PerfectInstruction - DMI Technology

Surgical Procedure for all PERFECT titanium implant Examination and treatment planning.

Carry out examination and treatment planning in the usual manner.

General patient information:

The patient would be informed before any treatment On the results of the pre-operative examination.
Explanation of the intended treatment that will include expected outcomes and risks involved.
Patients should indicate their acceptance of treatment by signing an appropriate consent form.
General contraindication of patient's medical status precludes surgical treatment, mental psychosis, alcohol and all listed information noted at the instruction for use.
PERFECT titanium implant should not be placed on patients where the remaining jaw bone is too diminished to provide adequate implant stability.

Warnings:

Excessive bone loss or breakage of PERFECT titanium implant may occur when an implant is loaded beyond its functional capability.
Physiological and anatomic conditions may negatively affect the performance of dental implants. A consideration should be taken when placing implants in patients with the following conditions:

Poor quality bone
Poor oral hygiene
Medical conditions such as blood disorders or uncontrolled hormonal conditions

Pre-operative examination includes a general evaluation of the patient's health, a clinical and a radiographic examination.
Special attention should have for soft and hard tissues, dental history, restorative status and occlusion. In complex cased accurate details can be fabricated by CT data.
Radiographic examination provides evaluation on anatomy, pathology, quantity and quality of the bone.
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. The implant can be stabilized in very little bone and bone augmentation can be carried out in the same session.

Local contraindications

Bone Quality

Traditionally, 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.

Diameter of drilled site

The special features of the PERFECT titanium implant allow insertion into a small diameter site. (See drilling sequence protocol).

Implant installation

Implant selection

DMI Dental Implants System is available in variety of diameters, lengths and special design. The implant site must be prepared in a way that will enable simplicity of placement, stability, will not damage vulnerable areas of the local anatomy maxillary sinus, nasal floor and inferior dental canal; and will not cause damage to the bone by overheating or trauma.

Pre Operative Handling

Planning before surgery as described above along with good understanding of the clinicians with DMI Implants System, will ensure efficient and accurate installation.
Premedication is given based on individual indications. Non allergic patient may be given 3g sachet of amoxicillin one hour before implant placement and 500 mg X3 four times daily post treatment of one week prophylactically.
Preparation of the room sterilization and surgical instruments.
Draping the patient with sterile operating sheets covering the body and head.
Local anesthesia is given is desired areas. Additionally is being given during surgery when needed.

Washing the mouth with 0.2% chlorhexidine solution for 2 minute.

Preparation of the implant site

Perform incisions to expose the surgical field.
Elevate the muco periosteal flaps.
Reshape alveolar ridge if necessary; the incision and flap elevation are extended to enable easy access to/and control over the implant sites and to permit satisfactory registration of the jaw morphology.
Mark the bone with a guide drill or the 2 mm drill for position the implant site. The drill sequence for small implant diameter is different 1 mm or 1.2 mm. It is recommended to keep 3.5 mm distance from each implant to another, which gives a minimum center to center distance of 7 mm. For precise spacing and parallel placement use parallel guide, more options are available.
For angulations, depth and parallel to be checked use parallel/depth guide, more options are available. For future restoration for placement abutments use Surgical Set Abutment (Navigate), Surgical Straight (Navigate) Abutment, Surgical Angular 15° (Navigate) Abutment or Surgical Angular 25°( Navigate) Abutment.

You can use a guide drill of your choice like a round bur or a sharp pointed guide drill. Mark drilling speed should not exceed 1,500 rpm and should be performed under ample irrigation.

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.
Drills should be replaced when their cutting efficiency is reduced.
All preparation of bone tissue must be carried out under ample irrigation with saline solution and using an intermittent drilling technique.

Drill selection

The surgical drills come in sequential diameters and in two lengths. The drills are made of surgical titanium and are to be used with internal irrigation. A Teflon ring in the irrigation canal facilitates friction free insertion of the irrigation tab.
All drills are color and groove coded for easy identification during surgery.
Drills are groove marked for lengths.
Nominal length marks are measured from the beginning of the parallel walls. The length does not include the triangular shaped cutting edge. Actual osteotomy length is roughly 1 mm longer.
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.
Optional surgical drills with flat heads are also available for such situations.

Drilling sequence

The drilling protocol is adapted to the implant diameter and bone quality at the site.
The instructed drilling steps are suggested for dense/cortical bone.
In softer bone fewer steps may be performed. In soft bone, 2 mm or 2.8 mm drills are often enough for all implant sizes (see protocol below).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. If you feel strong resistance at any point during insertion, rotate the implant counterclockwise 2-3 rounds then continue to insert the implant.

Drills protocol for UNIQUE titanium implants

The kind of PERFECT Titanium Implant	The density Bone type	Marking Surgical Drill 1,9 mmd	Surgical Drills 2 mmd	Surgical Drills 2,5 mmd	Surgical Drills 2,8 mmd	Surgical Drills 3,2 mmd	Surgical Drills 3,65 mmd	Surgical Drills 4,2 mmd	Surgical Drills 5,2 mmd	Countersink Surgical Drill
The standart platform in diametr 3.75 mm	D3-D4	+	+	+/-	+/-
	D2	+	+	+	+	+				+/-
	D1	+	+	+	+	+	+
The standart platform in diametr 4.2 mm	D3-D4	+	+	+	+/-	+/-
	D2	+	+	+	+	+	+			+/-
	D1	+	+	+	+	+	+	+
The standart platform in diametr 5.0 mm	D3-D4	+	+	+	+/-	+/-	+/-
	D2	+	+	+	+	+	+	+		+/-
	D1	+	+	+	+	+	+	+	+/-
The standart platform in diametr 6.0 mm	D3-D4	+	+	+	+	+/-	+/-	+/-	+/-
	D2	+	+	+	+	+	+	+	+
	D1	+	+	+	+	+	+	+	+	+/-

Preparing the PERFECT titanium implant

The PERFECT titanium implant of DMI are provided in a double packaging in order to reserve sterility. The outer packaging is made from recycled materials, carton paper, which indicates the identification data of the PERFECT titanium implant, measurements, type, expiry date, sterile, brand name, manufacture, representative, CE mark. Within the Outer packaging, there is a PERFECT titanium implant in a double sterile package, 2 labels, instructions for use.
The assistant opens the external packing and puts out from it the internal packing. From the internal packing the carrier of the PERFECT titanium implant connected with the PERFECT titanium implant is going out.
The doctor should extract the PERFECT titanium implant by the carrier not touching the walls of the inner test tube and transfer it to the formed hole in the osseous.

Inserting the PERFECT titanium implant

Initial insert of the PERFECT titanium implant into the prepared site manually:
While installing of the screwed PERFECT titanium implants it is possible to screw the implant manually or with the help of the physiodispencer, which can be tuned on the definite speed. The manual screwing is started by the holding with the fingers the PERFECT titanium implant by the carrier till the strong resistance is felt and then by means of the key “Ratchet” or “Bush”.
The 2.42 mm insertion tools can then be inserted directly into the PERFECT titanium implant to continue insertion. As soon as you encounter resistance start using the wrench or the surgical screwdriver.
If proximity to teeth does not allow insertion of the PERFECT titanium implant with the pre mounted carrier, you can pull it straight out (it is held with friction) at any time during insertion and replace it with a 2.42 mm insertion tool. These tools come in three options for use, with accordance to the PERFECT titanium implant type, with the wrench or screwdriver (hexagonal 6.35 mm) or with a square 4 mm wrench.
Alternatively you can use the 2.42 mm motor mount for contra angle tool for motorized insertion. Install at low speed (20 rpm) with ample irrigation. Set the maximum torque to 45Ncm.
Caution: Excessive force while inserting the PERFECT titanium implant with the wrench or screwdriver must be avoided. It could cause undue compression of the bone and result in necrosis and impaired result. If you feel strong resistance at any point during insertion, rotate the PERFECT titanium implant counterclockwise 2-3 rounds then continue to insert the PERFECT titanium implant. Or retrieve the PERFECT titanium implant and drill a wider hole.

Installation of cover screw

In case of a two-stage surgery, 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 PERFECT titanium implant and tighten it lightly.

One-stage surgery

When stabilization is adequate and a one stage protocol is desired a trans mucosal healing abutment should be placed.

Immediate loading

The DMI Dental Implants System is indicated also for immediate loading when good primary stability is achieved and with appropriate occlusal loading.
The DMI Dental Implants System is indicated also for immediate loading on single tooth when good primary stability is achieved and with appropriate occlusal loading.

Special surgical protocols

Immediate implantation- The 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 PERFECT titanium implant. Bone augmentation can be immediately followed as indicated – all in the same session.

Closed and Open Sinus Floor Elevation- The unique design of the PERFECT titanium implant allows insertion into a small drill hole and gradual condensation in all dimensions throughout the entire length of the PERFECT titanium implant.

Immediate Implantation Aesthetic Zone - Achieving aesthetic results in the anterior maxilla is very difficult and considered highly unpredictable. The buccal bone plate is usually very thin and oftentimes missing altogether, whereas maintaining bone height and soft tissue architecture requires at least 1.5mm of bone thickness buccal to the PERFECT titanium implant.

	∅ 3.75 mmd	∅ 4.2 mmd	∅ 5 mmd	∅ 6 mmd
	Cat No.	Cat No.	Cat No.	Cat No.
10 mml	131037	131042	131050	131060
11.5 mml	131137	131142	131150	131160
13 mml	131337	131342	131350	131360
16 mml	131637	131642	131650	131660