1. Study Club Name NobelReplace Straight Drill Protocol
Date of Presentation
This a “sub module” intended to be included within other presentations
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2. 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

3. NobelReplace Straight Surgery Kit Introduction

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

5. NobelReplace Straight Surgery Kit Introduction

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

7. 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

8. 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

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

10. NobelReplace Straight RP Drill Protocol, Medium Bone1 2 4
If indicated
Drill numbers refer to the drill numbers as listed on the actual Surgical Kit
1mm
Ø Ø 2.4/2.8 Ø 3.2

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

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

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

19. Manual Torque Wrench Surgical Verify direction set for implant insertion

20. 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

21. NobelReplace Straight Manual Torque Wrench Surgical
45 Ncm
For Immediate Function Ncm

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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

33. 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
Source: Sterilization - Parallel Drilling protocol.ppt
Used in:
NobelActive Drilling Protocol
NobelActive 3.0 Drilling Protocol
External Hex Drill Protocol
Parallel Wall Drill Protocol

34. 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

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