Guideline for the Speaker “TREATMENT OPTIONS FOR THE SEVERELY RESORBED MAXILLA WITH ZYGOMATIC IMPLANTS”

Important instructions for the Speaker: How to prepare your course Instruction slide Important instructions for the Speaker: How to prepare your course The following slide set has been created to support you in preparing for your course delivery. The structure of this guideline presentation is based on the relevant detailed course recipe that is available on the Speaker Portal. In order to achieve global consistency and the most effective delivery of our courses, we kindly ask you to always refer to this recipe when preparing your presentation. This guideline presentation contains a selection of slides you can choose from to enhance your own material. You are required to follow the course topics as stipulated in the recipe or the agenda from the guideline presentation as is, and may adjust the detailed content and timing as desired. Additional materials (including videos and animations) can be found in the respective course library on the Speaker Portal. To have a consistent start and finish of all Nobel Biocare courses, we have designed a generic set of intro and exit slides, which we kindly ask you to include in your presentation (especially the course objectives). The “key messages” are important points that should be repeated throughout the course for the participants to remember. Please ensure your presentation reflects these messages accordingly. In order to continuously improve the content and keep it up-to-date, Nobel Biocare very much appreciates your support. If you have any comments regarding the provided material, please provide your feedback to your local Nobel Biocare T&E contact.

Key Messages Instruction slide Zygomatic implants are an evidence-based surgical and prosthetic solution since 1999 In severely resorbed cases, zygomatic implants are the only possibility to rehabilitate the patient immediately Zygomatic implants are a proven alternative to bone grafting Careful attention to planning will facilitate a more straight-forward prosthetic reconstruction

Agenda Welcome and introduction Basic principles of zygomatic implants Diagnostics, treatment planning and risk assessment Clinical pre-surgical evaluation Radiological preparation Live surgery Prosthetics on zygomatic implants Maintenance requirements Hands-on training Scientific support Conclusion and wrap-up

Welcome and introduction Instruction slide Welcome and introduction Introduce speaker and present short biography Introduce participating NB staff (focus on skill, education, i.e. dental assistant or technician, etc.) Provide ‘housekeeping’ information (restrooms, breaks, and related) Ask participants to introduce themselves and ask why they are here Why are we here? (Aim of the course) Present course objectives Present agenda in brief

Location, date Presenter name “TREATMENT OPTIONS FOR THE SEVERELY RESORBED MAXILLA WITH ZYGOMATIC IMPLANTS“ Location, date Presenter name

Replace with key points of speaker biography Dolore eu feugiat nulla facilisis at vero et Accumsan et iusto odio dignissim qui blandit Praesent luptatum zzril delenit augue duis dolore te feugait nulla Facilisi. Lorem ipsum dolor sit Amet, consectetuer adipiscing elit, sed diam nonummy Mibh euismod tincidunt ut laoreet dolore Magna aliquam erat volutpat. Ut wisi enim ad minim veniam. Replace with key points of speaker biography

Nobel Biocare on-site staff Name, Title Certified dental technician or dental assistant or other Complete with additional point regarding knowledge in dental field

Course objectives Revise biological and anatomical considerations of the maxilla and the zygomatic bone Consider the indications and contraindications for the zygomatic implant Explore pre-treatment planning, including anticipation of the provisional prosthesis Observe surgical placement of zygomatic implants Associate prosthetic solutions pertaining to the zygomatic implant Explore the steps in converting the patient’s existing denture into an immediately-loaded, fixed prosthesis Practice hands-on placement of zygomatic implants Discuss maintenance of zygomatic implants and how to manage complications Review supporting scientific literature and clinical evidence of zygomatic implants Aim of this course: Enabling you to grow your business by implementing zygomatic implants in your practice

Agenda Part 1 Welcome and introduction Part 6 Live surgery Part 2 Basic principles of zygomatic implants Part 7 Prosthetics on zygomatic implants Part 3 Diagnostics, treatment planning and risk assessment Break Part 8 Maintenance requirements Break Part 4 Clinical pre-surgical evaluation Part 9 Hands-on training Part 5 Radiological preparation Part 10 Scientific support Lunch Part 11 Conclusion and wrap-up

Agenda Welcome and introduction Basic principles of zygomatic implants Diagnostics, treatment planning and risk assessment Clinical pre-surgical evaluation Radiological preparation Live surgery Prosthetics on zygomatic implants Maintenance requirements Hands-on training Scientific support Conclusion and wrap-up

Basic principles of zygomatic implants Instruction slide Basic principles of zygomatic implants This chapter should cover the following topics: History of and indications for the zygomatic system Biologic and anatomic considerations of the maxilla and the zygomatic bone with corresponding structures Clinical aspects of bone quality and quantity in the compromised maxilla

Basic principles of zygomatic implants Bone resorption

Basic principles of zygomatic implants Bone resorption

Atrophy of the Maxilla after Tooth Loss Basic principles of zygomatic implants Bone quantity Atrophy of the Maxilla after Tooth Loss A B C D E Reference: Lekholm, U. and G.A. Zarb, Patient selection and preparation. In tissue-integrated prosthesis: Osseointegration in clinical dentistry., ed. P.-I. Brånemark, G.A. Zarb, and T. Albreksson. 1985, Chicago: Quintessence Publ Co. 199-209

Basic principles of zygomatic implants Concept – Patient Comfort Predictable Procedures For edentulous or partially edentulous maxillary cases with severe to extreme bone resorption In most cases enables the clinicians to treat patients without bone grafts Anchoring of implant in zygomatic bone (os zygomaticus) Immediate or delayed loading protocol NobelProcera Implant Bridge on implant or abutment level or NobelProcera Implant Bar Overdenture 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.

Basic principles of zygomatic implants Indication In the edentulous and partially edentulous maxilla when the posterior alveolar crest has resorbed to such an extent that additional implants would otherwise require the support of onlay or inlay grafts. End of the line treatment after previous failed implant attempts Maxillectomy cases - Reconstruction of the severely mutilated maxilla

Basic principles of zygomatic implants Brånemark System® Zygoma implants TiUnite all the way to the top Solid coronal part Diamond Coated Drills

Basic principles of zygomatic implants TiUnite® results in fast, predictable osseointegration Pre-clinical and clinical studies have shown that the speed of osseointegration is enhanced in comparison to a machined surface.1 SEM image of the TiUnite surface showing pores in the 1–10µm range Osteoblast anchored in the pores of a TiUnite surface. 1 Ivanoff CJ et al. Histologic evaluation of bone response to oxidized and turned titanium micro-implants in human jawbone. Int J Oral Maxillofac Implants 2003; 3:341-348

Basic principles of zygomatic implants Grooves on threads Bone forms much more rapidly inside groove compared to rest of implant Increased surface area for “Bone-to-implant contact” (BIC) “Mechanical interlock” - faster osseointegration when compared to implants without grooves (especially in soft bone) High primary stability Hall J, Miranda-Burgos P, Sennerby L. Stimulation of directed bone growth at oxidized titanium implants by macroscopic grooves: an in vivo study. Clin Implant Dent Relat Res. 2005;7 Suppl 1:S76-82.

Basic principles of zygomatic implants Platforms and lengths of Brånemark System® Zygoma implants Platform Ø Implant Length Implant Ø 4.4 mm Implant Ø 3.9 mm Platform Diameter: 4.1 mm Implant Diameter: 3.9 & 4.4 mm Implant Lengths: 30, 35, 40, 42.5, 45, 47.5, 50, 52.5 mm

Basic principles of zygomatic implants Cover screw and healing abutment Brånemark System® Zygoma implants Brånemark System Zygoma Implant Cover Screw Brånemark System Zygoma Healing Abutment Cover Screw Brånemark System RP Healing Abutment Brånemark System RP

Basic principles of zygomatic implants Instruments for Brånemark System® Zygoma implants E D C B A The Brånemark System Zygoma Surgical Kit includes: A. Depth indicator angled B. Depth indicator straight C. Drill guard short D. Drill guard E. Handle

Basic principles of zygomatic implants Product Reference Line Round bur Depth indicator angled 7.5 mm Depth indicator straight Brånemark System Zygoma implants Twist Drill 2.9 Pilot Drill 3.5 Twist Drill 3.5

Basic principles of zygomatic implants Procedure Sinus window Retractor

Basic principles of zygomatic implants Drill sequence Round Bur Twist Drill Ø2.9 mm

Basic principles of zygomatic implants Drill sequence Depth Indicator Pilot Drill ø 3.5 mm

Angled Depth Indicator Basic principles of zygomatic implants Drill sequence Angled Depth Indicator Twist Drill Ø 3.5 mm

Basic principles of zygomatic implants Implant placement Connection to Handpiece Engage Implant Assembly Packaging Plastic

Basic principles of zygomatic implants Implant placement Implant Placement Connect Handle

Basic principles of zygomatic implants Implant placement Remove Insertion Tool Connect Cover Screw

Basic principles of zygomatic implants Prosthetic considerations Abutment Connection Impression

Basic principles of zygomatic implants Prosthetic considerations

Basic principles of zygomatic implants Prosthetic considerations Brånemark System & Zygoma Implants, NobelProcera Implant Bar Overdenture . 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.

Basic principles of zygomatic implants Speaker note! Basic principles of zygomatic implants Prosthetics Speaker note for slide 34: From the restorative perspective, there is a broad flexibility in the final prosthetic design. The clinician is now able to deliver precision milled supra-constructions with passive fit and excellent esthetics for each individual patient need.

Basic principles of zygomatic implants Prosthetic considerations Brånemark System & Zygoma implants, NobelProcera Implant Bar Overdenture 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.

Basic principles of zygomatic implants Prosthetic components Brånemark System Zygoma Multi-unit Abutment RP Brånemark System Zygoma Multi-unit Angled Abutment RP Brånemark System Multi-unit Abutment RP Brånemark System Multi-unit Angled Abutment RP

Basic principles of zygomatic implants Instruction slide Basic principles of zygomatic implants Note for the Lecturer: Nobel Biocare is delighted to assist you with information and support material on our products and solutions. The topic covered in this section of the presentation addresses clinical issues and content. We feel that as an experienced clinician, this is your area of competence, and therefore we would suggest that you augment the lecture with your personal information and presentation material. General material can be found on our speaker portal. We encourage you to review the information provided for appropriate use in your presentation.

Agenda Instruction slide Welcome and introduction Basic principles of zygomatic implants Diagnostics, treatment planning and risk assessment Clinical pre-surgical evaluation Radiological preparation Live surgery Prosthetics on zygomatic implants Maintenance requirements Hands-on training Scientific support Conclusion and wrap-up

Diagnostics, treatment planning and risk assessment Instruction slide Diagnostics, treatment planning and risk assessment This chapter should cover the following topics: Treatment options (indication, contraindication, classifications of implant treatment – advanced and complicated, inclusions and exclusions) Pretreatment diagnostic procedures Anticipation of prosthetics (removable and/or fixed) in the different treatment stages Construction of a diagnostic provisional prosthesis to evaluate intra orally important changes regarding the tooth position Centric relation and jaw relation, tooth position, occlusion, esthetics, lip support & phonetics Surgical adjustment for the planned prosthesis like palatal and occlusal screw holes for a PIB or crown and future maintenance Saliva conditions Brånemark System Zygoma implants are available for treatment planning only in NobelClinician Software A solution for Guided Surgery is not available for Brånemark System Zygoma implants Model-based treatment planning Interpreting findings from clinical and radiological examination (bone volume, soft tissue, esthetic and functional evaluation) Possible surgical template design, material and construction (radiographic and surgical)

Diagnostics, treatment planning and risk assessment NobelClinician™ Software Courtesy of Dr Brent Allan, Australia * Brånemark System Zygoma is available for treatment planning only in NobelClinician Software and is not available for Guided Surgery 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.

Diagnostics, treatment planning and risk assessment NobelClinician™ Software * Brånemark System Zygoma is available for treatment planning only in NobelClinician Software and is not available for Guided Surgery 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.

Diagnostics, treatment planning and risk assessment Speaker note! Diagnostics, treatment planning and risk assessment Speaker note for slides 41 and 42: Please present your own cases as treatment planned using the NobelClincian Software. Further presentation material to support this topic can be found on the Speaker Portal in the tracks G01 and G02. If you are not familiar with the NobelClinician Software, please ask your local Nobel Biocare contact to support you or leave this section out.

Diagnostics, treatment planning and risk assessment Instruction slide Diagnostics, treatment planning and risk assessment Note for the Lecturer: Nobel Biocare is delighted to assist you with information and support material on our products and solutions. The topic covered in this section of the presentation addresses clinical issues and content. We feel that as an experienced clinician, this is your area of competence, and therefore we would suggest that you augment the lecture with your personal information and presentation material. General material can be found on our speaker portal. We encourage you to review the information provided for appropriate use in your presentation.

Agenda Instruction slide Welcome and introduction Basic principles of zygomatic implants Diagnostics, treatment planning and risk assessment Clinical pre-surgical evaluation Radiological preparation Live surgery Prosthetics on zygomatic implants Maintenance requirements Hands-on training Scientific support Conclusion and wrap-up

Clinical pre-surgical evaluation Instruction slide Clinical pre-surgical evaluation This chapter should cover the following topics: Treatment options (indication, contraindication, classifications of implant treatment in the atrophic maxilla, inclusions and exclusions) Pretreatment diagnostic procedures including prosthetic-driven planning

Clinical pre-surgical evaluation Instruction slide Clinical pre-surgical evaluation Note for the Lecturer: Nobel Biocare is delighted to assist you with information and support material on our products and solutions. The topic covered in this section of the presentation addresses clinical issues and content. We feel that as an experienced clinician, this is your area of competence, and therefore we would suggest that you augment the lecture with your personal information and presentation material. General material can be found on our speaker portal. We encourage you to review the information provided for appropriate use in your presentation.

Agenda Instruction slide Welcome and introduction Basic principles of zygomatic implants Diagnostics, treatment planning and risk assessment Clinical pre-surgical evaluation Radiological preparation Live surgery Prosthetics on zygomatic implants Maintenance requirements Hands-on training Scientific support Conclusion and wrap-up

Radiological preparation Instruction slide Radiological preparation This chapter should cover the following topics: Interpreting findings from clinical and radiological examination (bone volume, soft tissue, esthetic and functional evaluation)

Radiological preparation Instruction slide Radiological preparation Note for the Lecturer: Nobel Biocare is delighted to assist you with information and support material on our products and solutions. The topic covered in this section of the presentation addresses clinical issues and content. We feel that as an experienced clinician, this is your area of competence, and therefore we would suggest that you augment the lecture with your personal information and presentation material. General material can be found on our speaker portal. We encourage you to review the information provided for appropriate use in your presentation.

Agenda Instruction slide Welcome and introduction Basic principles of zygomatic implants Diagnostics, treatment planning and risk assessment Clinical pre-surgical evaluation Radiological preparation Live surgery Prosthetics on zygomatic implants Maintenance requirements Hands-on training Scientific support Conclusion and wrap-up

Live surgery Instruction slide This chapter should cover the following topics: Live surgery with live transmission to include placement of the immediate prosthesis on the patient

Live surgery Instruction slide Note for the Lecturer: Nobel Biocare is delighted to assist you with information and support material on our products and solutions. The topic covered in this section of the presentation addresses clinical issues and content. We feel that as an experienced clinician, this is your area of competence, and therefore we would suggest that you augment the lecture with your personal information and presentation material. General material can be found on our speaker portal. We encourage you to review the information provided for appropriate use in your presentation.

Agenda Instruction slide Welcome and introduction Basic principles of zygomatic implants Diagnostics, treatment planning and risk assessment Clinical pre-surgical evaluation Radiological preparation Live surgery Prosthetics on zygomatic implants Maintenance requirements Hands-on training Scientific support Conclusion and wrap-up

Prosthetics on zygomatic implants Instruction slide Prosthetics on zygomatic implants This chapter should cover the following topics: Provisional solutions for Brånemark System Zygoma implants Type of abutments Individualized prosthetics with NobelProcera on Brånemark System Zygoma implants with an adequate hygienic design Immediate loading 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.

Prosthetics on zygomatic implants Instruction slide Prosthetics on zygomatic implants Note for the Lecturer: Nobel Biocare is delighted to assist you with information and support material on our products and solutions. The topic covered in this section of the presentation addresses clinical issues and content. We feel that as an experienced clinician, this is your area of competence, and therefore we would suggest that you augment the lecture with your personal information and presentation material. General material can be found on our speaker portal. We encourage you to review the information provided for appropriate use in your presentation.

Agenda Instruction slide Welcome and introduction Basic principles of zygomatic implants Diagnostics, treatment planning and risk assessment Clinical pre-surgical evaluation Radiological preparation Live surgery Prosthetics on zygomatic implants Maintenance requirements Hands-on training Scientific support Conclusion and wrap-up

Maintenance requirements Instruction slide Maintenance requirements This chapter should cover the following topics: Oral hygiene chair-side and home care Cleaning and maintenance of the prosthesis on the dental laboratory side and home care Post-operative recall Complication management (e.g. sinusitis)

Maintenance requirements Instruction slide Maintenance requirements Note for the Lecturer: Nobel Biocare is delighted to assist you with information and support material on our products and solutions. The topic covered in this section of the presentation addresses clinical issues and content. We feel that as an experienced clinician, this is your area of competence, and therefore we would suggest that you augment the lecture with your personal information and presentation material. General material can be found on our speaker portal. We encourage you to review the information provided for appropriate use in your presentation.

Agenda Instruction slide Welcome and introduction Basic principles of zygomatic implants Diagnostics, treatment planning and risk assessment Clinical pre-surgical evaluation Radiological preparation Live surgery Prosthetics on zygomatic implants Maintenance requirements Hands-on training Scientific support Conclusion and wrap-up

Hands-on training Instruction slide This chapter should cover the following topics: Placement of zygomatic implants on phantom heads

Hands-on training Instruction slide Note for the Lecturer: Nobel Biocare is delighted to assist you with information and support material on our products and solutions. The topic covered in this section of the presentation addresses clinical issues and content. We feel that as an experienced clinician, this is your area of competence, and therefore we would suggest that you augment the lecture with your personal information and presentation material. General material can be found on our speaker portal. We encourage you to review the information provided for appropriate use in your presentation.

Agenda Instruction slide Welcome and introduction Basic principles of zygomatic implants Diagnostics, treatment planning and risk assessment Clinical pre-surgical evaluation Radiological preparation Live surgery Prosthetics on zygomatic implants Maintenance requirements Hands-on training Scientific support Conclusion and wrap-up

Scientific support For scientific evidence we refer you to our Nobel Biocare web-page: http://www.nobelbiocare.com/en/resource-library/scientific-evidence/default.aspx

Agenda Instruction slide Welcome and introduction Basic principles of zygomatic implants Diagnostics, treatment planning and risk assessment Clinical pre-surgical evaluation Radiological preparation Live surgery Prosthetics on zygomatic implants Maintenance requirements Hands-on training Scientific support Conclusion and wrap-up

Wrap-up Revise biological and anatomical considerations of the maxilla and the zygomatic bone Consider the indications and contraindications for the zygomatic implant Explore pre-treatment planning, including anticipation of the provisional prosthesis Observe surgical placement of zygomatic implants Associate prosthetic solutions pertaining to the zygomatic implant Explore the steps in converting the patient’s existing denture into an immediate-load, fixed prosthesis Practice hands-on placement of zygomatic implants Discuss maintenance of zygomatic implants and how to manage complications Review supporting scientific literature and clinical evidence of zygomatic implants Aim of this course: Enabling you to grow your business by implementing zygomatic implants in your practice

Thank you for you attention! “treatment Options for the Severely Resorbed Maxilla with zygomatic implants“ Thank you for you attention!

Conclusion and wrap up Round off lecture and show appreciation to lecture team Optional: Mentorship options: guidance through initial straight-forward patient cases Optional: Advise participants of mentorship options to support them through their first straight-forward patient cases Inform about upcoming courses and events Announce sales offer and distribute (handout, not in ppt) Distribute and collect course evaluation forms Distribute certificates

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Mentorship This is an optional slide Insert information here if there is an established Mentorship Program in your country. … Questions? Please contact: Contact Name Title Telephone Email Address

Upcoming courses and events List courses or events that will be of interest to audience “Next course in this series” Speaker: Speaker Name and credentials listed here Date: Date listed here Location: Location listed here More information: Contact name or web address listed here