailand. 19.12 MegaGen Implantat erhält eine Auszeichnung als Weltklasse-Produkt. 30.06. MegaGen Implantat wurde als World Class 300 ausgezeichnet! 15.05. Das erste MegaGen Baltic Symposium in Litauen 15.-16.05.2015, Vilnius, Litauen, Kempinski Hotel Cathedral Square. 01.05. Das 11. Jahrestreffen des MegaGen International Symposium in NewYork 1.-2.5.2015, Grand Hyatt Hotel. 31.03. Das MegaGen Implantat erhält den Award of Industrial Technology.

2015


MegaGen Vision 2022 Eureka R2 Project - Make it possible “ Now we’ve found it! This is it!” + “Revolution/Renaissance” Eureka R2 is MegaGen’s long-term projects for upcoming 10 years to become the true leader in implant industry by providing a new paradigm of dentistry with upgraded digital technology to clinicians.

Are you satisfied with today’s implant treatment?

What improvements do we hope in the future?

What are your expectations? The osseointegration, which was founded by Dr. Branemark in 1960, has brought a revolution to the field of dentistry. It was introduced as the final solution of dental treatment on 1985 at Toronto symposium, however, for the past 30 years, it has become as the first treatment option for tooth loss. The standard protocol of implanting a fixture into the alveolar bone followed by prosthetics building-up after a certain healing period could appeal to all the clinicians. With the development of various regeneration materials and technics as well as introduction of new CAD-CAM concept, implantology has become the most concrete treatment method that can be used for any patient with any condition. The exclamation of “Eureka!” can be dedicated to the overall development of implantology so far; MegaGen decided to start an ambitious project, “Eureka R2,” to develop a new paradigm of implant dentistry. Eureka R2, as the 2nd revolution in implant dentistry, will guide to practice easier, safer, and more economical treatment.


Mission 2

Mission 1

Set up a concrete treatment plan by fabricating prosthetics with ideal occlusion and shape before the surgery using digital scanning technology.

Develop the analysis system which merges all the data into one.

Mission 3 Actuallize the One-Day Implant through this process.

Four Missions

Mission 4 Find ultimate method and material for ideal bone or tissue regeneration with minimal invasion and shortest healing period.

Eureka R2 will present an ideal treatment method through a completely accumulated database from panoramic radiograph, CT, cephalometrics, model, and photos. This means the best treatment result can be predicted by any clinician with the help of a computer program. ‘One-Day Implant’ protocol became possible with the specialized design of AnyRidge® implant which secures excellent stability and stable ISQ pattern. On top of this advantage, R2GATE™ software made it possible to prepare permanent and temporary prosthetics even before implant placement. In the end of Eureka R2 project, the regeneration technique to recover insufficient alveolar bone in a short period of time will be developed.


8


IMPLANTAT SYSTEM AnyRidge® MiNi™

9


Die neue Oberflächentechnik garantiert hervorrangende Ergebnisse

S-L-A mit Nano CA2+ Integration

1. MegaGen entwickelte eine neue, durch Kalzium Ionen besiedelte Implantatoberfläche auf Basis der bewährten S-L-A Technik. 2. Die Kalzium Ionen erzeugen eine CaTiO3 Nanostruktur auf der Oberfläche, die aktiviert die Osteoplastenbildung bei /nach Implantation. 3. Der Name dieser einzigartigen, innovativen Oberfläche ist XPEED.

10


/11

S-L-A Oberfläche mit Ca++ Einarbeitung

S-L-A

surface with Ca2+ Incorporation

MegaGen entwickelte eine neue, durch Kalzium Ionen besiedekte Implantatoberfläche auf Basis der bewährten S-L-A Technik. Die Kalziumionen erzeugen auf der Implantatoberfläche eine CaTIO3-Nanostruktur und aktivieren MegaGen has developed surface treatment based on S-L-A technique with calcium ion die Osteoblasten des Knochengewebes. Dieses Verfahren wurde unter dem Namen XSPEED bekannt. Bei XSPEED incorporation process. Calcium ion creates a CaTiO3 nanostructure on the surface, wirdand ein activates grossflächiger BIC (Bone Implant mit deutlich besserer Grenzflächen-Scherfestigkeit als ®. The name of this unique surface treatmenterzielt, is XPEED osteoblasts in the livingContact) organisms. bei herkömmlichen RBM- oder S-L-A Verfahren.

Fast & Strong Osseointegration

Higher BIC (Bone to Implant Contact) results stronger removal torque after osseointegration XPEED demonstrates higher BIC and requires stronger removal torque than the RBM or conventional S-L-A surface treatments. ®

70 60

58.0

50

%

Histological analysis

Bone to implant contact(BIC)

S-L-A

52.8

40

RBM

37.5

30 20 10 0

S-L-A

RBM

Removal torque

100

Clinical test result after 4 weeks of implantation (in rabbit)

Ncm

80

Histological examination of Ti implants with XPEED , S-L-A, RBM surfaces treatment illustrated XPEED makes highest BIC. Bone contact was measured over the surface of Ti implants. ®

61.6

60

®

55.8

40

30.8

20 0

S-L-A

RBM

Why “blue” colored surface guarantees safety? During XPEED treatment, S-L-A surface is neutralized with complete removal of acid residue. The blue color of XPEED surface is the symbol of cleanliness. ®

®

Cell attachment

Nano-thickness

XPEED is completely different from conventional HA coating technique. Because Ca ions incorporate into the surface as nano-thickness, XPEED will not be peeled nor absorbed after fixture placement which was common in conventional HA coating. ®

2+

®

Implant

0.5 ~ 0.7um

11 S-L-A with nano Ca2+ incorporation


Evidence on the effect of Xpeed Surface treatment Ca2+ ion

- Large amount of cations are created on the implant surface due to Ca - Therefore, more adhesion of PO43- ions occurs on Ca rich layer. - PO43- ions adhere on Ca rich layer, and Ca re-adhere on PO43- ion layer. - Increase of apatite layer like bone mineral, accelerates mineralization to make hydroxyapatite. 2+

2+

2+

Apatite formation on the surface of treated sample

Large amount of new bone was formed early on the Ca2+ implanted titanium surface, compared with titanium, even at 2 days after implantation into rat tibia .

XPS analysis Ca2+ ion:23.99At.%

Amount of hydroxyl radical on calcium-ion-implanted titanium and point of zero charge of constituent oxide of the surface-modified layer T. HANAWA*à, M. KONà, H. DOI°, H. UKAI±, K. MURAKAMI±, H. HAMANAKA°, K. ASAOKAà

EDX Analysis (mapping) : Ca2+ ion (green point)

CaTiO3 Nano-structure

CaTiO3 could increase osseointegration with juxtaposed bone needed for increased implant efficacy. x20000

Increased osteoblast adhesion on titanium-coated hydroxylapatite that forms CaTiO3. Webster TJ, Ergun C, Doremus RH, Lanford WA.

x300

CaTiO3 TiO2 + 2H2O = Ti(OH)4(aq) Ti + 2H2O = TiO2 + 2H2↑ Ca2+ + Ti(OH)4(aq) = CaTiO3(s) + 2H++ H2O

CaTiO3 CaTiO3 Hydrothermal modification of titanium surface in calcium solutions

12 S-L-A with nano Ca2+ incorporation


Courtesy of Dr. Achraf Souayah

Fast Osseointegration !

Courtesy of Dr. Siormpas Konstantinos

Fig 1. Preoperative Panoramic Radiograph

Fig 3. Preoperative clinical photograph

Fig 2. Postoperative Panoramic Radiograph

Fig 4. After AnyRidge (Xpeed surface) Implants installation

Fig 5. Immediate loading with provisional restoration

Fig 7. Postoperative intraoral Radiographs

Fig 6. Placement of final prosthetics

Fig 8. Postoperative Panoramic Radiograph

1. Immediate functional loading of single implants: a 1-year interim report of a 5-year prospective multicenter study / Authors: Giuseppe Luongo, MD, DDS, Carolina Lenzi, DDS, Filiep Raes, MD, DDS, Tammaro Eccellente, MD, DDS, Michele Ortolani, MD, DDS, Carlo Mangano, MD, DDS / Journal Name & Volume Number : Eur J Oral Implantol. 2014 Summer;7(2):187-99. 2. The management of immediate implant placement to optimize aesthetic outcome in the anterior maxilla / Authors: Howard Gluckman and Jonathan Du Toit Journal Name & Volume Number : INTERNATIONAL DENTISTRY AFRICAN EDITION VOL. 4, NO. 4; 48-57

Long Term safety !

Courtesy of Dr. Kwang Bum Park

Fig 2. Postoperative Panoramic Radiograph Oct. 20, 2011

Fig 1. Preoperative Panoramic Radiograph Sep. 22, 2011

Fig 3. Preoperative clinical photograph

Fig 7. Panoramic Radiograph after the final loading Apr. 19, 2012

Fig 4. After AnyRidge (Xpeed surface)Implants placement (Ø4.5 x 10.0)

Fig 5. Prepare for the final loading

Fig 8. 2Y 3M F/U Jan. 28, 2014

Fig 6. Placement of final prosthetics

Fig 9. 2Y 10M F/U Aug. 11, 2014

1. Safety and effectiveness of maxillary early loaded titanium implants with a novel nanostructured calcium-incorporated surface (Xpeed): 1-year results from a pilot multicenter randomised controlled trial / Authors: Marco Esposito, Maria GabriellaGrusovin, Gerardo Pellegrino, Elisa Soardi, Pietro Felice / Jounal Name & Volume Number : Eur J Oral Implantol 2012;5(3) 2. Retrospective study of the survival rates of a surface- treated external connection implant system / Authors: Kwang-Bum Park, Myung-Hwan An, Sang-Taek Lee, Young-Jin Lee, Hyun-Jin Kim,Woo-Chang Noh and Hyun-Wook An / Jounal Name & Volume Number : IDT May 2014; 21-24

13 S-L-A with nano Ca2+ incorporation


AnyRidge® Hauptvorteile ➲ ➲

Exzellente Primärstabilität, sogar bei schwierigen Knochenverhältnissen

Garantiert keine Schraubenlockerungen Einmalige und messbare ISQ Verhaltensweisen, die wichtig sind für verlässliche und vorhersagbare Ergebnisse für Imidiate Loading. ➲

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Eigenschaften & Vorteile Implantat Verpackung | Konzept Cover Screw & Healing Abutment Abutment & Protethik Optionen I. Implantat Level Protethik II. Abutment Level Protethik 1. Solid Abutment & Komponenten 2. Octa Abutment & Komponenten 3. Multi Uni Abutment & Komponenten 4. Flat Abutment & Komponenten

III. Overdenture Prothetik 1. Meg. Rhein Abutment und Komponenten 2. Keratoren

Fallberichte

15


Charakteristiken & Vorteile

Ⅰ. Das Konzept

Dünne aber stabile Abutmentschraube Durchmesser 1,8mm

Starke Abutmentwand: Für stabilen Halt im Implantat

Unterschiedliche Optionen:

Konische Abutmentform:

Vorgefertigte Abutments in individualisierbaren Höhen und verschiedenen Durchmessern verfügbar

✔ Unterschiedliche Winkel je Durchmesser (8°, 10°, 12°, 14°) ✔ Grössere Durchmesser = grösserer Winkel

Schulterverlauf:

Unterschiedliche Gingivahöhen:

1mm beschleifbar ohne Veränderung des Durchmessers

Von 2mm bis 5mm

Eine prothetische Plattform:

«S-Line» Verlauf des Abutmenthalses:

Jedes Abutment passt auf jedes Implantat

Grössere Implantatdurchmesser in schmalen Kieferkamm:

Für ein natürlich erscheinendes Emergenz Profil

Durch das weite Gewinde bleibt bereits bei Implantation mehr Knochen erhalten

Scharfes Gewinde:

Ermöglicht eine sehr hohe Primärstabilität bei gleichzeitig geringer Kompression des Knochens. Auch grosse Implantatdurchmesser lassen sich somit leichter inserieren.

Keine Schneidekanten und dennoch selbstschneidend:

✔ Scharfe Gewindeflanken für einen «drucklosen» aber sicheren Halt ✔ Kein Reissen und Wackeln am kortikalen Knochen zu Insertionsbeginne.

Maximaler Erhalt des Kortikalen Knochens:

Kleine Bohrung:

Wichtig für gute ästhetische Langzeitergebnisse

✔ Grosse Implantatdurchmesser werden in kleine Bohrungen inseriert. ✔ Dies ermöglicht das ausgeprägte Gewindedesign. ✔ Maximaler Knochenerhalt (Weniger invasive Chirurgie)

Konischer Implantatkörper:

Leicht zu inserieren und sichere Primärstabilität

Implantatdurchmesser Kerndurchmesser

Identischer Kerndurchmesser, unterschiedliche Gewindeweite 3.5 4.0 4.5 5.0 2.8 3.3 3.3 3.3

5.5 3.3

5.0(S) 4.0

Identischer Kerndurchmesser, unterschiedliche Gewindeweite Implantatdurchmesser Kerndurchmesser

5.5(S) 4.0

6.0 4.8

6.5 4.8

7.0 4.8

7.5 4.8

8.0 4.8 Kerndurchmesser 3,5 mm unterhalb Implantatschulter

Kerndurchmesser

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Megagen |

AnyRidge®

Ⅱ. Chirurgie Extreme hohe Primärstabilität, sogar bei schwierigen Knochenverhältnissen. Anyridge Implantate schneiden den Knochen einfach und verdichten ihn gleichzeitig. 1. Implantat Inserierung

• Weicher Knochen

The super self-tapping threads have a single core diameter that facilitates minimal site preparation by utilizing a smaller osteotomy to place a wider fixture with special threads.

• Harter Knochen

AnyRidge® Fixture with its super self-tapping thread design is easier than other traditional implants at hard bone. *Caution! : The osteotomy socket (drilling) size should almost reach the size of fixture to avoid getting stuck in the bone during placement.

<1mm

1mm

>1mm

1

1mm

2

Easy way to avoid stuck in the bone during AnyRidge implant placement

1. Due to extremely strong initial stability of AnyRidge fixture, it can be stuck in the middle during placement especially in mandibular hard bone. Please consider ‘One millimeter Rule’ to avoid this in the best and easiest way. Clinician can customize the drilling sequence once he fully understand the concept and characteristics of AnyRidge system to get preferred initial stability. ‘One millimeter Rule’ is simple; if an implant engine (40Ncm) stops leaving one millimeter above the crest, use ratchet wrench to screw it down to preferred position. We recommended to place implant platform 0.5~1.0mm under the crest. 2. If a fixture stucks in the middle leaving more than 1mm above the crest in hard mandibular bone, it is recommended to remove it using a wrench rather than trying to screw it down with excessive torque. Please use a cortical bone drill than is included in a surgical kit, the depth of cortical bone drilling can be adjusted according to the bone condition. Then, place the same fixture into the osteotomy socket.

2. Individuelles Bohrprotokoll dem Behandler angepasst

• AnyRidge® system has no fixed drilling protocol, just make your own protocol based on patient’s bone quality to attain preferred initial stability or simply drill an osteotomy socket to given conditions and then decide the diameter of a fixture.

Example 1) Ø5.0mm fixture can be placed 2.9mm osteotomy socket in D4 bone. Excellent initial stability can be attained

➲ Lance Drill

Example 2) In hard one, it is highly recommended to make a socket almost same diameter size as a fixture

➲ Stopper Drill 2.8

➲ Lance Drill

AnyRidge® Fixture 5.0

➲ Stopper Drill 2.8

➲ Stopper Drill 3.3

➲ Marking Drill 3.8

AnyRidge® Fixture 4.0

• Improved drill design has simplified drilling sequence, you can even harvest autogenous bone using these specially designed drills. (Recommended speed : 50 RPM, 50 Ncm with saline solution irrigation)

• The best way to get ideal initial stability with AnyRidge system is placing a fixture using a surgical engine, leaving one or two treads above the crest; then use ratchet wrench to place the platform at the desired position.

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Ⅲ. Protethische Versorgung Optimale ästethische Ergebnisse durch die Vielfalt der protetischen Optionen. Garantiert keine Schraubenlockerungen! 1. Keine Schraubenlockerungen, Form und Kraftschlüssige Verbindung

• Magic 5° (5° Internal Connection)

Durch unsere einzigartige 5° konische Verbindung, vermeiden Sie Schraubenlockerungen und erhalten eine Form und Kraftschlüssige Verbindung. Der Biologischer Spalt wird dadurch minimiert, und es besteht kein Micro-Gap und der Crestale Knochen. AnyRidge

Separation force between fixture and abutment after cold welding.

49.49 A

25.36

Company A 1.5° Connection B

AnyRidge 5° Connection

11.46

Company B 8° Connection

(n=5) Performed Retention Test to evaluate the fixture-abutment retention force using Universal Testing Machine -R&D center in MegaGen Implant Co.,Ltd.(2009)-

2. Biologischer S-Linien Verlauf 3. Optimale Hex Verbindungshöhe 4. Für alle Indikationen unterschiedliche Abutment Optionen

Helps to achieve beautiful, natural-looking esthetics.

Feel AnyRidge connection. It starts with impression taking and lasts until final restoration.

Every case, every shape, every size. Everything was considered to satisfy every need.

Various post heights

Cuff height

Complete hermetic seal

S-line

[SEM image] Magic Five Connection : 5° Morse taper

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Megagen |

AnyRidge®

▸▸ Zweierlei Verbindungsarten zwischen Implantat und weiteren Komponenten 1. Alle temporären Systemkomponenten haben einen Führungszapfen am Gewindeansatz und liegen ausschliesslich auf der Implantatschulter auf. •

Cover Screws, Healing Abutments, Impression Coping (transfer and pick-up type), Temporary Cylinders have ledges on the bottom which prevent from cold welding with a fixture.

Hand Drivers(1.2 Hex) or Impression Drivers can be used easily to screw these components in and out.

25~35Ncm is recommended to connect a permanent abutment into a fixture.

A fixed abutment cannot be removed with finger force even after complete removal of Abutment Screw because of perfect cold welding. To remove a permanent abutment, Abutment Removal Driver should be used.

2. Alle finalen Abutments erreichen eine extrem feste Verbindung mit dem Implantat, auch bei wenig Anzugsdrehmoment.

19


▸▸ Anleitung zur sicheren Entfernung des permanenten Abutments vom Implantat Bezüglich durch die sehr starke Verbindung zwischen Abutment und Impantat müssen Sie sich keine Sorgen zu Schraubenlockerungen machen. Zur Abutmententfernung nutzen Sie bitte unseren eigens dafür vorgesehenen "Austreiber" (Remover Driver).

Hand Driver (1.2 Hex)

1

2

3

Abutment Removal Driver

4

5

1. 2. 3. 4. 5. 6.

20

6

Use a Hand Driver(1.2 Hex) to unscrew Abutment Screw. Continue to turn counter-clockwisely until you feel a click of disengagement. Push down Hand Driver once again to catch and fix Abutment Screw. Lift up Hand Driver lightly and continue to turn counter-clockwisely until Abutment Screw engages with the inner screw of Abutment. Remove Abutment Screw completely from the abutment. Insert an ‘Abutment Removal Driver’ and continue to turn clockwise until the abutment comes out of fixture. You can feel some resistance during screwdown of the Abutment Removal Driver, but don’t worry, simple exert is needed disconnect the abutment from the fixture.


Megagen |

Ⅳ. Versorgung Das einzigartige Implantatdesign sorgt für hervorragende Langzeitergebnisse!

45

AnyRidge 4.5 x 10mm

Company OS

AnyRidge 5.5 x 10mm

Company NB

Stress Distribution (Fixture-Bone) Cortical Bone Thickness - 0.8mm Cancellous bone level - D4

35

1. Hervorragender Erhalt des kortikalen Knochens

Stress(MPa)

AnyRidge does not depend on cortical bone 25 fir initial stability; decreased stress on cortical bone helps to prevent bone resorption after 15 implantation. 5

45

AnyRidge 4.5 x 10mm

Company OS

AnyRidge 5.5 x 10mm

Company NB

Stress(MPa)

Stress(MPa)

15

-5

25 300.0

15

2

Length (mm)

4

6

0

AnyRidge

Company OS

25Cancellous bone level - D4 15

2

EZ Plus

Rescue

Length (mm)

4

6

Performed Finite element 5 analysis to evaluate the fixture-bone stress using

250.0 ABAQUS 6.8 -R&D center in MegaGen Implant Co.,Ltd.(2009)-

5

-5

200.0

kgf

-5

0

NB Company Advanced coronal design allows maximum cortical bone preservation around implants. AnyRidge 5.5 x 10mm CompanyStress NB Distribution (Fixture-Bone) Beyond Cortical Bone Thickness - 0.8mm osseointegration, AnyRidge can 35 Cancellous bone level - D4 assure beautiful gingival line by preserving Stress Distribution (Fixture-Bone) - Round faced and narrow thread design and maintaining more cortical bone. Cortical Bone Thickness - 0.8mm

5

35

AnyRidge 5.5 x 10mm

45 4.5 x 10mm AnyRidge

Stress(MPa)

45

AnyRidge 4.5 x 10mm

25

-5

• More cortical bone = More soft tissue volume Company OS = Beautiful gingival line

Stress Distribution (Fixture-Bone) Cortical Bone Thickness - 0.8mm Cancellous bone level - D4

35

0

150.0 100.0

2

50.0

2

0

Length (mm)

4

Length (mm)

4

6

3.5

4.0

6 - Less insertion torque - Excellent initial stabilization - Resistance to compressive force - Minimal Shear force creation - Higher BIC

0.0 6.0

(n=8)

Diameter

- Round faced and narrow thread design

EZ Plus

AnyRidge

Rescue

- Round faced and narrow thread design - Round faced and narrow thread design AnyRidge

EZ Plus

Rescue

- Less insertion torque

300.0 EZ Plus

idge

.5

AnyRidge®

Rescue

- Excellent initial stabilization - Resistance to compressive force

250.0

- Minimal Shear force creation

200.0

kgf

- Higher BIC

3.5 150.0 100.0

4.0

6.0

- Less insertion torque

(n=8)

Diameter

- Resistance to compressive force Theinitial sharp and high alveolar crest (yellow arrow) - Excellent stabilization - Minimal Shear force creation

50.0

could be maintained due With this maintenance of alveolar bone, the peri-implant marginal gingiva showed almost no recession during 2.5 - Minimal Shear force creation years of follow-up, even in the case of limited ridge width. to biologydriven implant design. - Resistance to compressive force BIC - Higher

0.0 3.5

4.0

Diameter 4.0

- Excellent initial stabilization

• A Human Biopsy (2.5 yrs after placement)

- Less insertion torque

6.0

6.0

(n=8)

- Higher BIC

(n=8)

Diameter

21


Implantat Produkt & Verpackung

Ⅰ. Implantatgrößen

Durchmesser Bevel Durchmesser Implantatschulter

Innensechskant: 2,3 mm (bei allen Implantaten identisch)

Durchmesser 3,5 mm unterhalb Implantatschulter Durchmesser Bevel Durchmesser Implantatschulter

Ø6.0~Ø8.0

Ø4.0~Ø5.5

Ø3.5

Drei unterschiedliche Bevel Durchmesser mit der gleichen prothetischen Plattform

Weitester Gewindedurchmesser Beveldurchmesser Plattformdurchmesser

Durchmesser 3,5 mm unterhalb der Implantatschulter

Weitester Gewindedurchmesser 0.5mm breiter als der Implantatdurchmesser bei 3.5mm 0.4mm breiter als der Implantatdurchmesser bei 4.0~8.0mm *Beispiel Ø3.5 = Implantatdurchmesser + 0.5mm Ø4.0~Ø8.0 = Implantatdurchmesser + 0.4mm

Implantat 3,5 mm 3,5 mm(Schulter) / 3,8 mm (Bevel) Implantat 4,0mm-5,5mm 3,5 mm (Schulter) / 4,0 mm (Bevel) Implantat 6,0mm - 8,0mm 5,0 mm (Schulter) / 5,5 mm (Bevel)

Länge Implantat-Ø 3,5 - 5,5 mm: 0.8mm kürzer als die angegebene Länge

Core

Implantat Ø 6,0-8,0 mm: 0.6mm kürzer als die angegebene Länge

Wichtig!! Es ist erwiesen, dass eine Implantatposition unter Knochenniveau (0,5 - 1,0mm) bessere Ergebnisse bezüglich des Erhalts des krestalen Knochen zeigt. Beim Anyridge-System wird das Implantat in idealer Position ohne weitere Bohrungen so platziert, dass keine wichtigen anatomischen Strukturen beschädigt werden.

Abutmentschraube Schmaler Apexdurchmesser

Durchmesser 1,8 mm x Steigung 0,35mm

Ø3.5 : 1.6mm Ø4.0~5.5 : 1.8mm Ø6.0~8.0 : 3.0mm

Implantatdurchmesser

[SEM-Bild]

22


Megagen |

AnyRidge®

Ⅱ. Anyridge® Grössen Small Ø3.5

Durchmesser (mm)

Abdeckschraube inklusive

3.5

Regular Ø4.0

Durchmesser (mm)

Abdeckschraube inklusive

4.0

Regular Ø4.5

Durchmesser (mm)

Abdeckschraube inklusive

4.5

Länge (mm) Ref.C

7

FANIHX3507C

8.5

FANIHX3508C

10

FANIHX3510C

11.5

FANIHX3511C

13

FANIHX3513C

15

FANIHX3515C

Länge (mm) Ref.C

7

FANIHX4007C

8.5

FANIHX4008C

10

FANIHX4010C

11.5

FANIHX4011C

13

FANIHX4013C

15

FANIHX4015C

Länge (mm) Ref.C

7

FANIHX4507C

8.5

FANIHX4508C

10

FANIHX4510C

11.5

FANIHX4511C

13

FANIHX4513C

15

FANIHX4515C

4.0

2.8 L

3.5

4.4

3.3 L

4.0

4.9

3.3 L

4.5

23


➲ ANYRIDGE® GRÖSSEN Wide Ø5.0

Abdeckschraube inklusive

Durchmesser (mm)

5.0

Wide Ø5.5

Abdeckschraube inklusive

Durchmesser (mm)

5.5

Super Wide Ø6.0

Abdeckschraube inklusive

Durchmesser (mm)

6.0

Super Wide Ø6.5 Abdeckschraube inklusive

Durchmesser (mm)

6.5

24

Länge (mm) Ref.C

7

FANIHX5007C

8.5

FANIHX5008C

10

FANIHX5010C

11.5

FANIHX5011C

13

FANIHX5013C

15

FANIHX5015C

Länge (mm) Ref.C

7

FANIHX5507C

8.5

FANIHX5508C

10

FANIHX5510C

11.5

FANIHX5511C

13

FANIHX5513C

15

FANIHX5515C

Länge (mm) Ref.C

7

FALIHX6007C

8.5

FALIHX6008C

10

FALIHX6010C

11.5

FALIHX6011C

13

FALIHX6013C

Länge (mm) Ref.C

7

FALIHX6507C

8.5

FALIHX6508C

10

FALIHX6510C

11.5

FALIHX6511C

13

FALIHX6513C

5.4

3.3 L

5.0

5.9

3.3 L

5.5

6.4

4.8 L

6.0

6.9

4.8 L

6.5


Megagen |

Super Wide Ø7.0

Durchmesser (mm)

Abdeckschraube inklusive

7.0

Super Wide Ø7.5

Durchmesser (mm)

Abdeckschraube inklusive

7.5

Super Wide Ø8.0

Durchmesser (mm)

Abdeckschraube inklusive

8.0

Länge (mm) Ref.C

7

FALIHX7007C

8.5

FALIHX7008C

10

FALIHX7010C

11.5

FALIHX7011C

13

FALIHX7013C

Länge (mm) Ref.C

7

FALIHX7507C

8.5

FALIHX7508C

10

FALIHX7510C

11.5

FALIHX7511C

13

FALIHX7513C

Länge (mm) Ref.C

7

FALIHX8007C

8.5

FALIHX8008C

10

FALIHX8010C

11.5

FALIHX8011C

13

FALIHX8013C

AnyRidge®

7.4

4.8 L

7.0

7.9

4.8 L

7.5

8.4

4.8 L

8.0

25


Zusätzliche AnyRidge Fixtures AnyRidge Core 4 Implantate

Wide Ø5.0_Core Ø4

Abdeckschraube inklusive

Durchmesser (mm)

5.0

Wide Ø5.5_Core Ø4

Abdeckschraube inklusive

Durchmesser (mm)

5.5

∅3.5 2.8

Länge (mm) Ref.C

7

FANIHX5007SC

8.5

FANIHX5008SC

10

FANIHX5010SC

11.5

FANIHX5011SC

13

FANIHX5013SC

15

FANIHX5015SC

4.0 L

5.0

Länge (mm) Ref.C

7

FANIHX5507SC

8.5

FANIHX5508SC

10

FANIHX5510SC

11.5

FANIHX5511SC

13

FANIHX5513SC

15

FANIHX5515SC

5.9

4.0 L

5.5

∅4.0

∅4.5

∅5.0

∅5.5

∅6.0

∅6.5

∅7.0

∅7.5

∅8.0

3.3

3.3

3.3

3.3

4.8

4.8

4.8

4.8

4.8

4.0

4.0

Diese Erweiterung des Implantatsortiments hilft ihnen bei Implantationen in harten Knochenverhältnissen. Es bietet mehr Sicherheit bei extremer Belastung wie z.B. bei Bruxismus.

Core 3.3

Dünner Knochen

26

5.4

Core 3.3

Core 4.0

Normaler Knochen


Megagen |

AnyRidge®

Ⅲ. Verpackung - Ampulle Obere Abdeckung

Die Ampulle wurde so konstruiert, dass sie mit einer Hand geöffnet werden kann!

: schützt das Implantat

Implantat

Aufnahme Implantat

Eindrehinstrument Die Implantate halten sicher am Instrument, kein Herunterfallen!

Untere Abdeckung

: schützt die Abdeckschraube Sechskant als Indexierung und Rotationsschutz beim AnyRidge® Implantat Abdeckschraube

Aufnehmen der Abdeckschraube

- Beschriftung Unterschiedliche Farben für verschiedene Implantate Durchmesser

3.5mm

Produkt Name Small

Ø4.5/ L=13

With Cover Screw FANHIX4513C

150610A0211-01 MODEL NAME

FANIHX4513

4.0mm 4.5mm

Größe

Mount-Free

2015-06-10 2020-06-09 001

Ø = Implantat Durchmesser L = Implantat Länge

Regular

5.0mm 5.5mm Wide

Do not reuse

Consult Instructions for use

Rx Only

Caution

rev.

Do not resterilize

01

Do not use if package is damaged

Super Wide

(01)08806388217618 (10)150610A0211-01 (11)150610 (17)200609 (21)001 MegaGen Implant Co., Ltd. 472 Hanjanggun-ro Jain-myeon Gyeongsan-si Gyeongsangbuk-do Korea Repulbic of 712-852

6.0mm 6.5mm 7.0mm 7.5mm 8.0mm

Kern Ø4

27


Cover Screw & Healing Abutment Cover Screw

Höhe

Ref. C

0.8

AANCSF3508

1.6

AANCSF3516

2.6

AANCSF3526

Durchmesser Gingivahöhe (GH)

Ref.C

Zum Verschluss des Implantats. Verwenden Sie einen 1,2 mm Innensechskantschlüssel (5-8 Ncm)

Healing Abutment Zur Ausheilung und Ausformung des Weichgewebes vor der prothetischen Versorgung. Erhaltlich in den Durchmessern von 4,0mm 7,0mm und in den Gingivahohen 3,0mm - 7,0mm Verwenden Sie einen 1,2 mm Innensechskantschlussel (5-8 Ncm)

Ø4.0

Ø

GH

Ø5.0

Implantatniveau

Ø6.0

Scan Healing Abutment

- Beeinhaltet die Abutmentschraube - Ermöglicht die Abdrucknahme vom Scan Post, ohne das Healing Abutment entfernen zu müssen. - Das Scan Healing Abutment sollte 2.0mm freistehen, um einen akkuraten Scan Abdruck nehmen zu können.

System

AnyRidge

Can get scan data without removing Scan Healing Abutment from Scan Post • included spare Abutment Screw • Different colors depend on the system • Scan healing abutment should be exposed 2.0mm on the surgical site for accurate scanning

Scan Post • Die Anwendung des Scan Abutments wird explizit empfohlen, wenn Sie EXOCAD im Einsatz haben. • Bitte wählen Sie den Scan Post Durchmesser gemäss dem Durchmesser des Scan Healing Abutment.

28

System

Durchmesser Gingivahöhe (GH)

Ref.C

3

AANHAF0403

3

AANHAF0703

4

AANHAF0404

4

AANHAF0704

5

AANHAF0405

5

AANHAF0705

6

AANHAF0406

6

AANHAF0706

7

AANHAF0407

7

AANHAF0707

3

AANHAF0503

3

AANHAF0803

4

AANHAF0504

4

AANHAF0804

5

AANHAF0505

5

AANHAF0805

6

AANHAF0506

6

AANHAF0806

7

AANHAF0507

7

AANHAF0807

3

AANHAF0603

3

AANHAF1003

4

AANHAF0604

4

AANHAF1004

5

AANHAF0605

5

AANHAF1005

6

AANHAF0606

6

AANHAF1006

7

AANHAF0607

7

AANHAF1007

Profil Durchmesser

4 4 4 5 5 5 6 6 6 7 7 7

Profil Durchmesser

4.0 Common

Höhe

5.5 6.5 7.5

Höhe (mm)

Ø7.0

Ø8.0

Ø10.0

Ref.C

4 5 7

ARISH4004T ARISH4005T ARISH4007T

4 5 7

ARISH5004T ARISH5005T ARISH5007T

4 5 7

ARISH6004T ARISH6005T ARISH6007T

4 5 7

ARISH7004T ARISH7005T ARISH7007T

Höhe (mm)

AR-∅4 AO-∅4 AR-∅5 AO-∅4.5 AR-∅6 AO-∅5.5 AR-∅7 AO-∅6.5

Profi Durchm

D

H

AnyRidge

D

Ref.C

SP4009 SP5009

7

Scan Healing Abutment

Scan cap

SP6009 SP7009 * Bitte achten Sie darauf, dass das Scan Healing Abutment nicht mehr als 2,5mm freisteht, um die Implantateinheilung nicht zu beeinträchtigen


Megagen |

AnyRidgeÂŽ

Abutment & Prothetische Optionen

I. Auf Implantatniveau

Zirconia Coping

Zirconia Abutment

Gold Abutment

CCM Abutment

EZ Post Abutment

Milling Abutment

Angled Abutment

Standard

Temporary Abutment [Metal]

C-type (Cerec)

TiGEN Abutment

Fuse Abutment

Profil Durchmesser

Lab Analog

Transfer Impression Coping Driver (Refer to Page.206)

Impression Coping [Transfer]

Cover Screw

Impression Coping [Pick-Up]

Healing Abutment

Scan Healing Abutment

Scan Post

Abutment Removal Driver

29


➲ Impression Copings

Impression Coping (Transfer Typ) Fur die geschlossene Abformtechnik zu verwenden. Das Design der Abformpfosten sorgt fur eine einfache und genaue Ubertragung der Situation. Die Halteschrauben der Abformpfosten konnen mit dem „Impression Driver“ und/oder einem 1,2 mm Innensechskantschlussel ein- oder ausgedreht werden.

Durchmesser

Ø4.0

Ø5.0

Ø4.0

Ø5.0

Impression Coping (Pick-up-Typ) Fur die „offene“ Abformtechnik zu verwenden. Das Design der Abformpfosten sorgt fur eine sichere und genaue Ubertragung der Situation. Die Halteschrauben der Abformpfosten kann mit einem 1,2 mm Innensechskantschlussel einoder ausgedreht werden.

Durchmesser

Ø4.0

Ø5.0

Höhe (mm)

Typ

12 16 12

Ref.C

AANITH4012T 2-Piece

AANITH4016T AANITH5012T

16

AANITH5016T

12

AANITH4012HT

16 12

2-Piece Hand driver (1.2 Hex)

16

Höhe (mm)

7 12

3 Platform level P.D

AANITH5012HT AANITH5016HT

Typ Ref.C

12 16

AANITH4016HT

AANIPH4012T 2-Piece

AANIPH4016T AANIPH5007T

16

AANIPH5012T 7 Platform level P.D

30

16

12

12


AnyRidge®

Megagen |

➲ Lab Analog & Temporary Abutments

Lab Analog

Durchmesser Farbe

Ø3.5

Ref.C

Magenta

AANLAF35

Ø4.0 ~ Ø5.5

Blue

AANLAF4055

Ø6.0 ~ Ø8.0

Yellow

AALLAF6080

Hex

Temporary Abutment

Durch- Cuff Height messer (mm)

Packungseinheit: Abutment mit Schraube Zur Herstellung provisorischer Versorgungen. Lieferbar mit oder ohne Indexierung. Die gerillte Oberflache der Abutment sorgt fur ausreichend Retention beim Einarbeiten in die provisorische Versorgung.

Ø4.0

2

Typ

Non-Hex

Ref.C

Hex

AANTMH4012T

Non-Hex

AANTMN4012T

10

2 Platform level Ø4.0

Fuse Abutment

Milling

Ø5.0

Packungseinheit: Abutment mit Schraube Verwenden Sie einen 1,2 mm Innensechskantschlussel (30 Ncm)

15°

25° Höhe

Typ

Durchmesser Mesiodistal Labiolingual

Gerade

Ø 5,5

15°

Ø 4,5

25°

Ø 4,5

Milling

Ø 5,0

Ø 5,5

Ø 5,0

GH mm

3

1

Höhe mm

Art. Nr.

5,5

AFAP5535P

7

AFAA5315P

7

AFAA5325P

11

AANTAH5012T

11

GH

1

Platform level Hex

Hex

Mesio distal

Mesio distal Labiolingual

Labiolingual

31


Fuse Abutment™ Warum ist das Fuse Abutment bei provisorischen Kronen unverzichtbar? Variabler Winkel: gerade

Ähnlich wie patientenindividuell gefertigtes Abutment, ausgezeichnete Ästhetik!

Fuse AbutmentTM ‑ das Designkonzept

15°

25°

Ähnlich wie patientenindividuell gefertigtes Abutment, ausgezeichnete Ästhetik! Gekehlte Kontur

S-Linie

Mesio-distal

Labio-lingual

Elliptische okklusale Ansicht wie bei natürlichem Zahn

Fuse Abutment ‑ das Grundprinzip TM

Micro-movement test of implant Implantat-Mikrobewegungstest

Displacement(mm)

0.5 0.4

D1

Fuse Abutment area

0.3

D2 D3

0.2

D4

0.1

0

50 100 150 200 250 300 350 400 450 500 Force(N)

Durchgeführter Druckfestigkeitstest zur Bewertung der Mikroauslenkung bei der Knochendichte mit Universal-Testgerät. F&E-Zentrum Megagen Implant Co., Ltd (2012)]

Fuse Abutment Druckfestigkeitstest Compressive strength test of Fuse Abutment Compressive strength(N)

250 200 150 100

Average < 180N

50 0

1 Displacement(mm)

2

Specimen 1 Specimen 2 Specimen 3 Specimen 4 Specimen 5

Durchgeführter Druckfestigkeitstest zur Bewertung der Streckgrenze für das Fuse Abutment mit Universal-Testgerät. F&E-Zentrum Megagen Implant Co., Ltd (2012)

32

1992 beschrieb J. B. Brunski, dass bei einem Implantat eine höhere Wahrscheinlichkeit zur Fibrointegration als zur Osseointegration zwischen Knochen und Implantatoberfläche besteht, wenn während der Osseointegration Auslenkungen von über 100 µm am Implantat auftreten. (John B. Brunski, Bio-mechanical implant interface. Clinical Materials, Vol. 10, 153-201). Daher muss das Implantat gegen Auslenken unter direkter Belastung geschützt werden. Dies ist allerdings auch dann schwierig, wenn provisorisch ein Harz mit einem Titanzylinder verwendet wird. Man geht davon aus, dass dies zum Teil der Metallkomponente des provisorischen Zylinders zuzuschreiben ist, weil diese extreme Kräfte auf das Implantat übertragen kann. Das war einer der Gründe, warum man die direkte Belastung nur ungern einsetzte. Damit wurde es erforderlich, einen Spezialzylinder zum provisorischen Einsatz zu entwickeln. Dieser soll brechen, wenn die Belastung so stark wird, dass es zur Fibrointegration bzw. ausbleibender Osseointegration kommt, und so das Implantat schützen. Vorzugsweise sollte es problemlos möglich sein, eine provisorische Krone auf diesen provisorischen Zylinder aufzusetzen. Wir haben versucht, die Belastung zu messen, die bei einer Auslenkung von 100 µm an einem Implantat auftritt,

das sicher in Knochenmaterial ausreichender Dichte und ohne Schäden sitzt. Zunächst wurden AnyRidge-Implantate mit einem Drehmoment von über 40 Ncm in den international anerkannten Standard-Knochenblock eingedreht und jeweils mit einem Abutment versehen. Zur Messung der Belastung des Implantats bei einer Auslenkung von 100 µm kam ein Instron-System zum Einsatz. Die durchschnittliche Belastung lag bei 220 N (22,4 kgf); wenn also das neue provisorische Abutment unter dieser Last bricht, kann es das Implantat vor Auslenkung oder Beschädigung schützen. Ausgehend von die-

sem Versuch ist es uns gelungen, ein spezielles provisorisches Abutment mit niedriger Bruchfestigkeit von unter 200 N (20,4 kg) zu entwickeln, das wir Fuse Abutment nennen. Ein zusätzlicher Vorteil ist das anatomische Profil, das zu einer ansprechenden Ästhetik auch bei Provisorien beiträgt.


Megagen |

AnyRidge®

➲ Abutment Optionen Hex

EZ Post Abutment

H

Packungseinheit: Abutment mit Schraube und Laborschraube EZ Abutments sind goldfarben beschichtet um im Gingivabereich eine exzellente Asthetik zu gewahrleisten. Die naturliche Ausformung der Abutment (Biologische S-LINE) im Gingivabereich unterstutzt das Weichgewebe und dessen Ortstandigkeit. Verwenden Sie einen 1,2 mm Innensechskantschlussel (30 Ncm)

Platform level

GH

Ø Durchmesser

Gingivahöhe (GH)

Abutment Höhe (H)

Typ

2 Ø4.0

Ø5.0

3 4

Profile GingivaDiameter höhe (GH)

Ref. C

AANEPH4027L 7

Hex

Pfosten- Typ höhe (mm)

2

AANEPH4037L

AANEPH6027L

3

Ø6.0

AANEPH4047L

Ref.C

7

4

Hex

AANEPH6037L AANEPH6047L

5

AANEPH4057L

5

AANEPH6057L

2

AANEPH5027L

2

AANEPH7027L

3 4

7

5

ZrGEN Abutment

- beeinhaltet die Abutment Schraube: Anyridge (AANMSF) MiNi (MIAS14/MIAZ1410) • Titanbasen • 1 Set beeinhaltet 10 STK Titanbasen Können aber auch einzeln bezogen werden MiNi ZrGEN beeinhalten spezielle ZrGen Schrauben • Die Titanbasen sind in den DentalCAD Systemen: - 3 Shape - Exocad enthalten.

Hex

AANEPH5037L

3

Ø7.0

AANEPH5047L

7

4

AANEPH5057L

Hex

5

AANEPH7037L AANEPH7047L AANEPH7057L

Standard System

Durchmesser

Kragenhöhe

4

0.6

Schafthöhe (mm)

4.5

4.5

Hex

6

AnyRidge

4.5

1.5

Typ

Hex

6

Ref.C

AANIPR4015.MTN AANIPR4016.MTN AANIPR4525.MTN AANIPR4526.MTN

P C D

TiGEN Abutment

- beeinhaltet die Abutment Schraube. . AnyRidge (AANMSF) . MiNi (MIAS14/MIAZ1410) • 1 Set beeinhaltet 10 STK • Unterstützt die Dental CAD Systeme: - 3Shape - Exocad - Dental Wings

Standard System

AnyRidge

Farbe

Gold

Durch- Länge messer

12

20

Typ

Ref.C

Hex Non-Hex

ARTR1220.MTN ARTR1220N.MTN

Extra System Farbe

Durch- Länge messer

3.3 Gold

4.0 4.8

Typ

Hex

Ref.C

ARTXN1220.MTN

Non-Hex ARTXN1220N.MTN 12

20

Hex

ARTXM1220.MTN

Non-Hex

ARTXM1220N.MTN

Hex

ARTXL1220.MTN

Non-Hex ARTXL1220N.MTN

P C

D

33


➲ Abutment Optionen (weitere)

Gold Abutment Packungseinheit: Abutment mit Abutmentschraube und Laborschraube Schmelzpunkt des Abutment: 1400 - 1450℃ Verwenden Sie einen 1,2 mm Innensechskantschlussel (30 Ncm)

Milling Abutment Packungseinheit: Abutment mit Abutmentschraube und Laborschraube Abutment zum individuellen ausarbeiten und gestalten

Durch- Gingivamesser höhe (GH)

Ø4.0

1

Hex

Pfostenhöhe (mm) Typ Ref.C

11

Hex

AANGAH4012L

Non-Hex

AANGAN4012L

Non-Hex

P.H

C.H

Platform level P.D

PfostenGingivaDurchhöhe (mm) höhe (GH) messer

Ref.C

2

AANMAH4029L

3

Ø4.0

4

Ø5.0

AANMAH4059L

2

AANMAH5029L

3

AANMAH5039L

9

AANMAH5059L

2

AANMAH6029L

3

AANMAH6039L

9

AANMAH6059L

2

AANMAH7029L

AANMAH7049L

5

AANMAH7059L

CCM Abutment

PfostenGingivaDurchhöhe (mm) höhe (GH) messer

Packungseinheit: Abutment mit Schraube und Laborschraube

Ø4.0

1

P.D

AANMAH7039L

9

4

C.H Platform level

AANMAH6049L

5

3

P.H

AANMAH5049L

5

4

Ø7.0

AANMAH4049L

5

4

Ø6.0

AANMAH4039L

9

11

Hex

Typ Ref.C

Hex

Non-Hex

AANCAH4012L

Non-Hex AANCAN4012L

P.H

Schmelzpunkt des Abutment: 1380 ~ 1420°C Verwenden Sie einen 1,2 mm Innensechskantschlussel (30 Ncm)

34

C.H

Platform level P.D


Megagen |

AnyRidge®

Angled Abutment Verfugbar in den Angulationen 15° oder 25°, jeweils in den Durchmessern 4mm, 5mm, 6mm und den Gingivahohen 2mm - 5mm.

Hex-E

15°

Zusatzlich sind die Abutment mit "Hex oder Hex-E" lieferbar (siehe Bild)

Hex

25°

15°

25°

Packungseinheit: Abutment mit Schraube und Laborschraube zum individuellen gestalten.

P.H

Angled Abutment sind goldfarben beschichtet um eine exzellente Ästhetik zu gewahrleisten. Die naturliche Ausformung der Abutment (Biologische S-LINE) im Gingivabereich unterstutzt das Weichgewebe und dessen Ortstandigkeit.

C.H Implantatniveau

Verwenden Sie einen 1,2 mm Innensechskantschlussel (30 Ncm)

P.D

PfostenGingivaDurchhöhe (GH) höhe (mm) messer

Typ

Gingiva- PfostenDurchhöhe (GH) höhe (mm) messer

2

AANAAH4215L

2

AANAAH4315L

3

AANAAH4415L

4

AANAAH4515L

5

Hex

5

15°

2 3

Hex-E

4 5 2

AANAAE4215L

2

AANAAE4315L

3

AANAAE4415L

4

AANAAE4515L

7

3

AANAAH4225L

Ø6.0

5 2

Typ

Ecke

Ref.C

AANAAH6215L AANAAH6315L

Hex

AANAAH6415L 15°

AANAAH6515L AANAAE6215L AANAAE6315L

Hex-E

AANAAE6415L AANAAE6515L

7

AANAAH6225L

AANAAH4325L

3

AANAAH4425L

4

AANAAH4525L

5

AANAAE4225L

2

AANAAE4325L

3

AANAAE4425L

4

5

AANAAE4525L

5

AANAAE6525L

2

AANAAH5215L

2

AANAAH7215L

AANAAH5315L

3

AANAAH5415L

4

AANAAH5515L

5

Hex

4 5

25°

2 3

Hex-E

4

3

Hex

4 5

15°

2 3

Hex-E

4 Ø5.0

Ref.C

3 4

Ø4.0

Ecke

5 2 3 4

7

Hex

25°

2

4 5

2

AANAAE5315L

3

AANAAE5415L

4

AANAAE5515L

5

AANAAH5225L

5

3

AANAAE5215L

Hex-E

Ø7.0

2

AANAAH5325L

3

AANAAH5425L

4

AANAAH5525L

5

AANAAE5225L

2

AANAAE5325L

3

AANAAE5425L

4

AANAAE5525L

5

AANAAH6325L

Hex

AANAAH6425L 25°

AANAAH6525L AANAAE6225L AANAAE6325L

Hex-E

AANAAE6425L

AANAAH7315L

Hex

AANAAH7415L 15°

AANAAH7515L AANAAE7215L AANAAE7315L

Hex-E

AANAAE7415L AANAAE7515L

7

AANAAH7225L AANAAH7325L

Hex

AANAAH7425L 25°

Hex-E

AANAAH7525L AANAAE7225L AANAAE7325L AANAAE7425L AANAAE7525L

35


Abutment-Niveau Prothetik

Multi-unit Abutment & Komponenten (All-on-4) (N_Type)

CCM Cylinder

Scan Abutment

ZrGen Abutment

Temporary Cylinder

Impression Coping

[0°]

Lab Analog

[17°] Multi-unit Abutment

36

[30°]

Healing Cap


Megagen |

AnyRidge®

Multi-unit Abutment™ Die Lösung für den zahnlosen Patienten Prothetisch kompatibel

Verschiedene Gingivahöhen

mit Nobel Abutment

Gerade: 1.5, 2.5, 3.5, 4.5mm 17°: 2.5, 3.5mm 30°: 3.5, 4.5mm

Verschiedene Angulationen Straight, 17°, 30°

Vorteile 1. Einfache und kostengünstige Lösung für Zahnlose Patienten 2. Teure und Zeitaufwändige Knochenaufbauten lassen sich vermeiden 3. Verschiedene Abutment zur einfachen Versorgung der Implantate verfügbar (0˚, 17 ˚, 30 ˚) 4. Kompatibel mit Nobel-Typ

Verbindung passend zu AnyRidge

Post Height

Abutment Angle

Platform Diameter Post Diameter

✓ Post Height ✓ Post Diameter ✓ Post Angle ✓ Abutment Angle ✓ Cuff Height

Post Angle

Cuff Height

∅4.8 2.2mm ∅4 44°

Platform Diameter Post Height Post Diameter Post Angle Abutment Angle Cuff Height

Kompatibel mit Nobel Multi-unit Prothetik

17° 2.5 / 3.5

30° 3.5 / 4.5 37


➲ Multi-unit Abutment Multi-unit Abutment [AR] - Straight Packungsinhalt: Abutment und Platzierungshilfe

Gingivahöhe (GH) mm

Typ

1.5 2.5 3.5

Ref.C

Cuff

MUAARN0015C 1-piece (M1.8)

4.5

MUAARN0025C MUAARN0035C MUAARN0045C Ø4.8

Multi-unit Abutment [AR] - 17° Packungsinhalt: Abutment, Abutmentschraube und Platzierungshilfe

Gingivahöhe (GH) mm

Typ

2.5 3.5

Hex

MUAARH1745LC MUAARN1725LC Non-Hex

4.5

Packungsinhalt: Abutment, Abutmentschraube und Platzierungshilfe

38

MUAARH1735LC

2.5

Gingivahöhe (GH) mm

3.5 4.5 3.5 4.5

17°

MUAARH1725LC

4.5

3.5

Multi-unit Abutment [AR] - 30°

Ref.C

Cuff

MUAARN1735LC MUAARN1745LC

Typ

Hex

Non-Hex

Ref.C

30°

MUAARH3035LC MUAARH3045LC MUAARN3035LC MUAARN3045LC

Cuff


Megagen |

AnyRidge®

➲ Zusatzteile für Multi-unit Abutment

Healing Cap

Abutmentschraube (MUAS) inklusive

Impression coping (Pick-up)

Typ

Ref.C

Regular

MUAHCL

Wide

MUAHCWL

Verbindung

Ref.C

Non-Hex

MUAICT

Regular

Wide

Halteschraube inklusive

Lab Analog

Temporary Cylinder Abutmentschraube (MUAS) inklusive

CCM Cylinder

Abutmentschraube (MUAS) inklusive

Orginalform

Ref.C

Multi-unit Abutment(Nobel)

MUALA

Verbindung

Ref.C

Non-Hex

MUATCL

Verbindung

Ref.C

Non-Hex

MUACCML

39


➲ Zusatzteile für Multi-unit Abutment Multi-unit Driver

Right Angle Driver

Hand Driver

Removal Driver [Austreiber]

40

Hex

Länge

Ref.C

2.0

10

MUD10

Hex

Länge

Ref.C

2.0

10

MURAD10

Hex

Länge

Ref.C

1.2

20

MUHD1220

Hex

Länge

Ref.C

1.2

20

MUARD20


Megagen |

AnyRidgeÂŽ

Implantatausrichtung und Abwinkelung Wichtig Bitte achten Sie beim platzieren der Implantate auf die axiale Ausrichtung sowie auf die Position der Indexierung (Rotationsschutz).

Abutment Indexierung (Sechskant) 1

Eindrehhilfe Indexierung (Sechskant) 2

Implantat Indexierung (Sechskant) 3

Verpackung Packungsinhalt Multi-unit Abutment

Multi-unit Abutment mit Platzierungshilfe

CCM Cylinder Temporary Cylinder Lap Analog Impression Coping

41


Overdenture Niveau Prothetik

Meg-Rhein Abutment & Komponenten

Retentive Cap set

Lab Analog

Impression Coping

Meg-Rhein Abutment

42


Megagen |

AnyRidge®

➲ Meg-Rhein Overdenture System

Meg-Rhein Overdenture System

Gingivahöhe (GH) mm

Ref.C

- 1 Meg-Rhein Abutment - 1 Plastic Carrier - 1 Stainless Steel Housing - 1 Protective Disk - 5 Retentive Caps (Black-Lab, Yellow-0.6kg, Pink-1.2kg, White-1.8kg, Violet-2.7kg) • Kompatibel mit Rhein83 aus Italien. • Verwendbar bis 30° Achsdivergenz • Empfohlener Drehmoment: 15 Ncm

0

ADR00P

1.0

ADR01P

2.0

ADR02P

3.0

ADR03P

4.0

ADR04P

5.0

ADR05P

6.0

ADR06P

8.8

C.H

White Cap & Violet Cap Yellow Cap & Pink Cap Protective Disk Stainless Steel Housing & Black Cap Meg-Rhein Abutment with Plastic carrier

43


➲ Komponenten für das Meg-Rhein Abutment

5 Retentive Caps (White)

• Retentionseinsatz "White 1,8 Kg" Nachfüllpackung (5 Stk.) • Zu verwenden wenn höhere Abzugskraft gewünscht als bei "Pink 1,2 Kg"

5 Retentive Caps (Violet)

RCWP

• Retentionseinsatz "Violet 2,7 Kg" Nachfüllpackung (5 Stk.) • Zu verwenden wenn höhere Abzugskraft gewünscht als bei "White 1,8 Kg"

5 Stainless Steel Housing

Ref.C

Ref.C

RCVP

Ref.C

MHP

• Matrizengehäuse (5 Stk.)

Stainless Impression Coping (Pick-Up) • Abformkappen Metall (2 Stk.)

44

Ref.C

044CAIN

5.5


Megagen |

Lab Analog

Retentive Cap Removal Tool

Ref.C

PLA

Ref.C

091EC

90

• Zum entfernen der Retentionseinsätze aus dem Matrizengehäuse

Insertion Tool (Einbringwerkzeug)

AnyRidge®

Ref.C

085IAC

83

• Zum einsetzen der Retentionseinsätze in das Matrizengehäuse

40

Keratoren gerade und abgewinkelt auf Anfrage verfügbar. Bitte fragen Sie hierzu nach dem separaten Einleger

? 45


AnyRidge Fallbericht â&#x17E;˛ Clinical Case 1

- Courtesy of Dr. Kwang-Bum Park

AnyRidge implant can make excellent initial stability even at this extremely loose bone. Fig 1. This 52 year-old male patient lost his maxillary left first molar due to periodontitis during implant treatment for other teeth. The panoramic radiograph was taken about one month after extraction, and a large extraction socket defect was expected. On the clinical examination, the inter-arch space for future crowns was very limited due to large tuberosity, so it was planned to remove bone and soft tissue from this sites (red line on panoramic view). The remaining vertical height was about 7~8 mm under the sinus floor. Fig 2. Two parallel incision lines were made on the crest expecting the soft tissue amount after reducing the crestal dimension. There was no buccal plate remaining on the extraction socket of the first molar area. Fig 3. During the procedure to make an ideal shape of alveolar ridge, all the cortical bone was removed from the crest. Fig 4. Now the ridge has normal shape and inter-arch distance was recovered enough to make ideal contour of crowns. However, the bone density was extremely soft without any cortical bone. It was much less than Type IV bone density. At the case of like this, how long do we have to wait after implant placement to start the prosthetic procedures? Normally we wait for at least 6 months for Type IV bone with conventional implant system because we cannot get enough initial stability due to less bone density. However if we can make excellent initial stability with mandibular implants by changing implant design, we may start prosthetic procedures after 3 months or less. That is one of important design concepts on AnyRidge implant system.

Fig 1

Fig 2

Fig 3

46


Megagen |

Fig 5. Two osteotomy sockets were prepared with a single trial of drilling using a trephine (4050 which has 5.0mm outer diameter). Bone density was extremely soft as expected, and there was enough ridge width both to buccal and lingual side. If we place fixtures with conventional thread design, satisfactory initial stability is really difficult to achieve due to loose bone density. AnyRidge implant was designed to have same core diameter, but different thread depth with increase of fixture diameter. So in the case like this, we needed to consider the bone density uring socket preparation to choose adequate depth of thread which could affect initial stability. Fig 6. Two 7.0(W)x8.5(L)mm AnyRidge fixtures were placed with excellent initial stability because of deep and knife threads. Compared with the size of osteotomy sockets, the fixtures were 2mm bigger in diameter, but the core diameter of these wide fixtures are only 4.8mm. The whole depth of thread could be used to engage bone to get more BIC and better initial stability.

AnyRidgeÂŽ

Fig 4

Fig 5

Fig 6

Fig 7. The bone defect was grafted with autogenous bone which was harvested during reshaping of alveolar ridge and trephination. And primary closure was made to make sure bone regeneration. Fig 8. The panoramic view after surgery. Fig 9. Three months after implant placement, the second stage surgery was made and provisional restoration was delivered two weeks later. The final restoration was delivered about one month later for the maturation of regenerated bone. On the radiograph taken 2.5 years later, the crestal bone regenerated up to the level of platform.

Fig 7

Fig 8

Fig 9

47


â&#x17E;˛ Clinical Case 2

- Courtesy of Dr. Kwang-Bum Park

AnyRidge implant has excellent surface treatment which can be osseointegrated at this extreme case of bone defect. Fig 1. This patient was 56 years old male patient and had a chief complaint of chewing difficulty on the left first mandibular molar due to periodontitis. On the panoramic radiograph, the tooth was floated with complete bone loss to the apex, and there was not enough bone to get initial stability for implant placement at the apex above mandibular nerve. So I decided to extract the tooth and wait for 4 months for regeneration of the socket. Fig 2. The patient came back to my office after 4 months. Healing appeared good enough clinically, but the panoramic view still showed large socket defect. In many cases like this, we can expect some amount of bone fill in the socket which can allow minimal initial stability for implant placement.

Fig 1

Fig 3. When the flap was opened, I was very embarrassed that bone regeneration did not occur in the socket. None of remaining bone could be used for implant fixation. Fig 4. A widest AnyRidge implant 8.0mm was placed on the mesial wall of extraction socket, but there was no initial stability. This trial was quite heroic treatment, but there was no other option except this because he flied many hours for this surgery. Fig 5. The mixture of Allograft (Mega-Oss) and Synthetic bone (Bone Plus) was placed into the remaining socket defect and a collagen membrane was covered. Then primary closure was made with releasing incision on the periosteum.

Fig 2

Fig 3

Fig 4

Fig 5

48


Megagen |

AnyRidgeÂŽ

Fig 6. On the panoramic view after surgery, we could find that none of the fixture was engaged with remaining bone, so it had more than 1.6mm gap from the tip to the depth of knife threads. I worried about the bone filling and success of the osseointegration on this fixture. Fig 7. However, I was surprised with the hard cortical bone regeneration over the cover screw when I did the second stage surgery with the Biolaser. Fig 8. On the intraoral radiograph taken several weeks after second surgery, we could see the fully regenerated bone into the bottom of thread depth.

Fig 6

Fig 9. The patient came back to our office to get one more implant on the maxillary upper molar after 2 years from the first implant surgery. The regenerated bone was matured and showed very stable crestal bone on the intraoral radiograph.

Fig 7

Fig 8

Fig 9

49


MiNiTM Hauptvorteile ➲

Zweiteiliges Implantatsystem

Belastbare Lösung für kleine Frontzähne und Zähne mit schmalen Leisten ➲

50

Klein aber fein


Eigenschaften & Vorteile Implantat | Cover Screw & Healing Abutment MiNi Overdenture Implantate Prothetische Versorgungsoptionen Fallberichte

51


Eigenschaften & Vorzüge

Ⅰ. Charakteristiken

MiNi - klein aber fein TM

Im vergleich zu Firma A zeigt das MiNi mit dem Durchmesser vergleichbare Werte. Jedoch ist das Implantat mit dem Durchmesser 3,25mm im Bereich der Plattform deutlich belastbarer. [Druckfestigkeit] 800

784.4

Load (N)

750 700 650

676.6

657.1

600 550 500

MiNiTM Ø3.0

MiNiTM Ø3.25

Company A Ø3.0

[Wandstärke] Ø3.0

Ø3.4

A B

II° Verbindung

MiNiTM Ø3.0

Ø3.0

A

A

B

MiNiTM Ø3.25

B

Company A Ø3.0 (unit : mm)

M1.4 Abutmentschraube

1.7mm Sechskant

Parallel wall thickness

MiNiTM Ø3

MiNiTM Ø3.25

Company A Ø3

A

0.28

0.47

0.34

B

0.31

0.42

0.44

Mechanical test using universal testing machine in accordance with ISO 14801, -R&D center in MegaGen Implant Co.,Ltd.(2013)-

XPEED Oberflächenbehandlung

Knife thread "Schneidegewinde"

52


Megagen |

Implantat / Cover Screw & Healing Abutment MiNi Implantat - beeinhalltet die Cover Screw

• Der Plattform Durchmesser eines Ø3.0 Implantates beträgt 3.0mm. • Der Plattform Durchmesser eines Ø3.25 Implantates beträgt 3.4mm.

Durchmesser

Länge (mm)

Ref.C

8.5

MIIF3008C

10.0

MIIF3010C

11.5

MIIF3011C

13.0

MIIF3013C

15.0

MIIF3015C

8.5

MIIF3308C

10.0

MIIF3310C

11.5

MIIF3311C

13.0

MIIF3313C

15.0

MIIF3315C

Ø3.0

Ø3.25

Cover Screw

• Zum Verschluss des Implantats. • Verwenden Sie einen 1,2 mm Innensechskantschlüssel (5-10 Ncm) • Einbringung nur mit Fingerkraft

Healing Abutment • Zum Verschluss des Implantats. • Verwenden Sie einen 1,2 mm Innensechskantschlüssel (5-10 Ncm) • Einbringung nur mit Fingerkraft

Ref.C

Höhe (mm)

0.5

Profil Durchmesser

Ø3

Ø3.5

MICS2505

Gingivahöhe (GH) mm

Ref.C

1.0

MIHA3025

1.5

MIHA3030

2.5

MIHA3040

3.5

MIHA3050

4.5

MIHA3060

1.0

MIHA3525

1.5

MIHA3530

2.5

MIHA3540

3.5

MIHA3550

4.5

MIHA3560

Ø3.0

L

Ø3.4

L Ø3.25

0.5

von oben

C.H

C.H

53


Abutment & Prothetik Optionen

EZ Post

Gefrästes Abutment

Abgewinkelte Abutment

Provisorisches Abutment

ZrGEN Abutment

TiGEN Abutment

Fuse Abutment

Meg-Rhein Abutment

Labor Analog Geschlossene Abformung

Offene Abformung

Abformpfosten (Transfer)

Abformpfosten (Pick-up)

Abdeckschraube

54

Einheilkappe


Megagen |

➲ Abutment Optionen und Komponenten

EZ Post Abutment

Profil PfostenDurchmesser Höhe

• Packungseinheit: Abutment mit Schraube (MIAS14) • Verwenden Sie einen 1,2 mm Innensechskant-schlüssel (15 Ncm)

5.0

Ø3.5

7.0

9.0

Milling Abutment

• Packungseinheit: Abutment mit Schraube • Verwenden Sie einen 1,2 mm Innensechskant- schlüssel (15 Ncm)

Profil PfostenDurchmesser Höhe

Ø3.0

9.0

Gingivahöhe (GH)

Ref.C

1.0

MIEP3505HT

1.5

MIEP3515HT

2.5

MIEP3525HT

3.5

MIEP3535HT

4.5

MIEP3545HT

1.0

MIEP3507HT

1.5

MIEP3517HT

2.5

MIEP3527HT

3.5

MIEP3537HT

4.5

MIEP3547HT

1.0

MIEP3509HT

1.5

MIEP3519HT

2.5

MIEP3529HT

3.5

MIEP3539HT

4.5

MIEP3549HT

Gingivahöhe (GH)

5

C.H

P.D

7

9

Ref.C

1.0

MIMA3009HT

1.5

MIMA3019HT

2.5

MIMA3029HT

3.5

MIMA3039HT

4.5

MIMA3049HT

9.0 C.H

55


➲ Abutment Options & Components

Angled Abutment

Profildurchmesser

Gingivahöhe (GH)

• Packungseinheit: Abutment mit Schraube • Verwenden Sie einen 1,2 mm Innensechskant- schlüssel (15 Ncm)

Typ

Winkel

2.5

MIAA3215HT Hex

3.5 4.5

Ø3.5

2.5 Hex-E

Hex

15°

MIAA3215ET

C.H

C.H

Ø3.5

Ø3.5

MIAA3415ET

Standard System

Durchmesser

MiNi

3

Kragen- Schafthöhe (mm) höhe

0.6

2.5

Typ

Ref.C

Hex

MIPN3013.MTN

P C

• Titanbasen • 1 Set beeinhaltet 10 STK Titanbasen Können aber auch einzeln bezogen werden MiNi ZrGEN beeinhalten spezielle ZrGen Schrauben • Die Titanbasen sind in den DentalCAD Systemen: 3 Shape, Exocad enthalten.

TiGEN Abutment

- beeinhaltet die Abutment Schraube. . AnyRidge (AANMSF) . MiNi (MIAS14/MIAZ1410)

D

Standard System

MiNi

Farbe

Durch- Länge messer

N/A

12

20

Typ

Ref.C

Hex

MITN1020.MTN

• 1 Set beeinhaltet 10 STK • Unterstützt die Dental CAD Systeme: 3Shape, Exocad, Dental Wings

Temporary Abutment • Packungseinheit: Abutment mit Schraube • Verwenden Sie einen 1,2 mm Innensechskant- schlüssel (15 Ncm)

Profildurchmesser

Ø3.0

Länge (mm)

Typ

12

Hex

Ref.C

MITA3012HT

12

Ø3.0

56

Hex-E

MIAA3415HT

MIAA3315ET

4.5

- beeinhaltet die Abutment Schraube: Anyridge (AANMSF) MiNi (MIAS14/MIAZ1410)

15°

MIAA3315HT 15°

3.5

ZrGEN Abutment

Ref. C


Megagen |

Impression Coping

Profildurchmesser

Länge (mm)

- beeinhaltet Guide Pin

• Transfer Type: Zur Einbringung der Impression Coping Schraube (Abdruckschraube) steht ein 1.2mm Einbringwerkzeug zur Verfügung

12 Ø3.5 16

Typ

Transfer

MIIT3512HT

Pick-up

MIIP3512HT

Transfer

Transfer type

Ref.C

Hex

Pick-up

MIIT3516HT

16

14

MIIP3516HT

Pick-up type

Ø3.5

Lab Analog

Länge (mm)

Ref.C

12

Fuse Abutment

• Packungseinheit: Abutment mit Schraube • Verwenden Sie einen 1,2 mm Innensechskantschlüssel (15 Ncm)

12

MILA300H

Labiolingual

Typ

Ø3.5

Mesiolingual

GH (mm)

Höhe (mm)

Gerade

Art.Nr.

MFAP3535P

Abgewinkelt (15°)

Ø5.0

Ø3.5

3.5

Abutmentschraube

7.0

MFAA3315P MIAS14

Mesio distal

15° Labiolingual Höhe

Mesio distal

GH Labiolingual

57


MiNi Overdenture Implantat

• Die Durchmesser 2.5 / 3.0 / 3.5mm und 2.0 /

Profildurchmesser

Ø 2.5

Gingivahöhe (GH)

2

4.0mm zusammen mit den Implantatlängen

8.5/10.0/11.5/13.0mm sind zu 100% kompatibel mit Rhein83

Ø 2.5

Ø 3.0

Ø 3.0

Ø 3.5

Ø 3.5

58

4

2

4

2

4

Länge (mm)

Ref. C

8.5

OF25208

10

OF25210

11.5

OF25211

13

OF25213

8.5

OF25408

10

OF25410

11.5

OF25411

13

OF25413

8.5

OF30208

10

OF30210

11.5

OF30211

13

OF30213

8.5

OF30408

10

OF30410

11.5

OF30411

13

OF30413

8.5

OF35208

10

OF35210

11.5

OF35211

13

OF35213

8.5

OF35408

10

OF35410

11.5

OF35411

13

OF35413

GH

MiNi Overdenture Implantat

1. Schnelle Osseointegration Dank der S-L-A Oberfläche 2. Hervorragende Eignung zur Prothesen Unterstützung 3. Einfache Nutzung - Intuitive Handhabung 4. Exzellente ästethisches Design 5. Minimale Bohrsequenz mit der Möglichkeit 1 Schritt Einbringung

L

1. Produktkonzept:

D


Megagen |

➲ MiNi Overdenture Komponenten

Initial Drill

• Wird verwendet um den Kortikalknochen initial zu Körnen • Es wird empfohlen den Knochen in voller Implantatslänge zu bohren

Profildurchmesser

Länge (mm)

33

ID1818S

Ø1.8

38

*ID1818M

43

*ID1818L

Ref.C

(*) separate Verkaufsartikel.

Shaping Drill

• Jeder Bohrer hat Tiefenmarkierungen von 7mm- 15mm • Das duale Markierungssystem (Rillen und Laser Markierungen) hilft visuelle sowie radiografische Tiefen einfach zu identifzieren

Länge (mm)

Profildurchmesser

Ø2.0

Ø2.5

Ø2.8

Ref.C

33

SD2018S

38

*SD2018M

43

*SD2018L

33

SD2518S

38

*SD2518M

43

*SD2518L

33

SD2818S

38

*SD2818M

43

*SD2818L

Ø2.0

Ø2.5

Ø2.8

(*) separate Verkaufsartikel.

Handpiece Connector

Ratchet Connector

Typ

Ref.C

Short

OHCS

Typ

Short

Länge (mm) Ref.C

12

ORCS

59


Overdenture Prosthesis

Meg-Rhein Abutment & Teile

Retentive Cap Set

Lab Analog

Impression Coping

Meg-Rhein Abutment

60


Megagen |

➲ Meg-Rhein Overdenture System

Meg-Rhein Overdenture System

Kragenhöhe (mm)

Ref.C

- 1 Meg-Rhein Abutment - 1 Plastic Carrier - 1 Stainless Steel Housing - 1 Protective Disk - 5 Retentive Caps (Black-Lab, Yellow-0.6kg, Pink-1.2kg, White-1.8kg, Violet-2.7kg)

• Kompatibel zum Rhein83 System aus Italien

0

MDR00P

1.0

MDR01P

2.0

MDR02P

3.0

MDR03P

4.0

MDR04P

5.0

MDR05P

6.0

MDR06P

• Empfohlener Eindruck Torque: 15Ncm

8.8

C.H

White Cap & Violet Cap Yellow Cap & Pink Cap Protective Disk Stainless Steel Housing & Black Cap Meg-Rhein Abutment with Plastic carrier

61


➲ Komponenten für das Meg-Rhein Abutment

5 Retentive Caps (White)

• Retentionseinsatz "White 1,8 Kg" Nachfüllpackung (5 Stk.) • Zu verwenden wenn höhere Abzugskraft gewünscht als bei "Pink 1,2 Kg"

5 Retentive Caps (Violet)

RCWP

• Retentionseinsatz "Violet 2,7 Kg" Nachfüllpackung (5 Stk.) • Zu verwenden wenn höhere Abzugskraft gewünscht als bei "White 1,8 Kg"

5 Stainless Steel Housing

Ref.C

Ref.C

RCVP

Ref.C

MHP

• Matrizengehäuse (5 Stk.)

Stainless Impression Coping (Pick-Up) • Abformkappen Metall (2 Stk.)

62

Ref.C

044CAIN

5.5


Megagen |

Lab Analog

Retentive Cap Removal Tool

Ref.C

PLA

Ref.C

091EC

• Zum entfernen der Retentionseinsätze aus dem Matrizengehäuse

Insertion Tool (Einbringwerkzeug)

• Zum einsetzen der Retentionseinsätze in das Matrizengehäuse

90

Ref.C

085IAC

83

40

63


MiNi Fallberichte â&#x17E;˛ Fallbericht

- Courtesy of Dr. Achraf Souayah

Fig 1. Intra-oral initial situation, front view Fig 2. DSD analysis. The yellow dotes shows where the right canine should be moved for better smile outcome Fig 3. Details of incision design. Front view Fig 4. Final Drills in sites, front view. Flap was elevated and two osteotomy sockets were made for 3.0 mm Mini fixtures. Fig 5. Implant placement on site # 22. There was enough bone left labio-lingually even at this thin ridge. There was no bone defect. Fig 6. Occlusal view of the placed implants, 0.5 mm sub-crestally. Two 3.0*13mm MiNi implants were placed with excellent primary stability. Fig 7. Sutured implant sites. Frontal view Fig 1

Fig 8. Sutured implant sites, occlusal views & Post-operative retro-alveolar radiographs Fig 9. Healed sites at 2 months recall, occlusal view Fig 10. Different views of the copings placed over the EZ Post Abutments

Fig 1

Fig 11. Views of the temporary crowns with clean margins and concave buccal contour Fig 12. Clinical photo of the intra-oral solidarization of the prefabricated teeth to the copings Fig 13. Clinical photo immediately after temporary crown cementation. Notice the vertical position of the gingival margins of the laterals.

Fig 3

Fig 4

Fig 14. Temporary smile of the patient immediately after temporay cementation of the provisionals.

Fig 5

64

Fig 6


Megagen |

Fig 7

Fig 8

Fig 9

Fig 10

Fig 11

Fig 12

Fig 13

Fig 14

65


MEGAGEN KIT

66


Megagen |

AnyRidge Kit

R2 Kit

Ⅰ. Abutment Selection Guide Kit Ⅱ. Surgical Kit Ⅲ. Prosthetic Kit Ⅳ. Bone Profiler Kit Ⅴ. Optional Components

Ⅰ. R2 Universal Kit II. R2 Narrow Kit III. R2 Full Surgical Kit 1. AnyRidge System 2. AnyOne System IV. Anchor Kit

MiNi™ Kit

AnyRidge®

911 Kit

67


AnyRidge Kit

Ⅰ. Für eine einfache Auswahl des optimalen Abutments

Ref.C

KANASG3000

Zur bestmöglichen Bestimmung von Abutmentlösungen

• Die Farben indizieren verschiedene Kragenhöhen: Yellow (Gelb): 2mm; White (weiss) 3mm, Pink (pink): 4mm, Red (rot): 5mm. • Kann im Autoclave sterilisiert werden

Straight type (EZ Post & Solid Abutment select)

68

Angle type(15°) (Angled Abutment select)

Angle type(25°) (Angled Abutment select)


Megagen |

Ⅱ. AnyRidge Surgical Kit: Standard Type

Ref.C

KARIN3003

Direction Indicator (for osteotomy sockets)

Ratchet

AnyRidge®

Path Finder (for pre-placed fixtures)

Torque Wrench

Lance Drill

MiNi

Cortical Bone Drill

Drill Extension

Ratchet Connector

Hand Driver

Abutment Removal Driver

Marking Drill

Handpiece Connector

69


â&#x2026;Ą. AnyRidge Surgical Kit: Full Type

Ref.C

KARIN3001

Direction Indicator (for osteotomy sockets)

Path Finder (for pre-placed ďŹ xtures)

Ratchet

Torque Wrench

Cortical Bone Drill

Lance Drill

Handpiece Connector

rill

Ratchet Connector

70

Point Trephine Bur Trephine Bur

Abutment Removal Driver

Marking Drill

Stopper Drill

Drill Extension

Hand Driver


Megagen |

AnyRidge®

➲ Surgical Kit Komponenten Lance Drill (Pilotbohrer)

Durchmesser

Typ

Ref. C

Ø2.0

Long

MGD100L

Wird verwendet um die kortikale Schicht des Knochens anzubohren und die Bohrrichtung vorzugeben. Fräst auch seitlich, ermöglicht somit auch eine Positionsänderung der "Pilotbohrung".

15

10

2.0

Marking Drill (Formbohrer)

Jeder Bohrer hat, den Implantatlängen entsprechend Teifenmarkierungen von 7.0mm - 15mm. Die Tiefenmarkierungen sind zur besseren visuellen und radiologoschen Erkennung lasermarkiert und als Rillen ausgearbeitet. Die AITIN-Beschichtung der Bohrer beugt Korrosion vor und verzögert die Abnutzung.

Durchmesser

Länge (mm)

Ref. C

Ø2.0

TANTDF2018

Ø2.5

SD2518S

Ø2.8 Ø3.3

18

SD2818S TANSDF3318

Ø3.8

TANSDF3818

Ø4.3

TANSDF4318

Ø4.8 Ø5.4

TANSDF4815 15

Ø5.9

TANSDF5415 TANSDF5915

L

D

Stopper Drill (Bohrstopps)

Durchmesser

Ø2.0

Ø2.8

Ø3.3

Ø4.8

Länge (mm)

Ref. C

7

TANTDF2007

8.5

TANTDF2008

10

TANTDF2010

11.5

TANTDF2011

7

SD2807M

8.5

SD2808M

10

SD2810M

11.5

SD2811M

7

TANSDF3307

8.5

TANSDF3308

10

TANSDF3310

11.5

TANSDF3311

7

TANSDF4807

8.5

TANSDF4808

10

TANSDF4810

11.5

TANSDF4811

L

L D

71


➲ Surgical Kit Components

Point Trephine Bur

(PointTrephan Fräsen)

Durchmesser

Ref. C

Ø5.0 (In.Ø4.0)

SPTB4050

5.0

Trephine Bur

(Trephan Fräsen) • • • • •

Minimiert die Bohrsequenz Schritte, speziell für weite Implantatdurchmesser; Hilfreich um Eigenknochen zu sammeln; Hilfreich um nicht eingeheilte Implantate zu entfernen Tiefenmarkierungen sind bei 7,8.5, 10, 11.5, 13mm (wie die Implantatlängen); Markierungen am Bohrschaft bilden den innen-aussen Durchmesser des Bohrers ab.

Durchmesser

Typ

Ø3.5 (in Ø2.5)

Ref. C

TANTBL2535

Ø5.0 (in Ø4.0)

Kurz

Ø6.0 (in Ø5.0)

TANTBL4050

Ø7.0 (in Ø6.0)

TANTBL6070

Ø3.5 (in Ø2.5)

TANTBE2535

Ø5.0 (in Ø4.0)

Lang

Ø6.0 (in Ø5.0) Ø7.0 (in Ø6.0)

32

TANTBL5060

TANTBE4050

D

TANTBE5060 TANTBE6070

3.5, 5.0 sind im Kit enthalten. 38

Cortical Drill (Kortikalbohrer)

Werden benutzt um den Eindrehwiderstand in D1-D2-Knochen zu kontrollieren bzw. zu erleichtern. Die AITIN Beschichtung der Bohrer beugt Korrosion vor und verzögert die Abnutzung.

72

Durchmesser

Ref.C

Ø3.5

TANCDL3500

Ø4.0~ Ø5.5

TANCDL4055

Ø6.0~ Ø8.0

TANCDL6080

Diameter 1 Diameter 2


AnyRidge®

Megagen |

Handpiece Connector (Eindrehhilfe ISO Schaft) Implantat-Eindrehhilfe mit ISO Schaft für Hand-und Winkelstück. Zum direkten und sichern Aufnehmen der Implantate aus der Verpackung.

Länge (mm)

Typ

Ref. C

5

*Ultra short

TANHCU

10

Short

TANHCS

15

Long

TANHCL

10

Short (MiNi)

HCS17

15

Long (MiNi)

HCL17

(*) Separate sales item.

Ratched Connector (Eindrehhilfe Ratsche)

Hand Driver -1.2 Hex (Schraubendreher)

Zum Eindrehen und Lösen aller Schrauben, Abdeckschrauben und Healing Abutments

Länge (mm)

Typ

Ultra short

Short

Long

MiNi

L Option

Ref. C

6

Ultra short

TANREU

10

Short

TANRES

15

Long

TANREL

15

Short(MiNi)

RCS17

20

Long (MiNi)

RCL17

Länge (mm)

Typ

Ref. C

5

*Ultra-short

TCMHDU1200

10

Short

TCMHDS1200

15

Long

TCMHDL1200

20

*Extra-long

TCMHDE1200

Ultra short

Short

Long

MiNi

L Option

Option

L

(*) Separate sales item.

Option

73


➲ Surgical Kit Komponenten Abutment Removal Driver

• Used to remove final abutment ; use after removing Abutment Screw. • Insert straight into the abutment and rotate clockwise. • Long Abutment Removal Driver is for disconnecting an abutment with a cemented crown.

Drill Extension (Bohrverlängerung)

Länge (mm)

Ref. C

17.5

TANMRD18

25.0

*TANMRD25

L

(*) Separate sales item.

Ref.C

MDE150

Zur Verlängerung von Bohrer. Bitte mit nicht mehr als 35Ncm Drehmoment belastetn.

Ø2.8

Drill Indicator (Parallel Pin)

Zur Überprüfung der Bohrrichtung und der Parallelität mehrerer Bohrungen

Ø4.7

Länge (mm)

Ref. C

8

8

Ø1.9 / Ø2.8

MDI2029

2

2

Ø3.2 / Ø4.7

MDI3348

8

8

Ø1.9

Path Finder (Parallel Pin)

Länge (mm)

Ref. C

10

TANPFF3580

Ø3.2

L

Zum Überprüfen der Position und Ausrichtung bei Implantaten.

Torque Wrench & Adapter (Drehmomentratsche)

Zum finalen Eindrehen von prothetischen Schrauben- Es kann ein Drehmoment von 15-45 Ncm erzeugt werden.

Typ

Ref. C

Torque Wrench

MTW300AT

*Torque Wrench Adapter(Handpiece)

TTAI100

Torque Wrench Adapter(Ratchet)

TTAR100

Torque Wrench

Torque Wrench Adapter

(*) Separate sales item. Handpiece

74

Ratchet


GUIDE PIN

OPTION

Ø4

Ø5

Ø6

Ø7

Megagen |

Ⅲ. AnyRidge Protethisches Kit

AnyRidge®

Ref.C

KANPK3000

Ein Kit mit allen Arten von Eindrehwerkzeugen, die für eine prothetische Versorgung notwendig ist.

Ratchet

Transfer Impression Coping Driver

Abutment Removal Driver

Ball Driver

Hand Driver

AnyRidge Solid Driver

Octa Driver

Transfer Impression Coping Driver • •

Typ

Funktioniert rein über die Friktionskraft Für den transfer Typ von Impression Copings

Ref. C

Zur zweiteiligen Abdrucknahme (2 Piece Impression Coping)

TCMID

Zur einteiligen Abdrucknahme (1 Piece Impression Coping)

TCMIDE

1

2

1. 2. 3. 4.

3

4

Verbinden Sie Impression Coping mit dem Einbringwerkzeug (Impression Driver) Verändere die Verbindung mit dem Implantat indem Sie den Halter gegen den Uhrzeigerisin drehen Drücken Sie den "Hiolder" und führen Sie den Impression Copying in das Implantat Drehen Sie den "Driver" gegen den Uhrzeigersinn um sicherzustellen, dass es eine stabile Verbindung zwischen Impression Coping und Implantat gibt.

75


Ⅳ. AnyRidge Bone Profiler Kit

Ref.C

KARBP3000

Zum Entfernen von Knochen, welcher in der Einheilphase über das Implantat gewachsen ist und somit das platzieren eines Gingivaformers oder Abutments beeinträchtigt.

• Bringen Sie einen Guide pin in das Implantat ein und wählen Sie einen Bone Profiler mit dem Durchmesser entsprechend des auf dem Implantat zu befestigenden Artikels aus. • Es sind vier verschiedene Bone profiler (Ø4mm - Ø7mm) mit entsprechendem Guide Pin im Kit enthalten.

AnyRidge®

Bone Profiler Kit Rev.00

GUIDE PIN

Bone Profiler & Guide pin

• Die Bone Profiler können einzeln nachgekauft werden • Jede Packung enthält einen Bone Profiler mit GuidePin

OPTION

Profil Durchmesser

Ø4 Ø5 Ø6 Ø7

Ø4

Ø5

Ø6

Ø7

Länge (mm) Ref.C

13

8

Bone profiler

TANBPL40G TANBPL50G Guide pin

TANBPS60G TANBPS70G L

76


Megagen |

AnyRidge®

Ⅴ. Zusätzliche Komponenten - nicht im Surgical Kit beeinhaltet

Right Angle Driver Tip

• Kann für alle Cover Screws und alle Abutment Screws sowie Healing Abutments genutzt werden • die Hex Spitze arbeitet mit einem maximalen Drehmoment von 35-45Ncm

Lindermann Drill

Länge (mm)

Typ

4

Ultra-short

10

Short

15

Long

20

Extra Long

Ref.C

MDR120SS Hex 1.2

MDR120S MDR120L

L

MDR120EL

Ref.C

Durchmesser (mm)

2

TEEL200M

2

Hand Tap

Typ

• Zum Nachschneiden/Reinigen des Innengewindes

Multi-unit Driver (2.0 Hex) (For Multi-unit Abutment)

• Zur Aufnahme und Befestigung von multi-unitAbutments (gerade Multi Unit Abutments)

Flattening Drill

• Zum begradigen von unebener Knochenstruktur

Ref.C

M1.8

THT180L

Länge (mm)

Typ

10

Short

TCMMUDS20

15

Long

TCMMUDL20

Ref.C

L

Flattening Lance

Durchmesser (mm)

Ø5.0 / Ø2.0 Ø6.0 / Ø2.0

Länge (mm)

3.5

Flattening Housing

Ref.C

FD5020 FD6020 L Diameter Ø2.0

77


Manuel Inserter (Hand-Einbringhilfe)

Ref.C

TANMI

• Speziell designed für eine manuele Implantatinserierung von Anyridge Implantaten • Sehr hilfreich für Sofortimplantation im maxillaren anterioren Bereich • Die Spitze des Einbringwerkzeuges hat die selbe Struktur wie der hand-piece-connector (Einbringwerkzeug für das Handstück)

Trephine Bur Stopper

• Trephan Fräsen mit Tiefenkontrolle passend zu den Implantatlängen

Länge (mm)

Ref.C

7.0

TANTSF2307

8.5

TANTSF2308

10.0

TANTSF2310

11.5

TANTSF2311

Connection

Trephine Bur Stopper

L

Bottom Drill

• Zum Entfernen des Knochens im Anschluss an die Nutzung des Trephan Bohrers

Durchmesser (mm)

Ø3.3 Ø3.8 Ø4.8 Ø5.8

Short (32mm)

TCMBDS38 TCMBDS48 TCMBDS58

Ø3.3

TCMBDL33

Ø5.8 Ø6.8

10

TCMBDS33

TCMBDS68

Ø4.8

8.5

Ref.C

Ø6.8

Ø3.8

78

Typ

7

Long (38mm)

Type

TCMBDL38 7 (7.5)

TCMBDL48 TCMBDL58 TCMBDL68

D

13 11.5 (13.5) (12) 8.5 10 (9) (10.5)


Megagen |

911 Kit

Set zur Sicheren Entfernung von Abutmentbeschädigungen Oder Abutmentbrüchen.

AnyRidge®

Ref.C

KPSCS3000

Hex

Hex

4

6

8

0

5

M1.4 Magenta

M1.6 Blue

M1.8 Yellow

M2.0 Red

M2.5 Green

4

6

8

0

5

M1.4 Magenta

M1.6 Blue

M1.8 Yellow

M2.0 Red

M2.5 Green

79


➲ 911 Kit Komponenten Fixture Remover

• Zur Entfernung des Implantates. Wenn Sie einen Fixture Remover nutzen, bedenken Sie bitte den äussersten Durchmesser des Implantates. Im Falle von AnyRidge Implantaten selektieren Se bitte einen Fixture Remover analog der Plattform Grösse

Durchmesser (mm)

Länge (mm)

Ref.C

15

*FSS3035

20

*FSL3035

15

FSS3540

20

FSL3540

15

FSS4555

20

FSL4555

15

FSS6080

20

FSL6080

Ø3.0~Ø3.6

Ø3.7~Ø4.6

Ø4.7~Ø5.6

Ø5.7~Ø7.0

Fixture Remover Screw

• Wird genutzt um Implantat mit Fixture Remover (Implantat Entferner) zu verbinden • Empfohlenes Eindrehmoment: - FSS14, FSS16: 40~50 Ncm - FSS18, FSS20, FSS25: 70~80 Ncm.

Applied Fixture Thread

M1.4 (MiNi)

• Wird genutzt um Implantat removal screw mit dem Implantat zu verbinden

Torque Wrench

• TW500: Genutzt zur Überprüfung der Ncm beim Entfernen des Implantates • TW70: Genutzt zur Überprüfung der Ncm beim Aufbringen der Implantat Remover Screw

80

Torque

Violet

40~50 *FSS14 Ncm FSS16

M1.6 (EZ Plus, ExFeel Ø3.3) Blue M1.8 (AnyRidge) M2.0

(AnyOne, MegaFix, EZ Plus, ExFeel)

M2.5 (Rescue)

Torx Driver

Farbe

Yellow Red

Ref.C

L

4

6

8

0

5

FSS18 70~80 FSS20 Ncm

Green

FSS25

Länge (mm)

Ref.C

5

TD05

15

TD15

20

TD20

Typ

Ref.C

300Ncm

TW500

70Ncm

TW70

L


Megagen |

AnyRidge®

➲ 911 Kit Komponenten

Abutment Remover

Länge (mm)

Ref.C

22

ASS

27

ASL

• Um defekte (abgebrochene / angebrochene) Abutments sicher zu entfernen. • Bitte nutzen Sie Schrauben Durchmesser M1.8 & M2.0

Screw Remover

• Wird genutzt um beschädigte Schrauben zu entfernen • Schraubengrösse der Systeme: - M1.4 = MiNi - M1.8 = AnyRidge - M2.0 = AnyOne

Screw Remover Guide Wird genutzt um das Tool Screw Remover von Seitwärts Bewegungen zu schützen, beim Entfernen der Schraube

Länge (mm)

30

Typ

Ref.C

M1.4 & M1.6

45 30

*SS1416S *SS1416L

Genutzter Implantat Durchmesser

Typ

Internal

External

L

SSS

M1.8 & M2.0

45

L

SSL

Ref.C

10∘

SSIG10

16∘

SSIG16

22∘

*SSIG22S

22∘

SSIG22

22∘

*SSIG22W

Hex 2.4

SSEG24

Hex 2.7

SSEG27

Hex 3.3

SSEG33

(*) Separate sales item.

Ref.C

Screw Remover Guide Holder

SSGH

Ein Werkzeug, um den Screw Remover Guide zu unterstützen

Hex Remover Genutzt um Abutment Screws, Cover Screws oder Healing Abutments mit hex Verbindung zu entfernen

Länge (mm)

Ref.C

22

HSS

27

HSL

L

81


➲ Abutment "911" Kit für AnyRidge

Ref.C

Set zur Sicheren Entfernung von Abutmentbeschädigungen oder Abutmentbrüchen

ARARS

Components High Speed Bur + Abutment Remover Driver + Abutment Remover Housing

How to

grind remaining fractured abutment using a high-speed bur, and remove the residue using a housing-connected driver

Recommendations

1. If an abutment hex is not separated even though the abutment is removed up to the stopper, remove the abutment hex with pincette. 2. Check the blade before usage. It is highly recommended to use a new bur if it is worn out. 3. Wash and sterilize immediately after every usage

※Cautions 1. Perpendicularly insert a high-speed bur into a fixture 2. Do not overload when using a high-speed bur. Adequate irrigation is highly recommend when using. 3. The given kit case is for storage only. Do not sterilize.

High Speed Bur

Abutment Remover Driver & Housing

82

Ref.C

ARARHB18

Ref.C

ARARD ARARH


Megagen |

AnyRidge®

911kit Fixture Remover ➲ Fixture Remover Screw: Single use only ➲ Do not use in case of a gap in Fixture Remover

Remove the prosthesis of the Select a Fixture Capture Screw fixture to be removed, and the of the same size as the fixture surrounding bone. internal screw. Use the Torx Driver to turn the screw clockwise (40Ncm~70Ncm) to place in the fixture. (Use of torque less than 40Ncm for M1.6, and 60Ncm for other products may lead to loosening)

Select a Fixture Remover that fits the fixture diameter. Turn the fixed Fixture Remover Screw counterclockwise until it touches the fixture. (For a torque of greater than 300Ncm, it is recommended to use a Trephine bur)

Fixture and Fixture Remover are tightly connected as rising force and descending force are combined. (Suction is needed; debris may happen on removal of a fixture)

Using Torque Wrench, turn counterclockwise and pull out fixture and Fixture Remover. (No more than maximum torque per fixture)

Removed fixture can be pulled out, turning Fixture Remover and fixture clockwise, holding onto vice plier.

Insert the Abutment Remover Use the Ratchet Wrench to in the fractured abutment hole. turn clockwise in order to join the abutment and the Abutment Remover as one body. (Ratchet Wrench is included in surgical kit)

Move the Abutment Remover sideways while pulling up to remove it. (Use of excessive force may traumatize the fixture or the bone)

Abutment Remover ➲ Can use for abutments that use M1.8 & M2.0 screws. ➲ Cannot use for abutment that use M1.6 and M2.5

Secure the separated abutment in a vice or vice pliers. Use the Ratchet Wrench to turn counterclockwise to separate the abutment with the Abutment Remover.

83


911kit Screw Remover

Remove the broken Abutment Screw and the abutment.

Select the correct Screw Re- Secure the Screw Remover mover Guide that fits the fixture Guide and insert the Screw connection to join. Holder in the Screw Remover Guide hole.

Push the Screw Remover down- Remove the pieces of broken wards while rotating counter screw from the fixture internal clockwise to separate it from the screw using forceps. fixture internal screw. (rpm:30~50, Torque : 30Ncm)

When separating the holder from the guide, push in the direction of the arrow to separate.

Hex Remover

In cases that Abutment Screw, Cover Screw or Healing Abutmentâ&#x20AC;&#x2122;s hex is damaged.

84

Use the Ratchet Wrench to turn counterclockwise to join the abutment with the Abutment Remover as one body. (Use a torque of less than 40Ncm., Ratchet Wrench is included in surgical kit.)

Place the removed abutment in the vice. Use the Ratchet Wrench to turn clockwise to separate the abutment with the Hex Remover.


Megagen |

AnyRidge®

R2 Narrow Kit (KAGNS3000) Tap Drill

Implant Carrier

Ref.C R2TD30MI R2TD34MI

Ref.C ICNH1722

Implant Carrier (Handpiece type) (Optional)

Stopper Drill

Initial Drill

Ref.C ICNH1722H Ref.C R2ID1901N

Ref.C R2SD1813N

Ref.C R2SD1811N

R2SD2513N

R2SD2511N

R2SD2813N

R2SD2811N

Ref.C R2SD1810N

Ref.C R2SD1808N

R2SD2510N

R2SD2508N

R2SD2810N

R2SD2808N

Second Drill

Ref.C R2SD1805N

When do we use Narrow Kit?

[Mandible single case] When Ø5.0 stent cannot be fabricated due to narrow distance between the teeth.

[Mandible multiple case] When fixture cannot be place near adjacent teeth due to large stent core on regular stent.

Regular VS Narrow Stent Guide Core Ø5

Ø3.5

Regular Stent [Guide Core Ø5]

Narrow Stent [Guide Core Ø3.5]

85


III. R2 Full Surgical Kit für das AnyRidge Implantat System Das R2 Full Kit ist so konzipiert, dass es mit alle Bohrern und Komponenten bestückt ist, die benötigt werden, um den Digitalen Guided Surgery Prozess: R2GATE Planungssoftware und R2 Navi Guide zu nutzen.

Cortical Bone Drill

Ref.C

Ref.C

Ref.C

Ref.C

Ref.C

Ref.C

R2CD 3405

R2CD 3805

R2CD 4305

R2CD 4805

R2CD 5305

R2CD R2CD 5805 6305

Ref.C

In type I or II bone, crestal bone is partly reduced to lower the pressure against the fixture during placement.

Ref.C

KAGIN3000

Ref.

MRW040S

AnyRidge

Initial Drill Initial Drill

RATCHET WRENCH

Second Drill

CORTICAL DRILL

Ø3.4

Ø3.8

Ø4.3

Ø4.8

Ø2.8

Ø3.3

Ø3.8

Ø4.3

13mm

11.5mm

INITIAL DRILL 10mm

8.5mm

Ref.C R2ID2601

SECOND DRILL

Ref.C R2SD2605

7mm

Ø2.0

Drilling to make the initial drill path

Ø2.5

DRILL EXTENSION

Guide Stop Drill

Drill Extension

Drill diameter : Ø2.0 ~ Ø5.9 Drill Length : 7.0 ~ 13.0mm

Guide length : 13.5mm Drilling length : 7.0 ~ 13.0mm

86

Product coodinator : Jung Ho Nam, kkangtong@megagen.co.kr

Ref.C MDE150


Ø4.3

Ø3.8

Megagen |

AnyRidge®

Implant Carrier

Bone Profiler

: Handpiece type : Ratchet type ▶ R – AnyRidge Regular ( ø3.5 ~ø4.5 )

Ref.C AGBP40

Ref.C AGBP50

Ref.C AGBP60

This is used to minimize the interference of the crestal bone when connecting ZrGEN Abutment, [Used before placing the fixture / Recommended RPM 600 ~1000]

Ref.C ICRH2324H

Ref.C ICRH2324

▶ W – AnyRidge Wide ( ø5.0 ~ ø6.0 ) Ø4.0

Ø5.0

Ø6.0

BONE PROFILER

Ø4.8

Ø5.3

Ø5.8

Ref.C ICWH2324H

Ø6.3

Ref.C ICWH2324

IMPLANT CARRIER

HANDPIECE RATCHET ADAPTER EXTENSION S

L HAND DRIVER

Ø4.3

Ø4.8

Ø5.4

Ø5.9

REMOVAL DRIVER

OPTION

Hand Driver

Ref.C TCMHDS1200

: 1.2 hex driver (Short) : 1.2 hex driver (Long) : Abutment Remover Driver

Ref.C TCMHDL1200

Ref.C TANMRD18

Handpiece Adapter

Ratchet Extension

Ref.C AGHA

Ref.C MRE400S

87


IV. Anchor Kit Bei zahnlosen Patienten fixieren Sie die Bohrschablone mit Hilfe der ANCHORPIN am Kiefer. Bitte beachten Sie, dass die Bohrschablone während dem Befestigen richtig sitzt sowie gleichmäßig und fest angepresst wird. Ist das erste Implantat inseriert, setzen Sie einen passenden STENT-ANCHOR durch die Bohrschablone in das Implantat ein. Dies garantiert Ihnen die richtige Position der weiteren Implantate und unterstützt den sicheren Sitz der Bohrschablone. Zur Kontrolle der Positionen der inserierten Implantate platzieren Sie die STENT-ANCHOR nach Entfernen der ANCHOR-PIN erneut.

Torx Tip

Ref.C AGTT80

Anchor Pin

Ref.C TCMACP2015

Ref.C Ref.C TCMACP2018 TCMACP2020

AnyRidge

Tip Driver

Product coodinator : Eui Jin Han, a2568491@megagen.co.kr

KAGAS3000

Ref.C TD

Stent Anchor M1.8 (AnyRidge)

M2.0 (AnyOne)

Ref.C AGSAR18

Ref.C AGSAR20

Ref.C AGSAW18

88

Ref.C

System

Ref.C AGSAW20


Megagen |

AnyRidge®

➲ Anwendungsbereiche des Anchor Kit`s:

Case 1. When it is possible to get stability from neighboring teeth. (No need to use the Anchor kit)

Place the R2 Navi-Guide™ by placing it onto the neighboring teeth.

Case 2. When it is hard to get stability from fully edentulous case or neighboring teeth. 1. Fix the R2 Navi-Guide™ temporarily by asking patient to bite the R2 Navi-Guide™ using a resin or other tools. 2. Please use the Pin that R2GATE™ program selected, and place that Pin on the Driver Tip. 3. Insert the Pin into the R2 Navi-Guide™ that the patient is biting, and turn it into clockwise to fix the R2 Navi-Guide™ to bone. *Make a hole on the Guide using Ø2.0 Drill if a density of the bone is high. Then, insert the Anchor Pin into the hole.

Case 3. - When it is necessary to re-implant a fixture after separating the R2 Navi-Guide™. - When the stability of the R2 Navi-Guide™ is weak even though all planned Anchor Pins are used (This is only for the cases with edentulous jaws and implantations of three or more fixtures).

* Cases for re-implant a fixture after failure 1. Check the condition of an implanted fixture after a separation of a R2 Navi-Guide™. Evulse the fixture when the implantation is considered as a failure for lack of stability or a path is inaccurate. 2. Replace the R2 Navi-Guide™. Insert the R2 Navi-Guide™ Anchor to the R2 Navi-Guide™ Hole of the neighboring fixture, and place the R2 Navi-Guide™ by turning it into clockwise. * When it is hard to get stability of the R2 Navi-Guide™ by an Anchor Pin only 1. When the stability of a fixture by an Anchor Pin only is low, start an implantation from molar areas. Then, connect the R2 Navi-Guide™ Anchor with an installed fixture to increase stability.

89


➲ Preparations for R2 Navi-Guide™ surgery. 1. Package check

Prosthesis type

Check what are contained in the delivery package received from R2GATE Center.

ZA : Zirconia customized abutment PR : Provisional restorations

Patient’s name

R2 Navi-Guide™ type

R : Regular core R2 Navi-Guide™ W : Wide core R2 Navi-Guide™

Patient’s name

2. Received two R2 Navi-Guide™? Do you plan to place a wide diameter fixture ? One is for regular diameter of drills and another is for wide diameter of drills & fixture insertion.

All diameter of general drill hole(core) and guide part of drills are 5.0mm. So from 3.5 to 4.5 diameter fixture can be placed through general drill hole. But In order to insert wide diameter fixture (over the 5.0mm), drill hole(core) should be made for wide diameter drilling and fixture insertion.

R

W

Drilling sequence:

Up to 4.3mm diameter of drilling, use the regular hole R2 Navi-Guide™ (marked “R”). Then that change to wide hole R2 Navi-Guide™ and continue to drill with bigger diameter drills.

3. Sterilization for R2 Navi-Guide™ and prostheses Put the R2 Navi-Guide™ and all prostheses into a bowl (jar) with an antiseptics (ex. Chlorhexidine Gluconate) for 30 minutes before surgery.

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Megagen |

AnyRidge®

➲ Types and retention of R2 Navi-Guide™ 1. Tooth - supported type Cusp Stop Drilling Core Cusp Stop

✽ Cusp Stop : To check the accuracy of R2 Navi-Guide™, Designer makes a few number of “Cusp stopper” on the cusp of the mesio-distal neighbor teeth. When R2 Navi-Guide™ is seated, check its fitness of contact between cusp and hole. There should not be a gap.

[Minimum size of model] Even it’s tooth support type R2 Navi-Guide™, 3/4 arch model is required for design and accurate retention.

2. Dual - supported type

Cusp Stop Drilling Core Anchor Hole Strut bar

3. Fully tissue - supported type

1~4 implants The residual teeth are still remained around the implantation site. The Main retention of R2 Navi-Guide™ comes from the remaining teeth. So, with the larger number of remaining teeth, retention will be higher and more stable. The damage and porosity of the remaining teeth on the model are not acceptable for the design of R2 Navi-Guide™ and its adaptation.

Free-end case Most of the free-end

case, R2 Navi-Guide™ gets the retention from a remaining tooth and residual ridge. All anatomical forms of teeth, alveolar ridge, vestibule should be represented clearly on the model. ✽ Anchor Hole : The anchor hole can be designed for additional retention. The location will be decided during diagnosis and confirmed by user. ⌀ 2.0 drilling might be required to insert anchor pin into the hard bone. (Maxillary anterior, Mandibulary regions).

Drilling Core Anchor Hole

Fully edentulous case In the fully edentulous case, R2 Navi-Guide™ gets the support from the residual ridge and gets the retention from anchor pins. All anatomical structure (palatal, vestibulare) should be represented clearly on the model. ✽ Putty bite : Right initial positioning of R2 Navi-Guide™, putty bite will be provided. Combine putty bite and R2 Navi-Guide™ first than put it in the patient mouth together. Let the patient bite it strong and insert the anchor pin into each hole.

The distortion of the model is an important factor of the error on diagnosis and R2 Navi-Guide™. Please understand checking point of R2 Navi-Guide™ fabrication, and try to make accurate impression and model.

91


➲ Adaptation of R2 Navi-Guide™ before surgery This procedure is essential to check the accuracy of R2 Navi-Guide™. 1. Tooth & tissue supported type

Check the “Cusp stop” of R2 Navi-Guide™ To check the accuracy of R2 Navi-Guide™, our designer makes a few number of “Cusp stopper” on the cups of the neighboring teeth. When R2 Navi-Guide™ is seated, check its fitness of contact between cusp and R2 Navi-Guide™ hole. There should not be a gap. Cusp Stop

Cusp Stop

2. Fully tissue supported type

Putty bite and Anchor pin

For an edentulous case, R2 Navi-Guide™ is seated using the putty bite and fixated with anchor pins specially designed for R2 Navi-Guide™ positioning.

1. The connected R2 Navi-Guide™ and the seating jig are delivered into the mouth together and seated. 2. Patient should bite with maximum occlusal force on the R2 Navi-Guide™ and seating jig. 3. Tighten the anchor pin using a hand driver. 4. 2.0mm drilling will be required in advance if the drilling point have a thick cortical bone.

92


Megagen |

AnyRidge®

➲ Basic principles of drilling with R2 Navi-Guide™ 1. Design concept of guide drills - All guide drills have the unique out-forms for the safe and efficient drilling. - The length of each drill is sum of 28.5mm + drilling part length. Therefore, if a patient’s mouth opening is not big enough, guide surgery is not appropriate.

2. 13.5mm of guided length

Drill Stopper 16

Guide Part

Drill Part

12.5 Fixture Platform

The length of guide part at the R2 Navi-Guide™ is 13.5mm. According to general literature for guide surgery, this length is better as longer as it be. But it can be the reason for contra-indication for guide surgery.13.5mm is optimal number regarding to clinical approach and it’s function.

3. Always start drilling when the guide part of a drill is engaged enough in the guide hole Start drilling when your drill gets the full support from the inside wall of drill core. Start drilling with low speed (300 rpm) and raise it up to 800 RPM. Up & down motion is also important to get cooling down of the drill and osteotomy socket.

4. Don’t guess, just feel it from a finger tip - R2 Navi-Guide™ has a stopping structure inside, so every drills will stop at the accurate position. - Make it sure to check a drill goes down to full depth and stops by the stopper. Most mistakes on vertical positioning come from this fault.

93


➲ R2 Universal Kit Drilling Sequence

1. Universal Drilling The meaning of universal drilling is to create vertical pass way for the selected implant. It increases the length of osteotomy to the fixture length.

Initial Drill

2nd Drill

Ø2.0 Drill

Ø2.5 Drill

Ø2.8 Drill

Ø2.8 Drill

2. The Shape of osteotomy after drilling The purpose of the universal drilling is to make ostetomy accessible for the next drills. 2nd drilling is the most important. It widens entrance part at the cortical bone. Next drillings are just for lengthening of osteotomy.

3. 7.0, 8.5, 10, 11.5, 13mm Length - Universal drilling has 0.5mm shorter than its marked number. and every drill has 2 step diameter for the next drill. Ø2.8 Drill should reach to the depth of implant length, or the implant fixture may not be positioned deep enough as planed. Length

7.0

8.5

10.0

11.5

13.0

A

6.5

8

9.5

11

12.5

16

R2 Navi-Guide™ Stopper Line

12.5 2.25 Ø2.6

3 2 2.5

Fixture Platform Line

2

A

0.8

Ø2.5

Ø2.8 Ø4.6

94

Ø2.0

Ø2.5

Ø2.5

Ø2.5

Ø2.8

Ø2.8


Megagen |

AnyRidge®

➲ Drilling Strategies Color-coded analysis of the bone morphology enables you to identify the invisible bony structure easily and to predict an optimal drilling sequence for strong initial stability of an implant. R2 Center provides the R2 diagnosis report with a proposed drilling sequence for adequate initial stability. However, the final decisions on drilling sequence should be made by the clinician, and R2 center has no responsibility with this proposal.

1. Recommended drilling Speed : 500 ~ 800 RPM with copious irrigation Start drilling with low speed and then raise it to the maximum speed when a drill is engaged with the guide hole.

2. Apico-coronal position and Hex direction control by using torque wrench 1. Apico-coronal position Depth of the fixture can be controlled by rotating the fixture with torque wrench until marking line of the ratchet connector goes to upper part of the R2 Navi-Guide™ window. 2. Hex direction control With proper apico-coronal position, please turn the ratchet connector clockwise up to 1/6 circle until the green colored column matches with the window of R2 Navi-Guide™ completely.

95


â&#x17E;˛ Recommended condition for ONE-DAY IMPLANT & immediate loading

According to our own clinical experiences & data, we strongly recommend to check two values : Insertion Torque & ISQ.

1. Insertion Torque value : more than 45Ncm

Available on our R2 Universal Kit.

2. ISQ value: more than 75

rpm

To have stable ISQ value, we recommend to use MEG-TORQ to fasten a smartpeg with 5 Ncm torque force consistently.

96

5


R2 Kit

MegaGen Kit Megagen |

254 /255

AnyRidge®

➲ Guide for Multi-unit Abutment of R2 ➲ Guide for Multi-unit Abutment of R2 TIP! Drilling should be done with Narrow Crest Drill (For sloping drill)

1. Place Multi-unit Abutment After checking a fixture path using Carrier, place a fixture and connect Screw. (Recommended torque: 25Ncm)

2. Place Temporary Cylinder Connect Temporary Cylinder on anterior region first. (Recommended torque: 15Ncm)

97


â&#x17E;˛ Guide for Multi-unit Abutment of R2

Abutment Screw Temporary Cylinder Temporary Cylinder Screw Multi-unit Abutment

Abutment Screw Temporary Cylinder Temporary Cylinder Screw

Resin

or Multi-unit Abutment of R2

Multi-unit Abutment

Digital Milling Denture

Resin

â&#x17E;˛ Guide for Multi-unit Abutment of R2

Digital Milling Denture

enture Position Fix pre-manufactured Digital Denture with flexible resin and harden using a right cure gun.

3. Set Digital Denture Position Fix pre-manufactured Digital Denture with flexible resin and harden using a right cure gun.

4. Fix Digital Denture Remove Digital Denture, and connect Temporary Cylinder on posterior region. Replace Digital Denture

fix it using the resin. Repeat this process as necessary. After removing Digital Denture, fill up the gap enture Remove Digital Denture, and connect Temporaryand Cylinder on posterior region. Replace Digital Denture between interior and exterior region of Temporary Cylinder on denture and harden using a right cure gun.

and fix it using the resin. Repeat this process as necessary. After removing Digital Denture, fill up the gap between interior and exterior region of Temporary Cylinder on denture and harden using a right cure gun.

98 5. Complete Digital Denture Check the fitness of Digital Denture inside of the mouth, and complete Denture by cutting protruded part of Temporary Cylinder.

gital Denture Check the fitness of Digital Denture inside of the mouth, and complete Denture by cutting


Multi-unit Abutment

Resin

â&#x17E;˛ Guide for Multi-unit Abutment of R2

Megagen |

Digital Milling Denture

AnyRidgeÂŽ

3. Set Digital Denture Position Fix pre-manufactured Digital Denture with flexible resin and harden using a right cure gun.

4. Fix Digital Denture Remove Digital Denture, and connect Temporary Cylinder on posterior region. Replace Digital Denture

and fix it using the resin. Repeat this process as necessary. After removing Digital Denture, fill up the gap between interior and exterior region of Temporary Cylinder on denture and harden using a right cure gun.

5. Complete Digital Denture Check the fitness of Digital Denture inside of the mouth, and complete Denture by cutting protruded part of Temporary Cylinder.

99


Produkte für den DIGITALEN WORKFLOW

100


CAD/CAM Abutments I. ZrGen Titanbasen II. TiGen: Pre-milled Abutmentblรถcke

101


R2GATE

“Diagnose und Fallplanung” sind die halbe Miete zum Erfolg.

MegaGen stellt diverse R2 services zur Verfügung. Wir wünschen viel Spass bei der Nutzung dieser!

Dies wird Kompass in der täglichen Implantat Praxis werden

102


Megagen | R2GATE™

Ⅰ. R2 Gate™ Planning service Perfect planning for Optimal Implant Positioning R2GATE™ helps you to set up prosthetic-driven treatment planning through optimal implant positioning which provides an intuitive view of all elements such as CBCT, STL, prosthetic design that are essential for implant simulation before the surgery.

Ⅲ. ONE-DAY Implant® service Deliver prosthetics on the same day of visit. Various types of prosthetics can be delivered on the same day of patient’s visit. Recover function & esthetics immediately!

Ⅱ. R2 Navi-Guide™ service Actualize your planning into reality perfectly. R2 Navi-Guide™ (the surgical guide) is manufactured by the state-of-the-art 3D printing technology in accordance with the result of treatment planning. R2 Navi-Guide™ completes your daily implant practice with confidence.

IV. Click to make service Make R2 ONE-DAY Implant possible on the very first visit of a patient Manufacture all of prosthetics at your own clinic with MegaGen Digital Pragmatism! Just send a scanned data, then MegaGen R2 Center will provide the final design, and the designed file will be sent within an hour. Click to make it yourself!

103


Ⅰ. R2GATE™ Planning Service The most brilliant solution & service for implant planning.

If you would like to buy a diagnosis & treatment planning service of R2GATE™, just ask our distributors in your country, and send them a CBCT file and model cast.

Characteristics & Advantages 1. Ideal Implant positioning

Prosthetic-driven Implant positioning R2GATE™ allows you to do prosthetic-driven treatment planning for optimal implant positioning. It provides an eidetic view of all elements that you need for implant practice such as CBCT, STL, and prosthetic designs before the surgery.

2. Digital-EYETM

Find the hidden DNA of CBCT Digital-EYE™ of R2GATE™ helps to make an accurate diagnosis by restructuring the 256 shades of the gray scale into colors to analyze and show you the real bone density and morphology.

Conventional view

Digital EYE™ view

3. Drilling Strategy

Maximum initial stability Color-coded analysis of bone morphology via Digital-EYE™ enables to easily identify the invisible bony structure and predict an optimal drilling sequence to gain strong initial stability.

104


Megagen | R2GATE™

Ⅱ. R2 Navi-Guide™ Service Turn your treatment planning into reality. Your daily implant practice will become more precise.

Tempting R2 Navi-Guide™ surgery? Just call our sales representative in your country. Our R2 Navi-Guide™ service will help your implant practice much faster, more economical & precise.

Characteristics & Advantages 1. The state of the art 3D printing technology pro duces a highly accurate surgical guide which brings your treatment planning into reality. 3D Printing

2. R2 Navi-Guide™ is ex- tremely useful in every cases from single to full mouth case even with bone deficiencies.

Single

Multiple

Full-Mouth

3. R2 Navi-Guide™ will be your rudder and compass for ideal implant positioning.

105


Ⅲ. ONE-DAY IMPLANT® Service

Various types of prosthetics can be manufactured using R2GATE™ program and delivered to your clinic even before surgery. The esthetics and function can be rehabilitated immediately. One-Day IMPLANT® service is easy to order. Just click “One-Day IMPLANT®” option when you confirm the diagnosis and treatment planning, and leave the rest to us!

Characteristics & Advantages 1. R2 Center provides efficient prosthetics to achieve the ONE-DAY IMPLANT® for various indications.

Single implant

Cementation type (ZrGEN & PMMA) - Ti-Based - Customized Abutment - PMMA CAD/CAM provisional restoration

2. Immediate loading? R2GATE™ will help you make the right decision for immediate loading by showing you the bone density and cortical engagement analysis data in advance. However, the decision should be made by a clinician according to the situation. The prosthetics can be delayed few weeks if the condition is not suitable for immediate loading.

106

Multiple implants

Cementation type Screw retained type (ONE-BODY type) - Ti-Based - PMMA CAD/CAM provisional restoration

Full arch restoration Cementation type, Screw retained type, Customized abutment, or Overdenture combination - Customized abutment - Inner coping - 3D Printed Denture with pink gingival coloring


Megagen | R2GATE™

Ⅳ. Click to Make Service You can manufacture customized abutment, R2 Navi-Guide, temporary crown without any additional fee nor complicated design; just one simple click will do everything for easy and fast manufacturing. Please counsel with sales representatives for cost effective MegaGen Digital Pragmatism products to receive “Click to Make Service.” Just send Scanned Data and CBCT on the day of patient’s first visit.

Characteristics & Advantages 1. CADless solution from R2 Center!

Just send Scanned Data, and CBCT (only for Navi Guide). Navi Guide and essential prosthetics will be designed within an hour.

ONE-DAY Guided Surgery

ONE-DAY Customized Abutment

After sending scan file and CT data in the morning, the surgery is possible within 4 hours. (The surgery can be delay according to the clinician’s confirmation on the diagnosis)

This can simply be done at your clinic through a oral or model scanning, but is more inexpensive than the ready-made abutments.

“R2 Navi Guide sugery. Do not delay it anymore”

Completes manufacture Customized Abutment within 1 hour

ONE-DAY Shell & Crown

implant surgery is done, place a beautiful and functional crown right after the surgery. Shorter chair time with greater satisfaction.

2. MegaGen Digital Pragmatism! Manufacture all of the prosthetics at your

own clinic with MegaGen Digital Pragmatism. No more complicated CAD/CAM! Enjoy yours with MegaGen!

⇒Refer to Page.258 DIGITAL PRAGMATISM 1

DIGITAL PRAGMATISM 2

It is composed of inexpensive and practical machines.

Customized Abutment, No additional workforce, proR2 Navi Guide, gram or design. It is convenTemporary Crown, ient and simple. Transparent orthodontic system, Model printing for prosthetics. Simple and fast fabrication of essential prosthetics.

Cost-effective and functional

More than 100% of clinical uptake

DIGITAL PRAGMATISM 3

Convenient and Simple

107


V. Workflow and Processing Simple order process : R2 Service is very simple, fast and cost effective. We have world-wide R2 Center network. Please contact to nearest R2 Center or MegaGen distributors at applicable countries.

Contact

Simple Order

Submit

CBCT

Planning Order

CAST

Confirm

SCAN DATA

Take CBCT with R2Tray in patient’s mouth as well as accurate impression to make a stone cast. Please send CBCT and the cast to R2 Center.

or

Download

(HYPERLINK “http://www.r2gate.com” www.r2gate.com & delivery) * Self-manufacturing - Chose “in-lab service” on order page - Just send scan data when manufacturing CAD/CAM prosthesis only.

Deliver Planning

Surgery R2 Center will work on patient’s data for initial diagnosis to save your working time. (It takes approximately 3~4 hours for a full-mouth case)

Super merging & Initial Diagnosis

R2 Center will send you the initial diagnosis report or project file. You have to review it thoroughly and need to give us your confirmation. (It will take less than 5 minutes per fixture to correct the implant positioning according to your preference. All the responsibility is on you for this step)

Confirmation

Diagnosis and Confirmation

Please give us your confirmation quickly for faster service. If you request R2 Center for manufacturing, choose your preferred service based on the diagnosis & treatment planning : R2 Navi-GuideTM only or One-Day Implant®.

Manufacturing

R2 Center will start manufacturing products with CAD/CAM and 3D printer.

Please download ordered design file when using “Click to Make Service.”

or

Fast Delivery

All packages including disposable drills will be delivered to your clinic shortly.

Rocket delivery

Official Delivery period Single case : 1week (7 working days) Full mouth case : 2weeks (14 working days) Delivery period may vary according to the location & country. Please contact with our distributors for more informations.

108

For more details information, you can download the R2 Implant service manual as PDF version from our R2GATE website. www.R2GATE.com


Megagen | R2GATE™

World-wide R2 Center Network Please find the nearest R2 Center from your country.

Small changes make a big difference. Try it today!

Germany

South Korea IDDA T: +82 70 4352 1120 E: R2GATE@gmail.com www.R2GATE.com USA (New York) T: +1 201 363 1033 E: proskang@gmail.com www.ddx-usa.com USA (Los Angeles) Megacis Dental Lab T: +1 714 502 0900 E: Megacisdentallab@gmail.com www.manta.com Germany ZirkonCustoms, Joseph-Baur-Straße 6, 86316 Friedberg Tel: 0821 6601761 Email: christopherjehle@zirkon-customs.com

Romania T: +4 0784 709 496 E: vlad.hritcu@r2eucenter.com www.r2eucenter.com

Russia Tel : +7 926 526 2697 implantguru@gmail.com    

China Tel : +86 57427709926 office2@runyes.com

Netherlands Tel :+31 (0)88 84 84 100             Eduard@megagen.nl         

Japan Tel: +81 6 6710 9188 watanabe@johnny-s.com         

Turkey Tel :+90 21 2211 3932             megagenturkiye@gmail.com   

Italy Tel : +39 348 085 543 2 megagenitalia@libero.it

Iran Tel :+98 7132 275961             dinparvaramin@gmail.com

For other countries, please contact nearest R2 Center or your sales representative for R2 Implant Service.

109


110


Megagen | R2GATE™

Clinical Case Report

Turning your imagination into reality • Diagnosis & Treatment planning with R2GATE™ and the clinical result • Understanding and Purpose of Surgical Stent Surgery • Clinical cases using an R2 Navi-Guide™ (1) • Clinical cases using an R2 Navi-Guide™ (2) - Author : Dr.Jong Cheol Kim (The investor of R2GATE™)

111


1. Diagnosis & Treatment planning with R2GATE™ and the clinical result - Dr. Jong-Cheol Kim Implant surgical procedure using guided static surgery A 68 year old patient presented with the necessity of full mouth reconstruction. Unfortunately, he suffered from pneumonia and had to be hospitalized for about 6 months before the implant surgery. There was partial maxillary bone loss as shown in the panorama below taken before surgery. The patient would need GBR procedure to recover lost bone. At a late stage, the patient and his family changed their minds, preferring minimally invasive implant surgery after the long-term hospitalization due to pneumonia. In this situation, flapless surgery would offer the least invasive option if no GBR treatment was to be carried out. In this case, direct surgery would not be possible, and a blind technique would be required. Under such conditions, most doctors would want to simulate the surgery using all available options - CT images, prognosis program and customized guided drills. This is the story of an approach to guided static surgery converging CBCT (a media device) and CAD/CAM technology through this clinical case.

These are the photos and panoramas of the patient’s oral cavity after 6 months hospitalization. We need to take alginate or rubber impressions for a full mouth reconstruction using guided surgery. The plaster model is the sent to a digital center which produces the stents. 3 different materials based on the plaster model are sent back to us. Using a wax rim, the operator will decide the implantation position of the upper central incisor, and mark the extension line connected to central line of the face. The facial soft tissue can also be controlled and the bite plane of the deployment angle can be decided by editing the wax rim. We can refer the arrangements of the stent from these procedures. The position of the CR and vertical dimension are decided with a Gothic arch attached to the plaster model. We can decide the so called ‘verti-centric’ with a Gothic arch.

These pictures show the Gothic arch traces that indicate the movements of the mandible and the stable mandibular position. Proper VD (Vertical Distance) has been decided. Bite material will be poured into the oral cavity with the Gothic arch to record the ‘verti-centric’, then a CBCT image is taken. The pictures to the right are the CBCT photos with the Gothic arch. Preparation is now complete.

112

CBCT images are sent to the digital center server online, the Gothic tray containing verti-centric movements, the plaster model and the wax rim with facial information will be also be sent by regular mail. Specialists at the digital center will start mounting on an Articulator based on the received materials. These pictures show the model mounting procedure. The maxillary and mandibular plaster models, the inter-maxillary space and the wax rim information can be digitalized using a dental scanner.

These pictures show the diagnostic wax-up made based on scanned materials by Dental CAD saving a lot of time. All the information regarding the diagnostic wax-up can be opened as a file on R2GATE™ program. The principle of R2GATE™ developed by Megagen implant Co., Ltd. is layering the DICOM (CBCT) image and the STL file (attained by scan and CAD). By layering the images, we can simulate the implantation based on the prosthetic appliance position seeing the diagnostic wax-up, the plaster model image and the bone condition at the same time. This makes mock surgery using the ‘Top-Down treatment’ idea possible. The operator’s surgical concept can be simulated using two- and three-dimensional images. Below pictures show the simulated implantation of 10 maxillary teeth and 8 mandibular teeth. Another advantage of R2GATE™ is the actualization of the mock surgery results as opposed to other CT viewers which only check the result via a monitor. This simulation result can be extracted as a file that can be used to design with Dental CAD.

These pictures show the full denture drilling guide designed based on the sources from digital CAD. Not only the drilling guide holes, but also the pin holes needed to fix the stent can be designed. In addition the customized abutment and prosthetic appliance can be designed. This means we can


Megagen | R2GATE™

MegaGen’s R2 Navi-Guide™ is very accurate

recover function and aesthetics immediately by placing the upper prosthetic appliance (if the case of suitable ISQ value) because an upper prosthetic appliance fitting exactly to the implants placed through the customized drill guide can be produced in advance. The CAM method currently attracts more users than CAD. CAM has 2 different ways of manufacturing - milling or 3D printing. This will be expanded in the following pages.

These pictures show the maxillary and mandibular implant drill guides produced by 3D printing. The pictures below show the customized zirconia abutments and temporary crowns produced by milling. As a result, the dentist can receive a drilling guide and a maxillary prosthetic appliance, and may decide whether to connect the maxillary prosthetic appliance or not depending on the ISQ value. The bone can be drilled through the fixed guided stent using anchor pins as you see in the pictures below. This shows the result of flapless minimally invasive implant surgery.

You can check the satisfactory CT results.

We produced the final prosthesis after 3 months. At this time, the mandible has zirconia abutments and temporary PMMA crowns have been placed in the mandible to allow further recovery of the patient.

Panoramas and pictures of 10 implants placed using a maxillary stent in the same way. The customized zirconia abutment and the temporary crowns produced in advance were placed after observing a satisfactory ISQ value. The satisfied CT results can be observed.

This shows panoramas and standard radiographs at 1 month after the final prosthesis was placed. This has been a brief introduction to the general process of guided static surgery using R2GATE™. Due to time & space limitations, this is only an overview - we hope you will be stimulated to ask for more information about R2GATE™ and CAD/CAM. Over the following pages, we will elaborate on the explanation and focus on the prognosis before surgery with R2GATE™, on surgical simulation, and hope that the whole process will be clear. Mandibular CT after the surgery

Maxillary CT after the surgery

113


2. Understanding and Purpose of Surgical Stent Surgery - Dr. Jong-Cheol Kim As you can see on the previous pages, R2GATE™’s virtual simulation has the advantage of combining DICOM (CBCT) and STL files enabling the depiction of the overall status of the patient with real time digital videos before commencing surgery. This handy function means that dentists can decide the optimal position for placing implant fixtures and allow a quick overview of the diagnostic wax-up, the soft tissue and the bone. In other words, virtual simulation has reached an outstanding level for finding implant positions as close as possible to real surgery using CAD/ CAM. A simple schematic diagram follows below.

CBCT

DICOM:Digital Imaging & Communications in Medicine

cases. Here are some examples.

STL Standard Tessellation Language

This case is a 56-year-old female with a right maxillary second premolar defect. As can be seen in radiographs, the mesiodistal “Interproximal bone level” area seems adequate, but the faciolingual area shows significant bone loss.

R2 Navi-Guide™ surgery

This schematic method of stent surgery can be either ‘Open flap surgery’ or ‘Flapless surgery’. Most clinicians think that ‘Guided surgery” means “Flapless surgery”. With this concept, the range of clinical applications for drill guides is extremely limited in cases of the lack of hard and soft bone tissue. If instead, one thinks of ‘Guided surgery” as correct “implant position’, it makes the application much more useful in many clinical

114

The defect of the mesiodistal space is quite wide, making it difficult to decide the position of both prosthesis and implantation. With R2GATE™ however, true virtual patient simulation procedures can be carried out. The dentist is able to determine surgical options before surgery thanks to the simulation available with R2GATE™.


Megagen | R2GATE™

R2 Navi-Guide™ does a very important role for the implant cases with defects

◀ Before and after the removal of flat abutment fixing i-Gen

The position of the implants can be determined using R2GATE™ and easily configured – use of an R2 Navi-Guide™ and Ti-mesh (i-Gen) is decided with the virtual diagnostic procedure. Final suturing is also shown.

4 months after the surgery R2 Navi-Guide™-guided surgery is ‘3D positioning and realization of implantation’ as you can see in the clinical case presented. Over the next pages, we will introduce a variety of clinical cases using an R2 NaviGuide™.

115


3. Clinical cases using an R2 Navi-Guide™ (1)

- Dr. Jong-Cheol Kim

As described earlier, the Clinical Significance of Guided Surgery using R2GATE™ software and an R2 Navi-Guide™ is 3D positioning and its realization with implants. Now I would like to present some clinical cases using R2GATE™ software and an R2 Navi-Guide™.

The R2 Navi-Guide™ and prosthesis are produced with this data.

The patient above came to the clinic complaining of movement in the #21 tooth. Cervical caries was immediately identified with the CT. This patient requested rapid, aesthetic, functional recovery over the shortest possible duration of treatments. We planned immediate loading of zirconia customized abutment and a temporary crown, if excellent initial stability could be obtained after implantation using R2GATE™ and an R2 Navi-Guide™. 2 preparations were needed in the clinic.

Firstly, an alginate impression of both the upper / lower jaw was taken and stone casts produced. Accurate impressions and stone casts are essential as they are the basis for all the material (data) using R2GATE™.

Second a CBCT scan is needed. As shown in these pictures, the patient bites a unique tray (R2 tray) and the CBCT scan is shot. This R2 tray is utilized as a standard of superposition of the CBCT and the STL files. These 2 processes are preoperative in the clinic. Stone casts can be sent via parcel service and the CBCT file via internet to the R2GATE™ Center.

116

This R2 Navi-Guide™ must be placed carefully to avoid damaging the buccal alveolar bone following the tooth extraction.

The drilling may then be performed to the size of the implant using drills exclusive for the R2 Navi-Guide™ system exactly according to our virtually planned surgery in R2GATE™. As the pictures show, complete drilling processes are recommended to be performed following the guide part of the R2 Navi-Guide™.

Pick up the implant after finishing drilling, using the hand ratchet connector. The correct combination between ratchet connector and fixture should be accurately checked. The fixture can then be placed in the prepared site after this confirmation.


Megagen | R2GATE™

You can use the R2 Navi-Guide™ for Immediate Implant Placement case

We recommend the use of an implant motor. Once the implant is almost completely placed with the motor, the final vertical depth and position of the implant should be completed using a torque wrench to match exactly with the virtual plan.

The location of the fixture may be matched to the R2GATE™ plan by matching the window of the R2 Navi-Guide™ and the black line and green code on the ratchet connector.

The pre-made customized zirconia abutment may be connected after bone grafting the gap between the socket and the fixture.

These pictures show the temporary crown, immediately after surgery and then the healed site after 2 weeks.

After time needed for soft tissue healing, the prosthesis can be made using an impression for final prosthesis taken at the customized abutment level.

▲ The figures above can be applied only to an AnyRidge Implant. These figures cannot be generally applied to other implant systems. In order to assess the possibility of immediate loading, we use both the placement torque and the ISQ value. Only when using the AnyRidge System, do we try immediate loading – and then only if the placement torque is over 45N and the ISQ value is over or equal to 70 in D3~D1 bone without parafunctional problems.

After 4 months, this is the image of the final prosthesis loaded. For the success of immediate loading, 1. Bone quality 2. Implant design 3. Surgical technique 4. Occlusal loading control should all be considered. Next we will introduce you to how to use the ‘Digital EYE™’ to assess bone quality using R2GATE™ for surgical planning.

117


It guarantees a success of an implant through ‘Digital EYE™’ function even at the poor bone quality

4. Clinical cases using an R2 Navi-Guide™ (2) At the end of the last article, the necessary conditions for the success of immediate loading were briefly mentioned. 1. Bone quality 2. Implant design 3. Surgical technique 4. Occlusal loading control Most long-term observational research mentions that the above four requirements affect the success of immediate loading. Utilizing CBCT as an assessment of bone quality is now being introduced in research papers. In evaluating bone quality R2GATE™ also uses a function that enables preoperative evaluation of bone quality and makes it possible to suggest a suitable drilling sequence to increase initial stability.

- Dr. Jong-Cheol Kim

[ Ex. 1, 2, 3, 4, 5 ] Correct drilling sequence, implant position, and loading protocol can be determined based on CT analysis. Take note though [Example 4, 5] even if initial stability can be gained by determining bone density, do you think immediate loading is always possible? What are your thoughts, readers?

CT images shown on both the left and right are the same patient’s CT image. Depending on the machine, as shown in the pictures, totally different images are created. CBCT is different to MSCT (Multi Slice CT) – it does not apply the HU (Hounsfield Unit) concept. This makes it more difficult to evaluate the bone quality.

In order to resolve the disadvantages of CBCT, R2GATE™ has installed the ‘Digital EYE™’. The colors shown on the image of the soft tissue helps to understand the bone quality thanks to the contrast of color. You may identify the relatively hard cortical bone density and the cancellous bone clearly falls under classification D4 according to Lekholm and Zarb’s classification. Considering this bone quality, you might make 2 step under-drilling compared to the planned fixture diameter.

118

This clinical case used ‘Digital EYE™’, predicted the bone quality and pre-set the drilling sequence to obtain satisfactory initial stability, and also increased the number of implants for a ‘One Day Implant’ case. What the ISQ value would be at the time of surgery?


Megagen | R2GATE™

R2 Navi-Guide™ is very effective for Full Mouth cases, even with thin ridge

Edentulous clinical cases need restoration and we present another clinical trial. Do you think that a fixation screw is the only way to obtain stability of the stent when using an R2 Navi-Guide™ for edentulous cases? Toothsupported guides have the highest precision. Currently, ‘Team Eureka R2’ is trying to develop a way to obtain ‘Dual stability’ by using the Palatal Denture Stabilizer.

One way to change fully edentulous cases to a tooth-supported case would be placing mini implants. Mini implants were originally developed for the purpose of maintaining temporary dentures and the can be used on edentulous cases with R2 surgery. For the mini implant placement, the implant position is not important - simply place it where it can be placed most easily.

Two R2 Navi-Guide™s can be easily manufactured based on the basic CAD/CAM system. The first R2 Navi-Guide™ gets support from four mini implants. The method is to place fixtures on areas not related to the location where the mini implants will be placed. Then, a surgical stent will be used to place the fixtures and finally the mini fixtures are removed.

As mentioned in an earlier article, the author placed implants on the basis

of the R2 Navi-Guide™, executed GBR, and made the closure suturing. Once again, the purpose and significance of R2 Navi-Guide™ surgery is not simply flapless surgery but to virtually manage & observe the result of surgery before the actual surgery following your own clinical philosophy.

‘Megagen Eureka R2’ started ambitiously with the intention of beginning a 2nd Renaissance in the field of implant treatment and recovery using our own program. The ‘R2GATE™’ programme is evolving to realize this aim. Next year, we will be able to move beyond the implant field and provide new methods for GBR. In addition, we hope to achieve virtual surgery on

the lower jaw using face analysis.

- Courtesy of Dr. Kwang-Bum Park, Dr. Seong-Eon Kim, Dr. Sang-Taek Lee.

* This clinical case can be viewed on www.R2GATE.com ‘How to get a reliable ISQ value’

119


CAD / CAM Abutment

Ⅰ. ZrGEN®

ZrGen ist eine Marke der Firma MegaGen für Titanbasen. ZrGen garantiert ästethische Ergebnisse und einfache Arbeitsabläufe.

Anwendungsbereiche von ZrGen® ZrGEN Coping

PMMA Provisional Crown

ZrGEN Monolithic

ZrGEN Crown

ZrGEN Bridge

ZrGEN Coping for PFZ

ZrGEN

Zirconia customized body

Zirconia Final Crown

ZrGEN® Subrakonstruktionen

ZrGEN®

Tooth shade cuff area

Klinische Anwendungsbeispiele

120

Minimized Ti-connection


Megagen | R2GATE™

➲ ZrGEN® Prothetik Crown ZrGEN Abutment

ZrGEN® Abutment

Zirconia Coping

Scan Healing Abutment

Scan Abutment

Refer to Page. 277

Standard

Refer to Page. 277

C-type (Cerec)

➲ ZrGEN Abutment Optionen ZrGEN Abutment

- beeinhaltet die Abutment Schraube: Anyridge (AANMSF) MiNi (MIAS14/MIAZ1410) • Titanbasen • 1 Set beeinhaltet 10 STK Titanbasen Können aber auch einzeln bezogen werden MiNi ZrGEN beeinhalten spezielle ZrGen Schrauben • Die Titanbasen sind in den DentalCAD Systemen: - 3 Shape - Exocad enthalten.

Standard System

Durchmesser

4

Kragenhöhe

0.6

AnyRidge

MiNi

4.5

1.5

3

0.6

Schafthöhe (mm)

4.5 6 4.5 6 2.5

Typ

Hex Hex Hex

Ref.C

AANIPR4015.MTN AANIPR4016.MTN AANIPR4525.MTN AANIPR4526.MTN MIPN3013.MTN

P C D

121


- ZrGEN Abutment

• Ti-base für Sirona Cerec Nuter → CEREC • Titan-basen Typ

C-Type System

Durchmesser

3.9

AnyRidge

4.3

5.5

P C

D

122

Kragenhöhe

0.5 1 2 0.5 1 2 0.5 1 2

Schafthöhe (mm)

Typ

Ref.C

ARCS3405.MTN ARCS3410.MTN

Small 4.7

ARCS3420.MTN ARCS3805.MTN ARCS3810.MTN ARCS3820.MTN ARCL4505.MTN

Large

ARCL4510.MTN ARCL4520.MTN


Megagen | R2GATE™

Ⅱ. TiGEN

®

TiGEN® ist eine Marke der Firma MegaGen für Titanbasen. ZrGen garantiert ästethische Ergebnisse und einfache Arbeitsabläufe.

➲ TiGEN Prothetik Crown

Milled TiGEN

Scan Abutment

Scan Healing Abutment

TiGEN Abutment

123


➲ TiGEN Abutment Optionen

TiGEN Abutment

- beeinhaltet die Abutment Schraube. . AnyRidge (AANMSF) . MiNi (MIAS14/MIAZ1410) • 1 Set beeinhaltet 10 STK • Unterstützt die Dental CAD Systeme: - 3Shape - Exocad - Dental Wings

Standard System

Farbe

AnyRidge

Gold

MiNi

N/A

Durch- Länge messer

12

20

Typ

Ref.C

Hex

ARTR1220.MTN

Hex

MITN1020.MTN

➲ Scan Abutment Optionen Scan Abutment

- beeinhaltet die Abutment Schraube. . AnyRidge (AANMSF) . MiNi (MIAS14/MIAZ1410) • Für Chairside / Labside • Beeinhaltet eine Abutment Schraube

124

System

Durch messer

AnyRidge

4.0

MiNi

3.5

Länge (mm)

Typ

9

-

AANISR4009T

13

-

AANISR4013T

9

-

MISS3509 T

13

-

MISS3513T

System

Ref.C

L


Megagen | R2GATE™

Scan Healing Abutment

D DurchHöhe System messer (mm)

- Beeinhaltet die Abutment Schraube. . AnyRidge (ARIHS1804/ARIHS1805/ ARIHS1807) • Die Anwendung des Scan Healing Abutments ermöglicht Scan Daten zu erhalten, ohne das Healing Abutment mehrfach zu entfernen. • Beeinhaltet die Abutment Schraube • Scan Healing Abutments sollten 2mm im Sichtbaren Bereich sein, um akkurate Scan Ergebnisse zu erzielen

Scan Post • Scan Healing Abutments sollten 2mm im Sichtbaren Bereich sein, um akkurate Scan Ergebnisse zu erzielen. • Es wird empfohlen den Scan Post zu nutzen, wenn Sie die Exocad Software im Einsatz haben • Diverse Scan Posts, analog den durchmessern der Scan Healing Abutments

AnyRidge

System

4 4 4 5 5 5 6 6 6 7 7 7

Durchmesser

4.0 Common

5.5 6.5 7.5

Ref.C

4 5 7

ARISH4004T ARISH4005T ARISH4007T

4 5 7

ARISH5004T ARISH5005T ARISH5007T

4 5 7

ARISH6004T ARISH6005T ARISH6007T

4 5 7

ARISH7004T ARISH7005T ARISH7007T

H

AnyRidge

AnyOne

D

Ref.C

AR-∅4 AO-∅4 AR-∅5 AO-∅4.5 AR-∅6 AO-∅5.5 AR-∅7 AO-∅6.5

SP4009 SP5009

7

Scan Healing Abutment

Scan cap

SP6009 SP7009 * If Scan Healing Abutment is exposed more than 2.5mm, it may unstablize a fixture and results in fixture failure.

125


REGENERATION

126


Bone Graft Material

Augmentation

Ⅰ. Auto-Max™ Ⅱ. Mega-Oss™

Ⅰ. i-Gen™ Ⅱ. Package Ⅲ. Clinical Cases

Narrow Ridge Ⅰ. SmarThor™ Ⅱ. BonEx Kit™ Ⅲ. Procedures of Ridge Split Technique Ⅳ. Clinical Cases

Sinus Ⅰ. MICA Kit™ Ⅱ. MILA Kit™

Soft Tissue Harvest

127


Autogenous Bone Harvester

Auto-Max

Beschreibung

Auto-Max

1. Design Concept

Ø3.5

Ø5.0 Ø3.5

Ø6.0 Ø5.0

Ø6.0

Auto-Max

AM2535

Ø2.5~Ø3.5 / Stopper

AM4050

Ø4.0~Ø5.0 / Stopper

AM5060

Ø5.0~Ø6.0 / Stopper

AM6070

Ø6.0~Ø7.0 / Stopper

Ø7.0

Spezielles Klingendesign der Schneiden um mit niedriger Drehzahl arbeiten zu können.

Grosse Öffnung zur Kühlung und zur Entnahme der Knochenspäne

Stopper - Material: Ti-6AI-4V (Titanlegierung) - Beschichtung: TiN

Glattes Bohrerdesign für wenig wiederstand bei der Bewegung des Tiefenstoppers

Entwickelt zur leichten Platzierung und Entnahme des Tiefenstopps

Rille zur Positionierung des Tiefenstopps zu Beginn des Vorgangs

Geschlossener Tiefenstopper um keine Knochenspäne zu verlieren

4mm Stop

128

Spec.

Ø7.0

Material: S42010

Geschlossener Tiefenstopper um keine Knochenspäne zu verlieren

Ref.C


Megagen |

2. How to use

Regeneration

1.

Setzen Sie den Auto-Max in das Handstück und platzieren Sie den Tiefenstopper auf der Markierungsrille des Bohrers.

2.

Der Auto-Max sollte möglichst senkrecht auf dem Knochen stehen. Drücken Sie den Bohrer an der gewünschten Position leicht an und starten Sie den Bohrvorgang mit ca. 500RPM mit reichlich Kühlung.

3.

Keine pumpenden Bewegungen während des Bohrvorgangs, dies könnten zu Verlust gesammelter Knochenspäne führen.

4.

Nach Erreichen der maximalen Bohrtiefe von 4mm stösst der Tiefenstopper an.

5.

Entfernen Sie den Tiefenstopper und sammeln Sie die gewonnenen Knochenspäne in einem sterilen Tray.

Wiederholen Sie die Schritte 1-5 bis Sie die gewünschte menge Knochen gewonnen haben. 6.

Jeder Sammelvorgang sollte an einer neuen Position getätigt werden. Vermeiden Sie Überschneidungen der Entnahmestelle.

[e.g.] .0 Ø7

(O)

.0 Ø6

.5 Ø3.0 Ø6

Ø3.5

Ø5.0

Ø3.5 Ø3.5 Ø6.0

Ø5.0 Ø7.0

Ø6.0

Ø7.0

(X) Ø5.0

Ø3.5 Ø6.0

Ø5.0 Ø7.0

Ø6.0

.0 Ø57.0 Ø

Ø7.0

(X) Ø3.5

Ø5.0

Ø6.0

Ø3.5

Ø7.0

Ø5.0

Ø6.0

Ø7.0

.0 Ø5 .5 Ø3

(X)

(O)

2.

1.

3. Products

4mm

Ø3.5 Ø3.5

Ø5.0 Ø5.0

Ø6.0 Ø6.0

Ø7.0 Ø7.0

129


â&#x17E;˛ Clinical Cases

- Courtesy of Dr. Kwang-Bum Park

Fig 1. Severe periodontitis on # 35 was extracted 2 months before. Fig 2. #34 was extracted and the socket was degranulated SmarThoroughly. Fig 1

Fig 3. Auto-Max was prepared for bone harvesting.

Fig 2

Fig 4. Autogenous bone was harvested from the ramus. Fig 5. The defect was filled with harvested autogenous bone following implant placement.

Fig 3

Fig 4

Fig 6. Intra-oral radiograph immediate after surgery. Fig 5

Fig 6

Fig 1. The prosthetics on the mandibular right molar were broken with secondary caries. Fig 2. Three implants were placed after extraction and degranulation of residual roots. All the implants showed bone defects.

Fig 1

Fig 3. Auto-Max harvested autogenous bone from edentulous area. Fig 4. The autogenous bone was mixed with Mega-Oss bovine to increase volume of graft.

Fig 2

Fig 5. The defects were filled with the graft mixture and covered with a collagen membrane. Fig 6. The panoramic radiograph taken immediately after surgery.

Fig 3

Fig 7. Intra-oral radiographs taken after delivery of customized abutments.

Fig 4

Fig 5

Fig 6

130

Fig 7


Megagen |

Regeneration

BonEx Kit™ Beschreibung

Durchmesser

Länge (mm)

Tiefenmarkierungen (mm)

BonEx Kit

-

-

-

Ref. C

KBECS3000

Ø2.4

TCMBE2413

Ø2.8

TCMBE2813

Ø3.3

BonEx Kit component Ø3.8

13

7 / 8.5 / 10 / 11.5

TCMBE3313

Expander

TCMBE3813

Ø4.3

TCMBE4313

Ø4.8

TCMBE4813

Step-by-step ridge Expander can be placed with a Handpiece & a Ratchet Extension, matching with the core shape of the AnyRidge Fixture .

Ratchet Connector (TANRES)

option Lance Drill (MGD100L)

Ratchet Connector (TANREL) Handpiece Connector

Chisel Tip

Chisel Handle

(TCMSC403) Useful in very narrow bone (<2mm) Use Lance Drill before Expanders to avoid bone breakage during drilling. Can be tapped until the end with a Mallet.

(TANHCU) (TANHCS)

131 Product coodinator : Eui Jin Han, a2568491@megagen.co.kr


Augmentation Ⅰ. i-Gen

>2.5mm

Leichte horizontale Überdimensionierung notwendig um >2 mm labialen Knochen nach Regeneration zu erhalten

Linguale Erweiterung Linguale Erweiterung ermöglicht grössere Sanierungsarbeiten oder Wiederaufbau

≥2mm Sichere Abdichtung des Implantats und Fixierung der Membrane

>100°stumpfer Winkel Zum Vermeidung von Irritationen am Weichgewebe

0.5~ 1.0mm

Eine "Einschrumpfung" des Aufbaus muss bei Augmentation berücksichtigt werden

Apikale Seite

Regenerationslinie i-Gen Membrane

132

um ein zusätzliches befestigen der Membrane zu vermeiden, muss diese mit "Vorspannung" am Knochen anliegen


Megagen |

Regeneration

➲ i-Gen Components

i-Gen Screw

Typ

M 2.0

Kragenhöhe (mm)

M2.0

Geeignet für folgende Implantate: • MegaGen (AnyOne) • Straumann (Standard & Standard Plus): Ø 3,3/ 4,1/ 4,8 • Nobel Biocare (Nobel Replace Tapered Groovy): Ø 4,3/ 5,0/ 6,0 • Astra (OsseoSpeed): Ø 4,5/ 5,0; OsseoSpeed EV: Ø 4,8/ 5,4 • Neobiotech (IS): Ø 3,5/ 4,0/ 4,5/ 5,0; (IT): Ø 3,5/ 4,0/ 5,0 • OSSTEM (TSIII): Ø 4,0/ 4,5/ 5,0/ 6,0/ 7,0

M1.8

M1.6

M 1.8

Geeignet für folgende Implantate: • MegaGen (AnyRidge) • Dentsply-Frident (Ankylos C/X Implant): Ø 4,5/ 5,5/ 7,0 • Zimmer (TSV): Ø 3,2/ 3,7/ 4,1/ 4,7/5,2/ 5,7/ 6,0 • Nobel Biocare (Nobel Replace Tapered Groovy): Ø 3,5 • Astra (OsseoSpeed EV): Ø 4,2

M 1.6

Geeignet für folgende Implantate: • MegaGen (EZ Plus Internal _Small) • Straumann (Bone Level): Ø 3,3/ 4,1/ 4,8 • 3i (Osseotite certain & Full Osseotite NT Certain): Ø 3,25/ 4,0/ 5,0/ 6,0 • Dentsply-Frident (XiVE): Ø 3,4/ 3,8/ 4,5 • OSSTEM (TSIII): Ø 3,5

i-Gen Cover Screw - Use Hand Driver(1.2 Hex)

M1.4

Ref.C

1.0

IA2010

2.0

IA2020

3.0

IA2030

1.0

IA1810

2.0

IA1820

3.0

IA1830

1.0

IA1610

2.0

IA1620

3.0

IA1630

1.5

IA1415

2.0

IA1420

3.0

IA1430

C.H

C.H

C.H

C.H

• Anthogyr (Axiom) • Camlog (Conelog) Ø 3,3/ 3,8/ 4,3 • Astra (OsseoSpeed EV): Ø 3,6 • Dentaurum (tioLogic): Ø 3,3 / 3,7 / 4,2 / 4,8 • Bredent (SKY): Ø 3,5 / 4,0 / 4,5 / 5,5

M 1.4

Geeignet für folgende Implantate: • MegaGen (MiNi™) • Astra (OsseoSpeed): Ø 3,5; (OsseoSpeed EV): Ø 3,0 • Dentsply-Frident (XiVE): Ø 3,0

Typ

Hex 1.2

Höhe (mm)

1.0

1.0

Ref.C

ICS3510

• Zum Eindrehen Hand Driver 1.2 Hex nutzen

Flat Healing Abutment

Hand Driver (1.6 Hex)

Höhe (mm)

Ref.C

2

FHA402

3

FHA403

4

FHA404

Länge (mm)

Typ

Ref.C

10

Short

TCMHDS1600

H

L

133


â&#x2026;¡. i-Gen Package

Full & Trial package ver 2.0 (AnyRidge or AnyOne) Full & Trial package ver 2.0 (AnyRidge or AnyOne)

Recommended types of i-Gen for eac (Refer to below table)

Recommended types A1, ofB1, i-Gen for each C1 A2, B2, C2 (Refer to below table)

A1, B1, C1

on i-Gen Screw on i-Gen Screw

Place an implant in the defect

Connect on i-Gen Screw to the inserted implnat

Typ

material Fill the defect with bone graft material

Put on Put on

i-Gen Screw i-Gen Screw

Cover Screw Healing Abutment Cover Screw Healing Abutment

Put i-Gen membrane on the i-Gen Screw

Maxilla Maxilla

Fix i-Gen membrane with a Cover Screw or Healing Abutment

Cover the area with soft tissue and make a tight suture

Full Package

Full Package

material

Komplettpaket Full Package Ref.C

M2.0

IGFP20

M1.8

IGFP18

M1.6

IGFP16

M1.4

IGFP14

/ 6ea / 6ea

2.5mm / 3ea 2.5mm / 3ea

3.5mm / 3ea 3.5mm / 3ea

Hand Hand

Full Package includes : 12 i-Gen membranes / 12 i-Gen Screws (1mm, 2mm, 3mm cuff x 4each) / 6 Cover Screws / 6 Healing Abutments (2.5, 3.5mm height) / 1 Hand Driver (Hex 1.6)

Trial Package

Typ

Trial Package Testpaket Trial Package

Ref.C

M2.0

IGTP20

M1.8

IGTP18

M1.6

IGTP16

M1.4

IGTP14

Hand Hand

1mm Cuff / 2ea 1mm Cuff / 2ea

/ 2ea / 2ea

2mm Cuff / 2ea 2mm Cuff / 2ea

2.5mm / 2ea 2.5mm / 2ea

3mm Cuff / 2ea 3mm Cuff / 2ea

3.5mm / 2ea 3.5mm / 2ea

Trial Package includes : 6 i-Gen membranes / 6 i-Gen Screws (1mm x 2ea, 2mm x 2ea, 3mm x 2ea) / 2 Cover Screws / 4 Healing Abutments (2.5, 3.5mm height) / 1 Hand Driver (Hex 1.6)

134

A2, B2, C2

Mandible Mandible


Megagen |

Regeneration

➲ i-Gen membrane

1. How to use

Ideal + Regeneration membrane ⇒ i-Gen membrane 1. Place an implant into the recipient site. 2. Connect a i-Gen screw to the implant and bone grafting. Usually 1 mm cuff height is good enough for vertical space, but 2 or 3 mm cuff height of i-Gen Screw can be chosen according to situation. The amount of graft material should be enough to fill the space between i-Gen membrane and the fixture. 3. Selection of i-Gen membrane and placement. According to the size and shape of bone defect, an i-Gen membrane can be chosen from 9 different shapes. Match the hole of i-Gen membrane with the screw hole of i-Gen screw. 4. Fixate i-Gen membrane with a i-Gen Screw. Choose a i-Gen cover Screw or Flat Healing Abutment to fix i-Gen membrane depending on the need of one or two stage surgery. Tight adaptation of soft tissue flap is recommended.

(Proper soft tissue management is the key to successful regeneration! If the i-Gen membrane is denuded following wound dehiscence, it is advisable to remove it immediately)

2. Which i-Gen?

i-Gen membrane has 9 different sizes and shapes. As seen on the figure left, alveolar bone has different widths according to locations. It can be divided into three categories; Anterior(Sky blue dots), Premolar(Blue dots) and Molar(Dark blue dots). For Anteriors, ‘narrow’ membranes can be used, which has 4.5mm buccal horizontal extension from the center of fixture. For Premolars, ‘Regular’ membranes which has 5.5mm buccal extension, can be selected. The molar area usually needs wide membrane (6.5mm from fixture center), especially at the immediate placement case with wall defects. Type A and B membranes are only to cover single wall defects. Type C has a lingual extension to cover lingual wall defect. Type C has a lingual extension to cover lingual wall defect.

A1

B1

C1

maxillar

A2

B2

C2

A3

B3

C3

mandibular

135


â&#x2026;˘. Clinical Cases 1 : Extremely thin mandibular posterior Fig 1. This 65 year-old male patient visited with a chief complaint of discomfort on #24 during chewing. On the panoramic view, large bone defect was observed. Fig 2. The tooth was extracted and socket was degranulated SmarThoroughly. A 4.5mm AnyRidge Fixture was placed at the center of socket with excellent initial stability.

Fig 1

Fig 3. An i-Gen Screw, 1mm cuff height, was connected with the fixture. A 1.6mm Hex Driver is needed to place a i-Gen Screw, which was included in the kit. Mega-Oss allograft was grafted into the defect. Fig 4. The combined image of i-Gen membrane, a i-Gen Screw and a Healing Abutment. A Healing Abutment was connected on the i-Gen Screw to fix the i-Gen for one stage surgical approach. Watch the horizontal extension of i-Gen.

Fig 2

Fig 5. Simple suture was made to adapt the buccal flap against the Healing Abutment.

Fig 3

Fig 4

Fig 5

136


Megagen |

Regeneration

- Courtesy of Dr. Kwang-Bum Park

Fig 6. Postoperative panoramic and intra-oral radiograph. Fig 7. 3 months after surgery. Gingival healing was excellent and intraoral radiograph showed considerable increase in radiopacity. Fig 8. Usually flap opening is not necessary to remove i-Gen membrane, but in this case the flap was elevated to check the bone regeneration. The i-Gen membrane was maintained very stable in the tissue, and it was easily removed with a hemostat. Fig 9. The defect was filled with healthy regenerated bone. From the occlusal view, the buccal bone had more than 3mm width at the level of implant platform.

Fig 6

Fig 7

Fig 10. Flap was closed with simple suture.

Fig 8

Fig 9

Fig 10

137


Sinus

Ⅰ. Krestaler Zugang MICA kitTM

Ref.C

SGIS3000

(MegaGen Implant Crestal Approach Kit)

➲ MICA kit Komponenten

ASBE Trephine Bur

Innen / Aussen Durchmesser

Länge (mm)

Ø3.5/ Ø4.0 Ø4.0/ Ø5.0

Innen / Aussen Durchmesser

2/4/5/6/8 Marking

Länge (mm)

Innen / Aussen Durchmesser

Ø2.8/ Ø3.8 Ø4.8/ Ø5.8

D (Out)

SPTB4050

2

SPTB5060

Länge (mm)

2/4/5/6/8/10 Marking

Ref. C

SMR2838 SMR4858

2 4 5 6 8

138

4 5 6

Ref. C

SPTB3540 2 Marking

Ø5.0/ Ø6.0

Mushroom

2

ASBESS45 ASBESS56

Ø3.5/ Ø4.0 Ø4.0/ Ø5.0

D (Out)

ASBESS34

Ø5.0/ Ø6.0

Point Trephine Bur

Ref. C

8


Megagen |

Cobra

Hand Driver

Durchmesser

Länge (mm)

4

-

Typ

Länge (mm)

1.2 Hex

Sinus Express Bur

Durchmesser

10

Länge (mm)

Ø2.8

Ref. C

SCB401

Ref. C

TCMHDS1200

Ref. C

EB28

Ø3.4 Ø4.2

Regeneration

EB34 2/4/5/6/8/10 Marking

EB42

Ø4.8

EB48

Ø5.8

EB58

D 2 4 5 6

8 10

Spreader & Condenser

Durchmesser

Ø2.8/Ø3.8

Länge (mm)

2/4/5/6/8/10 Grooving

Ref. C

SSC3828

139


MICA kit Charkteristiken & Vorteile NEW Express Bur

1. Cleansibility

Combined function of Diamond Drill and Reamer Drill

2. Safety

The smooth surface makes cleaning easy and leaves no residue after cleaning. Stopper provides safe drilling without damaging a membrane even when visibility is poor.

3. Repeated use

Bone chips can be easily removed without getting stuck, so longer life is guaranteed.

4. Cutting capability

Its excellent bone cutting capability eliminates the need to use of the point or ASBE trephine burs.

① Cleansibility

Diamond Drill

140

Express Bur

③ Repeated use

② Safety

Egg shell test

Diamond Drill

Express Bur

Diamond Drill

Express Bur


Megagen |

Regeneration

How to use Crestal approach

Fig 1

Fig 2

Fig 3

Fig 4

Fig 5

Fig 6

Fig 7

Fig 8

Fig 1. Drill with a Point Trephine Bur : 2mm at a time until the laser marking is reached. Fig 2. Drill with ASBE Trephine Bur until 1-2mm of bone is left and break the bone by slightly tilting the bur.

Remove the collected bone in the trephine by unscrewing the Mini Screw and rotating the shank.

Fig 3. Adjust the position of the stopper to 1mm longer than the remaining bone height and drill with a Express Bur 0.7-1mm smaller in size than the diameter of the fixture. Fig 4. Use the Mushroom to lift the membrane through the hole made. Fig 5. Lift membrane using the Cobra. Fig 6. Graft the harvested bone and alloplastic material using the Spreader. Fig 7. Adjust the stopper of Condenser and fill the bone material up to desired depth by pressing. Fig 8. Install fixtures into the holes.

141


â&#x17E;˛ Clinical Cases

- Courtesy of Dr. Samual Lee

Fig 1. Diagnosis with CT Fig 2. Before surgery Fig 3. Flap reflection Fig 4. ASBE Trephine Bur & Express Bur: expand the hole

Fig 1

Fig 2

Fig 3

Fig 4

Fig 5

Fig 6

Fig 7

Fig 8

Fig 9

Fig 1

Fig 2

Fig 3

Fig 4

Fig 5

Fig 6

Fig 7

Fig 8

Fig 5. Spreader & Condenser : bone graft & condensation Fig 6. Place a fixture Fig 7. Graft any buccal defect and place a collagen membrane Fig 8. Suture Fig 9. Postoperative intra-oral radiograph

Fig 1. Intra-oral radiograph(before) surgery Fig 2. Point Trephine Bur : mark a exact point to drill Fig 3. ASBE Trephine Bur : make a hole Fig 4. Express Bur : expand the hole Fig 5. Spreader & Condenser : bone graft condensation Fig 6. Place a fixture Fig 7. Intra-oral radiograph (after) surgery Fig 8. Postoperative panoramic view

142


Megagen |

Ⅲ. Seitlicher Zugang MILA kitTM

Regeneration

Ref.C

KLSCN3000

(MegaGen Implant Lateral Approach Kit)

➲ MILA KIT Komponenten

Point Trephine Bur

Innen / Aussen Durchmesser

Ø6.5 / Ø7.5

Länge (mm)

0.5

Ref. C

TLSTBU6705

D (Out)

0.5

Lateral Trephine Bur

Innen / Aussen Durchmesser

Länge (mm)

Ref. C

Ø6.5 / Ø7.5

1

TLSTBU6710

Ø6.5 / Ø7.5

1.5

TLSTBU6715

D (Out) L

Window Opener

Innen / Aussen Durchmesser

Ø6.5 / Ø7.5

Länge (mm)

1.7

Ref. C

TLSWO6715

D (Out)

1.7

Durchmesser

Ø7.0

Länge (mm)

2/4/5/6/8/10 Marking

Ref. C D

Express Bur

EB70 1

Membrane Elevator

Durchmesser

Länge (mm)

Ref. C

Ø5.8

-

TLSME001

2.8

-

TLSME002

5.8

2.8

143


â&#x17E;˛ How to use Lateral approach

Fig 1

Fig 2

Fig 3

Fig 4

Fig 5

Fig 6

Fig 7

Fig 8

Fig 9

Fig 1. Using the Point Trephine Bur Identify the position to drill accurately. Fig 2. Choose Trephine depending on the thickness of the remaining bone and drill again over the hole made by Point Trephine Bur. Fig 3. Use Window Opener to fracture and remove the window wall. Fig 4. Completely remove the remaining window wall with Express Bur. Fig 5. Use Membrain Elevator 001 through the hole to perform the first membrane lift through the hole. Fig 6. Use Membrain Elevator 002 to elevate the membrane. Fig 7. Graft with autogenous bone collected or alloplastic material. Place the fixture. Fig 8. Close with the window wall. Fig 9. Suture.

144


Megagen |

â&#x17E;˛ Clinical Cases

Regeneration

- Courtesy of Dr. Samual Lee

Fig 1. Trephine Bur : Trephine with 1mm external stopper Fig 2. Point Trephine Bur : Make a exact point to drill Fig 3. Window Opener : Detach window wall Fig 4. Window Opener : Remove the wall Fig 5. Express Bur : Completely remove the remaining window wall

Fig 1

Fig 2

Fig 3

Fig 4

Fig 5

Fig 6

Fig 7

Fig 8

Fig 6. Elevator : Lift membrane Fig 7. Graft : Autogenous bone collected or alloplastic material Fig 8. Previously detached window wall was tapped into the position to prevent soft tissue migration into the sinus bone grafting.

145


Soft Tissue Harvest I. Safe, Simple, Speedy

1. Design Concept

Beschreibung

Sorft Tissue Harvest

Typ

W=5

Ref. C

TCMST5010

This is the device designed to capture the soft tissue easily when the soft tissue transplant in mouth is needed. Soft Tissue Harvester is used for structuring the soft tissue of patients.

Plastic Handle

Direction Cutting Edge

Cutting Edge

2. Instruction for Use & Procedure

Find out the size and part of tissues to be collected and cut as if pulling toward the handle of the device.

146

After cutting the tissues for required length and stop the device to send back to the original place. Cutting of end part is made with #15 blade or others and collect it.


Instrument

Material

Ⅰ. MEGA ISQ™ Ⅱ. MEG-TORQ® Ⅲ. MEG-CLEANER™ Ⅳ. MEG-INJECT® Ⅴ. MEG-ENGINE Ⅵ. Free Arm Forte Ⅶ. Clean Area Plus Ⅷ. Luminance LED NOVE

Ⅰ. MEGA SIL™ Ⅱ. EZ Seal® Ⅲ. EZ Print

INSTRUMENTE & MATERIAL

147


Instrument

Ⅰ. Die Original-Technologie von Osstell MEGA ISQ™ Smart Peg

Description Ref.C

MEGA ISQ Smart Peg

OSSTELL-ISQ

AnyRidge type

OSSTELL-AR67

MiNi type

OSSTELL-87 AnyRidge

Bestimmen Sie die Behandlungszeit mit einer objektiven Messung! Sinnvolle Entscheidung zur Belastung; wann belasten? Rechtzeitige Warnungen zur Vermeidung von Fehlschlägen Garantierte Qualität; zusätzliche Diagnostik für höchste Qualität

148

Product coodinator : Jerry Park, bond2104@megagen.co.kr

MiNi


Megagen |

1. Optimal Loading Decision

• When is the right time to load?

2. Early warningsPreventing failure

• Early warnings instead of failure

3. Quality assurance

• Diagnostics add quality

Instrument & Material

The MEGA ISQ System makes easier for dentists to decide when is the optimal time to load implants. It’s the ideal substitute for tactile assessment. The decision will always be complicated. Several key clinical parameters and risk factors are involved, which most of them are related to the stability of the implant. Accurate measurements of implant stability therefore provide valuable diagnostic insight that helps ensure successful treatments. At placement, stability can be difficult to quantify objectively by merely relying on tactile perception. Torque measurements are difficult to repeat once the implant has started to integrate and can therefore not provide a baseline for subsequent comparisons. The invasive torque method may even damage the healing if used for monitoring osseointegration.

A failed treatment result the patient to suffer and considerable costs for both the patient and the dentist. A precise and reliable diagnostics tool like MEGA ISQ reduces the risk of failure. Each implant patient is unique and must be judged by his / her own characteristics. Factors affecting the outcome of loading include the patient’s age, the density and volume of the bone – as well as the degree of osseo-integration. Dentists sometimes encounter patients whose initial stability score is low. The reason could be that they have had to undergo a bone graft. In such higher-risk situations, most surgeons would avoid an early-loading protocol. Similarly, a significant decrease in stability indicates a potential problem and should be considered as an early warning. The surgeon may prefer to unload the implant – or perhaps place additional implants – and then wait until stability increases. Thanks to the accuracy of ISQ measurements, surgeons can make a more well-informed choice of protocol for each patient. By comparing initial and secondary stability readings, they can detect and act on any unexpected development during healing and osseo-integration. This makes the treatment of high-risk patients easier and more predictable – allowing more of these patients to be treated and more of their treatments to be successful.

Because MEGA ISQ helps the dentist to decide when to load and avoid failure in high-risk situations, it becomes a quality-assurance system for the clinic. Most patients intuitively understand the stability measures and how they govern when to load an implant and when to wait. This increases their sense of confidence, security and quality. MEGA ISQ also facilitates communications – between surgeon and prosthodontist, as well as among different clinics. They can now compare treatments and results in an objective manner, and transfer valuable knowledge and experience among themselves or to dentists in training.

▼ Warranty

MEGA ISQ is covered by a 12-month warranty from the purchasing date. Users always have free access to MegaGen by phone and e-mail, should questions arise that are not covered by the operating manuals.

Niedrige Stabilität Indikation Chirurgisches Protokoll Restauratives Protokoll

Mittlere Stabilität Implantat gefährdet, ISQ überwachen

Full Splint 2 Stage Traditional Healing

Hohe Stabilität Partial 1-or2-stage Early

Einzelimplantation 1 Stage Verfahren Sofortimplantation

149


4. Perfect Matching

• Innovatives SchneidgewindeDesign, exakte Diagnose Innovatives Schneidgewindedesign, exakte Diagnosestellung. Die Primärstabilität des AnyRidge-Implantats hängt nicht von der Kortikalis ab. Durch Reduktion der Belastung der Kortikalis wird die Resorption von Knochenmaterial im Anschluss an die Implantation verhindert. Das einzigartige AnyRidge Schneidgewinde und die selbstbohrende Konstruktion sorgen für eine höhere Primärstabilität unabhängig vom Knochendefekt. So kann die Knochendichte progressiv zunehmen, der Kieferkamm wachsen und die Festigkeit gegenüber Kompressionskräften maximiert und die auftretenden Scherkräfte minimiert werden.

Vergleich der Kurven (eigene Daten)

ISQ 80

70

60

50 0

1

2

3

4

5

6

7

AnyRidge Implant A Implant B Implant C

• Gerundete Flächen, mit selbstscheidenden Gewinden ­Geringeres Eindrehmoment ­Hervorragende Primärstabilität ­Festigkeit gegenüber Kompressionskräften ­Minimierung der Scherkräfte ­Größere BIC-Fläche

150

8

9

10 wks


Megagen |

5. Comfortable, fast, easy

Instrument & Material

Obtaining an exact measurement of an implant stability using the MEGA ISQ is a completely non-invasive procedure. It can normally be performed in a few seconds. An experimentation shows that patients find it both comfortable and reassuring. 1. The SmartPeg is attached to an implant. It screws into the implant’s inside thread effortlessly. 2. The hand-held probe stimulates the SmartPeg magnetically, without actually being connected to it – or even touching it. 3. An ISQ value is generated and shown on the display. It reflects the level of stability on the universal ISQ scale – from 1 to 100. The higher the ISQ value, the more stable the implant.

6. Stability development in different bone quality

High initial stability (ISQ values 70 and above) tends not to increase with time even if the high mechanical stability will decrease and to be replaced by a developed biological stability. Lower initial stability will normally increase with time due to the lower mechanical stability being enforced by the bone remodeling process (osseointegration). Values such as ISQ 55 or lower should be taken as a warning sign and actions to improve the stability might be considered (larger implant diameter, prolonged healing time etc.)* * Implant stability measurements using Resonance Frequency Analysis.

Implant stability (ISQ)

70

55

Placement

Abutment

One year

Bone quality 1 Bone quality 2 Bone quality 3 Bone quality 4

The SmartPeg is a small, precision-crafted metal rod that should be assembled with the implant (or abutment) while a measurement is being performed. It’s easy to mount and requires minimal space in the patient’s mouth. It is for a single-use and delivered in sterile boxes of five units. In non-homogenous bone, the SmartPeg automatically resonates in two perpendicular directions – thus providing a correct value for the highest as well as the lowest stability direction of the implant.

151


Early Loading Guide

with AnyRidgeÂŽ & MEGA ISQâ&#x201E;˘ Protocol for an objective evidence of Implant stability Published in the Dental News April 7 through 28, 2014.

1. Loading Time Determining Criteria and Conditions for Early Loading _ Dr. Chang Hoon Han 2. Clinical Case Report 1 _ Dr. Chang Hoon Han 3. Clinical Case Report 2 _ Dr. Seung Yup Lee 4. New Protocol for an Objective Evidence of Implant Stability _ Dr. Kwang Bum Park

152


Begin Prosthetic process in only 4 weeks With Confidence! objective evidence with ISQ values

Red dotted arrow Line shows average ISQ values using other implants

â&#x20AC;ť independently evaluated clinical studies of 100â&#x20AC;&#x2122;s of cases show stable or increasing ISQ values continuously when using AnyRidge implants. Case studies available on request from anyridge @ imegagen.com

Implant Post suture placement removal

Prosthetics begin

153


1. Loading Time for Determining Criteria and Conditions for Early Loading - Dr. Chang Hoon Han Loading time To assess stability and osseointegration level of implants, many experiments were done including the tensional test, push-out/ pull-out test, histomorphometric analysis, removal torque test, radiographic analysis, cutting resistance measurements, insertion torque test, percussion test, periotest, and resonance frequency analysis (RFA). First let’s go over some of the methods that can easily be used clinically. The percussion test is the simplest method to use clinically. It assesses the status of implant with the characteristics of sound by tapping the mount of implant or abutment using a dental instrument. However it relies on subjective judgment, Thus, it has the disadvantage of not being able to assess the stability of implant accurately. The radiographic test provides an important information on the preop bone quality and quantity, and can relatively easily measure the changes of marginal bone surrounding the implant. However, its downside is that it is difficult to standardize resolutions, grey-scale, and radiograph taking method for an accurate interpretation. a

d

Tensional

Insertional/Removal Torque

b

Push-out

c

Pull-out

e

Periotest

f

RFA

(Figure 3) OsstellTM

Loading Determining Criteria and Conditions for Early Loading

More recently developed OsstellTM Mentor and the most recently launched the fourth generation OsstellTM ISQ or Mega ISQ use a small magnetic resonance rod called SmartpegTM making clinicians measure the stability of implants more simply.

(Figure 5) Osstell Mento™

Next, there is the Periotest (Simens AG, Bensheim, Germany) to measure the mobility of a natural tooth by assessing the damping effect of PDL. The periotest values (PTV) range -8 ~ +50. However, the values of successful implants are around -5~+5 which mean its sensitivites low, and there is a considerable variation of values depending on such things as the height of abutment, and the position and direction of the force applied.

(Figure 1) Periotest Ⓡ

(Figure 2) Periotest Ⓡ M

A More objective method would be the Resonance Frequency Analysis (RFA). In early days, the second generation of OsstellTM was cumbersome to use as it required connection of Lshapedtransducer to the implant.

154

(Figure 4) The application of OsstellTM electronic transducer to the implant

(Figure 6) MegaGen Mega ISQ™

Principles of measuring implant stability using the RFA devices of the third or later generations will be discussed. First, we need to check and get ready for the type of Smartpeg prefabricated for each type of implant system. Smartpeg is connected to an implant using a Smartpeg Mount which is a screwdriver specific to the implant whose stability we are going to measure. Then, when the probe on the RFA device is brought near to the magnetic material on the top of Smartpeg, a magnetic field is formed between the coil in the probe connected to the device and the Smartpeg. Now the device senses the vibration from the Smartpeg and displays it with a number from 1 to 100. The value is called a Implant Stability Quotient (ISQ). Usually the ISQ values at the time of implant placement are 55~75 in maxilla and 65~85 in mandible. ISQ value of an implant is less than 60 at the time of implant placement can be considered as low in stability, and the surgeon should try to select a bigger diameter implant or implant designed for high initial stability. Successfully osseointegrated implants show over time the ISQ values of 60~85 in maxilla and 70 ~ 95 in mandible.


Megagen |

Smart PegTM

Generally 5 to 10 Ncm of force is recommended to connect Smartpeg to an implant. If an excessive force is applied, the screws on the Smartpeg will be damaged and error rate of the measured values will rise. Manufacturers of Smartpegs recommend to discard after a use, and explain that the more they use, the more unstable the measurements would become. However, a local study on the reuse of Smartpegs concludes that ISQ values do not change even as they were used repeatedly 400 times of connecting and disconnecting the Smartpegs, and can be used as long as the screw lines remain intact and magnetism stay unchanged. Another local study on the reuse of Smartpegs shows two or more of high steam sterilization pressure reduces the stability of ISQ values. The auSmarThor of this paper also experiences that Smartpegs can be reused after disinfection by a low temperature plasma sterilizer, provided their screw lines are not damaged and magnetism is not lost. These RFA devices are very useful to determine a loading time with changes of the initial stability of an implant and can be measured repeatedly during a treatment period. Also, RFA devices are required for a long term maintenance of implants as implant stability changes can be continuously monitored. Implant stability can be divided into two categories primary and secondary stability. The primary stability is a mechanical stability obtained at the time of implant placement and is affected by bone quality and quantity at the implant site, as well as the form, diameter, and length of an implant, and placement method. The secondary stability refers to the implant stability resulting from the bone regeneration and remodeling in the interface between the implant and the tissue after the implantation. The primary stability obtained shortly after the implant placement gradually decreases while the secondary stability increases The total stability is lowered with a dipping phenomenon. As demonstrated by many studies, ISQ values representing the stability of an implant go down until week 3 after the implant placement, fluctuate slightly up to week 6 to 8, and then slowly go up afterwards. So, it has been reported that an implant should not be loaded around 3 week, but recent studies report that immediate or early loading can be tried when the bone quality at the implant site is favorable and the initial stability at the time of implant placement is good. For a successful immediate or early loading, implants with the thread design and surface that can provide high initial stability and minimize the stability dipping should be chosen.

(Figure 7) KnifeThread®

Early Loading Guide

The auSmarThor uses the implant design that has narrow threads (knife threads) of the rounded face, which facilitates high initial stability at the time of implant placement. The KnifeThread® design structure does not damage the unique architecture of cancellous bone and can minimize the compressive force on the surrounding bone.

Also, the implant surface is treated with XPEED®, to process neutralization in the final step to remove the possibility of residual acid which has been a problem in the existing SLA surface treatment. Calcium ions on the fixture surface form a calcium titanate nano- structure layer by a chemical reaction in uniform 0.5μm thickness, solving the problem of surface peeling during the placement or absorption of coated layer after the placement. So better BIC and removal torque values can be achieved compared to other RBM or SLA surface treatments.

(Figure 8) XPEED® surface treatment

This design and surface treatment minimize the dipping of stability and shorten the time necessary for osseointegration making them a good choice for immediate or early loading.

Published in the Dental News April 7, 2014. (Mon)

155


2. Clinical Case Report 1 - Dr. Chang Hoon Han One of the methods that can most objectively assess the level of clinical implant stability and osseointegration is Resonance Frequency Analysis (RFA) using the OsstellTM device. The OsstellTM device indicates the Implant Stability Quotient (ISQ) values are from 1 to 100. The primary stability, the mechanical stability obtained at the time of implant placement, gradually decreases while the secondary stability by a bone remodeling in surrounding bone slowly increases, creating the dipping phenomenon where the total stability goes down. As reported by many studies, ISQ values representing implant stability go down until week 3 after implant placement, fluctuate slightly up to week 6 to 8, and then slowly go up afterwards. However the implants with a thread design and a surface that can minimize the compressive force on the surrounding bone do not have large post-op ISQ value reductions and the stability is maintained. If such implants are used clinically, immediate or early loading can be done because they can minimize the stability dipping and less time necessary for osseointegration. For successful immediate or early loading, we need to pay attention to insertion torque together with ISQ values at the time of placement, and more than 45 N/cm of insertion torque and 75 or higher ISQ values are recommended. Letâ&#x20AC;&#x2122;s look at some cases of immediate or early loading in light of insertion torque and ISQ value changes.

(Figure 2) AnyRidge 4x11.5mm

AnyRidge 4x11.5mm

AnyRidge 4.5x11.5mm

AnyRidge 4.5x11.5mm

AnyRidge 4.5x11.5mm

AnyRidge 4.5x11.5mm

AnyRidge 5x11.5mm

AnyRidge 5x11.5mm

(Figure 2)

Case 1 : 60 years of age / Male The patient was a 60 year old man and it was planned to place implants 4 months after the bilateral sinus graft (figure 1). Eight implants were placed on the upper jaw in a one stage approach with immediate placement after extraction for the central incisor area (figure 2). ISQ values were measured right after the placement and also at one week intervals using OsstellTM. The initial stability at numbers 16, 24 and 26 where sinus lift was performed was low and ISQ values were also lower than other regions. However as time progressed, the stability did not go down much and maintained, and from week 3 continuously went up. In the upper central incisor area where immediate placement was performed, the initial stability was high and the ISQ values continuously increased as well from about 70 post-op (figure 3). Final prosthesis was delivered at 9 week post-op (figure 4), and the results have been good during the follow-up period without distinct symptoms (figure 5).

(Figure 1)

156

(Figure 3)

(Figure 4)

(Figure 5)

Case 2 : 43 years of age / Male The patient was a 43 year old male. Despite various attempts the broken implant screw at number 26 could not be removed, so it was decided to explant the whole fixture (figure 6). As the previous implant diameter was 5mm, the fixture was pulled out with a 6mm diameter trephine drill, and 8mm implant was immediately placed. The insertion torque at the time of placement was 50 N/cm and the ISQ value was 75 (figure 7). Impression was taken at 1 week post-op and the final prosthesis was delivered at week 2. The ISQ values at week 1 and at the time of prosthesis delivery were 75, little difference from the immediate post-op (figure 8). During the follow-up period, good results were observed without any particular symptoms (figure 9).


Megagen |

Early Loading Guide

#16 100

(Figure 6)

(Figure 7) AnyRidge 8×10 mm IT 50N / ISQ 75

90 80 70 76

79

78

78

79

79

79

1W

2W

3W

4W

5W

6W

60 50 40 30 20

(Figure 8) OP + 2 weeks, SQ 75 -> 75 (Figure 9) OP + 2 weeks, OP + 16months

Case 3 : 47 years of age / Female A 47 year old female patient lost the upper left first molar region. The pre-op CT showed relatively favorable bone quality and quantity. A 6 mm diameter implant was placed and the insertion torque was 50 N/cm and ISQ value was 72 at the time of placement (figure 10). Impression was taken right after surgery, final prosthesis was delivered one week later, and the ISQ value increased to 77 (figure 11). During the follow-up period, good results were observed without any particular symptoms (figure 15).

10 0 OP

(Figure 15) ISQ Value in Healing Period

Case 5 : 56 years of age / Male A 56 year man received the final prosthesis 1 week post-op in the lower left second molar region (figure 16). At one week intervals after the delivery of final prosthesis, the prosthesis was disconnected and changes in ISQ values under loading were checked. The ISQ values were confirmed to be stable without big changes even after the loading (figure 17).

. 10

12

11

(Figure 10) AnyRidge 6×10 mm, IT 50N / ISQ 72 (Figure 11) OP + 1 weeks, ISQ 72 -> 77 / OP + 1 weeks (Figure 12) OP + 19months

Case 4 : 41 years of age / Female A 41 year old female patient lost the upper right first molar region. The pre-op CT showed relatively favorable bone width and the height of the residual bone was about 6mm. Sinus lift was performed using a crestal approach and simultaneously 4.5x10mm implant was placed. The insertion torque was 45 N/ cm and ISQ value was 76 at the time of placement (figure 13). Impression was taken right after surgery and final prosthesis was delivered one week later, and the ISQ value increased to 79 (figure 14). At one week intervals after the delivery of the final prosthesis, the prosthesis was disconnected and changes in ISQ values under loading were checked. The ISQ values were confirmed to be stable with no big changes even after the loading (figure 15). 13

(Figure 16) OP + 1 weeks #36 100 90 80 70

72

70

OP

1W

60

73

73

75

77

78

78

78

2W

3W

4W

5W

6W

7W

8W

50 40 30 20 10 0

(Figure 17) ISQ Value in Healing Period

14

(그림 17) ISQ Value in Healing Period

(Figure 13) AnyRidge 4.5×10 mm, IT 45N / ISQ 76 (Figure 14) OP + 1 weeks, ISQ 76 -> 79 Published in the Dental News April 14, 2014. (Mon)

157


3. Clinical Case Report 2 - Dr. Seung Yup Lee No clear objective criteria is established regarding appropriate implant loading time after surgery. The reality is most clinicians rely on radiographs or their data based on their experiences for a specific surgery. A rule of thumb for the loading time is 3 to 6 months for the upper jaw and 2 to 4 months for the lower. Then, what are the more objective decision criteria for implant loading time? One of the methods that can most objectively assess the level of clinical implant stability and osseointegration is montly Resonance Frequency Analysis (RFA) using OsstellTM device. The OsstellTM device indicates the Implant Stability Quotient (ISQ) values from 1 to 100. The primary stability, the mechanical stability obtained at the time of implant placement, gradually decreases while the secondary stability by bone remodeling in the surrounding bone slowly increases after implant placement creating the dipping phenomenon where the total stability goes down. As reported by many studies, ISQ values go down until week 3 after the placement of an implant, fluctuate slightly up to week 6 to 8, and then slowly go up afterwards. Then, can we determine the implant loading time based on ISQ values as they represent implant stability? If there is no dipping phenomenon where ISQ values gradually decrease after placing the implant and the values are stable above a certain level without decreasing or even increasing, would immediate or early loading be possible? To put the conclusion first, ISQ values are one of the important objective indicators to determine the implant loading time, but it cannot be the absolute criteria. In other words, the high immediate postop ISQ values cannot guarantee the success of immediate or early loading. Even so, the ISQ values measured after a certain period of wound healing after surgery may have some clinical implications. If that is the case, what factors other than ISQ values need to be considered for immediate or early loading? First is the implant thread design and surface that can obtain high initial stability and minimize the compressive force on the surrounding bone. In fact, implants with such design show no considerable reduction in ISQ values in the initial stage after placing implants and the stability is maintained or even increased. If these implants are clinically applied, they would minimize the dipping of stability and reduce osseointegration time which makes immediate or early loading possible. Along with the implant design, one of the important factors to be considered for immediate or early loading is the ITV (Insertion TorqueValue) at the time of placement. It may be even more important than ISQ values. Based on successful clinical results of immediate loading, 45 N/cm or higher insertion torque, and 75 or higher ISQ values are recommended. Next is the bone density. This should be considered together with ITV. Appropriate ITVs can be obtained by clinically modifying the drilling sequence when implants are inserted through accurately determining the bone density. Lastly, patientâ&#x20AC;&#x2122;s occlusal factors and eating habit including a parafunction should also be taken into account.

Letâ&#x20AC;&#x2122;s look at some clinical cases for factors we need to consider for immediate or early loading.

(Figure 1) Generally initial stability obtained at the time of placement varies depending on bone quality and loading time is roughly determined based on the stability.

(Figure 2) If we can achieve high initial stability at the time of implant placement regardless of bone quality, we can start loading almost at similar time which would benefit both patients and surgeons.

Case 1 The patient was a 30 year old man. An Implant was planned for the lower left second molar region which was extracted three years ago. As oral and radiograph examination revealed sufficient bone width and quantity, flapless surgery was planned using a surgical stent. The immediate post-op ISQ values were very high with 80 or above on both buccal and lingual sides, so the initial stability was excellent. Therefore ,a customized abutment and a temporary crown fabricated considering the final prosthesis from the diagnostic stage of surgery were connected. As the patient complained about a little discomfort three weeks later, loading was immediately stopped since the new ISQ measurements were lower than 60. Two month post-op, the ISQ value was above 75 again and stable, so the final prosthesis was delivered.

(Figure 3) Initial Visit

(Figure 4) Immediate Post-op, ISQ value: B/86, L/88

158


Megagen |

5

(Figure 10) Initial Examination (Figure 11) Immediate post-op, ISQ value : B/78, L/78 (Figure 12) 7 month follow-up, ISQ value : B/77, L/79

6

Discussion

(Figure 5) 3 Week Post-op, ISQ value: B/56, L/59 (Figure 6) 2 Month Post-op, ISQ value: B/75, L/78

< (Figure 13) CT Views of Each

Case 2 An implant was planned in the upper left first molar region for a female patient in her 50s. Oral examination and radiograph showed sufficient vertical as well as horizontal bone quantity and well preserved keratinized tissue, therefore flapless surgery with a surgical stent was processed. Both immediate post-op buccal and lingual ISQ values low, below 70, so immediate or early loading was not chosen. According to the conventional healing protocol, we waited 3 months and measured the ISQ values again which were 75 or above. As the values were stable, the implant was loaded with the customized abutment and temporary crown. Based on the stable ISQ measurements, final prosthesis was delivered after that. 8

7

Early Loading Guide

9

What are the differences among the cases? Although in all three cases of the implant treatment were successful, the first two cases can be viewed as failures in terms of immediate and early loading. As stated before, ISQ values are important but not absolute. Among the determining factors of immediate or early loading, So, other factors to achieve strong ITV (initial torque value) should be considered to perform a modified drilling protocol based on the accurate estimation of the bone density in addition to the ISQ values. Lastly proper adjustment of occlusion is also important. The best way to determine the bone density would be CT. Carl Misch (in 1988) introduced it as the most useful method to determine cortical bone thickness and trabecular bone pattern. However, the black and white image on the conventional CT provides lake of information to determine accurate bone for density. So, color coding relative density differences in anatomical structures with various colors would be of great help for clinicians to identify the relative bone density.

(Figure 7) Initial Examination, (Figure 8) Immediate Post-op (Figure 9) 4 month post-op, ISQ value: B/75, L/76

Case 3 A male patient in the 40s presented a slight deficient keratinized tissue but had enough vertical and horizontal bone quantity, So flapless implant placement surgery with a surgical stent was planned for the lower left first molar region. The immediate post-op ISQ values were high with 75 or higher both buccaly and lingually. A customized abutment and a fabricated temporary crown considering the form of the final prosthesis from the diagnostic stage for the surgery were connected. The values were maintained without distinct decreases as time went by. Final prosthesis was delivered 4 week post-op. Favorable results were obtained during the 7 month follow-up. 10

11

12

(Figure 14) Case 2. Color Coding using R2GATE software

The second case is color coded using R2GATE software for more accurate determination of relative density differences of the anatomical structures with color details compared to the conventional CT view (Figure 14). As in the figure, the bone density at the implant site is estimated to be not high. There still remain numerous issues in applying immediate loading, that is, the One Day Implant treatment in all cases. However, highly predictable treatment is definitely possible if implants with the thread design and surface that can achieve high initial stability, yet minimize the compressive force on the surrounding bone are used to maintain proper ITV, Stable ISQ values and occlusion can be appropriately controlled. Published in the Dental News April 21, 2014. (Mon)

159


4. New Protocol for an Objective Evidence of Implant Stability - Dr. Kwang Bum Park In a series of articles for the last three weeks, Dr. Chang Hoon Han and Dr. Seung Yup Lee have shown objective ways to determine implant stability in bone and relevant clinical cases. It is well known that implants can be loaded earlier than before thanks to the advancement of implant design and surgical approaches, and the improvement of innovative surface treatment techniques. We are not really surprised or greatly impressed when we see speakers talk about 2 month or 3 month loading in a lecture or symposium. because many people have already published enough data on immediate loading. In spite of that, if we look back on what individuals have been doing in clinics, we need to contemplate on how often we really have used the immediate or early loading. No matter what others say, we, clinicians, prefer to remain in the comfort zone using familiar method that we are used to do and think to minimize side effects the best way. Breaking the habit is challenging. The loading protocol concept that professor Branemark had proposed, waiting 3 months for mandible and 6 months for maxilla is still vivid and alive among us, 50 years after the introduction of the concept. Let’s have a look at one more Chang Hoon Han’s case. When would you start loading in this case? Many people basically might think we need to wait for 6 months as it is maxilla but can load ‘a little earlier’ because the bone density looks pretty good on the radiograph.

▲ AnyRidge implant system and Mega-ISQ should be ready. The patient’s lower number 36 is extracted due to cracks and implant treatment is planned.

An implant was placed immediately after extraction which would be customarily done. 6.0x11.5mm implant was placed and superior stability was obtained despite it was fixed only by the buccal and lingual septal bone. After grafting the mesial and distal socket defect with allograft, and connecting the healing abutment, one-stage surgery was performed. When can you start loading in this case?

Pre-op

Here, two 4.0x10.0mm implants were placed with one stage surgical approach as the stability was excellent without any particular bony defect. Since you saw the surgical situation, can you determine the loading time? Many doctors I have met until now answered they would load at month 3. Even that is a great progress as the average 6 months has been reduced to 3 months!

160

3 Month Post-op

These are pre-op, 6 week and 3 month post-op intraoral radiographs. Are they ready loaded based on these pictures? Certainly bone is regenerated on month 3 but how much confidence can these pictures give us for loading?

Z

5 Month Post-op

In this case, Dr. Chang Hoon Han delivered the final prosthesis in just 6 weeks in single crowns and not splinted! Many readers may think it is possible, but not many are ready to adopt this protocol in their clinics immediately. Why is that? I think it is because of lack of solid objective criteria that can guarantee successful results.

6 Week Post-op

8.5 Month Post-op 1.5 Year Post-op Month


Megagen |

In the end, the provisional crown was delivered at day 118, over 5 month post-op, and the final prosthesis was connected at 8.5 months. The results were also excellent during the follow-up.

Early Loading Guide

A suggestion on the Loading Time with AnyRidge Implant (predictable 6 week loading protocol)

Even though the auSmarThor realizes better than anybody else the AnyRidge implant compared to other existing implant systems is superior in terms of initial stability, AnyRidge does not lower but maintains the ISQ from the time of placement and facilitates osseointegration faster thanks to its Xpeed surface treatment, he did not attempt to load because of his attitude to play safe and not to risk any side effects. Any clinician can understand it. Comparison in loading time between EZplus & AnyRidge

Ez plus (without ISQ)

Case

Average Loading Time(D)

Max. Implant

11

125.6

Mand. Implant

9

105.8

Total

20

124.5

AnyRidge (without ISQ)

Case

Average Loading Time(D)

(Table 2)

AnyRidge (with ISQ)

Case

Average Loading Time(D)

Max. Implant

10

129.6

Max. implant

4

84.8

Mand. Implant

9

112.8

Mand. implant

9

53.8

Total

19

121.8

Total

13

80.1

(Table 1)

(Table 1) compares the average loading time of EZ Plus and AnyRidge. The number of days from placement to loading was calculated from twenty randomly selected cases and the results are surprising that similar loading time is habitually used even in cases where the stability was found to be good during surgery. Compared to this, when ISQ values began to as an objective indicator, the loading time was cut almost by one third which was as much as 4 to 5 weeks. This proves again that old habits die hard. Now how about determining the loading time more objectively doing away from the habits? By doing so, I believe we can reduce the number of visits per patient considerably, and save your time as well. This will eventually show you a new way to step ahead of your competitors. On average of 10 to 12 visits are required for the exisiting treatment pattern from a surgery to completion of a prosthesis delivery based on the auSmarThor’s personal experience, but the visits were reduced by half, 6 to 7 visits. (Table 2) describes the auSmarThor’s loading protocol that was used clinically. Although the One-Day Protocol of immediate loading right after implant placement using the R2Gate and Eureka System is already established and the success rate has been around 95% in about 2,000 cases for the last 2 years, I understand number of people feel the preparatory stage rather complicated. Then, what about trying this protocol shown with the graph? It will definitely reduces the patient’s number of visits greatly, shortens the treatment time for you and contribute s to your business quite a lot.

AnyRidge implant system and Mega-ISQ should be ready. The first ISQ values are measured on the day of implant placement right after surgery which requires just 2 to 3 minutes of clinic time. And ISQ is measured again at week 1 when the patient comes back to take the stitches out. This also takes less than 5 minutes, a simple step that can be often done by an assistant. The ISQ values are measured again at week 4 when soft tissue is almost healed. Now three ISQ values from a patient are prepared. Impressions can be taken if these 3 values are almost similar or increasing over time. Today intraoral scanners are available, so precise digital impressions can be taken easily without the need for you to pay much attention to it. Usually it takes at about 1 or 2 weeks to prepare customized abutments and prosthesis. At most, 2 weeks will be enough at the most. When the patient comes back 6 week post-op, ISQ values are measured one more time. If the values are not smaller than those at week 4, prosthesis can be confidently delivered. It is not important whether it is temporary or final. The stability of implant is already confirmed, so we can certainly proceed the prosthesis. If you repeat this procedure a few times, your confidence in using the One-Day Implant will grow. Today implants are much different from those 2 or 3 decades ago. With a little attention and positive mindset to incorporate new changes, we will be able to make the implant procedures much more interesting and effective which will contribute more to our business. -> The clinical cases here are contained in ‘How to get a reliable

ISQ value’in the clinical cases of www.R2GATE.com.

Published in the Dental News April 28, 2014. (Mon)

161


Wireless Auto Torque Driver

MEG-TORQ®

Beschreibung Ref.C

MEG-TORQ

Rechtwinkelschraubendreher

mit 2 Rechtwinkelschraubern [1 lang, 1 kurz (1,2 Sechskant]

Slot 0.5 Hex 0.9 Hex 1.2 Hex 1.25 Hex 1.6

kurz lang ultra-kurz kurz lang ultra-kurz kurz lang kurz lang

MEG-TORQ

Operating button (B)

MDR050S MDR050L MDR090SS MDR090S MDR090L MDR120SS MDR125S MDR125L MDR160S MDR160L

Ein/Aus, Drehmoment einstellen Rechtslauf / Linkslauf Umdrehungszahl einstellen

Präzise Drehmomenteinstellung, sehr kraftvoll! ➲ Als zweiter Implantatmotor bei weichem Knochengewebe ­ Zur schnellen Entfernung verschiedener prothetischer Produkte ➲ ­ Auch der Bereich der Molaren wird bequem erreicht ➲ ­ Erreichen von Implantaten im distalen Bereich ➲ ­ Exaktes Einstellen des Drehmoments zum ➲ Einschrauben des Abutments In Verbindung mit dem Weltklasse-Motor von FAULHABER, Deutschland und Vorgele aus der Schweiz

Maximales Drehmoment 35 Ncm

LED-Anzeige Bedienknopf (A)

U/min

rpm

Informationen zur Rotation

60

Informationen zum Drehmoment Akkuladestand

Kalibrierungsmodus

162


Megagen |

1. Accurate & Fast!

Early Loading Guide

1. Itâ&#x20AC;&#x2122;s possible to operate wide range of surgical procedures from implant placement to orthodon tics with various controllable torque and speed options. - Torque setting : 5, 10, 15, 20, 25, 30 and 35Ncm / RPM setting : 15, 30, 45 and 60 RPM rpm

5

rpm

10

rpm

rpm

rpm

20

15

25

rpm

30

rpm

35

The highest RPM speed > Rapid treatment Product

TORQUE

RPM

5~35N

15~60

value per every 5N)

value per every 15RPM)

Feature

MEG-TORQ (Possible to adjust the (Possible to adjust the Rapid treatment with higher speed compared to other brands. N Product

10~40

25

Expensive and takes more time to insert fixtures with low RPM

M Product

10~30

30

Inefficient performance due to low torque value and low speed

* One of the highest RPM products in the world enable to convenient and faster treatment. rpm

2. State-of-the-art TCS (torque calibration system) minimizes torque value errors between Motor Handpiece and Contra-Angle.Provided numerical data 0 as torqueing abutment screws (Torque gauge function) 3. Wide LCD display guarantees convenience. 4. More than 2 times faster than using manual torque wrench, enable to shorten chair time.

2. User-Friendly!

CAL

1. LCD Digital Display shows every function including torque, speed, direction of rotation, battery condition and calibration mode setting. Panel display is clear and easy to use. 2. Operation buttons at both ends allow clinicians to use in various angles and grip positions.

Pen Grip Using upper button

Palm-Up Grip Using lower button

3. Cordless Power Recharging (max 60 minutes of continuous operation time when fully charged) 4. Ergonomic Design empowers clinicians to operate easily. 5. One-handed operation provides a wider view of operation site. 6. Functions as an exact Torque Gauge to make perfect tightening of abutments and screws.

3. Clinical Advantage

Implant surgery by using MEG-TORQ without irrigation

#36 OP With MEG-TORQ MEG-TORQ setting: 35Nm, 60rpm Drilling with MEG-TORQ AnyRidge fixture 4011 Place implant with MEG-TORQ

- One-handed operation widens implants view and increases productivity and safety. - Easy to handle the prosthetics. Speedy, ac curate and safe operation - Visual access to operation site becomes easy thanks to the 2 operation buttons (up/ down) even in small spaces in the molar area. - Installation and removal of implant coping, healing abutment, and cover screws can be faster (more than 2 times) and more accurate. - MEG-TORQ is useful to reach to a distal implant or difficult cases such as lower third molar case than using hand-driver.

163


System zur schmerzfreien Anästhetikainjektion

MEG-INJECT ®

* Dieses Produkt wurde in Zusammenarbeit mit dem Unternehmen KMG Keomyung (koreanischer Marktführer mit mehr als 10 Jahren Erfahrung in diesem Bereich) entwickelt.

Beschreibung Ref.C

MEG-INJECT

mit 2 Handstücken Handstück zur schmerzlosen Injektion

MEG-INJECT MEG-INJ-HP

➲ ­Handstück mit Touch-Bedienung ­ ­Verschiedene Optionen zur Steuerung der ➲ Injektionsdosis einschl. Dosieroptionen

➲ ­­Eleganter Touchscreen für eine bequeme Bedienung

➲ ­­Komplett wasserdicht, mit Touchscreen und schnurlosem Ladesystem

KORPUS + INJEKTOR + PEDA L

KOMPLETTSET

MASSSTAB 1/3

TRANSPORTABLES ANÄSTHESIESYSTEM FÜR MODERATE SCHMERZE N

VOLLNARKOSE-SYSTEM

SMALL NO-OBLIG ATION

164


Early Loading Guide

Megagen |

1. Characteristics & Components

1. Light and convenient handpiece

- World’s first handpiece with controller - Single-handed operability without a pedal - Light weight enables you to operate for a long time without a fatigue.

2. Contactless charging & Ultralight system

- Holder is a cordless change cradle which is charged by an electromagnetic induction. - Easy to use and to move - 8 hours of continuous operation after a full charge.

3. Ergonomic design with easy-to-understand control panel

- Easy select the injection speed by a touch panel. - Equipped the constant voltage touch sensors and graphic indicators. (LED indicators let you make control easily.)

4. Various injection modes to clinical necessity

- Safe and easy anesthesia by keeping a constant injection amount and speed.(1/4, 1/2, F, S, H). - Efficient for to block anesthesia or periodontal ligament organization. (Recommended sized needle is required)

5. More efficient to use dental needle and medical needle at the same time.

(10 medical needels are given, but a handpiece must be purchased separately if a clinician uses a dental needle)

6. Voice guide / Aspiration function equipped.

2. Usage of Meg-Inject and Speed Control

Auto Mode

F

1. Pre-emission : air + infusion(0.11ml) 2. To control the speed of infusion from low speed to high speed automatically. 3. High speed 0.03ml/sec Low speed 0.006ml/sec Pre-emission 0.35ml

0.085ml / 17”

Pre-emission

Low speed

7”

1.26ml / 45” High speed 0.588ml / 21”

1/2

Pre-emission

L

1/4

Pre-emission

L

1’10”(±10%)

H

45”(±10%)

0.168ml / 6” H

30”(±10%)

Manual Mode 1. No pre-emission

2. Varies the speed and time of infusion according to its use.

S H

Inject the same amount in the same low speed Change to high speed by manually after starting from low speed

4’30”(±10%) Injection in different time intervals depending on the user’s control.

Handpiece

Specification

Handpiece controller Stop/Play

Product Name Low pain anesthesia injector Brand Name

MEG-INJECT

Battery

Lithium Polymer 3.7V /1,000Ah Battery charger with standard Micro USB type-B port5V±0.25V

Standard

47.96×28.78×165.75mm (L×W×H)

Weight

160g

Color

Handpiece holder Needle Speaker

White

Battery indicator

Cartridge Ampoule stick

Display : Checking dosage

Hold button Power

Touch sensors

165


www.imegagen.de

Hotline 06221 - 4551140 Email info@imegagen.de

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