Surgical Protocol

FOR TIDAL SPIRAL IMPLANT SYSTEMS TSI
The is a conical internal hex implant with a unique combination of design features that enable easy insertion and very high initial stability. The unique shape of the implant body and its variable thread design equip it with some exceptional abilities. It is self drilling, self tapping and self condensing, yielding outstanding advantages in all bone types and compromised situations.

The implant offers better control during insertion and high initial stabilization in all bone types with as little as 2-3mm of bone. Small diameter drilling results in minimal bone loss and reduced trauma. Location and orientation of implant can be altered even after insertion without trauma to the surrounding tissues. Its advantages are particularly obvious and unmatched in situations where there is minimal amount of bone and low bone density, compromised

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par al edentulism. total edentulism. The new head design promotes soft tissue health without loosing its height. Its narrow head allows for an increased volume of crestal bone round the implant neck. delayed and immediate loading. The TSI implant shares all the unique features of the spiral and in addition incorporates a different head design.  Single missing tooth.  One stage and two stage surgical procedures.achieving high stabilization in freshly extracted sites and thin sinus floors without prior bone augmentation. bone types and surgical protocols. anterior and posterior regions. Indications: The spiral implant is indicated for all situations. one stage and two stage procedures. That accounts for some additional benefits: The new implant allows closer placement of adjacent implants without compromising health of tissue and aesthetic outcome.  Upper and lower jaws. The spiral implant is therefore the champion of immediate placement and immediate loading. There is no resorbtion of surrounding bone. even after loading. This desirable consequence of the head design is demonstrated in all procedures: delayed implantations. immediate implantations. There is sufficient support for the tissues so that the original height of papillae can be maintained even between adjacent implants.  Immediate implanta on and immediate loading. 2 .

New Generation Dental Implant System Internal hex connection for superior aesthetics and to facilitate positioning and securing of the implant 0.3 mm machined collar to prevent gingival retraction and promote ideal oral hygiene maintenance Parallel micro grooves on the neck of the Implant to facilitate osseo.integration and to prevent bone resorbtion Parallel micro-threads at the neck of the Implant to reduce stress in the crestal bone Special tapered spiral design for : high primary stability  high secondary stability minimum lateral stress  self tapping and correct seating Asymmetric spiral grooves for stress distribution and bone condensation promoting the increase in Secondary Stability 2 vertical cutting slots at the apical third designed to improve self tapping action and the development of increased ‘ anchorage’ of the Implant Flat apex designed for sinus lift techniques 3 .

Surgical Protocol: Examination and treatment planning: Carry out examination and treatment planning in the usual manner. dense compact bone provides good initial stabilization for the installed implant while cancellous bone provides much reduced retention and therefore more of it is necessary for a high enough initial stabilization. Regular implants require sufficient quantity (a few millimeters) of good quality bone for minimal retention to achieve immediate stabilization in order to yield a successful result. The implant can be stabilized in very little bone and bone augmentation can be carried out in the same session. Bear in mind that in the majority of cases the implant's special abilities reduce the need for an additional surgical procedure of bone augmentation prior to the implant placement session even in compromised situations. In all situations where the initial stabilization is questionable it is necessary to augment the bone volume prior to implant insertion. This calls for an additional surgical procedure and a much prolonged process. Bone Quantity: Amount of bone available for implant retention differs from site to site. Bone Quality: Traditionally. The unique design features of the spiral implant 4 .

The thin layer of available bone can be at the implant's apex as in a freshly extracted tooth socked or at the implant neck as in a sinus lift situation. 5 .allow it to be anchored and stabilized in as little as 2mm of non cortical bone anywhere along the implant's length. Depth of drilled site: The self drilling capability of the implant allows it to be inserted into sites that have been prepared to a reduced depth. It could also be utilized in softer bone when maximum condensation is desirable. The implant is active at its apical part. enabling an angle change during insertion. Diameter of drilled site: The special features of the implant allow insertion into a small diameter site. This ability facilitates engaging in parallel to bone walls thus allowing anchorage in freshly extracted socked walls. This ability becomes very useful in situations of close proximity to vital anatomical structures such as the mandibular nerve canal or the maxillary sinus and nose cavity.

Drills should be replaced when their cutting efficiency is reduced. Drills are groove marked for lengths as shown below. 4. You can use a guide drill of your choice like a round bur or a sharp pointed guide drill. preserves precious bone tissue and allows the special incremental bone condensation feature of the implant to take effect resulting in enhanced initial stability. All preparation of bone tissue must be carried out under ample irrigation with saline solution and using an intermittent drilling technique.500 rpm and should be performed under ample irrigation.Preparation of the implant site: 1. Guide drills are not included in the kit. Drill selection All drills are color and groove coded for easy identification during surgery. 3. Perform incisions to expose the surgical field. Spiral Special Feature: Drilling a narrower hole saves time. 6 . Elevate the mucoperiosteal flaps. Mark the bone with a guide drill. Mark drilling speed should not exceed 1. Reshape alveolar ridge if necessary. 2.. Drilling Implant site is prepared in a sequential procedure using drills of increasing diameter with depth indication lines that give a reading of the desired drilling depth.

Actual osteotomy length is roughly 1mm longer. The instructed drilling steps are suggested for dense/cortical bone.8mm drills are often enough for all implant sizes (see protocol below). Drilling sequence The drilling protocol is adapted to the implant diameter and bone quality at the site. In soft bone. In softer bone fewer steps may be performed. It is important to bring into consideration the additional length in situations of close proximity to anatomical structures such as the mandibular nerve canal or sinus floor. 7 . The length does not include the triangular shaped cutting edge. Optional surgical drills with flat heads are also available for such situations.Nominal length marks are measured from the beginning of the parallel walls. 2mm or 2.

The resulting retention and stability are much higher without using bone condensing accessories such as osteotomes. thus allowing preservation of precious bone tissue and allowing the special incremental bone condensation feature of the implant to take effect. The vial's end is labeled with the implant type and diameter and color coded for implant length. A sticky label displays all pertinent information regarding the implant. Preparing the implant: All implants are delivered in sterile double packaging. It should be noted however that in case of high resistance to insertion (50 Ncm) as in a site with a substantial cortical bone layer additional steps may be necessary though usually not to the full length. skip last two drilling steps. When the bone is very soft. If you feel strong resistance at any point during insertion. For bone types 3. (New "Cortical Drills" will be available). rotate the implant counterclockwise 2-3 rounds then continue to insert the implant.Drilling Sequence Protocol for Bone Types I and II: In very hard cortical bone it may be necessary to drill with the next size drill just for the thickness of the cortical layer. Two labels are supplied in the 8 . Due to its special design it is possible to insert the implant into a prepared site of a much lower diameter than usual. The transparent outer blister houses a vial that includes the pre-mounted implant and a cover screw (if applicable). you can skip last drilling step.

surgical screwdriver and extension parts.5mm insertion tool. The hex connectors allow the use of ratchets. There is no need for a screw driver to disconnect the implant from its mount. The 2.35mm) and internal (2. It is attached to the implant by friction on one end and has external (6. When ready to place the implant. Avoid contact between implant and other oral tissues or saliva. Install at low speed (20rpm) with ample irrigation. As soon as you encounter resistance start using the wrench or the surgical screwdriver. Inserting the implant: Start inserting the implant into the prepared site manually.5mm) hex mounts on the other end. pull the pre-mounted implant out of the vial and place it directly into the prepared site. If proximity to teeth does not allow insertion of the implant with the pre mounted carrier. This delivery system simplifies the implantation process.5mm insertion tools can then be inserted directly into the implant to continue insertion. Open the blister package and place the vial on the sterile working area. 9 . Set the maximum torque to 45Ncm.5mm motor mount for contra angle tool for motorized insertion. It is released by simply pulling it out at any stage during the insertion process.package. you can pull it straight out (it is held with friction) at anytime during insertion and replace it with a 2. Alternatively you can use the 2. Implant Mount Implant mount supplied with all TSI implants. These tools come in three lengths for use with a square 4mm wrench.

If you feel strong resistance at any point during insertion. Installation of cover screw In case of a two-stage surgery. Special surgical protocols Self drilling The self drilling capability of the implant allows it to be inserted into sites that have been prepared to a reduced depth. One-stage surgery: When stabilization is adequate and a one stage protocol is desired a transmucosal healing abutment should be placed.Caution Excessive force while inserting the implant with the wrench or screwdriver must be avoided. Or retrieve the implant and drill a wider hole. 10 . It could also be utilized in softer bone when maximum condensation is desirable. remove the cover screw from its plastic holder (found at the bottom of the vial) using the hexagonal screw driver or the contra angle mount hex driver. Insert the cover screw into the implant and tighten it lightly. It could cause undue compression of the bone and result in necrosis and impaired result. This ability becomes very useful in situations of close proximity to vital anatomical structures such as the mandibular nerve canal or the maxillary sinus and nose cavity. rotate the implant counterclockwise 2-3 rounds then continue to insert the implant.

allowing bone fill and other 11 . Immediate implantation The unique design features of the spiral implant allow it to be anchored and stabilized in as little as 2mm at the bottom of freshly extracted sockets particular lead angle of the deep and sharp threads and their osteotom-like condensing action enables non traumatic insertion and excellent retention that is sufficient for stabilization of the implant. insert implant to drilled depth and continue to insert. Closed and Open Sinus Floor Elevation The unique design of the implant allows insertion into a small drill hole and gradual condensation in all dimensions throughout the entire length of the implant.Drill to 6-8mm. Do not rely on self drilling and self tapping abilities of the implant in situations where bone structure and density require too high a force for insertion (higher than 50 Ncm). Bone augmentation can be immediately followed as indicated – all in the same session. This feature results in good stabilization in as little as 2-3mm of bone even at the neck of the implant. The implant will drill its way into its final depth. Spiral Special Feature – Self Drilling Due to its unique design features the implant can be inserted into a narrow drill hole some times not even to the full length of the final placement.

whereas maintaining bone height and soft tissue architecture requires at least 1. Sometimes more than one session of bone augmentation is required for sustained results.augmentation procedures to be done at the time of implantation. Regular implants tend to slide into low resistance areas at the bottom of the socket and in order to achieve the desired results bone augmentation must be performed prior to implant placement. The buccal bone plate is usually very thin and oftentimes missing altogether. No prior bone augmentation is necessary thus reduced. The thin layer of available bone can be at the implant's apex as in a freshly extracted tooth socked or at the implant's neck as in a sinus lift situation. Spiral Special Feature The unique design features of the spiral implant allow it to be anchored and stabilized in as little as 2mm of non cortical bone anywhere along the implant's length. There is no need for a separate procedure of bone augmentation and a long wait prior to the implant placement procedure. Immediate Implantation – Aesthetic Zone Achieving aesthetic results in the anterior maxilla is very difficult andconsidered highly unpredictable. The TSIl implant changes all that. It allows you to anchor the implant into the palatal wall with excellent stability leaving ample space for bone augmentation on 12 .5mm of bone thickness buccal to the implant. number of surgical steps and overall treatment time is reduced.

Thus tooth extraction. 5. Spiral Special Feature . 4. Use the Surgical Driver to insert the implant at the same (almost horizontal) angle. 3.the buccal aspect. The implant's cutting and condensing abilities make this maneuver possible with total control. The palatal wall is penetrated with a small diameter drill perpendicular to its plane. 2. Perform Bone fill and other augmentation procedures as required. Tooth is extracted and the fresh socked is prepared in the regular manner. implant placement. bone augmentation and even immediate loading can all be done in one session with excellent and sustained aesthetic outcome. The resulting thick buccal bone assures bone height after remodeling. Place healing abutments for regular one stage protocol with delayed loading or prosthetic abutments for immediate loading. When the implant tip is secured (2-3 turns) continue insertion while constantly changing direction toward the desired orientation. 6. 13 .Controlled guidance of insertion Due to its unique design features the direction of the spiral implant can be controlled and altered during insertion. This feature allows controlled insertion without slipping into low density regions. Technique 1.

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