1. Cut a full-thickness flap with a first incision wide enough to expose the area where you intend to operate. If necessary, use mesial or distal incisions around the selected site.
Make a careful dissection of the lingual and buccal periosteum layer, preventing laceration and at the same time removing any fibrous adhesions. In case you do not want to practice the surgical flap, you can intervene using the circular punch ELCM to create a gingival operculum of 5 mm diameter.
2. After the preparation of the surgical site, mark the position of the implants on the outer cortex with the precision drill ELOSD, using if necessary a surgical guide. Drill at a maximum speed of 1000 rpm, cooling the site with sterile saline solution at 5 °. It is advisable to flush the implant site with an antibiotic.
During this phase it is possible to approximately quantify the quality of cortical bone.
3. Proceed by drilling the selected sites with the pilot reamer ELPD, controlling both the mesiodistal direction (as perpendicular to the ridge as possible ) and the bucco-lingual one, sometimes affected by anatomical limitations. During drilling (maximum cutting speed 800 rpm), move the contra-angle back and forth to cool the drill and to extract the chips of bone. In the case of compact bone do not exert excessive pressure on the contra-angle, it could overheat the bone tissue with a consequent risk of thermal necrosis.
During this process, care should be taken to check the direction and depth using the depth gauge and parallel indicator ELPAP.
4. Carry on with preparation of the implant site using the reamer suitable for the diameter of the implant to be inserted, penetrating the site until you reach the length of terminal preparation previously determined (refer to the black marks, corresponding to the length of the implant).
6. In order to insert the fixture in the prepared site, create a thread with the dedicated bone tap. This delicate phase can be performed using th contra-angle with the contra-angle mounter key ELKC at low speed (15/20 rpm), while cooling the site with sterile saline solution at 5 ° C. The same operation can be done manually with the ratchet ELKW and the ratchet mounter key ELKMC1 (short) or ELKMC2 (long). In the presence of poor quality bone we recommend avoiding tapping to obtain greater primary implant stability.
7. After having checked that the contents of the package to be opened corresponds to the size of the implant previously selected, open the package and remove the cap of the plastic container, exposing the head of the mounter.
Extract the implant either mechanically (7A) or manually (7B).
7A. (Advisable for fine threaded implants)
Insert the contra-angle mounter key ELKC (up to the stop, passing the O-ring) and remove the implant from its titanium container. Turning clockwise, insert the implant in the implant site at a rate not exceeding 15 rpm, until you meet increased resistance.
7B. Insert the ratchet mounter key ELKMC1 (short) or ELKMC2 (long) (up to the stop, passing the O-ring) and remove the implant from its titanium container. Turning clockwise, insert the implant in the implant site, insert the ratchet ELKW in the mounter key and finish screwing in a clockwise direction until you meet increased resistance.
8. To free the implant from its mounter, use the open-end key ELKM to allow loosening of the fastening screw using manual screwdrivers ELCSK1 or ELCSK2 or the contra-angle wrench ELPSCAK.
8A. In all those cases where you cannot finish the screwing with the mounter key, free the implant, as mentioned above in step 8, and continue screwing using the implant driver ELKIC1 or ELKIC2.
9. Remove the cover screw ELCS from the cap of the container by using the manual screwdrivers ELCSK1 or ELCSK2 and screw it on the implant.
10. Suture the surgical flaps over the implant. Use non-absorbable material sutures (nylon or Teflon). The sutures should be removed after 7/10 days.
Bone level implant (Fig.1 – Fig.2)
This type of implant has to be completely inserted and it is necessary to follow full surgical protocol, including the preparation of the shoulder with the special tool (ELPS up to the lower edge of the black mark, for implants ø 3.5 mm and 4 mm, or ELPS2 up to the top edge of the black mark, for implants ø 4.75 and 5.25 mm) which allows the non-threaded part of the implant to drop below the cortex.