Surgical

Surgical instruments

Only a limited number of instruments are sufficient to perform surgery

  • precision instruments
  • equipped with indicative depth markings
  • colour coded
  • time-saving

Bone preparation

Bone preparation is one of the most important factors determining successful implantation. It must be done precisely and a-traumatically. Implant site determines implant position and its angulation, therefore, defines the final, prosthetic outcome of the treatment.

When using implants the minimal transversal thickness of the bone after removing inappropriate structures should be as follows:

Implant diameter           Transversal thickness 
3.2 mm                             >5.2 mm
3.6 mm                             >5.6 mm
4.2 mm                             >6.2 mm
5.0 mm                             >7.0 mm

Drilling

The Dyna drills are externally irrigated and manufactured from surgical stainless steel. They are tapered and have two cutting edges for effective preparation of the implant site. All drills are marked by laser for easier identification of the preparation depth. The markings correspond with the lengths of the implants. Additionally all drills, on their shafts, have numeric markings of the drill diameter. Drills are available in a short and long version.

 

Using the drilling guide (recommended), initial preparation is made with the pilot drill. Drills are used in the standardized sequence until the desired diameter is reached. The markings on drills allow preparing the site to the exact depth corresponding with the implants’ length (markings must be fully covered beneath the bone).

Use excessive cooling (preventing possible thermal trauma) with sterile saline solution that additionally may be cooled before operation.

Facilitate bone chip removal by using a pump-up-and-down movement with moderate pressure force when drilling.

 

The recommended speed for preparation with Dyna drills and cortical reamers is 800 rpm as, otherwise, there is a risk of overheating the bone. It is however recommended to decrease the preparation speed by 150/200rpm each time the drill is changed to a wider one.

 

 

2.0 mm

800 rpm

3.2 mm

600-650 rpm

3.6 mm

400-500 rpm

4.2 mm

200-350 rpm

5.0 mm

<200 rpm

 

Positioning

The pre-surgical evaluation of implant patients is the first step to avoid interferences between prospective positions of implants, optimize the ideal fixture position and distribute the implants so that they are optimally arranged. However, it is often seen intraoperatively that anatomical situation is different than expected. Dyna parallel/depth gauge instruments enable simple and quick verification of the prepared site. They should be used, similarly to surgical templates, to verify the position and angulation of osteotomies so that the coronal extension would fit within the chosen prosthetic window.

The osteotomy part of the have the same length for all instruments and give excellent orientation during implant placement. Additionally, the gauges can also be used as try-in implants when assessing the extraction socket and/or soft tissues during immediate placement. All instruments have been provided with laser markings for easy identification of length and diameter.

Adjusting the cortical part

Once the implant site has been widened to the desired diameter, its cortical part has to be modified by the cortical reamer to achieve correct insertion of the Dyna Helix. Do not use the cortical reamer for Dyna Helix ST and TM implants or 6mm Dyna Helix DC!. The cortical modification enables atraumatic insertion of the implant without exerting too high forces on the marginal tissues but allows achieving satisfactory primary stability in various bone types. Use the markings on the cortical reamer depending on the implant length. There is a marking for 8mm implants, 10mm implants and implants ≥ 11.5mm. The recommended speed for the implant site preparation with Dyna drills and cortical reamers is 800 rpm as, otherwise, there is a risk of overheating the bone. It is however recommended to decrease the preparation speed by 150/200rpm each time the drill is changed to a wider one.

Tapping

In case of high density bone it is recommendable to tap the implant site before introducing the implant. In order to tap the implant site select the taper corresponding with the final diameter of the implant. Mount it onto the surgical handpiece or the torq wrench (5084G) and prepare, under cooling, the thread for Helix implants. The recommended speed for the implant site preparation is maximum 30 rpm. The instrument should reach the bottom of the implant site (this is not performed in case of a sinus floor elevation). All preparations should be done under excessive cooling (preventing possible thermal trauma) with sterile saline solution that additionally may be cooled before operation.

Seating

The implant packaging clearly indicates the type of implant, diameter and length.

Remove the closing cap from the tube and insert the implant with the octa driver with a slight pressure. Watch out, the implant is freely seated in the tube!

The tapered octagon on the octa driver assures the press-fit connection with the implant. This connection obsoletes the use of the special mounting device resulting in better visual control during implant insertion.

Do not use cooling during implant insertion!

  • Slowly thread the implant into its final position with torque wrench or contra-angle handpiece at a maximum speed of 30 rpm.
  • Position the machined polished collar under the crest.
  • Position the machined polished collar above the crest in case of a Dyna Helix TM implant. In some situations (e.g. to minimize the height above gingiva) the polished collar of the Dyna Helix TM implant may be placed slightly under the crest.
  • Minimal insertion torque for secure primary stabilisation   >25Ncm.
  • If the torque is >50Ncm thread the implant into place manually using the octa driver T.W. with torque wrench (no latch-head!).
  • If the torqueing force >60Ncm, there is a risk of damaging the bone (including overheating).
  • Disconnect the seating instrument from the implant and thread the cover screw.

The Dyna Helix® cover screw is delivered sterile, together with the implant, in the cap of the inner tube. The screw head is 0.35 mm high (1mm for the Dyna Helix TM implant). Tightening should be done with the Dyna Hex driver with 10Ncm or handtight. Helix® cover screws provide an excellent seal and cover during healing.

Please note for Dyna Helix DC / ST

Never overforce the implant into the site, it may lead to destroying the implant itself and/or bone necrosis. The torqueing force must not exceed 60Ncm.

Always stick to the standardized site preparation protocol:

  • sequence of drills,
  • intermittent drilling technique,
  • avoidance of excessive force during preparation,
  • use of sharp drills, reamers and tapping instruments (maximum 20 times per instrument depending on bone quality)
  • excessive cooling with chilled saline
  • adequate rational speed

Never touch the implant by hand. Avoid contaminating the implant with substances other than the blood and bone of the patient.

Never and in no way sterilize or re-sterilize the implant yourself neither with or without the packaging. An implant taken out only of its outer box can be stored, but not more than one month, in a clean and sterile place.

Prevent perforating or destroying vital anatomical structures.

Place the implants in the most favourable position (possibly parallel to one another and axial to bite forces). When placing more than two implants for fixed constructions do not position them in one straight line, and if this is not possible try to use different diameters. For the overdentures try placing the implants following the curvature of the alveolar ridge. Remember about the minimal distance from one another, type of prosthetic construction. The depth of placing should include consideration of biological width and possible initial bone resorption – which influences the papilla formation and the final aesthetic result.

Always thread and tighten the covering screw with the hex screwdriver before suturing the flap.

The large and small rubber rings in the Dyna drivers are subject to wear and tear. Check these regularly on function and replace them if needed.

Please note for Dyna Helix TM

Trans mucosal implants may unwillingly be (over)loaded when providing the patient with immediate restorations. This must be avoided when biomechanical criteria for immediate loading are not met. When using the Dyna Helix® TM implants prevent loading minimally 8 to 10 weeks depending on the patients situation. If possible restrain the denture from the patient the first 14 days after implantation. Always create sufficient space in the denture around and above the cover screws to prevent loading.

Never overforce the implant into the site, it may lead to destroying the implant itself and/or bone necrosis. The torqueing force must not exceed 60Ncm.

Always stick to the standardized site preparation protocol:

  • sequence of drills,
  • intermittent drilling technique,
  • avoidance of excessive force during preparation,
  • use of sharp drills, reamers and tapping instruments (maximum 20 times per instrument depending on bone quality)
  • excessive cooling with chilled saline
  • adequate rational speed

Never touch the implant by hand. Avoid contaminating the implant with substances other than the blood and bone of the patient.

Never and in no way sterilize or re-sterilize the implant yourself neither with or without the packaging. An implant taken out only of its outer box can be stored, but not more than one month, in a clean and sterile place.

Prevent perforating or destroying vital anatomical structures.

Place the implants in the most favourable position (possibly parallel to one another and axial to bite forces). When placing more than two implants for fixed constructions do not position them in one straight line, and if this is not possible try to use different diameters. For the overdentures try placing the implants following the curvature of the alveolar ridge. Remember about the minimal distance from one another, type of prosthetic construction. The depth of placing should include consideration of biological width and possible initial bone resorption – which influences the papilla formation and the final aesthetic result.

Always thread and tighten the covering screw with the hex screwdriver before suturing the flap.

The large and small rubber rings in the Dyna drivers are subject to wear and tear. Check these regularly on function and replace them if needed.

Torque

The Torque Wrench is a device for determining the torque applied to Dyna implants or prosthetic abutments, during seating. The wrench is supplied with a torque scale of max. 70Ncm and can be delivered together with 2 rotor bits. The rotor bit ISO1797/shank (art.no. C8381) is used for all drills and instruments with latch head connection. The rotor bit 4x4mm square (art.no. C8521) is used for all instruments with a T.W. connection. An arrow, and the words IN/OUT on the ratchet head indicate the rotation direction.

See the Torque Wrench enclosure for further instructions. Using the Torque Wrench allows much sensitive primary stabilization assessment.

  • Mechanical damage of latch-head instruments can occur above a torque of 50Ncm. Then use a T.W. instrument/driver in combination with the torque wrench in combination with the rotor bit 4x4mm square.
  • Do not use Hexagonal driver 5181RL in a hand piece with motor, but only in combination with the rotor bit and torque instrument.
  • The choice of the torque in particular case should include recommendations given by Dyna as well as the data from the literature and actual clinical situation.
  • Read enclosure carefully for intended use, cleaning and sterilisation process.

Overgrowing bone

It is not uncommon, especially when placing the implants subcrestally, that bone overgrows the upper part of the implant, reaching the closing screw. When unthreading the closing screw overhanging bone may prevent proper abutment connection. Using the Dyna sulcus reamer allows minimally invasive shaping the supra implant part of the bone and proper abutment connection.

This reamer can only be applied manually. It guarantees secure connection between the implant and all Dyna Octalock abutments, therefore preventing them from loosening or breaking.

Instruments storage

The standard Dyna Helix instrument cassette is used for all Dyna Helix implants. So during operation it is possible to choose the type of implant without opening other instrument cassettes. Because of the Dyna Octalock design all abutments can be used in combination with all Dyna Helix implants. Again a simplicity factor for a minimum number of instruments. Instruments manufactured by Dyna Dental are designed to be simple and universal.

The Dyna Helix instrument cassette is small, only 19,5 x 15 x 5,5 cm which makes it extremly storage-effective.

The tray is made out of polyphenylsulfone (PPSU) and fits in almost all autoclaves.

PPSU has an excellent high heat resistance and excellent hydrolytic stability what makes it an excellent choice for medical devices requiring repeated steam sterilisation.

There is a direct correlation between the precision of an implant system and the long-term results. Therefore tolerances of connections between instruments (eg drills and implants, implants and abutments, Hex screwdriver and fixation screws) are adjusted to realize a perfect fit. The use of original drills and instruments is a must.