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Home / Treatment With ORLUS / Tx
planning surgical procedure |
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3.
Selection of the orthodontic mini-implant and determination of implantation
depth
Specifications & Selection of the implant
ORLUS implants(figure 3) are available
in long type and regular type, depending on the length. The implants
are also available in mini type, standard type, and wide type,
depending on the diameter. An appropriate implant can be selected
according to the conditions of the soft tissues and hard tissues of
the location of placement.
 |
Fig. 3
Understanding of the design: the ORLUS mini-implant has a unique structure; it
can be inserted to a greater depth, and more support can be obtained from cortical
bone because it has a tapered core (a)that widens with height and a dual thread
(b)which consists of trapezoidal threads in the cervical area and reverse buttress
threads in the apical area. The A
part area without threads is designed for contact with the soft tissue while the B part area with trapezoidal threads is designed for contact with cortical bone to obtain
primary stability. In every case, the B part area should remain in contact with cortical bone for stability. And for areas with
thick soft tissue, the A part area of an implant should be of appropriate length for the thickness of the soft
tissue. |
By diameter
The diameter should be determined according to the condition of
the hard tissue (figure 4, 5) .
 |
Fig. 4
There are three main types of implants in diameter.
The diameter of an implant is chosen in terms of the mini
type, regular type, and wide type according to the quality
and quantity of cortical bone.
| a. |
Mini type (ORLUS
1O14107): The mini type implant is 1.4mm in diameter
at the center, and 1.6 mm at the cervical area. It is
used in places where abundant space is not available,
such as at the anterior alveolus. |
| b. |
Regular type (ORLUS
1O16106, 1O16107, 1O16108, 1O16208, 1O16309)
: The regular type implant is 1.6mm in diameter
at the center and 1.9 mm at the cervical area. This type
is used in general areas where the bone quality is adequate. |
| c. |
Wide type (ORLUS 1O18106, 1O18107,
1O18108, 1O18208, 1O18309): The
wide type implant is 1.8mm at the center and 2.2mm at
the cervical area. This type is used in general areas
and is useful in areas of inadequate bone quality. |
Fig. 5
A mini type is useful where the interdental space is narrow,
such as at the lower anterior alveolus. |
By length
A screw length of 5mm with pre-drilling and 6mm without pre-drilling
is usually sufficient for the bone contact. The length of the screw
used for bone support is 5-7mm and that of the soft tissue sealing
is 1-4 mm at the cylindrical neck area (figure 6).
The length should be determined according to the condition of the
soft tissue.
Fig.
6
There are two main types of implant differentiated by length
for different soft tissue conditions.
| a. |
Regular type: The length of screw in the bone is 5-7mm, and
that of the cylindrical neck is 1mm. For the cylindrical neck
section at the soft tissue interface, a length of 1.0 mm is
normally selected for the buccal area of the maxilla and mandible.
|
| b. |
Long type (ORLUS 1O16208, 1O16309, 1O18208,
1O18309) : The long type implant is designed for various
soft tissue conditions at the location of placement. In long
type implants, the length of the screw in the bone is 5-6mm
depending on personal preference, while the cylindrical neck
is 2-4mm long for the implant-soft tissue interface. Implants
with 2mm of cylindrical neck are sometimes preferred for movable
tissues; this prevents coverage by the epithelium. In the posterior
palatal area and the retromolar area, the length of the cylindrical
neck portion should be chosen by direct measurement using a
periodontal probe, since the thicknesses of the soft tissues
in the posterior palatal area and the retromolar area vary from
2mm to 6mm. |
Determination of insertion depth
As the amount of implant exposure increases, the discomfort of the
patient and stress from the oral environment also increases. This
can lead to adverse effects on the healing process and maintenance
of the implant. However, if the exposure level is too low, particularly
in the oral mucosa area or areas in which the soft tissue moves
a great deal, soft tissue covering, persistent inflammation, or
the development of abscesses may occur. Therefore, exposure of the
mini-implants should be adequate.
An adequate exposure level of the mini-implant is determined by
the condition of the soft and hard tissues, and the surrounding
environment within the oral cavity (figure 7).
In cases in which poor bone quality or insufficient primary stability
is an issue, it is better to implant deeper even though soft tissue
problems are likely to occur. When inserted deeper, the stress to
the implant from the surroundings decreases and, hence, produces
more favorable conditions for the healing process. Furthermore,
when placed deeper, the tapered core of an implant increases the
bone condensing effect, which then improves the quality of bone
so as to increase primary stability.
When an implant is placed in the mucosa, adequate exposure is needed
to ensure that the implant does not become covered. However, it should
be kept in mind that the larger the exposure, the more negative the
effect on the healing process, which in turn, could adversely affect
the stability of the implant.
Fig. 7
The insertion depth of the implant is
determined by the condition of the soft tissue, the condition of
hard tissues and stress from the surroundings. To prevent soft tissue
coverage, areas in which the soft tissue is very mobile (c) need sufficient exposure compared to general cases (a, b). However, in thick keratinized tissue, such as the palatal interdental area,
minimum exposure is acceptable (d). Implants that use indirect anchorage or bonding of the attachment necessitates
sufficient head exposure for resin work that needs fluid control(b).
Instruments
To minimize surgical trauma during implantation and to prevent root
damage, a manual pre-drill system (OS DRL-H116,
OS DRL-E161, OS DRL-E162) was developed (figure
8). The length of the ORLUS Surgical drill is limited; therefore, it
can only bore into soft tissue and cortical bone. Instruments exist
for direct implantation (figure 9) and
for indirect implantation (figure 10).
Fig.8
The Safe pre-drill system for safe implantation procedures.
The Safe drill has been designed to perforate cortical bone
efficiently and to prevent root injuries. The length of drill
is 4mm long, so the drill is unable to reach root surfaces
at the mucogingival junction.(d)
| a. |
Hand-driver type, which is used by insertion into a
hand-driver. (OS DRL-H116)
|
| b. |
Dental latch type, which is used by insertion into a
handpiece (for alveolar area) (OS
DRL-E161) |
| c. |
Dental latch type, which is used by insertion into a
handpiece (for midpalatal area)
(OS DRL-E162) |
| d. |
The length of drill is 4mm logn, So the drill is unable to reach root surfaces at the mucogingival junction. |
|
 |
Fig. 10
Instruments for the indirect approach. This is a dental latch type, which
is inserted into a handpiece.
a. Standard
driver tip (OS-DRT-E01)
b. Long
driver tip (OS-DRT-E02)
c. The
standard ORLUS Surgical drill (OS DRL-E161)
d. The
long ORLUS Surgical drill (OS DRL-E162)
|
Fig. 11
There is a notch on the driver tip and a ball bearing on the
handle. By pulling the end ring, you can put in the driver tip(a).
After inserting the driver tip while pulling the end ring(b),
take fingers off(c). Then, rotate the driver tip until you hear
a click sound, or until the bearing ball of the handle fits
into the notch on the driver tip (d). Make sure it has been
properly placed by pulling the driver tip. |
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