I M P L A N T STwo Techniques to Benefit Your Practice with a True Hybrid Implant:

the Skinny 2.4®

Selecting the proper implant for anygiven site should include anticipating surgi-cal anatomic variations as well as prosthet-ic cosmetic challenges. Dental implantdesign has advanced during the past threedecades to provide the profession withmore choices to suit these challenges.

A true hybrid implant is defined as animplant with a diameter of a mini implant,but with full prosthetic versatility.

The Skinny 2.4 offers an implant designthat can be considered the implant of choicefor many clinical case types. It offers thestandard internal hex, with the lead-in bevelthat has the greatest historical success withprosthetic connections.

The Skinny has more component optionsfor aesthetics and function than any otherimplant-to-prosthetic assembly. With theminor diameter of the embedded threadedportion 2.4mm in diameter, the Skinny hasthe minimum diameter that permits stan-dard restorative components.

The cross-sectional blueprint of the implantillustrates that there are no stress or fatiguepoints of less dimension than the original3.7mm internal hex design. That translatesinto a small diameter implant which is asstrong as the original internal hex.

The design of the Skinny requires a coun-tersink drill which ideally places theimplant flush with the osseous crest.Because the minor diameter of the Skinnyis 2.4mm, the final sizing drill is also2.4mm. This yields an osteotomy only0.2mm greater than a 2mm standard pilotdrill in radius or cutting dimension whichoften negates the need for a pilot drill – anadvantage when trying to simplify proce-dures.

FIGURE 1. Pre-operative presentation.Extremely petite 23 year old female withdiminutive bone volume.

FIGURE 2. Locator Drill determines exactlocation and trajectory.

FIGURE 4. The Skinny 2.4 is delivered tothe osteotomy via the vial cap driver.

FIGURE 5. Implant threaded into theosteotomy before final threading; the greendriver confirms angulation.

FIGURE 6. First stage surgical cover screw.The drilling sequence and insertion definesthe Skinny system: as easy as 1-2-3.

FIGURE 7. Flap closed.

FIGURE 8. Panoramic radiograph ofimplant placement.

FIGURE 3. The Skinny Final Sizing Drill.

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REPLACING A CONGENITALLY MISSING LATERAL INCISOR

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Case Presentation

Surgical Phase:The patient is a petite 23 year old femalewith a congenitally missing lateral incisor(Fig 1). She opted for implant placement torestore the edentulous space.The Skinny was chosen due to her diminu-tive bone volume and its hybrid ability to berestored with a variety of options; i.e. zirco-nia abutment, straight abutment, angledabutment, or custom UCLA abutment.Conventional mini implants do not offerthese choices.The site was prepared for the osteotomyusing a Locator Drill to determine angula-tion and trajectory (Fig 2). It was followedby the internally irrigated Final Sizing Drillwhich has a built-in countersink achievinga perfectly mated osteotomy for the lengthof implant chosen. The countersink featurealso prevents overdrilling. (Fig 3).The Skinny was delivered to the osteotomyemploying the “clever” delivery system;the implant/driver assembly is mounted ona vial cap which is digitally started into thesite (Fig 4). If additional torque is required,the cap is removed and the 4mm squaredrive system is used to thread the implant tofinal depth.The green driver (Fig 5) is removed usingthe included 0.050” hex tool. The pre-mounted first stage surgical cover screw isplaced (Fig 6) and the flap is sutured forclosure (Fig 7). A radiograph is taken atthis time to confirm placement(Fig 8). Prosthetic phase:

After three months of submerged healingthe patient is returned for exposure. A tis-sue healing abutment was placed and thegingiva was permitted to heal for an addi-tional two weeks (Fig 9). The healing abut-ment was removed and replaced using theoriginal green surgical driver, which is nowemployed as an impression coping (Fig 10).An impression was taken and a mastermodel was created using an implant analog(Fig 11). A 25˚ angled titanium abutmentwas chosen for this case and was custommilled by the laboratory.

The milled abutment was torqued on to theimplant (Fig 12) and impression was takenfollowing routine crown and bridge tech-nique (Fig 13). The finished crown wasinserted (Fig 14).

Conclusion:The prosthetic replacement of congenitallymissing lateral incisors has historicallybeen a dental challenge. This case demon-strates the need for a small diameterimplant with full prosthetic versatility. Inchallenging cases, or routine cases, theSkinny 2.4 can offer the patient and thepractitioner the benefits of decades ofimplant research and innovation. This casecould not have been accomplished with astandard diameter implant, nor a mini-implant with single attachment. TheSkinny is the perfect hybrid, seamlesslybridging the benefits of a standard diameterimplant with a mini. It makes possible astraightforward procedure yielding excel-lent esthetics, with no compromise instrength.

FIGURE 9. Tissue healing abutment.

FIGURE 11. Abutment ready to be custommilled.

FIGURE 10. Original green driver used asimpression coping.

FIGURE 12. Custom milled abutment readyfor final impression to fabricate crown.

FIGURE 13. Routine crown and bridgetechnique.

FIGURE 14. The finished case.

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When implants are used for a singletooth replacement of the molars, one of thechallenges is to provide enough strength to

withstand occlusal pressure and forces ofmastication. Mesial-distal dimension isalmost always present; however the bucco-lingual dimension may or may not be ade-quate for a single implant to have enoughbony surface contact area to withstandthese forces over time. The two implanttechnique should be considered as a viabletreatment option.

The strength of two implants vs. oneimplant is undisputable. Two Skinnieshave more surface area in contact with bonethan one standard or one wide diameterimplant of the same length. The Skinny canoften be placed flapless when there is anobvious bulk of bone. In treatment plan-ning any case, less surgical trauma isalways preferable, provided no compro-mise in outcome exists.Aesthetics are generally improved over thesingle implant method, because the emer-gence profile of molars is rectangular, notsquare, which lends itself to two circulardimensions instead of one circle in the mid-dle with exaggerated flaring. Using twoimplants with a supragingival furcation canbe restored with maximum cosmeticresults. The pricing of the Skinny, coupledwith the minimal chair time, makes this twoimplant technique as viable as a singleimplant therapy.

Case PresentationSurgical Phase:The patient is 40 year old female of averagebone structure with missing tooth #30 in anotherwise healthy, well maintained denti-tion (Fig 1).Since there was adequate bone both visual-ly and radiographically, the procedure wasdone flapless. The Locator Drill deter-mined the placement and angulation (Fig2), and the Skinny Final Sizing Drill fin-ished both osteotomies (Fig 3). TheSkinnies were digitally delivered toosteotomies using the vial cap driver (Fig4) and threaded to depth (Fig 5). Theprocess was repeated for the second

implant using the driver of the first implantto determine placement and angulation (Fig6-7). Once the second implant was placed(Fig 8), parallelism was confirmed visually

USING TWO HYBRID SKINNY IMPLANTS TO REPLACE A SINGLE MOLAR:1+1=3 IN STRENGTH, FUNCTION AND AESTHETICS

FIGURE 1. Missing tooth #30.

FIGURE 2. The Locator Drill to establishlocation and trajectory.

FIGURE 8. Delivery of the second implant.

FIGURE 5. The implant threaded to finaldepth.

FIGURE 7. Repeating the process with theFinal Sizing Drill.

FIGURE 6. Repeating the process with theLocator Drill.

FIGURE 4. Delivery of the implant to theosteotomy.

FIGURE 3. The internally irrigated SkinnyFinal Sizing Drill.

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by sequential drivers (Fig 9). After threemonths of submerged healing, the implantswere exposed and the tissue healing abut-ments placed (Fig 10). After two weeks,

the tissue healing abutments were removedand drivers were re-seated on the implantsto function as impression copings. Straightabutments were customized and torqued onthe implants (Fig 11). Crowns were fabri-cated and inserted (Fig 12).

Conclusion:Esteemed implantologist Dr. Michael Pikossuggests that a minimum of 2mm of cir-cumferential bone should remain for opti-mal implant integration success. TheSkinny helps maximize the bone volume inthe bucco-lingual dimension.Traditional procedures should be reviewedand revised on a case-by-case basis. Thispatient would not have achieved the sameresult with a single implant. The emer-gence profile of a single implant wouldhave a greatly exaggerated flare whichwould have created food impaction sitesthat are not easily self-cleansing proximateto the transgingival area. The cosmeticswould have been comprimised, and theocclusal forces would be focused on a sin-gle implant instead of distributed betweentwo implants, which could result in failureover time.

When determining a treatment plan, the practitioner would be well advised to thinkoutside the box and consider the Skinnyas the treatment of choice: "1 + 1 = 3."

FIGURE 12. Finished case.

FIGURE 11. Laboratory milled and paral-leled abutments placed ready for final impres-sion.

FIGURE 10. After three months of healing,the tissue healing abutments are threaded.

FIGURE 9. Surgical phase is completed.

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