WEBVTT LANGUAGE:en 1 00:00:00.000 --> 00:00:11.000 My name is Werner Hölscher. I have been a dentist since 1983 and have been here in the heart of Frankfurt since 1987. 2 00:00:11.000 --> 00:00:18.000 The goal of today's operation is to place three ICX implants in the upper right quadrant. 3 00:00:18.000 --> 00:00:24.000 Since the horizontal and vertical bone supply and bone density vary greatly, 4 00:00:24.000 --> 00:00:31.000 various implantation techniques as well as different implant lengths and diameters should be used. 5 00:00:31.000 --> 00:00:35.000 We start in region 1-6 with an internal sinus lift, 6 00:00:35.000 --> 00:00:42.000 in which the technique of balloon-assisted sinus floor elevation according to Prof. Benner should be used. 7 00:00:42.000 --> 00:00:46.000 After the access to the bone storage was made with a tissue punch, 8 00:00:46.000 --> 00:00:56.000 a small bone lid is now prepared with a tripan drill and removed with tweezers. 9 00:00:56.000 --> 00:01:10.000 Only now is the bone prepared up to about 1 mm in front of the sinus floor with the pre-driller of the Meisinger set. 10 00:01:10.000 --> 00:01:16.000 The low-torsion work enables the extraction of spongy bone, 11 00:01:16.000 --> 00:01:26.000 which is still necessary in the further course of the operation. 12 00:01:27.000 --> 00:01:36.000 Now with the osteotome a safe and defined access to the pineal gland can be created. 13 00:01:41.000 --> 00:01:45.000 In order to be able to assess the success of the previous measure, 14 00:01:45.000 --> 00:01:50.000 the newly created bone lid is tested for its mobility. 15 00:01:50.000 --> 00:01:56.000 You can clearly see here how it is still firmly connected to the mucous membrane of the sinus floor 16 00:01:56.000 --> 00:02:00.000 and can be moved with it. 17 00:02:06.000 --> 00:02:11.000 With piezo-technique, the surface of the bone is tried to smooth. 18 00:02:11.000 --> 00:02:18.000 This should prevent any sharp bone edges from leading to a tearing of the balloon. 19 00:02:21.000 --> 00:02:28.000 Through the piezo-assisted intralift procedure, we have the opportunity to check the membranes for their impurities 20 00:02:28.000 --> 00:02:33.000 in addition to the nasal blowing test, this time from the oral point of view. 21 00:02:33.000 --> 00:02:37.000 Here you can apply cooking salt solution under pressure on the membrane 22 00:02:37.000 --> 00:02:44.000 and get an impression of how far the membrane is intact or not. 23 00:02:51.000 --> 00:02:56.000 The oscillation of the liquid causes further dissolution of the membrane from the bone. 24 00:02:56.000 --> 00:03:02.000 It is quite possible that only through this measure the mucous membrane can be mobilized so far 25 00:03:02.000 --> 00:03:07.000 that the further planned use of the balloon becomes superfluous. 26 00:03:07.000 --> 00:03:12.000 Even if this case does not occur here, I have the impression that the combination of both methods 27 00:03:12.000 --> 00:03:17.000 is fundamentally useful and can contribute to a higher degree of safety. 28 00:03:19.000 --> 00:03:26.000 Now it is very sensitive to dilute the balloon by applying the cooking salt-filled syringe. 29 00:03:32.000 --> 00:03:37.000 Due to the chronically inflammatory changes in the mucous membrane, 30 00:03:37.000 --> 00:03:42.000 it is particularly important in this case that there is no rupture. 31 00:03:42.000 --> 00:03:46.000 Therefore, only a small volume is used for stretching, 32 00:03:46.000 --> 00:03:52.000 which is just enough to be able to insert an 8 mm long ICX implant. 33 00:03:53.000 --> 00:03:59.000 After the stretch with the balloon, the membrane is checked for its intactness again. 34 00:04:01.000 --> 00:04:06.000 You can clearly see how the light of the intraoral camera is reflected on the membrane. 35 00:04:06.000 --> 00:04:09.000 The membrane is now completely intact. 36 00:04:09.000 --> 00:04:12.000 The membrane is now completely intact. 37 00:04:12.000 --> 00:04:15.000 The membrane is now completely intact. 38 00:04:15.000 --> 00:04:18.000 The membrane is now completely intact. 39 00:04:19.000 --> 00:04:26.000 You can clearly see how the light of the intraoral camera is reflected on the intact surface of the sinus floor. 40 00:04:33.000 --> 00:04:39.000 In order to prevent further rupture, a collagen membrane is now inserted. 41 00:04:45.000 --> 00:04:49.000 Now the stuffing of the bone replacement material takes place. 42 00:05:02.000 --> 00:05:08.000 This has also become not only easier, but also safer through the use of piezo technology. 43 00:05:16.000 --> 00:05:22.000 Now the further preparation of the bone and implant bearings can take place according to the drilling protocol of Medentes. 44 00:05:25.000 --> 00:05:29.000 Thanks to the pre-driller tuned to different bone qualities, 45 00:05:29.000 --> 00:05:35.000 you can always achieve a high primary stability even with ICX implants without the use of special bone condensing techniques. 46 00:05:45.000 --> 00:05:49.000 The bone replacement material is now quite satisfactory. 47 00:05:53.000 --> 00:05:59.000 You can clearly see that the bone replacement material is now between the implant tip and the pineal gland. 48 00:06:01.000 --> 00:06:06.000 The individual shape of the balloon can be found in the form of the augmentation. 49 00:06:16.000 --> 00:06:20.000 In order to enable optimal closed healing, 50 00:06:20.000 --> 00:06:26.000 the punched out mucous membrane area is placed back at its removal point and fixed with a cross seam. 51 00:06:33.000 --> 00:06:40.000 In the further course, an ICX-plus implant with a diameter of 3.45 mm and an ICX-mini implant with a diameter of 3.45 mm 52 00:06:41.000 --> 00:06:47.000 and an ICX-mini implant with a diameter of 2.9 mm are placed in the area of ​​1.4 mm. 53 00:07:01.000 --> 00:07:07.000 Good pressure points are well representable in the DVT and help to control the pre-drilling. 54 00:07:10.000 --> 00:07:15.000 An internal sinus lift is also carried out in the area of ​​1.5 mm. 55 00:07:16.000 --> 00:07:22.000 Access to the pineal gland is only possible with piezo instruments from the Intralift set. 56 00:07:23.000 --> 00:07:28.000 Here, too, a soluble collagen membrane and bone replacement material are inserted 57 00:07:28.000 --> 00:07:33.000 before the 10 mm long ICX implant is inserted. 58 00:07:41.000 --> 00:07:46.000 The ICX-mini implants are basically provided with a ball head. 59 00:07:47.000 --> 00:07:52.000 This is relatively firmly screwed to the implant and you can see here 60 00:07:52.000 --> 00:07:57.000 how you can loosen this connection a little with special instruments. 61 00:07:58.000 --> 00:08:03.000 Thus, it is possible, after inserting the implant into the bones, 62 00:08:03.000 --> 00:08:10.000 to easily exchange this ball head through a lock screw. 63 00:08:16.000 --> 00:08:21.000 Despite the optimal implant position, the bone thickness appears to be limited, 64 00:08:21.000 --> 00:08:24.000 especially in the crestal area. 65 00:08:25.000 --> 00:08:29.000 Therefore, the bone spines collected beforehand are mixed with bone replacement material 66 00:08:29.000 --> 00:08:32.000 and stored laterally. 67 00:08:32.000 --> 00:08:38.000 After a controlled tissue regeneration, the augmentation is covered with a collagen membrane. 68 00:08:39.000 --> 00:08:44.000 This case has strengthened my impression that ICX implants are very flexible 69 00:08:44.000 --> 00:08:48.000 and can basically meet all OP indications. 70 00:08:49.000 --> 00:08:53.000 Thanks to the minimally invasive method of balloon-assisted sinus floor elevation, 71 00:08:53.000 --> 00:08:59.000 it was possible to insert an 8 mm long implant at a height of only 3 mm. 72 00:09:03.000 --> 00:09:08.000 Here is the X-ray gynecological conclusion after inserting all three ICX implants. 73 00:09:11.000 --> 00:09:17.000 The red line marks the new course of the sinus floor after internal sinus lift. 74 00:09:20.000 --> 00:09:25.000 My heart, when it comes to implantology, actually belongs to the ceramic implants, 75 00:09:25.000 --> 00:09:27.000 the zirconioxide implants. 76 00:09:27.000 --> 00:09:32.000 Today I like to use ICX when we are looking for alternatives, 77 00:09:32.000 --> 00:09:37.000 because unfortunately we cannot cover all indications with zirconioxide implants. 78 00:09:37.000 --> 00:09:42.000 The great thing about ICX is this large spectrum of platforms. 79 00:09:42.000 --> 00:09:47.000 We have five different diameters and a very sophisticated instrumentarium, 80 00:09:47.000 --> 00:09:51.000 both in terms of prosthetics and also in terms of the input instruments. 81 00:09:51.000 --> 00:09:54.000 And it's really fun to work with it. 82 00:09:54.000 --> 00:09:59.000 We have one failure. For us, the ICX implants are the means of choice.