SurgicalManual 2 04

Surgical Manual
OSSEOTITE® Certain™ Implant System And

OSSEOTITE External Hex System
CATSM
Rev. C 11/03
Introduction And Treatment Planning
This manual was designed to serve as a

reference guide for the dental practitioner to
utilize 3i implants and surgical instruments to
their maximum potential. 3i’s implant system
was developed to meet the diverse needs of
the patient and to offer the practitioner a
choice of surgical techniques customized to
meet each patient’s individual requirements.
TREATMENT PLANNING
Patient Evaluation And Patient Selection:
 General health
 Current medical status
 Medical history
 Oral hygiene
 Motivation and expectations
 Heavy tobacco use, chewing patterns and alcohol consumption.
 Periodontal status of the remaining teeth
 Health of the soft tissue
 Presence of occlusal abnormalities
 Diseases of the mucous membrane and connective tissues
 Pathologic bone disease and severe malocclusion
 Use of anticoagulants
 Existence of metabolic diseases
Preoperative Planning:
1. Clinical examination of the oral cavity

– Tissue tone and the state of the superficial tissues
should be evaluated.
– The patient should demonstrate an adequate
dimension of attached mucosa or keratinized tissue at
the site selected for implantation.
– In partially edentulous cases, the periodontal status of
the remaining dentition should be assessed
– The interaction between the implant restoration and
the adjacent natural dentition should be considered.
Preoperative Planning (cont.):
2. The bony foundation and ridge need to be clinically

analyzed
– At least one millimeter of bone should be present at the buccal and
lingual aspects of the implant following placement.
– Measure the existing bone foundation.
Radiographic Marking Balls (RMB30)
 Used to measure the vertical height of the bone.

 Can be embedded in a plastic template prior to radiographic
examination.
 Measurements can be taken to determine the amount of
bone available for implant placement.
Distortion factor formula:
(5 ÷ A) x B = amount of actual bone available
 Formula Key =
– Radiographic marking
ball = 5mm in diameter
– A = Size of marking ball
image on radiograph
– B = Length in
millimeters on the
radiograph of
available bone between A
the crest of the ridge
and the inferior alveolar B
nerve canal
A 2mm margin of safety, from the apical end of the implant to the adjacent vital
structure, should be considered.
Top-Down Treatment Planning
A protocol whereby the desired restorative result
is considered first, leading to consideration of the
ideal prosthetic platform and subsequent implant
selection based on bony anatomy.
5/6mm 6mm 4mm 4mm 5mm 3.25mm 5mm
Implant
Prosthetic
Platform
8 8 5 5 5.5 5 7.5
Crown
Diameter
5
8 9 5 5.5 4 3.5
5/6mm 6mm 4mm 4mm 4/5mm 4mm 3.25mm

Clinical Considerations
 Inadequate bone anatomy might be discovered during surgery.
 During the presurgical planning phase determine the vertical
dimension.
 Use study models preoperatively
– To evaluate the residual ridge, determine position and angulation of all
implants.
– A surgical guide stent can be constructed on the study model.
 Prevent compromising osseointegration
– Abundant and continuous irrigation with a cool, sterile irrigating solution is
mandatory during all drilling procedures.
– Avoid excessive pressure during preparation of the bone site.
 Sharp instruments of the highest quality should be utilized during
implant site preparation.
 Avoid excessive applied to the implant during the healing period.
Cleaning And Sterilization
Cleaning:
1. After use, place drills into a beaker of plain water, mild soap or
specialized cleaning solution.
2. Rinse with tap water for a minimum of two minutes while brushing
with a soft bristled brush to remove visible debris. Clean the interior
lumen with a thin wire to remove any remaining debris.
3. Place instruments in an ultrasonic bath containing enzymatic
detergent for five minutes*. Scrub the instruments again with a soft
bristled brush and ream interior lumen to remove any remaining
debris.
4. Rinse and flush the instruments for one minute using tap water.
5. Inspect visually for any remaining bone fragments or debris and
scrub as necessary.
*ENZOL enzymatic detergent was used to validate this process, per the manufacturer’s dilution recommendation.
Cleaning And Sterilization
Sterilization:
6. Remove the bur block from the surgical tray. Scrub the
surgical tray and block with a soft bristled brush and mild
soap. Rinse thoroughly.
7. Place the components into the surgical tray and pour ethyl
alcohol (do not use rubbing alcohol) over the burs and tray to
remove soap residue and minerals from the water. This step is
important to help prevent corrosion and spotting.
8. Wrap the surgical tray in paper or autoclave-approved bags
twice to prevent a tear of the outer packaging from
contaminated instruments.
9. Steam gravity sterilize for forty minutes at a temperature of
270° - 275°F (132° - 135°C).
3i Depth Gauge And Drill Marking System
Tip Dimensions
Drill Diameter Drill Tip
2.00mm .6mm
2.30mm .7mm
2.75mm .9mm
3.00mm .9mm
3.15mm 1.0mm
3.25mm 1.0mm
4.25mm .4mm
5.25mm .5mm
Note: A drill extension for areas of limited access is available.
Crest of
Bone
2mm Depth Implant w/

Twist Drill Gauge Cover Screw
Countersink Drills CD500 and CD600
Sub-Crestal Implant Placement Crestal Implant Placement
3i External 3i OSSEOTITE 3i External 3i OSSEOTITE

Hex Implant Certain Implant Hex Implant Certain Implant
OSSEOTITE NT™ Certain™ And OSSEOTITE NT Implant
Placement Protocol
OSSEOTITE NT™ Certain™
Sub-Crestal Placement
Crestal Placement
Supra-Crestal
Placement Protocol
OSSEOTITE NT™
Sub-Crestal Placement
Crestal Placement
Supra-Crestal
Placing the OSSEOTITE NT Implant
OSSEOTITE NT 8.5mm
Osteotomy
11mm
Osteotomy
13mm
Osteotomy
Implant Taps
OSSEOTITE ® Certain™ Implant Placement Protocol
Sub-Crestal Placement Of The 4mm OSSEOTITE

Certain Implant:
 Two-Stage Surgery
– Flare created by the countersink
determines where the cover screw will
ultimately seat
– Drill the countersink to the top of the laser
line.

Certain Implant:
 Place the OSSEOTITE Certain Implant so that the top of the
cover screw replica on the Certain Implant Driver is even with
the crest.
Sub-crestal OSSEOTITE Certain Certain cover screw seated

implant placement

Certain Implant:
 The implant is placed too deeply, the cover screw may not
seat completely, leaving a gap.
Implant placed too deeply Gap between cover screw and implant
Anatomy Of The Certain Implant Placement Driver
Depth Indicators:
4mm
3mm
Hex Orientation
2mm
1mm
Cover Screw Replica
0mm
Implant pick-up and insertion hex
O-Ring
Cover Screw pick-up and insertion tip


Certain Implant:
 Pick Up And Delivery of the implant.
Implant and driver hex design Implant pick up


Certain Implant:
 Pick Up And Delivery Of The Cover Screw Or Healing
Abutment
Cover screw pick up


Certain Implant:
 The cover screw
replica portion of the Sub-Crestal Placement
driver allows for visual Crestal Placement
verification of the cover

screw position.

Certain Implant:
 Two-Piece Bone Profiling Pin (IBPGP)
– Requires dedicated Bone Profiling Pin
used with the existing EP® Bone Profilers.
– Two-piece design.
– Easy to remove.
– Lubricating the top of the pin is with an
appropriate lubricant, such as tetracycline
ointment recommended.
– Do not exceed 50 RPM.

Certain Implant:
 EP Bone Profilers
– Bone Profiling Pin and corresponding Bone Profiler are available to
contour the bone that is to receive the EP Healing Abutment.
EP Bone Profilers correspond to sizes of EP Healing Abutments


Certain Implant:
 Bone Profiling Technique:
– EP Bone Profiler slides over the two-Piece

Bone Profiler Pin.

Certain Implant:
– EP Bone Profiler creates a flare in the crest of

bone.

Certain Implant:
– Flare of EP Abutment matches the flare of

the corresponding EP Bone Profiler.

Certain Implant:
– EP Healing Abutment seated properly onto

the implant in sub-crestal placement.
OSSEOTITE NT™
Surgical Tray
The OSSEOTITE NT
Surgical Tray is numbered
to indicate the appropriate
steps of the implant
placement protocol. The
following illustrated implant
placement protocol uses the
same numbering sequence.
Close-up view of Surgical Tray illustrating

numbering sequence
Crestal Placement Protocol
1. Set the drill speed at approximately

1,500 rpm.
– Instruments needed: Round Drill (RD100)
2a. Proceed with the Initial Twist Drill.

– Instruments needed: 2 or 2.3mm Twist
Drill (ITD215, DT215 or DTN215)
2b. Verify the direction and position of the

preparation.
– Instruments needed: Direction Indicator
(DI100 or DI2310)
3. OPTIONAL STEP
Use the Pilot Drill to shape the
coronal aspect of the implant site
– Instruments needed: Pilot Drill (PD100)
4. Final Drilling Step for 3.25mm

OSSEOTITE NT Implant
– Instruments needed: 3.25mm NT Shaping
Drill (NTSD32xx)
– Proceed to step 8a for 3.25mm
OSSEOTITE NT Implant placement

– Instruments needed: 4mm NT Shaping
Drill (NTSD4xx)
OSSEOTITE NT Implant placement

– Instruments needed:
5mm NT Shaping Drill (NTSD5xx)
– Proceed to step 8a for
5.0mm OSSEOTITE NT Implant
placement

– Instruments needed:
6mm NT Shaping Drill (NTSD6xx)
OSSEOTITE NT
Implant placement
8a. No-Touch™ Delivery System

– Remove contents from the implant box.
8b. No-Touch™ Delivery System

– Nonsterile assistant should peel back the
tray lid and drop the No-Touch Implant
Tray onto the sterile drape.
8c. No-Touch™ Delivery System

– Place the No-Touch Implant Tray into the
appropriate location on the surgical tray.
8d. No-Touch™ Delivery System

– Peel back the tray lid to expose the
implant and cover screw.
9. OSSEOTITE Certain
– Pick up the implant from the surgical tray
using the Certain Implant Placement
Driver Tip (IIPDTS or IIPDTL).
– Carry the implant to the mouth
facing upward to prevent
accidental dislodging.
9. EXTERNAL HEX
using the Handpiece Connector (MDR10).
10. Place the implant in the prepared site at about 15 to 20

RPM. The Spiral ICE™ design will allow smooth and
precise implant placement without tapping in all but the
most dense bone.
11. OSSEOTITE Certain

– To remove the Certain Implant Placement
Driver Tip (IIPDTS or IIPDTL) from the
implant, pull straight up and out.
9. EXTERNAL HEX
using the Handpiece Connector (MDR10).
12. Pick up the cover screw from the No-Touch™ Implant Tray.
12. Close tissue and suture.

OSSEOTITE®
Parallel Wall Implant
Surgical Tray
The OSSEOTITE Parallel Wall

Implant Surgical Tray is
numbered to indicate the
appropriate steps of the implant
placement protocol. The
following illustrated implant
placement protocol uses the
same numbering sequence.
Close-up view of Surgical Tray illustrating

numbering sequence
OSSEOTITE® Certain™ And OSSEOTITE Implant
Crestal Placement Protocol (For A 6mm Diameter Implant)
The drilling protocol for the Crestal Placement of the 6mm OSSEOTITE Certain
and OSSEOTITE Implant was chosen as a representative protocol to provide a
detailed implant placement synopsis.
 Placement Protocol Quick Reference Links
– OSSEOTITE NT™ Certain Implant Crestal Placement
– OSSEOTITE NT Implant Crestal Placement
– OSSEOTITE MicroMiniplant™ Implant Crestal Placement
– OSSEOTITE XP® 3/4 Or ST 3.75mm Implant Crestal Placement
– OSSEOTITE Certain 4mm Implant Crestal Placement
– OSSEOTITE 4mm Implant Crestal Placement
– OSSEOTITE XP 4/5mm Implant Crestal Placement
– OSSEOTITE XP 5/6mm Implant Crestal Placement
OSSEOTITE® Certain™ And OSSEOTITE Implant Crestal
Placement Protocol
For A 6mm Diameter Implant
1. Set the drill speed at approximately

1,500 rpm.
– Instruments needed: Round Drill (RD100)
Placement Protocol
2a. Proceed with the Initial Twist Drill.

– Instruments needed: 2 or 2.3mm Twist
Drill (ITD215, DT215 or DTN215)
Placement Protocol
2b. Verify the direction and position of the

preparation.
– Instruments needed: Direction Indicator
(DI100 or DI2310)
Placement Protocol
3. Use the Pilot Drill to shape the

coronal aspect of the implant site
– Instruments needed: Pilot Drill (PD100)
Placement Protocol
4. Proceed with the 3.00mm Twist Drill

to the desired depth.
– Instruments needed: 3.00mm Twist Drill
(ITD315)
Placement Protocol
5. Use the first cutting groove on the

5.00mm Pilot Countersink Drill to
widen the coronal aspect of the
osteotomy to allow the 4.25mm Twist
Drill to enter the osteotomy.
– Instruments needed: 5mm Pilot
Countersink Drill (CD500)
Placement Protocol
6. Once the coronal aspect of the

osteotomy has been piloted, proceed
with the 4.25mm Twist Drill to the
desired depth.
– Instruments needed: 4.25mm Twist Drill
(ITD423)
Placement Protocol
7. OSSEOTITE CERTAIN
– Advance the 6.00mm Pilot Countersink
drill all the way to the laser marking. This
will countersink the implant and allow for
crestal placement of the OSSEOTITE
Certain implant.
– Instruments needed: 6.00mm Pilot
Placement Protocol
7. EXTERNAL HEX
– Advance the 6.00mm Pilot Countersink
drill to the first cutting groove. This will
countersink the External Hex
OSSEOTITE implant and allow for crestal
placement.
– Instruments needed: 6.00mm Pilot
Placement Protocol
8. Proceed with the 5.25mm Twist Drill to the desired depth. The
recommended speed for a 5.25mm Twist Drill is 900 RPM.
Placement Protocol
9a. No-Touch™ Delivery System

– Remove contents from the implant box.
Placement Protocol
9b. No-Touch™ Delivery System

– A nonsterile assistant should peel back
the tray lid and drop the No-Touch Implant
Tray onto the sterile drape.
Placement Protocol
9c. No-Touch™ Delivery System

– Place the No-Touch Implant Tray into the
appropriate location on the surgical tray.
Placement Protocol
9d. No-Touch™ Delivery System

– Peel back the tray lid to expose the
implant and cover screw.
Placement Protocol

using the Certain Implant Placement
Driver Tip (IIPDTS or IIPDTL).
Placement Protocol
10. EXTERNAL HEX

using the Handpiece Connector
(MDR10).
Placement Protocol
11. Place the implant in the prepared site at about 15 to 20 RPM. The ICE® design will allow
smooth and precise implant placement without tapping in all but the most dense bone.
Placement Protocol

– To remove the Certain Implant Placement
Driver Tip (IIPDTS or IIPDTL) from the
implant, pull straight up and out.
Placement Protocol
12. EXTERNAL HEX

– To remove the implant mount, place the
Open-End Wrench onto the mount. Loosen
the screw at the top of the mount with a
Large Hex Driver or the Large Hex Driver Tip
inserted into the Right-Angle Driver and
rotate counter-clockwise. After the screw is
loosened, rotate the Open-End Wrench
counterclockwise slightly before removing
the mount. The mount may be carried from
the mouth with the Open-End Wrench
Placement Protocol

– Pick up the cover screw from the No-
Touch™ Implant Tray with the internal
connection implant driver (IIPDTS or
IIPDTL) and place onto the implant.
Placement Protocol
13. EXTERNAL HEX

– Pick up the cover screw from the No-
Touch™ Implant Tray with the Small Hex
Driver (PHD00N) or the Cover Screw
Inserter (CSI10) and place onto the implant.
Placement Protocol
14. Close tissue and suture

Single-Stage Treatment With A Two-Stage
Implant System
 Eliminates the need for a second-stage surgery.

 Reduces trauma.
 Decreases treatment time.
 Maintains restorative flexibility.
Single-Stage Treatment With A Two-Stage Implant System
– Implant fully seated in the osteotomy.
1. EXTERNAL HEX
– After the implant is fully seated in the
osteotomy, remove the implant mount from
the external hex implant.
– Select the appropriate one-piece healing
abutment depending upon the implant
seating surface, tissue depth and desired
EP® dimension.
– Bone profiling of the osteotomy may be
necessary to fully seat the healing
abutment onto the implant.
2. EXTERNAL HEX
– Select the appropriate one or two-piece
healing abutment depending upon the
implant seating surface, tissue depth and
desired EP dimension.
– Bone profiling of the osteotomy may be
necessary to fully seat the healing abutment
onto the implant.
3. Tighten the one or two-piece healing abutment Screw to 20Ncm and

suture the soft tissue around the healing abutment.
Surgical Indexing For 3i External Hex Implants
 Provisional restoration can be fabricated in the

laboratory while the bone and soft tissues are healing.
 The Surgical Index Coping screws into the implant and
registers the orientation of the implant hex.
 The Index Coping is then transferred to the guide stent.
 The implant analog is mated to the Index Coping and
secured in the preoperative stone model.
1. Align and attach the index coping with the implant hex and
attach the coping to the guide stent with cold-cure acrylic
resin.
2. Unscrew the index coping from the implant and remove the
guide stent and index coping assembly.
3. Mate the implant analog with the index coping and

attached guide stent.
4. Prepare the stone model using a large round bur to allow

space for insertion of implant analog.
5. Secure implant analog in the stone model using a cold-

cure acrylic resin or dental stone and then remove the
guide stent and index coping.

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Surgical Manual

OSSEOTITE® Certain™ Implant System And

This manual was designed to serve as a

1. Clinical examination of the oral cavity

2. The bony foundation and ridge need to be clinically

 Used to measure the vertical height of the bone.

5/6mm 6mm 4mm 4mm 4/5mm 4mm 3.25mm

2mm Depth Implant w/

3i External 3i OSSEOTITE 3i External 3i OSSEOTITE

OSSEOTITE NT™ Certain™

Sub-Crestal Placement Of The 4mm OSSEOTITE

Sub-Crestal Placement Of The 4mm OSSEOTITE

Sub-crestal OSSEOTITE Certain Certain cover screw seated

Sub-Crestal Placement Of The 4mm OSSEOTITE

Anatomy Of The Certain Implant Placement Driver

Cover Screw pick-up and insertion tip

Sub-Crestal Placement Of The 4mm OSSEOTITE

Implant and driver hex design Implant pick up

Sub-Crestal Placement Of The 4mm OSSEOTITE

Cover screw pick up

Sub-Crestal Placement Of The 4mm OSSEOTITE

driver allows for visual Crestal Placement

verification of the cover

Sub-Crestal Placement Of The 4mm OSSEOTITE

Sub-Crestal Placement Of The 4mm OSSEOTITE

EP Bone Profilers correspond to sizes of EP Healing Abutments

Sub-Crestal Placement Of The 4mm OSSEOTITE

– EP Bone Profiler slides over the two-Piece

Sub-Crestal Placement Of The 4mm OSSEOTITE

– EP Bone Profiler creates a flare in the crest of

Sub-Crestal Placement Of The 4mm OSSEOTITE

– Flare of EP Abutment matches the flare of

Sub-Crestal Placement Of The 4mm OSSEOTITE

– EP Healing Abutment seated properly onto

Close-up view of Surgical Tray illustrating

1. Set the drill speed at approximately

2a. Proceed with the Initial Twist Drill.

2b. Verify the direction and position of the

4. Final Drilling Step for 3.25mm

5. Final Drilling Step for 4.0mm

6. Final Drilling Step for 5.0mm

7. Final Drilling Step for 6.0mm

8a. No-Touch™ Delivery System

8b. No-Touch™ Delivery System

8c. No-Touch™ Delivery System

8d. No-Touch™ Delivery System

10. Place the implant in the prepared site at about 15 to 20

11. OSSEOTITE Certain

12. Close tissue and suture.

The OSSEOTITE Parallel Wall

Close-up view of Surgical Tray illustrating

1. Set the drill speed at approximately

2a. Proceed with the Initial Twist Drill.

2b. Verify the direction and position of the

3. Use the Pilot Drill to shape the

4. Proceed with the 3.00mm Twist Drill

5. Use the first cutting groove on the

6. Once the coronal aspect of the

9a. No-Touch™ Delivery System

9b. No-Touch™ Delivery System

9c. No-Touch™ Delivery System

9d. No-Touch™ Delivery System

10. OSSEOTITE CERTAIN