Untitled - Platon-implant.com


Untitled - Platon-implant.com

Chapter 1 Selection of indicationsChapter 1 Selection of indications1. Exam and diagnosis necessary for selection ofadaptable casesTo enhance the predictability of the implant treatment and guideto comprehensive success, a prosthetic diagnosis and comprehensivetreatment plan are required.For functional and aesthetic recovery of ultimate goals, theenvironmental improvement of the dentition, hard tissues, such asjaws and alveolar bones, and soft tissues, and the initial preparationinvolved is required. As implant treatment may require proceduressuch as bone grafting, GBR, sinus elevation before implant placement,there is a need to grasp local and systemic conditions through inquiryand clinical exam.1) Inquiry (chief complaint, Clinical history, actual symptom,medical history)Screening including systemic diseases, checking the need for initialpreparation before implant treatment, and patient’s state of mindis conducted. For the systemic exam, if necessary, a clinical exam isperformed to check for absolute contraindication according to oralsurgery and relative contraindication to systemic diseases, age, and oraldiseases (see the Table A on the right).2) Intraoral examInspection and palpation are conducted to check intraoral conditionsincluding the presence or absence of hyperfunctional occlusion,the condition of missing tooth, oral diseases such as periodontal disease,mucosal thickness and the presence or absence of attached gingiva,the mylohyoid muscle condition, vertical dimension (clearance),the presence or absence of bone torus. Furthermore, it is necessary tocheck how wide the mouth opens in order to choose the instrumentationthat could be used.Table ADiabetes:Control of blood glucose level by diet therapy and administrationof internal medicines, and sufficient infection controlspreoperatively and postoperativelyHypertension:Consideration of the severity of hypertension and risks on implantsurgeryManagement including the measurement of pulse, and SpO2Ischemic cardiac disease:Diacrisis of myocardial infarction and angina pectorisCareful determination for indications* The others:It is necessary to be aware of risk factors related to smokingand/or drinking, such as bruxism, and commonly used medicines.3) Prosthetic exam (model exam)It is necessary to define present problems through the examinationof the relationship between the dentition and occlusion, the occlusalplane condition, attrition, the defective space, and the clearance toopposing teeth. A diagnostic wax-up allows set up of the final appearanceof the prosthesis and provides guidance for the comprehensivetreatment plan, including periodontal and surgical treatments.4) Image exam (two and three dimensional exams)Different x-rays, such as panoramic, cephalogram, and digitalx-ray, as well as CT (if necessary, use of simulation software for implantplacement) are used for examining the maxillomandibular form, bonemass, bone quality, and bone width as well as to check the positionalrelation of residual roots and stumps of tooth or impacted teeth, associatedwith the final position of the prosthesis and its integration withbones.1 SURGICAL MANUAL FOR PLATON IMPLANT SYSTEM

2. Exam/diagnosis and simulation with modelsModels for the exam are mounted onto articulators by means offace-bow transfer. Wax-up is performed to put the design of superstructuresinto a tangible form by fully taking into consideration theideal prosthetic form at defective sites on models. Based on this wax-upprocedure, the relationship with opposing teeth, the optimum implantsize, the number of implant placement, the position and direction ofthis placement, are taken into consideration. If implant placementinto the optimum position for the prosthetic plan becomes impossiblebecause of clearance shortage resulting from extrusion of opposingteeth, alveolar-bone deficiency, and malformation, it is necessary toconsider surgical treatments including remaining-tooth treatment andGBR. However, no matter what treatments are conducted, when noimplants can be placed into the ideal position and the ideal direction,there may be cases where implant treatment must be abandoned.Chapter 1 Selection of indications1)Diagnostic wax-upDiagnostic wax-up is an important process to render implantsfunctional for a long term. Information obtained from a diagnosticwax-up provides guidelines on how to approach implant treatment.Therefore, this could be called a model to carry on treatment in a safemanner.Flow of exam/diagnosis with modelsThe detail treatment plan can be discussed by coronal reproduction on the site where theimplant is to be placed.Exam of the anatomically corrective size and shapeExam of the targeted occlusal modeDetermination of occlusal contact areas or pointsExam of aesthetics and cleaning abilityConsideration to adjacent contact pointsDetermination of the position and direction of the placed implantExam of bone tissue at the site where the implant is to be placedDefinition of tooth axis.Screening of the dentition and jaw is performed.j - k = implant diameter※ j : Residual ridge width - mucosal thicknessk : minimum required peripheral boneSelection of implant sizeBone level determined by bone mapping(P3 : see needle stent)21Functional and aesthetic factors that are put into tangibleforms by wax-upPosition of the implant placedDirection of the implant placedMargin positionEmergence profile of superstructuresAdapted implant sizePrediction on abutment sizeSimulation on anterior and lateral movementj - k = implant diameter※ j : Residual ridge width - mucosal thicknessk : minimum required peripheral boneSURGICAL MANUAL FOR PLATON IMPLANT SYSTEM2

3. Fabrication of diagnostic and surgical guideChapter 1 Selection of indications1) Radiographic template and needle stentX-ray diagnosis and bone mapping are very effective in understandingthe bone form at the site where the implants is placed, basedon the form of the superstructure provided by the diagnostic wax-up.Therefore, radiographic template, used during radiography, and needlestents, used for bone mapping exam, are utilized.Radiographic template (CT, panorama)Exam can be chosen depending on the purposes, such as an exam of the balance betweenthe form of the superstructure and the form of the bone or exam of the relationship betweenthe form of the bone and the direction of the placed implant.Needle stentThe mucosal thickness at the site of the implant is determined, and its value is transcribedinto the diagnostic model to allow three-dimensional diagnosis.Based on the information accumulated by the exams and diagnosesdescribed above, the implant size, the position, direction,and depth of the implant, as well as the position of the marginare decided.Plus, the comprehensive diagnosis is determined, as well as anatomicalinformation including bone mass at the site of the implant,the presence or absence of interference with the adjacentroot apex, the distance to the mandibular canal or maxillarysinus. Next, surgical stents are fabricated. With a risk of perforatingthe maxillary sinus floor, CT with X-ray stents allowscollection of more detail information.2) Surgical guideBased on the diagnostic wax-up and diagnostic (X-ray, needle)stents, or the available results from the three-dimensional diagnosticimaging on CT, surgical stents are fabricated. The steric informationobtained from the exam is used as a guide during the operation.Surgical guideThe position of the implants is decided from the comprehensive diagnosis. Correctivedrilling can be conducted because the placement direction can be better seen during surgery.Support system (fare-paying services)• For inexperience or lack of confidence in design, an experiencedinstructor is consulted.• We advise and support the optimum approach technique toindividual cases, including diagnostic wax-up, fabrication ofdiagnostic and surgical stents.• We fabricate custom abutments and superstructures thatmatch individual patients.Please feel free to inquire.3 SURGICAL MANUAL FOR PLATON IMPLANT SYSTEM

4. Exam and diagnosis on CT (two- and three-dimensional simulation)The exam on CT is a very effective method to discuss the positionof the implant because of grasping the jaw structure three-dimensionally.Image data on CT allows the preoperative simulation with specialsoftware to define the position of the corrective implant, the placementdirection, and the placement depth. Therefore, image data onCT becomes a factor determining success or failure. A possible examof the bone quality around the implant site is very effective in the needof accompanying surgery, such as GBR or sinus augmentation and inconsideration of implant procedures. Special software, “10DR” introducedin the present manual has various functions of the automatedposition retrieve for the inferior alveolar nerve (mandibular canal) andthe collision detection of the mandibular canal with implants etc.The use of “10DR” is recommended to prepare safe operative plan.Chapter 1 Selection of indicationsImages are used from software of “10DR” (tie-up: 10DR JA-PAN).As we also offer the production, please consult us.SURGICAL MANUAL FOR PLATON IMPLANT SYSTEM4

5. Caution at diagnosis (drills and placement depth)Chapter 1 Selection of indicationsPreparation of the implant socket with implant drills or tapertwistdrills is formed 0.25mm-0.4mm deeper than the arrival depth ofthe implant-body (hereinafter called implant) tip. When selecting animplant size, the vertical bone mass and the distance to the mandibularcanal or the maxillary sinus should be examined on the basis of thedrilling length of drills. A schematic diagram of the drilled depth tothe implant intraosseous length is as follows:jk l m nj Guide drillk Pilot drilll Bore-twist drillm Implant drilln Taper-twist drillThe drilling sequence is an absolute guideline. Taper-twist drillsmay not be used according to bone quality, the presence or absenceof accompanying operations, and sites. In middle drills,operators must determine the size alternation or the need fordrilling according cases.Pro forma amount• The distance between the adjacent natural tooth and the implantshoulder must be at least 1.5mm.• The distance between implants must be at least 3mm in thedistance between shoulders.• The bone width around implants must be at least 1mm.• The ideal mucosal height around implants must be approx.3-4mm.• The ideal distance from the lowest contact point of superstructuresto the alveolar bone crest must be approx. 4-5mm.5 SURGICAL MANUAL FOR PLATON IMPLANT SYSTEM

Chapter 2 Treatment plan1. PLATON system outlineTo prepare the treatment plan, it is necessary to determine the priorityof the treatment and the therapeutic regimen to restore the healthof the dentition with optimum functionality and aesthetics rather thanthe local functional restoration. Against a backbone of the treatmentplan, in the initial phase it is important to prepare and implement thetreatment plan with consistency on the basis of a reassessment at eachstep and the required exam/diagnosis in each case. Doing so allows adetermination of the implant size, the number of implants, the positionand direction of the implant to be placed, the amount of bone justbelow and around the site, problems with the bone width and attachmentmucosa, the relationship between dentition and opposing teeth,and the type of superstructure most suitable for obtaining the finalprosthetic form.Chapter 2 Treatment planType IVABProtocolSubmergedNonsubmergedA:Polished Surface1.2mmInfraboneB:Implant SurfaceBlasting + Acid etching+ GDT (glow discharge treatment)Abutment connection8°of taper friction fitSelf-tapCorresponding to D3-D4 bone qualityLine-up ofImplants diameter(mm)SURGICAL MANUAL FOR PLATON IMPLANT SYSTEM6

2. Superstructure I Differences among implant typesChapter 2 Treatment planThe PLATON system Type Pro can be used both nonsubmergedimplant and submerged implant.In the case of nonsubmerged implant (implant margins), thepositional relationship of the margins is determined by the depth ofthe implant placed. In the case of submerged implant, margins can beplaced freely by customizing the types or forms of abutments.Margin sectionPolished surface(Transmucosal)AbutmentPlaced intraosseouslyImplant3. Superstructure II Differences among retained typesProsthetic modes of the PLATON system are classified into threetypes: a cement-retained, a screw-retained, and a magnet-retained.Because adaptations and procedures vary according to each type, it isdesirable to decide therapeutic strategies during the treatment plan,including prosthetic procedures, such as the prosthetic type, wheretreatment flows up to the insertion of the superstructure and the selectionof required parts, as well as the selection of impression procedures.《Cement-retained》—Cement-retained abutments• Directly or temporarily cementing this type of the PLATONsystem to the abutment heads with cement.• Margin setting can be adaptive to the range of approx.1.5mm-2mm from supragingival to subgingival in considerationof cement removal and a fit-confirming area.7 SURGICAL MANUAL FOR PLATON IMPLANT SYSTEM

4. Selective criteria for the systemBased on the data obtained through exam and diagnosis for atreatment plan, one of the implant systems is selected by taking intoconsideration the type of alveolar bone, mucosa, and superstructure.Two factors should be considered when making a decision about whichsystem to select among the PLATON systems.The first factor is to make a decision about which the position toplace the margin of the superstructures. Taking aesthetics into consideration,margins may be placed subgingivally. However, taking cementremoval into consideration, margins may be placed at or over the gingivalmargins. Thus, it is necessary to determine which factor shouldbe emphasized in order to obtain the optimum margin line of the finalprostheses. One option of the above-mentioned margin placementsincludes a method placing the mechanically polished part of implantson the abutment side (head).The second factor is to select an impression taking method on thebasis of the system decided from the above-mentioned margin positionand retaining type. Impression taking procedures for the PLATONsystem include the direct impression taking procedure of the intraoralabutments and the procedure of transferring the implant level to themodel using copings for impression taking.Selection criteria for the PLATON implant systemProsthetic table• On the mechanically polished part of the implants• On the abutment side (picture)Chapter 2 Treatment planRetaining types• Cement-retained (picture)Impression-taking procedures• Transfer system (picture)• Direct impression takingSURGICAL MANUAL FOR PLATON IMPLANT SYSTEM8

5. Treatment steps (nonsubmerged protocol, submergedprotocol)Chapter 2 Treatment planOperative procedures are decided from residual-ridge conditions,the need for plate dentures during therapy, the number of surgicaltreatments, and the aesthetic request.The nonsubmerged protocol makes the implant face penetratethe mucosa and expose the oral cavity just as implant is placed. Thereis just one surgery. The submerged protocol is one where the restingend is kept under the mucosa (periosteum) until osseointegration isachieved once the implant placement and the abutments (healing caps)are inserted, following by an incision in the gingival mucosa, onceagain osseointegration is achieved (second-stage surgery). Two surgeriesare performed.Nonsubmerged protocolFirst-stage surgeryHealing periodProsthesis• Hole preparation• Suturing• Impression taking• Implant placement• Healing above theª Abutment insertion• Cap insertionmucosaSubmerged protocolFirst-stage surgeryHealing periodSecond-stage surgeryHealing periodProsthesis• Hole preparation• Suturing• Healing-abutment• Suturing• Impression taking• Implant placement• Healing below theinsertion• Healing above the• Abutment insertion• Flat-cap insertionmucosamucosa9 SURGICAL MANUAL FOR PLATON IMPLANT SYSTEM

Chapter 3 Informed consentAfter the adaptation of the implant treatment has been determinedon the basis of exams and diagnoses, explanations about implant treatmentsin general, an estimation of the treatment cost, days of treatment,treatment procedures, except for implants, and the risks associatedwith the treatment should be provided to the patients in order toobtain their informed consent. Patients must make the final decisionon the implant treatment. Efforts for implant treatment and a clearunderstanding of the responsibility involved could be the best way toestablish the patients’ confidence, as well as to avoid troubles in thefuture. It is important to enhance communication between dentistsand patients.1. Treatment details to be explained to patients on thebasis of the treatment plans Chapter 3 Informed consent• The need for systemic management and control before and duringsurgery (persons with any disease only).• The need for treatment and improvement of the residual teeth (cariestreatment, occlusal improvement, and plaque control).• The need for treatment and improvement of the jaws (surgical treatmentsincluding grafting).• The need for treatment and improvement of the mucosa (surgicaltreatments including frenectomy, soft tissue augmentation).• Implant type (mucosal thickness, aesthetics, cleaning ability, bonemass, bone width, and the possibility of combination it with a graft).• Implant size (defective sites, aesthetics, the form of superstructuresand predictive occlusal forces, bone mass, and bone width).• The number of implants to be used (defective sites, the form ofsuperstructures and predictive occlusal forces).• Placement position and direction (the form of superstructures andpredictive occlusal forces, and the bone form).• The form of superstructures and prosthetic mode (Cr or Br). SURGICAL MANUAL FOR PLATON IMPLANT SYSTEM10

Chapter 4 Preoperative preparationUnlike any common dental treatment, implant treatment involvesthe surgical placing of aseptic implants into the normal jawbone. Toestablish osseointegration, it is necessary that operative assistants andoperators fully understand the concept of cleanliness/uncleanliness, thebiochemical characters of the biomedical tissue, the procedures of theimplant technique, the structure of the implants and the implant tools,and how to use them.Chapter 4 Preoperative preparation1) Concept of cleanliness in implant treatmentThe implant placement surgery should always be conducted takinginto account the bloody involved in the treatment of generalsurgical levels, which is very different from common dental practices.Therefore, it is important to differentiate between clean areas andunclean areas. Plus, it is desirable that the dental team and the operatorsfully understand these points. Because infections during theimplant placement surgery have a profound effect on the establishmentof osseointegration, important matters are taken into consideration,such as instruments/tools used, the sterilization and disinfection offingers and operation fields, and a distinction between clean areas andunclean areas.ConceptStaffClean areas Sub-clean areas Unclean areasAreas where all instruments/tools were sterilized anddisinfected disinfecting agentsPortions and instruments/toolsthat were fully disinfectedthrough wiping withAll portions except for theenvironments prepared foroperationOperators and assistants Second assistants Other dental team membersCapsCostumeMasksSurgical gownsSterile glovesUniforms and masksfor general practiceInstruments/toolsSterilized surgical instrumentsSterilized implant kitsTransported instruments witha sterile packAll except for sterilizedinstruments/tools2) Preventive measures to avoid infection in the surgicalenvironment:• Training of operators and dental team members handling the sterilizingapparatus.• Integration of the concept of cleanliness/uncleanliness.• Definitive division of roles between surgical assistants (cleanliness)and indirect assistants.• Defining clean areas/unclean areas.• Making it obligatory to wear sterilized surgical gowns.• Management of instruments/tools.11 SURGICAL MANUAL FOR PLATON IMPLANT SYSTEM

3) Preparations up to the day before surgeryThe items described on the right should be observed the day beforesurgery, in preparation for safe implant surgery.An operator must make arrangements with the dental team membersconcerning the operative sites, the size of implants to be used, andthe treatment procedures, and the day before the implant surgery, theinstruments/tools that are going to be used, in order to prepare forany unexpected event during surgery, and to make the surgery easier.The instruments/tools to be used should be checked at least three daysbefore each procedure so as to be prepared in case new items need tobe purchased. New items may include replacements for deficient toolsand materials or damaged items. An inventory should be prepared tostock a certain number of practical items, such as suture thread, sutureneedles, replaceable blades, and gauze.When conducting the surgery on the chair for routine practicesrather than in the surgical room, it is recommended to take into considerationother patients’ schedule, taking the time needed to carefullyclean and disinfect the chair and its surrounding area.• Making arrangements considering surgical procedures.• Checking the implant system required during surgery.• Checking the surgical instruments/tools.• Sterilization and disinfection of the surgical instruments/tools.• Confirmation of patient’s medical record, x-rays, and data.4) Preparation of implant systemsDental engine for implants Implants (Type IV) DrillsChapter 4 Preoperative preparationGuide pins Depth gauge Tapping instruments Round drivers Hex driversExtensions Caps Healing abutmentsTorque ratchet Wrench Holder keySURGICAL MANUAL FOR PLATON IMPLANT SYSTEM12

5) Preparations and points to be checked just beforesurgery• The arrangement of the chair and its surrounding area, the disinfectionby wiping it, and covering of the light arm and suction gripwith sterilized cloths, etc.• Preparation of implants and drills used (the operational check of adental engine).• Preparation of surgical instruments/tools and surgical guide (confirmationwith a check list for the procedures).• The patient’s data, including x-rays, medical records, and models.• Operational check of the devices associated with the systemic management,including a vital sign monitor.• Verification and induction of the patient’s systemic conditions (bloodpressure, body temperature, etc.)• Treatment and disinfection of the surgical field (gargle, extraoral wiping,etc.)Check List of Implant Surgical InstrumentsSurgical DatePatient nameSurgeon First Assistant Second AssistantSurgeon part Implant size (Type mm ×mm)Surgeon part Implant size (Type mm ×mm)Surgeon part Implant size (Type mm ×mm)Surgeon part Implant size (Type mm ×mm)Surgeon part Implant size (Type mm ×mm)MemoBlade handleMetal cupsRaspatoriesDappen glassesScalprumsMirrorsOsteotriteProbesOsteotrite tweezersTw eezersBone filesVacuumsBone cutting forceps Vacuum chipsNeedle holderTraysUnhooked forcepsInjection syringe(sterile, unsterile) Hooked forcepsDrillsScissors for suture removal Tw eezers made by titanium MycellMalleteSurgical suctionRestractorsBone crusherFlat caps, Extension capsMosquitoBar stand for implant fixturesSystem toolsContra handpieceChapter 4 Preoperative preparationPreparation of data and preoperativemeetingPreoperative medicationGlass syringeImplant moter systemResponsible PersonConfirmation DateCleaning the unit and its surroundingareaDifferentiation between cleanareas and unclean areasPreparation of instruments/toolsPreparation of a contra-angleOperative check of the dental engineDifferentiation and organization of theinstruments according their usage frequencyPreparation of agents and practical itemsChecking blood pressure, pulse, andSpO2Checking physical conditions duringsurgeryDisinfection of the surgical field13 SURGICAL MANUAL FOR PLATON IMPLANT SYSTEM

Chapter 6 Surgical form1. Outline of drilling sequenceDrilling sequence are as shown in the figure below: After thepreparation of an implant socket was performed with three types ofbasic drills, the procedures are divided by each implant type. For densebone, tapping instruments should be used.Bone qualityD3 D4Implant placementType IV ProBone qualityD1 D2Implant placementGuide drill Pilot drill Bore twist drill Implant drillTaper twist drillTapping instruments ProFor porous bone, drills of thinner diameter by one size shouldbe chosen in consideration of bone condensing. For more detaileddrilling sequence, see the attached sheet, “Drilling Progression.”Chapter 6 Surgical formSURGICAL MANUAL FOR PLATON IMPLANT SYSTEM14

Drilling sequence and implant placementj k lRound bar(see page 23)Used for knife-edgeor requiring alveolectomy.Guide drill(see page 22)Guide pin(see page 34)Pilot drill(see page 22)m n o pBore twist drill φ 24-28(see page 23)Implant drill(see page 24)Bore twist drill φ 35-42(see page 30)Taper twist drill(see page 30-32)Chapter 6 Surgical formqr-ar-bsDepth gauge(see page 34)Implant placement(see page 46-53)Cap insertion(see page 54)Tapping instrument Pro(see page 40 and 41)11Used for dense boneof D1 or D2.Suturing(see page 57)15 SURGICAL MANUAL FOR PLATON IMPLANT SYSTEM

1) Basic drills & round barsBasic drills are the first step in common among all types ofimplants. The basic drills consist of three types of guide drills, pilotdrills, and bore twist drills φ 24-28. Following use of the basic drills,the implant socket is extended, adding adequate drills according to thetype or size of different implants.Guide drillsThese are drills for marking and guiding. This procedure is criticallyimportant in assessment of the thickness of the cortical bone andthe bone quality of the cancellous bone as well as the preparation ofguide holes. In the event of making a drilling direction error, in makinga correction, sufficient irrigation and pumping are required becausethese drills tend to clog geometrically.14mm12mm10mm8mmSLS: Total length; 29mmL: Total length; 34mmPilot drillsThese are drills used for preparation of pilot holes with higher cuttingability. For brittle bone or when unfamiliarity with drilling, it isnecessary to carefully operate the drills to avoid causing deflection.Diameter: φ 1.8Material: Stainless steelGuide drills should be used to prepare a starting point in casesinvolving the dense bone because of poor cutting ability.Chapter 6 Surgical form14mm12mm10mm8mmSLS: Total length; 32mmL: Total length; 40mmDiameter: φ 2.0Material: Stainless steel (TiN coating)SURGICAL MANUAL FOR PLATON IMPLANT SYSTEM16

Bore twist drills φ 24-28These are drills to extend the cortical bone at the implant socketopenedsite in the order corresponding to φ 2.0, φ 2.4, and φ 2.8.The round guide is provided at the pointed tip of drill to stabilize duringcutting. Drilling for extension should be conducted gradually bypumping. For harder bone, drilling should be carefully done to reducedrill shaking.8mm6mmSL4mmDiameter: φ 2.0-2.4-2.8Material: Stainless steel (TiN coating)S: Total length; 26mmL: Total length; 32mmChapter 6 Surgical formRound barsFor bone crests with knife-edge and inadequate bone width, roundbars are used to flatten bone. In this situation, it is ideal to preparethe bone so that a support bone of more than 1mm can be providedaround the implant.14mm12mm10mm8mmSLS: Total length; 32mmL: Total length; 40mmDiameter: φ 2.5Material: Stainless steelIn cases of knife-edge bone, the flat bone preparation results inshortening intraosseous length due to the decrease in verticalbone mass.17 SURGICAL MANUAL FOR PLATON IMPLANT SYSTEM

2) Drills used for Type IVIn placing implants, following using the above-mentioned basicdrills, the holes are prepared with implant drills, bore twist drills35-42, and taper twist drills (for more detailed drilling sequence, seethe attached sheet, “Drilling Progression”).Implant drills of φ 2.8 and φ 3.2 are used for all the sizes ofφ 3.3, φ 3.8, and φ 4.7. The size of the bore twist drill 35-42 isbasically used in bone preparation only for implants of φ 4.7. Specialtaper twist drills are used to prepare the implant socket according tothe intraosseous length of 8mm, 10mm, or 12/14mm.Implant drillsThese are formation drills. Drilling should be carefully performedalong the hole without excessive forces.16mm14mm12mm10mm8mmDiameterStainless steel (TiN coating)ø 2.8 ø 3.2S L S LChapter 6 Surgical formS: Total length; 32mmL: Total length; 40mmSURGICAL MANUAL FOR PLATON IMPLANT SYSTEM18

◆ Correlation chart between taper twist drills and ImplantsIntraosseous length: 8mm size (Model: 33-8)Intraosseous length: 10mm size (Model: 38-10)Intraosseous length: 12mm size (Model: 33-12)Intraosseous length: 14mm size (Model: 47-14)Chapter 6 Surgical form21 SURGICAL MANUAL FOR PLATON IMPLANT SYSTEM

3) Different system tools to assist preparation of implantsocketsSafe drilling procedures involve confirmatory works at each stepand corrective determinations. With the bone prepared depth andthe placement direction, or multiple placements, the works cover afairly broad spectrum, including parallelism and the distance amongimplants. Drill stoppers, guide pins, depth gauges, and drill extensionsas system tools are to support drilling.Drill stoppersThese are used as indicators to avoid excessive depth preparation ofimplant sockets.With the difficult of a visible operative field or a request for clearerdrilling depth, special stoppers are set in place. The stoppers can beremoved with a hex-driver.φ 2.0 (for Pilot drill)φ 2.8 (for Implant drill 2.8)φ 3.2 (for Implant drill 3.2)Material: Stainless steelChapter 6 Surgical formSURGICAL MANUAL FOR PLATON IMPLANT SYSTEM22

Guide pinsThese are used to check that the guide holes drilled by guide drillsare prepared on and at the intended direction and depth.14mm12mm10mm8mmL23L28L23 (Total length: 23mm)L28 (Total length: 28mm)Material: TitaniumWhere multiple implants are placed, the preparation should bemade from the distal site. Parallelism and the distance betweenimplants could be confirmed by placing a guide pin or a holepositioningguide into the first prepared hole. A piece of suturethread or floss should be passed through the hole of the guidepin to avoid misdeglutition.Chapter 6 Surgical formDepth gaugesThese are used to check the depth and diameter of implant socketsprepared by implant drills.ø 2.8 ø 3.2 ø 3.5(Total length: 26mm)14mm12mm10mm8mm6mmMaterial: Stainless steelø 4.2 ø 4.7(Total length: 24mm)ø 5.7(Total length: 22mm)Trials should be carried out after fully cleaning the implantsockets with physiological saline. If there is insufficient preparationup to the predetermined depth, the preparation shouldbe conducted again. A piece of suture thread or floss should bepassed through the hole of a guide pin to avoid misdeglutition.23 SURGICAL MANUAL FOR PLATON IMPLANT SYSTEM

Drill extensionsThese are tools for the extension of drills in the event of impossibledrilling up to the predetermined depth, due to interference of the contra-anglepart with the adjacent tooth. These can be smoothly removedby using a built-in magnet.17 mm extensionInserted drill length:13 mmTotal length: 30mmMaterial: Stainless steelDrill extensions must be used under irrigation by manual operationfrom the outside.Total length of Different drill sizes and Total length after inserting extensionsDrillGuide drillPilot drillBore twist drillImplant drillS29mm32mm26mm32mmTotal length46mm49mm43mm49mmL34mm40mm32mm40mmTotal length51mm57mm49mm57mmChapter 6 Surgical formTaper twist drill For 8mm26mm43mm38mm55mmTaper twist drill For 10mm28mm45mm40mm57mmTaper twist drill For 12/14mm34mm51mm40mm57mmRound bars32mm49mm40mm57mmCounter bore drill30mm47mmCircular punch30mm47mmPerforation drill23mm40mmSURGICAL MANUAL FOR PLATON IMPLANT SYSTEM24

4) Optional drillsCircular punch (drill for demucosation)This is used to penetrate and remove the mucosa on the flat cap inorder to expose the implant interface during the second-stage surgery.To use the drill, adaptable healing abutments are 4.0 mm in diameter.6mm4mm3mm2mmTotal length: 30 mmDrill diameter: outer diameter φ 3.5, inner diameter φ 2.7Material: Stainless steel (TiN coating)Perforation drill (drill for decortication)This is a drill to decorticate and encourage bleeding by drilling thebone to promote bone regeneration. This is used in GBR surgery, etc.Chapter 6 Surgical form3mmTotal length: 23 mmDrill diameter: φ 0.9Material: Stainless steel25 SURGICAL MANUAL FOR PLATON IMPLANT SYSTEM

5) Considerations during drilling○ Prevention of bone burnsResults to bone necrosis when the bone is heated to 47-50°C ormore. Be careful to minimize heat generation during drilling and onthe right items to activate the bone around implants.• Sufficient irrigation with cold sterilized physiological saline• Adequate rotating speed (600rpm-800rpm)• Use of sharp drills (contra-angle or bar shaking is taboo)• Dribble up-and-down movements and intermittent cutting(pumping movements)• Proper cutting pressureIn the event bone gets burned, it is recommended to retry drillingonce the bone has healed. For this to happen, a layer of theimplant socket should be cut to provide a fresh surface. If quantitativelypossible, a thicker implant by one size in diameter canbe placed.○ Infection preventionWhen infected bacteria or substances attach to implants or implantsockets, foreign-body reactions to the implants are caused. Thus, it isrequired to have thorough controls to avoid infection.After preparing the implant sockets, avoid implant placementwhen saliva is flowing in.○ Drills exchange timeCutting efficiency of the drills is one of many important factors toachieve osseointegration. It is recommended to replace them with newdrills once they have been used about ten times.○ Securement of bloodThe presence of blood on implant sockets is essential to achieveosseointegration.Bleeding due to the preparation of the implant sockets allows forbone regeneration (wound healing) through blood clotting. Dependingon the quality of the bone, some cases present little bleeding. Insuch cases, bleeding should be encouraged by drilling (decortication)through the inner wall of holes to reach the bone marrow using thinbars.○ Invasion into mandibular canal or maxillary sinusDrilling into the mandibular canal or the maxillary sinus shouldcarefully be made with CT images, if possible, while fully checking thedepth and direction to be prepared.○ Primary stability between bone quality and implantThe bone-implant relationship must be closely kept to achievegood osseointegration. To ensure primary contacts along the interfacebetween the implant and the bone, procedures for the preparation ofimplant sockets must be altered. In the PLATON drilling system, theimplant sockets are prepared 0.3mm to 0.5mm smaller than an actualimplant diameter at the final preparation step. For bone quality of D1or D2, the final floor is prepared with tapping instruments and theimplants are directly placed with implant self-tapping function forD3 or D4. Assessments of bone quality should be determined by earlydrilling.Where drilling has been performed frequently in dense bonecases, it is recommended to exchange the drills more often.Cutting performance of the drills depends largely on bonequality and drilling techniques. The use of worn dills causes adecrease in the cutting efficiency or bone burns.In cases of porous bone quality, bone condensing may be conductedonce the preparation has been conducted with smallerimplant drills, by one size in diameter, than the final drills.Where the implant socket has extended during the preparation,the hole could be corrected by using tapping instruments withoutthe need for follow-on drills.In cases of dense bone, perform the alteration of the intermediatedrill step, or use special tapping instruments. Or, preparethe final hole incrementally with larger implant drills by onesize in diameter (see below “Cases of dense bone”).Chapter 6 Surgical formSURGICAL MANUAL FOR PLATON IMPLANT SYSTEM26

6) Cases of dense boneWhere the bone at the implant site is closely taken up by compactbone, or is covered by 2mm-3mm of compact cortical bone, be sureto prepare the cortical bone layer using special tapping instruments.The need for tap preparation should be determined while evaluatingthe bone quality during drilling, or the implant placement in preparationof the implant socket. Also, where the need for tap preparationwas determined, and the implant placement is stopped once the tappreparation is done, we are asking you to place another new implant.Conduct the tap preparation while controlling bone burns throughsufficient irrigation, and preventing burr formations and clogging withcutting chips due to low speed rotation. Use special tapping instrumentscorresponding to implant sizes.Tapping instrumentsThese are instruments for tap preparation. Because the lengthof the tap part is set longer than that of the self tap provided to theimplants, tap preparation can be performed smoothly, and the implantplacement can be made with a minimum of resistance to implantinsertion. There are two types, for 8-10mm and 12-14mm by theintraosseous length of different sizes ( φ 3.3, φ 3.8, and φ 4.7).Chapter 6 Surgical formø 3.3 ø 3.8 ø 4.7Total length: 25.5mm1.2mmMaterial: Stainless steel (TiN coating)The placement should be made to match the grooves formed bytaps with implant threads.For dense bone, because the accumulation of bone cutting chipsin the implant socket may cause an increase in the placing resistance,place the implant following thorough cleaning of theimplant socket after tap preparation.Where implants are completely placed, prepare the bone up tothe top of the instruments. Also, where placement of the polishedsurface is controlled, prepare the bone based on a lasermark.27 SURGICAL MANUAL FOR PLATON IMPLANT SYSTEM

Procedure for Implants in bone quality of D1 and D2 (dense bone)Final hole preparation usingimplant drillsFinal hole preparation usingtaper twist drillsTap preparation into thecompact cortical bone siteImplant placementWith bone determined as harder during placementImplant placementTap preparation into thecompact cortical bone siteOpeningReplacementWhere the need for tap preparation was determined, place anothernew implant once the implant placement is stopped andthe tap preparation is done.Chapter 6 Surgical formSURGICAL MANUAL FOR PLATON IMPLANT SYSTEM28

7) Cases of narrow bone width (knife-edge)Sufficient supporting bone is required around the implants tomaintain them lengthwise. However, in some cases, there may not besufficient supporting bone due to a narrow buccolingual bone width.In such cases, there is a method that mechanically compresses andextends the existing bone in order to obtain enough bone to supportthe implants. In this method, bone spreaders are effective instrumentsto efficiently compress and extend the bone.Bone spreadersBone spreaders have conical drill forms with threads. Nine types ofline-ups from φ 2.4 to φ 6.0 allow manual compression, extension,and preparation of the hole, in steps (Fig. 6-10-1 to 6-10-3). Wherethe maxillary bone quality is porous, the use of gradually thick bonespreaders allows refinement of the porous bone around the implant, sothat primary stability is enhanced.14mm12mm10mmMaterial: Titanium8mmEach size (Total length: 33mm)Chapter 6 Surgical form29 SURGICAL MANUAL FOR PLATON IMPLANT SYSTEM

Bone spreading with bone spreadersFigure 6-10-1A guide hole is prepared to insert bonespreaders.Figure 6-10-2The hole is compressed and extendedusing bone spreaders in increasing sizeorder. The compression and extensionare carefully conducted to avoid puttingexcessive pressure on the bone.Chapter 6 Surgical formFigure 6-10-3An implant is carefully placed so thatthe compressed and extended bone(supporting bone) does not fracture ordehisce.SURGICAL MANUAL FOR PLATON IMPLANT SYSTEM30

8) Cases where the distance between the alveolar bonecrest and the maxillary sinus floor is contigutyThere are some cases of the vertical bone deficiency when implantsare placed into the maxillary posterior region because the distancebetween the alveolar bone crest and the maxillary sinus floor is contiguty.Many adverse conditions against the implants, which relate tobone mass and quality, are involved in the posterior region, particularlyadvanced bone resorption. When implants are applied under suchconditions, the sinus elevation that elevates the sinus mucosa must bedone to obtain bone mass, allowing for implant placement with boneaugmentation in its lifted space. Sinus elevation techniques includethe lateral wall approach, which allows access to the maxillary sinusby opening the maxillary lateral wall, and the socket graft procedure,which allows access from the alveolar ridge (implant socket floor) tothe maxillary sinus. It is considered that the former is a technique usedfor a residual vertical bone height of less than 5mm. In contrast, thesocket graft procedure is used in cases where the residual vertical boneheight is superior to 5mm, and primary stability can be sufficientlyachieved.Since superior diagnostic ability and skills are required in eithertechnique, it is recommended to attend exclusive seminars in the clinicalapplications. In the present manual, the socket graft procedure,with relatively less invasion, is outlined.Chapter 6 Surgical formSocket liftersThese are instruments used in the sinus elevation procedure inconjunction with the socket graft. Where tapping is used to elevatethe maxillary sinus, the structure is such that the bone fragments aresqueezed into the maxillary sinus floor while the concave forms at theend drill the bone.15mm12mm10mm5mmEach size (Total length: 28mm)Material: Stainless steel31 SURGICAL MANUAL FOR PLATON IMPLANT SYSTEM

Socket graft procedure using socket liftersDrilling is conducted to leave 1-1.5mm of bone at the maxillarysinus floor. At this time, the diameter of a hole prepared through drillingis matched with the diameter of the socket lifter to be used (Fig.6-11-1 and 6-11-2).An artificial bone replacement material is inserted into the preparedhole, followed by carefully tapping with a mallet while rotatingthe socket lifter so that forces are applied evenly (Fig. 6-11-3 and6-11-4).Once the lifting of the maxillary sinus floor, up to the estimateddepth, has been checked using a depth gauge (Fig. 6-11-5), an implantis placed (Fig. 6-11-6 to 6-11-8).Fig. 6-11-1Fig. 6-11-2Following the preparation with the guide drill,take an x-ray and verify the distance up to themaxillary sinus floor using a guide pin.Tap carefully to prevent damage to the Schneider membranewhen the end comes close to the estimated depth.Fig. 6-11-3 Fig. 6-11-4Chapter 6 Surgical formFig. 6-11-5 Fig. 6-11-6 Fig. 6-11-7If the hole is not deep enough, conduct tapping again. If the depth gaugecan be inserted without any resistance, verify that the Schneider membranehas not been perforated by taking an x-ray and checking for the presenceor absence of perforation. If perforation is observed, stop the surgery, andwait for the site to heal. To aid the healing process, supply the patient witha collagen product, etc. In general, the healing period is about 1-2 months.Fig. 6-11-8Be sure to take CT preoperatively, and conduct the procedureafter a thorough diagnosis.SURGICAL MANUAL FOR PLATON IMPLANT SYSTEM32

2. Implant placementThe implants are sterilized and come as a double package. Thereare packages with a holder.1) Preparation of placementThe basic system tools for implant placement are round drivers, thetorque ratchet, the spanner and hex-drivers for cap insertion. In addition,extension tools are included. These are effective in cases of interferenceof the adjacent teeth during placement operations according tocertain cases, or when an adjustment of the implant holder height isnecessary due to problems with the vertical dimension (clearance).When preparing for hard bone at the site where the implant is tobe placed, tapping instruments should also be prepared.In preparation for emergence circumstances, it is recommendedto anticipate several implant sizes.Round driversThese are hand drivers used when each holder is inserted, and theyare utilized as carriers into the mouth, or when tightening by hand isnecessary. Two types of sizes, by diameter, are provided correspondingto the insufficient space between the implant and adjacent tooth.Chapter 6 Surgical form(Diameter: 17mm)(Diameter: 10mm)Torque RatchetThis is a wrench with a ratchet mechanism and is used when eachholder is inserted. Also, this wrench is used to control a torque duringthe abutment insertion.Material: Stainless steelLength : 111mmMaterial : Stainless steel33 SURGICAL MANUAL FOR PLATON IMPLANT SYSTEM

SpannerThis is a concave tool used to lock the implant holder insertedon an implant, or to remove the implant holder after completion ofthe implant placement. The opposite side is used to hold the implantholder above the ratchet during implant placement.(Total length: 90mm)Material: Stainless steelHex driversThese are drivers commonly used in the general insertion/removalof the system parts, including caps, healing abutments, set screws, andabutments. Select one of three types according to the range of mouthopening or the vertical dimension (clearance).SSSLSS (Total length: 19mm)S (Total length: 21mm)L (Total length: 30mm)Material: Titanium alloyChapter 6 Surgical formSURGICAL MANUAL FOR PLATON IMPLANT SYSTEM34

ExtensionsWhen tools cannot be inserted due to the narrow space betweenthe implant and the adjacent tooth, these are used to extend the verticaldimension of the implant holders or head holders.SLS (Total length: 15mm)L (Total length: 22mm)Material: Stainless steelHolder keyThis is a tool to keep the implant holder in place if the ratchet, dueto insufficient space between the implant and the adjacent tooth, cannothold it once the implant holder lock is released.Chapter 6 Surgical form(Total length: 73mm)Material: Stainless steelThe holder key is the tool to use to release the implant holder.Do not use it during implant placement, etc. because it can distortor twist the holding part.35 SURGICAL MANUAL FOR PLATON IMPLANT SYSTEM

Gingival gaugeThis is a gauge used to measure the mucosal thickness when selectingcaps, healing abutments, and various abutments. It is comprised ofa measuring needle and a probe. The gauge end is placed vertically atthe site to be measured to make the measuring needle puncture. Thisgauge may also be used for bone mapping.(Total length: 30mm)7mm5mm3mm6mm4mm2mmMaterial: Stainless steelChapter 6 Surgical formSURGICAL MANUAL FOR PLATON IMPLANT SYSTEM36

2) PlacementFollowing the completion of all processes through drilling, besure to clean the implant sockets with sufficient physiological salineand suck it out using a suction catheter. Implants are placed once theimplant sockets are filled with blood. For harder bone, special tappinginstruments should be used before implant placement.Placement procedures of Implantsj A double wrapped implant is taken out after the implant type and size described on the caselabel are verified.Chapter 6 Surgical formk The sterilized bezel pack is opened to take out an ampule case in a clean area.By all means, avoid using resterilized implants. Should an implantcome in contact with unclean areas, dispose it and place anew implant.l Place the implant in the mouth while holding the ampule cap afteropening the ampule case.37 SURGICAL MANUAL FOR PLATON IMPLANT SYSTEM

Once the implant is placed in the mouth, attention is paid to avoid the implantfrom coming in contact with unclean areas (including the ampule case and intraoralmucosa).m The tip of the implant is inserted into the implant socket, and it isslightly screwed in clockwise. At this moment, the ampule cap is removedand placed with the round driver or a ratchet after the implant is retainedand stabilized.The ampule caps are plastic. Care must be taken when the implantplacement with the ampule cap is carried out in harderbone or when there is increasing placement resistance becausethe cap may break.Spannern The implant is screwed-in (clockwise) by hand while holding the round driver. If resistance builds up,the round driver is removed and a ratchet is used. Keeping the arrow side ( ★ side) of the ratchet up, theratchet is inserted in the square part of the implant holder and the implant is screwed in the arrow direction.To avoid shaking during placement, the implant should be slowly rotated until the blasted surface iscompletely inserted in the bone while holding the hex part (the head of the inner screw) using the circularpart of a spanner.RatchetChapter 6 Surgical formWhen tapping instruments are used during implant placement,attention should be paid to avoid the implant from coming incontact with unclean areas during placement.SURGICAL MANUAL FOR PLATON IMPLANT SYSTEM38

When the round driver interferes in the adjacent tooth, use theround driver mini or the extensions (see “Preparation for placement,”described previously for details).Round driver miniExtensionsWhen interference problems occur even if the above method isused, use the implant holder (L).Chapter 6 Surgical formo After the completion of placement, the hex part (the head of the innerscrew) on the tip of the implant holder is rotated counterclockwise, usinga spanner to release the lock and remove the holder once following the primarystability of the implant is verified.SpannerRatchet×When the round driver interferes in the adjacent tooth, use the round driver minior the extensions (see “Preparation for placement,” described previously for details).When releasing the lock using a spanner, reversing the directionof rotation may break the inner implant because the inner screwof the implant holder is twisted. Therefore, release the lock carefully.39 SURGICAL MANUAL FOR PLATON IMPLANT SYSTEM

When the ratchet interferes with the adjacent tooth, release the lock using aholder key. However, since the placement with the holder key causes distortionor twists, never use it (see “Preparation for placement” described previously, fordetails).Release with a ratchetRelease with a holder keyHolder keySpannerp After the inside of the implant has been thoroughly cleaned withphysiological saline and air-dried, a flat cap is inserted using a hex driver.plant location in the gingival margin orsupragingivallyFlat capFlat capThis is a cap for sealing common usable to all types of implants.If the position of the implant to be placed is predicted to belocated subgingival level, a measurement should be made preoperativelyusing a gingival gauge.Chapter 6 Surgical formø 3.4Material: TitaniumSURGICAL MANUAL FOR PLATON IMPLANT SYSTEM40

Chapter 7 Suture of mucoperiosteal flapsand postoperative careSuture of mucoperiosteal flaps and postoperative careAt first, the operative field is cleaned with the sterilized physiologicalsaline. Once the mucoperiosteal flaps have been repositioned,the adaptation of the flaps can be verified. If the flaps are not closed,release incisions are made to adjust the periosteal extension. Therelaxation incision is a process of making an incision in the basal area(the farthest distance from the suturing region) of the ablated periosteum.This increases the freedom of mucosal operations. However,pay attention to incision placement and range, due to the possibilityof constricting blood flow around the implant osseointegration or themucosal healing. In addition, the mucosa of the region in contact withthe polished surface region may be cut into a crescent-shaped line.Therefore, resect the site considering buccal, lingual, or buccolinguallyresection, based on the flexibility of the mucosa. Even if a skilled sutureprocedure is used, the suture must be made so that they do not dehiscebecause the keratinized mucosa has no flexibility. With selecting thesubmerged protocol, the mucosal flaps are completely sutured and theimplant is placed under the mucosa.Chapter 7Buccal view during suturing.Remain tension-free in your mind to avoid causing hematogenousinhibition.Occlusal view on the completed of suture.The knots should be placed on the buccal side, not just above thewound.Points for suture and ligation• The suture threads should not be tightened excessively toavoid causing hematogenous inhibition (tension-free).• To avoid causing a hematogenous disorder, the sutures shouldnot be sewn too close and should be made minimally.• The knots should not be placed just above the wound, butshould be put to either the right or left side (buccal side).• Monofilament threads, such as nylon, come loose easily so theligation should be made as a triple-knot (surgical knot).41 SURGICAL MANUAL FOR PLATON IMPLANT SYSTEM

1) Postoperative care and guidancePostoperative immediately, the intraoral cleaning is conductedwith physiological saline or gargles and the patient is asked to lightlybite down on a roll gauze for astriction of the wound (approximatelyone hour). If necessary, an antibiotic or an anti-inflammatory analgesicis given to the patient. As postoperative medications are determined,preliminary medication and dosing taken prior to the surgery shouldbe taken into consideration. Postoperative cautions must be fullyexplained to the patient. It is desirable to have a brochure preparedthat is given to the patient in which dosing, gargle or bath, drinking,smoking, meals, and use of the denture, etc. are described.Postoperative cautions should be clearly explained using apatient-friendly brochure.2) Existing prosthesesIt is important to avoid functional loading during the healing periodto achieve excellent osseointegration. With prostheses having a widetissue borne area, such as full dentures or distal extension dentures,avoid the use for two weeks after the operation.With adjustment of dentures, the mucosal surface on the implantplacedsite is adjusted. Once the adjustments are completed, the mucosalsurface of the denture is provided with cushioning by using a liner.The retained parts within resin of retainers, such as clasps, must notcome in contact with the placed implant. You might have to re-fabricatethe retainers. For intermediary defects with healthy adjacent teeth,conduct a temporary bridge restoration by using an adhesive resin onthe surfaces of the adjacent teeth. The cervical regions should be cutmore than usual in consideration of postoperative swelling.The brochure should be given to the patient after the implantsurgery along with postoperative medications.Suture of mucoperiosteal flaps and postoperative careChapter 7SURGICAL MANUAL FOR PLATON IMPLANT SYSTEM42

Chapter 8 Control and managementsduring the healing periodAn adequate unloading period and a thorough avoidance of thefunctional loadings are absolute requirements for the implants placedinto the bone to achieve osseointegration. For about 2 weeks after thesurgery, as mentioned previously, the use of the denture that has beenused, should be minimized to prevent applying loads. The unloadingperiod of Platon implants is three months for the mandible andsix months for the maxilla. However, a longer healing period maybe required based on the health of the individual bone. Because theprolonged healing period allows for achieving secured osseointegration,the inferior bone quality can be overcome. In addition, infectionprevention should be carefully considered. The removal of the sutureis commonly done seven to eight days after the surgery. However, theremoval of the suture should be done carefully so that the contaminatedsuture thread does not pass through the tissue during removal.Estimated unloading periodMaxilla: 6 monthsMandible: 3 monthsManagements during the healing period• Avoidance of functional loadings on the site where an implantwas placed ・・・ frequent adjustments of the temporary restorationand guidance• Infection prevention ・・・ regular examination and cleaning,disinfection, plaque control, and hygienic guidance• Maintenance of occlusal relationship ・・・ adjustments ofthe temporary restoration (prevention of extrusion or displacement).Control and managements during the healing period1) Submerged protocolThe submerged protocol also has the same basic technical cautionsas the nonsubmerged protocol. However, when the implant head completelylocated in the submucosa exposes from the mucosa, cleaningand disinfection should be repeated in order to keep thorough sanitaryconditions as it is rather than trying to re-suture too hard.Nonsubmerged protocolSubmerged protocolChapter 82) Verification of osseointegrationOsseointegration should be achieved within a specified period asmentioned previously. However, it is difficult to accurately determineosseointegration. The assessments of the achievement and healingperiod of osseointegration are made on the basis of the following factors:patient’s age, general conditions, and bone quality as factors onthe host side, cutting resistance against drilling during the placementsurgery, the extent of primary stabilization of the implant, and percussionsound as operator’s experiment factors, and objective assessmentcriteria, such as Periotest® and Osstell®.43 SURGICAL MANUAL FOR PLATON IMPLANT SYSTEM

The status after completion of the second-stage surgeryVerification of osseointegration• Inspection/Palpation• Periotest®, Osstell® (picture)• Percussion soundMobile diagnosis with Periotest®Control and managements during the healing periodChapter 8Mobile diagnosis with Osstell®SURGICAL MANUAL FOR PLATON IMPLANT SYSTEM44

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