Macchu Picchu. The lost city of the Incas Cuzco-Perù Song: “Tribute to Ayacucho” . Interpret: Dr.

r. Raul Garcia Zarate RBB

RBB
 COLEGIO
ODONTOLÒGICO
REGIONAL DE
LIMA
Programa Acadèmico Anual
Prof. Ricardo Benza Bedoya
RBB
Sistema de
Implantes
Biohorizons

RBB
 OBJETIVOS
1.Comprender las
generalidades del sistema
de implantes biohorizons
2.Explicar las innovaciones
màs importantes del
sistema de implantes
biohorizons
“Quien tiene muchos
vicios, tiene muchos
amos.”
Plutarco
Key features and benefits

• Proprietary Laser-Lok® microchannels†

• Anatomically tapered implant body

• Patented reverse buttress threads‡

• Proven internal hex connection

• Titanium alloy

†
Laser-Lok design patent #6,454,569 and 6,419,491
‡
Reverse Buttress thread design patent #5,964,766

6
Resorbable blast texturing (RBT)
• Highly complex
surface texture
• Increased
stability and
osseointegration*
• Biocompatible
resorbable
blast media

*Sawase T, Wennerberg A, Hallgren C, Miuyamoto I, Albrektsson T: Atomic force microscopic

study of commercially available implant abutments. Clin Implant Dent Rel Res 1(2):92-97, 1999.

7
Reverse buttress
threads
• Wide, flat leading edge
• Increased surface area
• Improved axial load
distribution
• Improved primary stability

Patent# 5,964,766

8
Anatomically Tapered

• 1-2mm of taper based on

implant diameter
• Ideal profile for
constrained spaces
• Improved primary stability
Apical 6mm
tapered

9
 Non-Laser-Lok (left) vs. Laser-Lok (right)
80 newton side load

10
Courtesy of Jack Ricci, PhD, NYU
 Courtesy of Jack Ricci PhD (NYU)

Thread Design
• Defines the interaction between the implant and
bone macrostructure
• “Machine screw” thread versus “wood screw”
thread:
– Machine screw thread: Screw and substrate have the
same or similar mechanical properties.
– Threads are small, closely packed, and v-shaped.
– Wood Screw: Screw and substrate are different
materials (substrate has lower stiffness).
– Threads are larger, with larger pitch.
– Threads designed to dig into the substrate.

11
 Courtesy of Jack Ricci PhD (NYU)

Thread Design Square thread similar

• “Wood screw” thread designed for axial compression

S
C
bone
Reverse buttress design has larger, deeper thread, and a lower
surface face designed to provide compressive force rather than
shear force.
12
 Laser-Lok® microchannels
• Controls epithelial
downgrowth

• Attaches and retains

crestal bone

Patent# 6,454,569 & 6,419,491

13
Old and New Microtextures
Courtesy of Jack Ricci PhD (NYU)

Machined surface RBT

14
 Biologic width around natural teeth
minimal dimension – 3mm

1mm
Sulcus

1mm
Epithelial
Attachment
1mm
Connective
Tissue

15
 Biologic width around
traditional implants

Tissue level
at the time
of placement

Bone level Microgap

at the time
of placement

Is there a better way?

16
 Tapered Internal with Laser-Lok

17
 Laser-Lok – proprietary

• Only surface of its kind

– Microgrooved surfaces for
mechanical stability
• Patented
• FDA cleared claims
– Inhibit epithelial
downgrowth
– Attach/retain crestal bone

18
 In vitro studies of cell response to surface microtexture:
cells on controlled microtextures

• Microgrooved surfaces produced from

silicon wafer templates.
• Microgrooves inhibited colonization
and caused directional colony
formation (Contact Guidance).

• Optimal groove size for inhibition of

fibroblast colonization was 6-12 µm
width and >2 µm height.

Ricci JL, Charvet J, Frenkel SR, Chang R, Nadkarni P, Turner

J, Alexander H: Bone Response to Laser Microtextured
Surfaces. In: Bone Engineering, edited by JE Davies, Em 2
Inc., Toronto, Ont. Canada, Chapter 25, 282-294, 2000.

19
Courtesy of Jack Ricci, PhD, NYU
 Supracrestal biologic width
with Laser-Lok
Tissue level
at the time
of placement

random Laser-Lok
Bone level
at the time roughened micro
of placement surface channels

20
21
GOAL: complete case management

CROWN
• CAD/CAM
• Restorative planning software
• Traditional lab processes

ABUTMENT
• CAD/CAM
• Restorative planning software
• Standard and esthetic

IMPLANT
• Biomechanically enhanced design
• Surgical planning software
SURGERY
• CT
• Intra-oral scanning
• Surgical planning software
• Surgical Guide
• Instruments
 Laser-Lok clinically supported – in vitro
•1.Suppress
3-12µmfibrous
microgeometries
encapsulation
vs.
• random
Inhibit blasted surfaces
cell growth
•2. 1¾-12µm
Cell orientationmicrogrooves,
& organization
• controlled
Directed tissue response
3.
• 2-12µm
Cellular linearguidance
contact grooves vs.
diamond patterns, controlled
4. 8 & 12µm parallel grooves vs. Human Bronchial Epithelial (HBE) Cells
square posts, controlled
MG8 surface
5. 8 & 12µm parallel grooves vs.
square posts, controlled
6. 8 & 12µm microgrooves vs.
random blasted surfaces Smooth
surface

HBE cell colony on smooth and MG8 surfaces

Courtesy of Jack Ricci, PhD, NYU

Ricci
23
 Laser-Lok clinically supported – human
1. Immediate, provisional load • No epithelial downgrowth
histology • Strong bone integration
2. Immediate, provisional load • Reduced crestal bone loss
histology with sinus graft
3. Clinical, radiographic and
histologic evaluation of hard
and soft tissue attachment
4. Prospective, controlled, multi-
center (37 mos. follow-up)
5. Prospective, randomized vs.
Nobel and 3i (3 year follow-up)

24
Courtesy of Jack Ricci, PhD, NYU Courtesy of Jack Ricci, PhD, NYU
 Placement levels
• May be placed either crestal or supracrestal
• Laser-Lok is a transition zone for uneven ridges

Supracrestal Uneven ridge Crestal

(machined and
8 micron Laser-Lok)

25
 Instrument sequence
2.0mm 2.5mm Crestal Bone Drills Abutment-
Starter Depth Width Increasing Depth and Bone Taps level Driver
Drill Drill Drills Gauge (Site-specific)

26
 1mm high silver bands determine crestal
and supracrestal placement

Supracrestal Crestal
Drill to
Placement leading Placement
edge

Drill to
trailing
edge

27
 Silver bands
defined on drill
wall chart and in
the Surgical
Manual (L0603)

28
 Depth verification
• Verify osteotomy
depth
• Manually insert
Depth Gauge

Width Increasing Depth 12mm Implant

Drill Gauge with Laser-Lok

29
 Bone Taps
• Usage dependent on
clinical assessment
• Prepares sites with
dense cortical bone
• One Bone Tap for each
body diameter

30
 Crestal Bone Drills (for dense bone)

Example 1 (Supracrestal). Only 1mm left above osseous crest

partial cutting geometry used.

Example 2 (Crestal). Full cutting Implant platform level

geometry used. with osseous crest

31
 Abutment-level drivers
• 3inOne Abutment
serves as surgical
mount
• Interfaces with
square drive
• Pick-up directly
from vial
• Drivers for both
Handpiece and
Ratchet are included

32
 Implant-level drivers
• May be used following
removal of 3inOne
Abutment
• Color-coded by
prosthetic platform
• Drivers for both
Handpiece and Ratchet
are included

33
 Healing Abutments

• 3 heights (1, 3, 5mm)

• 3 Emergence
– Narrow
– Regular and
– Wide Emergence
• Suture groove to apically
position tissue

34
 Simple Solutions Healing Abutments
• Used when a Simple Solutions
restoration is planned
• Develops soft tissue emergence
• Order by platform and collar
height

35
 Courtesy of Craig Misch, DMD

Microgap 

“ Platform Switching

36
 Immediately loaded, maxilla, 2 years

Courtesy of Cary Shapoff, DDS (CT)

37
 Laser-Lok case: Stuart Froum, DDS, NYU

Pre-op

At placement
2 ½ years post-op

38
 Courtesy of
Craig Misch, DMD

39
 Comprehensive portfolio

Prosthetics

Implants

Soft & Hard Tissue

40
 Restorative options

• Simple Solutions Restorations

• Traditional implant-level restorations
• Implant-supported overdentures
• Implant-stabilized overdentures

41
 Proven internal hex connection
• Supported by a comprehensive line of
internally hexed prosthetics

42
 Restorative options

• Simple Solutions restorations

• Traditional implant-level restorations
• Implant-supported overdentures
• Implant-stabilized overdentures
43
44
 Simple Solutions concept
• Cement-retained restorations in a minimal number of visits
• Pre-tapered abutments designed to be restored without
additional preparation
• Patients can wear a tooth-colored healing cap over the
abutment while the laboratory fabricates the final
prosthesis

1. Seat Simple 2. Make closed-tray, 3. Seat Final

Solutions Abutment pick-up impression Restoration

45