Study Club Name Nobel Replace Straight Drill Protocol

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

Agenda Nobel. Replace 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

Nobel. Replace Straight Surgery Kit Introduction

Nobel. Replace Straight Surgery Kit – Drilling Protocol is provided on the drill kit

Nobel. Replace Straight Surgery Kit Introduction

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

Agenda Nobel. Replace 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

General irrigation issues • External vs. internal, using both • Sterile saline solution • Precautions with drill extender • Demonstration of irrigation tubing

Nobel. Replace Straight RP Drill Protocol Drill and Tap Depth Markings 15 mm 13 mm 10 mm 7 mm 1 mm Nobel. Replace Straight Ø 4. 3 x 13 mm

Nobel. Replace Straight RP Drill Protocol, Medium Bone 1 Ø 2 2 4 Ø 2. 4/2. 8 Ø 3. 2 Drill numbers refer to the drill numbers as listed on the actual Surgical Kit If indicated 1 mm

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

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

Nobel. Replace Straight RP 4. 3 x 13 mm, Medium Density Bone Drill to the desired depth Check orientation Twist Drill with Tip 2 mm Direction Indicator 2000 RPM

Nobel. Replace Straight RP 4. 3 x 13 mm, Medium Density Bone Enlarge osteotomy & check orientation Enlarge the site Check orientation Twist Step Drill 2. 4/2. 8 mm Direction Indicator optional 2000 RPM

Nobel. Replace Straight RP 4. 3 x 13 mm, Medium Density Bone Enlarge osteotomy & confirm depth Enlarge the site Confirm Check osteotomy orientation depth Twist Drill 3. 2 mm Depth Probe 2000 RPM

Agenda Nobel. Replace 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

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

Nobel. Replace® Straight Implant placement Implant & Implant Driver Pick up implant Location of lobe Insert implant

Manual Torque Wrench Surgical Verify direction set for implant insertion

Nobel. Replace Straight RP 4. 3 x 13 mm, Implant Placement Torque to 45 Ncm maximum, align one lobe buccal One Lobe buccal Max 45 Ncm maximum Laser marking on implant driver illustrates the alignment of the tri-channel apexes for required buccal alignment.

Nobel. Replace Straight Manual Torque Wrench Surgical 45 Ncm For Immediate Function 35 -45 Ncm

Implant Placement Tri-Channel Connection Final implant rotational position Nobel. Replace 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 orientation 1 • Grooves on the Implant Driver indicate the position of the lobes Grooves on the 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 Implant Driver indicate the position of the lobes

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

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

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

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

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

Agenda Nobel. Replace 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

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

Nobel. Replace Straight RP 4. 3 x 13 mm, Hard Bone Protocol Dense Bone Protocol, if indicated Nobel. Replace Counterbore RP Screw Tap Straight RP 2000 RPM max 45 Ncm

Agenda Nobel. Replace 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

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

Support Tool: Cleaning and Sterilization Guidelines for Nobel Biocare Products • Review this document thoroughly • Ensure that your staff is clear and trained on these protocols • Can be downloaded from the Resources section of the Nobel Biocare website www. Nobel. Biocare. com

Agenda Nobel. Replace 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

Thank you very much for your attention!