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  • DENTIST’S GUIDE TO PLACING IMPLANTS IN SIMPLE CASES

    By Charles A. Babbush, DDS., MScD.

    A simple implant is one that has obtained a simplistic design, which is state of the art, using cutting edge technologies and materials to cover a broad range of typical applications. It should be an implant which can be utilized by the vast majority of dentists to restore the simple clinical cases ranging from single tooth to full arch edentulous patients and/or soon to be partially or totally edentulous. 

    A typical simple implant solution may involve an existing tooth which can no longer be restored or maintained. This dental unit may have fractured, has extensive decay or can no longer be maintained due to periodontal involvement. The tooth can be extracted, and in what at times can be a lower risk approach, a bone graft plug can be used as the optimal socket preservation technique, with the dentist preparing the crestal ridge with a more flattened topography for presumptively an easier implant placement. In addition, this simple case may also be one with a healing virgin area of bone from either a congenitally missing tooth or a healed extraction site

    Using a drill-based solution often precludes the necessity to open a flap, thus simplifying the process.  A drill system with built in stops, further reduces the risk of drilling too deep. The Zuga implant system is such a drill-based solution that simplifies the surgical procedure into 7 easy steps.

    Zuga Medical Simple Dental Implant Drill Set

    The Zuga implant system uses bone level implants, with built-in platform switching, and thus are designed to maintain crestal bone heights as well as soft tissue retention for a more natural esthetic result.

    A conical low angle taper design, which approximates a modified morse like taper with an internal hex connection, offers a tight and secure position of the abutment allowing the Zuga implant to achieve higher fatigue strength while preventing leakage. The Zuga tapered cylinder shaped implant body with half circle thread(s) allows for self-tapping insertion which produces increased initial stability, due to expansion of the approximating bone as well as gradually condensing of the surrounding bone.  Zuga’s patent-pending margin ring reduces the number of restorative steps while improving the esthetics at the margin.

    Simple dental implants - local anesthesiaStep 1: After the gingiva has healed over the bone grafted crestal region, the first step is to achieve local anesthesia. The gum punch is used to expose the crestal bone.  Using a Gum Punch reduces pain compared to an open flap, and eliminates the need for second stage surgery.

    Zuga Medical - Ball DrillStep 2: The second step uses the Ball Drill to position the point where the implant will be located and trims any roughness or irregularities on the crestal bone.

    Zuga Medical - Pilot DrillStep 3: The dentist uses the Pilot Drill in the third step to drill to the stop – a total of 8 mm depth using the Pumping Method.

    Zuga Medical - Twist DrillStep 4: Expand the diameter of the receptor site with the selected Twist Drill using the Pumping Method.

    Zuga Medical - Cortical Bone DrillIn step 5, the Cortical Bone Drill is used to make the shape of the receptor site comparable to the shape of the implant at the cortical level.  The depth of the cortical bone drill will match the thickness of cortical bone according to the CBCT.

    Zuga Medical - Using the TapStep 6 involves using the Tap. Use depends on the Type of bone:

    • Type I bone: full tappingļ¼ˆcover the scaleļ¼‰
    • Type II bone, tap 1/3-2/3 of distance
    • Type III bone, tap 1/3 of distance or no tapping
    • Type IV bone, no tapping

    Once the surgical preparation of the receptor site is complete, the next step is to place the implant.  Remove the implant from its container – Do not touch the implant threaded area.

    Zuga Medical - Placing the implantStep 7: Place the implant in the receptor site via hand instrument and rotate until the first few threads engage the bone.

    Zuga Medical - Use the ratchet and adapterStep 8: Use the ratchet and adapter to selectively tighten the implant to a minimum of 35 Ncm. Place 0.25-0.50mm below the crestal bone. Do not over-torque.

    Step 9: Place the cover screw (sealing cap - left), which prevents soft tissue from growing over and/or inside the Implant/Abutment interface. Alternatively, a healing cap (right) might be used avoiding a second stage procedure and also shaping the soft tissue healing to the final abutment.

    Zuga Medical - Sealing cap Zuga Medical - Healing cap

    Example of site pre-surgery, post placement, post restoration:

    Zuga Medical Dental Implants - X-rays

    In summary, we have presented an implant case, using Zuga Medical drill-based tools to place a bone level implant. With appropriate training, any dentist can place simple implants in a similar environment.

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