Study Club Name NobelReplace Straight Drill Protocol Date of Presentation This a “sub module” intended to be included within other presentations Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability. Nobel Biocare, the Nobel Biocare logotype and all other trademarks are, if nothing else is stated or is evident from the context in a certain case, trademarks of Nobel Biocare.

Agenda NobelReplace Straight Drill Protocol 1. Surgical Kit 2. Fundamental Parallel Drill Protocol 3. Fundamental Implant Placement 4. Dense Bone Protocol 5. Cleaning and Sterilization 6. Hands On 2

NobelReplace Straight Surgery Kit Introduction

NobelReplace Straight Surgery Kit – Drilling Protocol is provided on the drill kit

NobelReplace Straight Surgery Kit Introduction

NobelReplace Straight Surgery Kit – Numbers in the drill protocol chart refer to the numbers next to the actual drills

Agenda NobelReplace Straight Drill Protocol 1. Surgical Kit 2. Fundamental Parallel Drill Protocol 3. Fundamental Implant Placement 4. Dense Bone Protocol 5. Cleaning and Sterilization 6. Hands On 7

General irrigation issues External vs. internal, using both Sterile saline solution Precautions with drill extender Demonstration of irrigation tubing Discuss external versus internal irrigation What are the benefits and what are the disadvantages of each When must you use external irrigation If you would recommend using both, go over that When saline is used, it can require a little more maintenance of the instrumentation to keep the cannuli open. They must be flushed with water after the procedure. They should be flushed anyway, but there’s a little more of a disadvantage with saline in the maintenance aspect, although it’s not a problem whatsoever, as long as the staff understands what needs to be done to maintain the equipment after each procedure Drill Extension Shafts Regardless of the type of irrigation you would like to use, when you use the drill extension shafts, there are special precautions on the effectiveness of the internal irrigation and also on the stream from external irrigation hitting the drill, rather than the drill extension shaft For each of the courses, you should have irrigation tubing available, one packet to demo. Because it is something that is not intuitive. While you wull have staff do it, you’ll have to learn to do it yourself. Show the doctors how the irrigation tubing is applied to the system and how the peristaltic pump works and the associated controls

NobelReplace Straight RP Drill Protocol Drill and Tap Depth Markings 15mm 13mm 10mm 7mm 1mm NobelReplace Straight Ø4.3 x 13mm

NobelReplace Straight RP Drill Protocol, Medium Bone 1 2 4 If indicated Drill numbers refer to the drill numbers as listed on the actual Surgical Kit 1mm Ø 2 Ø 2.4/2.8 Ø 3.2

Drill with an in-and-out motion – flush bone chips, cool drill bit, 2 seconds max of drilling Proper drilling technique avoids potential damage to bone during osteotomy creation Keep drills in motion while in bone in-and-out motion 2 seconds of drilling, withdraw bit completely drill constantly rotating Intermittent in-and-out motion to keep drills cool flush bone chips maintain drilling efficacy Use external irrigation for Twist Drills Do not use irrigation during implant placement Withdraw completely 2 seconds

Twist Drills and Screw Taps available in different lengths Consider shorter tooling when limited vertical opening 18mm 18mm 15mm 15mm 13mm 13mm 10mm 10mm 7mm 7mm

NobelReplace Straight RP 4.3 x 13mm, Medium Density Bone Drill to the desired depth Check orientation Twist Drill with Tip 2mm 2000 RPM Direction Indicator

NobelReplace Straight RP 4.3 x 13mm, Medium Density Bone Enlarge osteotomy & check orientation Enlarge the site Check orientation Twist Step Drill 2.4/2.8 mm 2000 RPM Direction Indicator optional

NobelReplace Straight RP 4.3 x 13mm, Medium Density Bone Enlarge osteotomy & confirm depth Enlarge the site Confirm osteotomy depth Check orientation Twist Drill 3.2 mm 2000 RPM Depth Probe

Agenda NobelReplace Straight Drill Protocol 1. Surgical Kit 2. Fundamental Parallel Drill Protocol 3. Fundamental Implant Placement 4. Dense Bone Protocol 5. Cleaning and Sterilization 6. Hands On 18

Remove implant (aseptic) from outer vial Remove outer seal Update Patient Chart Deliver inner vial to sterile field Remove cap

NobelReplace® Straight Implant placement Implant & Implant Driver Pick up implant Location of lobe Insert implant

Manual Torque Wrench Surgical Verify direction set for implant insertion

NobelReplace Straight RP 4.3 x 13mm, Implant Placement Torque to 45Ncm maximum, align one lobe buccal One Lobe buccal Laser marking on implant driver illustrates the alignment of the tri-channel apexes for required buccal alignment. Max 45 Ncm maximum

NobelReplace Straight Manual Torque Wrench Surgical 45 Ncm For Immediate Function 35-45 Ncm

Grooves on the Implant Driver indicate the position of the lobes Implant Placement Tri-Channel Connection Final implant rotational position NobelReplace Tri-Channel Connection – turn until a “lobe” is buccal Make sure that one of the lobes is pointed to the buccal. This ensures ideal abutment orientation1 Grooves on the Implant Driver indicate the position of the lobes Grooves on the Implant Driver indicate the position of the lobes 1. This may not be the case when using angulated Multi Unit Abutments (MUA). Refer to the relevant Instructions for Use when using the MUA

Immediate Function – 35 to 45 Ncm For immediate function, the implant should be able to withstand a final tightening torque of 35 to 45 Ncm

Do not exceed 45Ncm! If the implant does not seat fully at 45Ncm, remove the implant and follow the dense bone protocol Reverse the torque wrench and back the implant out Place the implant back in titanium sleeve Further modify site e.g. depth, dense bone drill, Screw Tap

Example of dense bone protocol using dense bone block Site prepared with standard protocol Implant does not seat completely with handpiece torque set at 45 Ncm Site prepared with dense bone protocol Implant seats flush in dense bone block with handpiece torque set at 45 Ncm

Always use the ball on the torque wrench handle when placing implants Bypassing the ball on the manual torque driver will easily achieve 200 Ncm, and 300 Ncm with some effort

NobelReplace Straight – Loading options There are three options for finalizing the implant surgery. One-stage immediate function* Provisionalize implant for immediate esthetics and function, using Nobel Biocare temporary or final abutments. One-stage delayed function Use Screwdriver Unigrip to connect a healing abutment to implant. If applicable, suture back the soft tissue. Two-stage delayed function Use Screwdriver Unigrip to connect a cover screw to the implant. Suture tissue flap using desired technique. * Provided that final torque of min. 35 Ncm can be achieved at implant placement and max. torque as indicated in manual may not be exceeded

Agenda NobelReplace Straight Drill Protocol 1. Surgical Kit 2. Fundamental Parallel Drill Protocol 3. Fundamental Implant Placement 4. Dense Bone Protocol 5. Cleaning and Sterilization 6. Hands On 31

NobelReplace Straight Manual Torque Wrench Surgical – Implant Removal If implant is not fully seated at 45Ncm, remove the implant, return it to the Titanium vial and continue with the Dense Bone protocol

NobelReplace Straight RP 4.3 x 13mm, Hard Bone Protocol Dense Bone Protocol, if indicated NobelReplace Counterbore RP 2000 RPM Screw Tap Straight RP max 45 Ncm

Agenda NobelReplace Straight Drill Protocol 1. Surgical Kit 2. Fundamental Parallel Drill Protocol 3. Fundamental Implant Placement 4. Dense Bone Protocol 5. Cleaning and Sterilization 6. Hands On 34

Twist and Step Drills are single-patient use and should be discarded after use Always refer to the most current Instructions for Use regarding suggested cleaning and sterilization protocols Source: Sterilization - Parallel Drilling protocol.ppt Used in: NobelActive Drilling Protocol NobelActive 3.0 Drilling Protocol External Hex Drill Protocol Parallel Wall Drill Protocol

Support Tool: Cleaning and Sterilization Guideline Guidelines for Nobel Biocare Products Review this document thoroughly Ensure that your staff is clear and trained on these protocols Can be downloaded from the Resources section of the Nobel Biocare website www.NobelBiocare.com Source: Sterilization - Parallel Drilling protocol.ppt Used in: NobelActive Drilling Protocol NobelActive 3.0 Drilling Protocol External Hex Drill Protocol Parallel Wall Drill Protocol

Agenda NobelReplace Straight Drill Protocol 1. Surgical Kit 2. Fundamental Parallel Drill Protocol 3. Fundamental Implant Placement 4. Dense Bone Protocol 5. Cleaning and Sterilization 6. Hands On 38

Thank you very much for your attention! © 2009 Nobel Biocare Holding AG Thank you very much for your attention!