OCO Biomedical Presents

The Next Generation of Endosseous Implants

Restoring
OCO Biomedical
Dental Implant Systems
 [RESTORATIVE PROCEDURE
AND LAB TECHNIQUE]
I-Mini, ISI Complete One-piece,
TSI & ERI Two-piece Dual Stabilization™ Implants

THE DIRECT TECHNIQUE

September 6, 2021
 The ISI Complete and TSI Immediate Load
Dental Implant System
Available: Three +
ISI Complete Restorative
• Direct restorative only because it is a one-
piece implant and abutment Systems
• Temporized and load/function after being
placed
• 1 Direct and 2 Indirect
and 3 modified indirect
• The Conventional Two-
piece Abutment System
• Shielded margin
TSI (or ERI) with solid abutment
abutment • 6-8 position indexed
• Two-piece implant with Morse taper lock
interface
• 6-8 Position indexed interface
• TSI can be restored by either the Direct or
Indirect Methods
• All Two-piece abutments have 6 or 8
position indexing

80%+ of cases can be loaded immediately and put in function after placement!
TRIP: Tissue Retraction Impression Pickup
For Direct Restorative Technique

For straight For offset

abutments abutments
 Dual Stabilization® Implant System
• TSI Abutments

TSI C&B Taper/ IOT / O-Ball Parallel Wall 15 degree Healing Cuffs
Straight (Indexed) Offset C&B

Straight Skirted
& Offset Skirted & UMA UMA Healing Scalloped Indexed & Non-
Soon, scalloped- Cuff Skirted Indexed Waxing
contoured Abutments Sleeves
Fixed CB Solid Abutments (4mm, 5.5mm, & 7mm heights)
IOT Over Denture Abutments (0mm, 2mm, 3mm, & 4mm heights)
Locator Abutments (.07mm, 2.0mm, 3.0mm, 4.0mm, 5.0mm, & 6.0mm heights)
Shielded Abutments (straight & 15degree offset) Long & Short Available
Pedestal Abutments (Straight & Offset)
ISI & TSI Implant Restoration:
Direct Method

• The ISI Implant 1 to 2

months after placing
• The ISI & TSI with solid
abutment use the same
direct method

Ready to restore
ISI & TSI Implant Restoration:
Direct Method

• Snap the TRIP (tissue

retraction impression pickup)
onto the Implant collar to
prepare it for taking the
impression
ISI & TSI with Pedestal Abutments Implant
Restoration:
Direct Method
• Make sure the TRIP displaces the
gingiva and snaps over the top of the
collar of the implant
 TRIP Impression

• Inject medium bodied impression material into the top of the

TRIP until it flows from vents
Cover the TRIP

• Cover the impression

pickup (TRIP) by
flooding the area
around it with
medium body
impression
material
Complete the Impression

• With heavy body or putty, complete the

impression using a standard or triple-tray
Remove the Tray

• When set, remove tray

• The TRIP is picked up into the
impression
Modified vs. Non-Modified Abutments

• Use the solid analog when

the abutment is not
modified

• Use the Margin Analog

(MA) when the abutment
is modified
Lab Models

• The lab model with the

solid brass analog is
used when the
abutment is not
modified

• The Margin Analog (MA) is

used when the abutment is
modified vertically or for
the TSI with an offset
abutment
Lab Models

• Fill MA with hard

implant stone, epoxy
die material,
composite, etc.
• Pour the rest of the
impression with die
stone
Margin Analog Example
Tissue Retraction Impression
Pickup Snapped over the
abutment
Take an impression
Indexing will be captured in the
impression
Using the margin analog tool,
gently dab the margin analog
into the impression
The lab will pour in Polyurock and it
will harden to replicate the abutment
Acrylic Coping (AC)

• The Acrylic Coping

(AC) is used under
temps for perfect
marginal fit and as a
base for wax-up prior
to casting the metal
coping for the final
crown

Acrylic Coping (AC)

Acrylic Coping (AC)

• Wax-up & casting on working

and tissue model using the
AC as a base for a perfect
marginal fit

• AC to final PFM crown

Final Restoration Complete

• Final restoration completed and

cemented into place with an excellent fit
and emergence profile
• Precision fit comes from the machining
of the AC to match the margin at the
implant abutment interface

• Easier than
conventional crown
procedures and
construction
Alignment Correction

Oops – implant placed out of alignment? Or need to

accommodate anatomy or emergence profile?
• Use the 2 piece off-set abutment to align and the off-set trip for the
impression
• The TSI Two-piece implant must be used

OFF-SET
TRIP TRIP
Alignment Correction: Offset TRIP

• The top of the off-set

TRIP is perpendicular to
the implant
• Straight pressure
retracts the tissue and
easily snaps over the top
of the collar and around
the margin with
clearance for the off-set
abutment
Alignment Correction

• The mal-aligned
implant is now
aligned with other
ISI or TSI implants
with one piece
straight abutments
or adjacent natural
teeth
TRIP Impression

• Inject medium or regular bodied impression material

over and around the abutments
TRIP Impression

• Snap the straight and off-set TRIPs over the abutments

until you feel the ends stop firmly on the top of the collar
of the implants
Complete the Impression

• Flood the area around the trips with more medium

bodied impression material
• Then complete the impression using heavy bodied or
putty
 Pull the Impression

• Pull the impression

• Snap in a solid analog and a two-piece analog
Working Model
Anterior alignment : TSI, ERI Implant

• On an anterior tooth, the straight abutment may be out

of alignment with the other teeth
• Put in an offset abutment
• Take your impressions
Model

• Create the soft tissue model by putting soft tissue

material around the analog
• Fill the rest of the model with die stone
• Then the crown is made on the model
Case Example: Simple Direct Restoration of an
ISI, One-Piece and TSI with a Solid Abutment
Pre-op

Surgical removal and grafting

6 wks postop

4 mo postop
Ceka Bond (from Preat) placed on threads of
the solid, C&B abutment
Solid abutment threaded into TSI Implant
Abutment torqued to 30 N/cm
TRIPS (Tissue Retraction Impression Pickups) “snapped” over
the abutments onto the implant’s margin.
Flood Impression material through the occlusal
opening and out the vents of the TRIP
 TRIPS are pulled out into the impression
perfectly capturing the margin and indexing
of the implant/abutment
Solid Analog Modified to match the vertical
height on the abutment of the implant
Analogs engaged in the
Impression
 Models poured, trimmed, ACs placed on
analogs, crowns cast, porcelain added and
finished. Easier than a conventional crown!
Crowns cemented
Finalized case. Total lab fee $410.00 -
$50.00 implant surcharge. The
surcharge was Removed
Restoring a 15 yr old case
TSI Implant Restoration:
Example Cases
ISI & TSI Implant Restoration:
Example Cases
ISI & TSI Implant Restoration:
Example Cases
ISI & TSI Implant Restoration:
Example Cases
Upper and lower Restored
But, Did She Like It, NO!
Could Not Be Cleaned To Her Satisfaction ; so
Porcelain trimmed to make cleansable and soft
gingival prosthesis constructed
Case finalized and cleansable
ISI & TSI Implant Restoration:
Example Cases
• Chris – ready for the final restoration
• Placing the offset TRIP to make sure it fits and snaps into
place
ISI & TSI Implant Restoration:
Example Cases

• Cover the abutment with medium body impression material

ISI & TSI Implant Restoration:
Example Cases

• Then flood the area with the impression material

ISI & TSI Implant Restoration:
Example Cases
• A triple tray filled with heavy body or impression putty
and the impression taken
ISI & TSI Implant Restoration:
Example Cases
• Bottom of the TRIP penetrating out of the impression
• Shows the depth of the top of the lingual side of the
implant
Information: Margin Analog (MA)

• The Margin Analog (MA) used

for offset abutments and
modified straight abutments
using the direct technique
• Engage the non-beveled end
• Tool used to snap the MA into
the TRIP
Placing the MA

• With the tool, snap the MA into the TRIP and fill it with
acrylic, composite material or any flowable crown build-
up material
The Finished PMF Crown
Upper First Molar
Upper First Molar
Upper First Molar - Seated
Splinting Natural and Implant Supported Crowns
Use an Interlock , Small , Round, With No Stops.
Allows Vertical Movement on Natural Tooth
Prepped Natural Tooth and Implants
Cemented Natural tooth and Implant Crowns
Completed Case
ISI & TSI Restorative Components For
The Direct Technique
• Simple restorative procedures requiring minimal
tools and components
Tissue Retraction Margin Analogs (MAs) One- and Two-Piece
Impression Pickup (TRIP) Analogs

MA Placement Tool
For straight For offset
abutments abutments
Acrylic Coping (AC)
 RESTORATIVE PROCEDURE
AND LAB TECHNIQUE
[The Indirect Technique – TSI &ERI]
TSI/ERI Two-piece Dual Stabilization™ Implants and the
assortment of accessory
Abutments that are modified, fitted, and made ready along with
the restoration by the dental laboratory, to be delivered
Natural Contour Esthetic Abutment
Restoring Central Incisor with a
3mm Healing Cuff
3mm Healing Cuff Removed
Placing the Impression Coping
The IC is engaged by threading in the ball impression
screw by hand or with a .050 hex driver
With the tip removed, Inject Medium Body Impression
Material Around the IC and Ball
Complete the Impression with Heavy
Body Material in a Triple or Standard Tray
Snap on the TSI Analog

If the I-TRIP is
not removed with
the impression,
snap it into the
TSI Analog, and
then place both
pieces into the
boldly indexed
impression area.
Snap Into The Impression
Pour and Articulate a Soft Tissue
Model
Place a 2, 3, 4 or 5 mm Soft Tissue Healing Cuff to Maintain
the Emergence Profile
The Dental Lab Shapes, Sizes and
Parallels the Selected Abutment(s)
With the Abutments Shaped, the Restoration(s) is Completed on the Soft Tissue
Model
With the Healing Cuff Removed, the Indexed Abutment(s)
are Positioned with the Locking Screw – 20 n/cm
The Final Restoration(s) is Cemented
to Place and the Case is Finalized
Conventional Construction of a Zirconium Core
Crown total cost: $189.00
Open Tray Impression Technique
for the ERI or TSI Dental Implants

Using an impression coping and TSI/ERI Analogs

Two ERI Implant Placed (Central Incisors)
Engage the Natural Contour Esthetic Abutments and Ball
Impression Screws
Glob around abutments and screws with medium body
impression material
Fill the tray with hard body impression material
and take an impression
Remove the ball impression screws and abutments and
thread them into corresponding TSI/ERI analogs
Snap the abutments and analogs into the
impression as indexed
Place healing screws in ERI or use two more abutments and make Temps
Final Crowns
Tissue needed to be trimmed away
Abutments are torqued to 25 N/cm
[Custom Abutment Procedure]
ERI (or TSI) Dental Implant placed further than 15
degrees out of parallel
1mm healing collar is engaged for a period of healing
Remove the healing collar after implant integration
The Biotorq driver engages with the custom abutment
and is used to fixate the abutment into the implant

Biotorq Driver Custom Abutment Driver and Abutment

engaged
Biotorq Driver
threads in the fixed
Custom Abutment
Torque the
abutment to 30 N/cm
Engage the UCLA Impression pickup and position the flat side facially
Using the Thumb
Knob and .050 hex
driver, thread the
ball impression
screw into the
UCLA Impression
Pickup
Flood medium body impression material around
the UCLA Impression Pickup
Use hard body impression
material in the tray
Flat side of Impression Pickup is
formed in the impression
Remove the UCLA
Impression Pickup from the
Custom abutment (in the
mouth) and engage it to the
Custom Abutment Analog
 Warning!
Do not remove the Custom Abutment or change its
indexing. This abutment is to remain permanently
fixated into the implant
Snap the UCLA Impression Pickup and the Custom
Abutment Analog into the impression

Match the flat side on the abutment to

the flat side in the impression
Hand tighten Custom
Abutment healing collar
over the custom abutment
with the same Thumb
Knob and .050 hex driver
 Impression with Custom Analog
and Impression Pickup in place

Octa Waxing Sleeve used by

lab for custom abutment
[O-BALL OVERDENTURE
RESTORATIONS]

Using the Dual Stabilization®

Implant System
 Ready to Restore
• 4-on-the-Floor™
Placement Technique:
Four to six ISI Complete® (or
3.0mm I-Mini) One-Piece O-
Ball or TSI/ERI Two-Piece
(with O-Ball Abutments)
Implants places (2 in lower
anterior and 2 in lower
quads) in the mandible.
• Have a good, new denture
made with proper plane of
occlusion and esthetics.
Step 1:
For TSI, Attach O-ball Abutments

• For the TSI Implant,

screw the O-Ball
Abutments into
implant bodies with
O-Ball Driver (Cat#
0076 or 0076S).
 Step 2: Take Impression
• With ISI or ISD One-Piece
O-Ball Implants in place, or
TSI Two-Piece Implants in
place with O-Ball
Abutments, take an
impression directly of the
O-Ball Attachment/
Abutment, or with female
caps and O-rings in place
(if driving square is sub-
gingival).
 Step 3: Full Arch Impression

• Use medium
bodied impression
material around
the O-Ball
Attachments and
record a full-arch
impression with
standard (heavy)
body material.
 Step 4: Analogs

• Snap O-Ball
analogs into the
impression (in
female caps if are
used) and forward
to the laboratory.
 Step 5: Temporary Retention
• For the ISI or ISD One-
Piece O-Ball Implants or
the TSI Two-Piece Implants
in place with O-Ball
Abutments, use soft
denture liner (PermaSoft)
for denture retention while
the new denture is being
created or prior to final
reline.
• Excavate the original
denture and fill with soft
denture liner.
 Step 6: Lab Model

• The laboratory
pours a working
model using the O-
Ball Analogs.
• For a new denture
or reline, use a
sound, previously
constructed
denture.
 Step 7: Final Denture

• The laboratory will

incorporate the O-
ring encapsulators
into the new
denture or reline.
 Step 8: Final Seating
• Seat new denture.
• Final restoration is
complete.
• After seating, if the
denture is too tight, the
lumen of the O-ring
can be enlarged by
opening with a #6
Round Bur
In less than 2 weeks the healing looks great and he’s ready
for a reline and the final female attachments

X
Impression and TRIPs
• The abutments are
flooded with
medium body
impression
material and the
TRIPs snapped to
place
• Do not use self
curing acrylic to
place attachments
in the denture
The relieved denture is put to place and the patient
guided into occlusion
O-ball analogs placed into denture with
impression
Analogs in model on reline jig female attachments are now
placed on the analogs before processing
Finished Denture after Reline
Dentures in place and ground into occlusion
Flanges are trimmed and the size of the
denture is minimized
I-Mini IOT Restoration Case
O-Ball Overdenture: creating a Chrome
framework
Snap Caps (with O-rings) on to O-balls. Take an impression
if deep in tissue.
Do not place caps in impression (have lab pour model)
The lab will create a cast chrome cobalt framework to be
incorporated for the model
The lab will incorporate the framework into the denture
 Q&A

Thank You
Questions?