Chapter 3 – Basic techniques of AQB implant
Book editorial committee
The basic techniques of AQB implant can largely be divided into: one-piece type, one-piece T-type,
two-piece one-stage type, and two-piece two-stage type. The surgical procedures for each of these types
are illustrated in Figure 3-3-1. The steps leading to the formation of implant cavity are the same for eachof these types and conducted using the same AQB implant tools. The tools employed for each steps areshown in Fig. 3-3-2.
This chapter discusses the basic implant techniques, the steps that follow on from the incision anddetachment for AQB implants with reference specifically made to the one-piece type. For further details,
refer to the “AQB implant system manual” if necessary. The main body of this chapter will focus on theoutlines of the techniques and the general notes of caution, but a suitable decision needs to be madespecific to each of the cases as the state of each individual can have significant influences on thetreatment prognosis. The tools are nondurable therefore another set of tools needs to be prepared in order
to avoid panic to arise during the procedure.

1 to 3monthslater

1 piece type

Around 2
weeks later

Around 2
weeks later

Implantation
to suture

Ordinary
impression
takingCompletion ofsuperstructure
equipment

1 piece type

Anesthesia tocompletion ofsprue hole

Implantation
to suture

Ordinary
impression
takingCompletion ofsuperstructure
equipment

1 timemethodCommontasks
Commontools usage

Implantation
to suture

Exclusive
impression
takingCompletion ofsuperstructure
equipment

Implantation
to suture

Second OPE

Exclusive
impression
takingCompletion ofsuperstructure
equipment

Type

Name of product2peicetype2 times
methodFig. 3-3-1 Procedure of AQB implant installing surgery
Name of productType

Name of product

AQB roundbur
AQB drill
guide

Type

Name of product

3SL

AQB
circularknife

AQB endmill
reamer
AQB spiraldrill

4

3

AQB fixer

5

4

5

AQB fixer
support
AQB fixer
support
AQB wrench
free

AQB finger
screwdriver
AQB wrench
free adaptor
3

AQB reamer

AQB direction
checker

AQB alarmgage

4

5

AQB reamer
extension

TypeFig. 3-3-2-a Tool Sets for AQB implantStage of work

Tools

Anesthesia andincision
Marking at punch
stationRound burFinger screwdriver

Perforation of pilot
holes

Drill guide

Fixer extension

Confirm direction ofperforation

Direction checker

Wrench free adaptor
Fixer joint

Reamer extension

Magnify planting hole

Confirm depth anddiameter of planting
holeFinishing of planting
holeCounter drill

Reaming screwdriver *Spiral drill

Endmill reamer

Alarm gage
ReamerRemove gingiva periosteal flap
Planting andimplantation

Circular knife

1 piece1 piece T type

FixerFixer T type

Finishing

Pretreatment ofsuture

Wrench free fixer support

2piece
SOL driver bits
Pawn profiler guide

Pawn profiler

Sub-tool

HEX Screwdriver bits

Torque control

Healing cap(2 times method)

SutureHealing abutment(1 time method)

HEX screwdriver
For micro motor
OptionFig. 3-3-2-b List of tools for AQB implant
I.

Marking the site for perforation

Form a primary indentation with the AQB round bur to mark the centre of the implant cavity and thiscan also act to stabilize the first drilling perforation (Fig.3-3-3).
Having exposed a sufficient amount of alveolar bone surface, rotate the AQB round bur (Engine speed:
400-800 revolution/minute (rpm)) at the centre of the implant cavity to place an indentation withapplication of physiological saline solution. The cavity depth should be to the extent that the blade of theAQB guide drill does not slip out of the hole. Where a significant excavation in the alveolar bone ispresent, alveolar crest preparation may need to be considered.
II. Perforation of pilot hole
The pilot hole should be formed with the AQB guide drill at the implanting position in the direction of its
insert (Fig. 3-3-4).
Place the tip of the AQB guide drill in the indent formed with the round bur, and stand it in the directionof the implantation. Rotate the AQB guide drill (Engine speed: 400-800 rpm) for a hole that corresponds
to the length of the implant insertion under sufficient amount of saline solution.

The accuracy of the perforation hole can be improved with a surgical stent that is usually fabricatedpreoperatively on the study model.

Fig. 3-3-3Marking at the perforation site - Form an indentation
at the centre of the implant cavity by rotating theAQB round bur.

Fig. 3-3-4
Perforation of the pilot hole - Construct a cavity that
corresponds to the length of the implant with AQB
guide drill.
III. Confirming the direction of the perforation
The position, the direction and the space in relation to the adjacent teeth need to be confirmed with AQB
direction checking tool. For multiple installations the factors that are of particular concern are thespacing and the parallel nature of the insertion with respect to the adjacent implant bodies (Fig. 3-3-5). To
prevent the patients from swallowing the structure, pass a thread through the top of the checker, andinsert the narrow probe into the pilot hole formed with the AQB guided drill. Inspect the positioning, thedirection, and its position relative to the adjacent teeth of the cavity. In addition, where multiple
implantations are conducted, examine the parallel nature and the spacing of the cavities. If possible, ask
the patients to close their jaw to gain a rough estimate of the clearance. Where the ideal position,direction, and parallel insertion with multiple implants have not been achieved, the perforation holeshould be prepared carefully from this stage with the aim to recover the ideal structure as much as
possible.
In some bone morphologies, the height of the alveolar crest can become lower than the height before thesurgery with the expansion of the cavity. This should be considered when determining the implant size.
IV. Primary formation of the planting cavity
The expansion of the planting cavity is conducted in a step-wise manner with the AQB spiral drill (Fig.
3-3-6-a).
Under the application of saline solution, rotate the AQB spiral drill (400 -800 rpm) to enlarge the cavity inthe direction of the hole that was initially constructed with the guided drill in a step-wise manner. Thisshould be continued till reaching a diameter that is 0.5 mm less than the diameter of the implant body.
With regards to the length of the cavity, the drilling should be conducted till the groove marking on thedrill blade is hidden within the bone structure. In some of the bone morphologies, perforation should bemade to be 0.5 to 1.0 mm deeper than the length of the implant fixture, S (8 mm), M (10 mm), or L (12mm).
In some the bone structures such as the cortical bone, AQB counter-drill (Fig. 3-3-6-b) is employed as anoption. Drilling with this tool should be conducted by inserting the guide into the cavity at a slower speed,roughly 300 to 600 rpm, for perforating through the cortical bone.

Fig. 3-3-5
Confirm the direction of the perforation.
Assess the position, the direction, and the interval with theadjacent teeth; and for multiple planting, confirm the interval
and its parallel nature with the AQB direction checker.

Fig. 3-3-6-a,bExpansion of the cavity
Guide parta. Perform step-wise expansion of theimplant cavity with AQB spiral drillaV.

bb. AQB counter drills

Expansion of the implanting cavity

The AQB end-mill reamer should be employed to expand the base and axial plane of the cavity (Fig.
3-3-7-a).
Connect the AQB finger driver to the AQB end-mill reamer to drive through to the point at which thegroove marking is hidden within the jaw bone. The key point to note here is to supply the perforating holewith saline solution and to avoid the axis of the end-mill reamer from becoming dislocated. In addition, becareful of the patients swallowing the tools when conducting the procedures.
The blade attached to the tip of the AQB end-mill reamer enables the expansion of the cavities and canperforate through to deepen the hole to some extent, but if the finger driver is lowered to the level of thedental arch becoming in the way of the neighboring teeth, the length of the finger driver can be extended
with the AQB reamer extension driver (Fig. 3-3-7-b).
If the manual operation of the AQB finger driver becomes difficult AQB free-wrench adaptor with AQB
free-wrench is recommended (Fig. 3-3-7-c).
There are methods where the optional AQB reaming drill (Fig. 3-3-7-d) is employed instead of the AQB
end-mill reamer. AQB reaming drill can be operated by attaching the engine specifically for implants, at
400 to 800 rpm, and paying attention not to over-perforate.

Fig. 3-3-7-a~b Expand the cavity
a. The AQB end-mill reamer should be employed to expand the base and axial plane of the cavity
b. If the finger driver is lowered to the level of the dental arch becoming in the way of the neighboring
teeth, the length of the finger driver can be extended with the AQB reamer extension driverc. If the manual operation of the AQB finger driver becomes difficult AQB free-wrench adaptor withAQB free-wrenchd. AQB reaming drill
VI. Verifying the length and the diameter of the implanting cavity
Inspect the depth and the diameter of the implanting cavity with the AQB alarm gauge (Fig. 3-3-8).
Clean the interior of the cavity thoroughly after expanding the diameter with an AQB end-mill reamer,with physiological saline solution to ensure a complete removal of the debris including bone splints.
Thread a string to the top of the alarm gauge to prevent the patient from accidental swallowing, before its
insertion into the planting hole to determine the diameter and the depth of the cavity.
This step should confirm that the complete burial of the HA coated layer of the implant body, both
mesiodistal and especially, in the buccolingual direction is possible. If the depth is inadequate, drill
further into the hole with the use of AQB end-mill reamer, or the AQB spiral drill if necessary. Upon
insertion of the alarm gauge, if there is rattling or a loosely fitted implant, there is a risk ofover-expansion of the hole in the final steps using the AQB reamer. There are situations where thefinishing touches with the AQB reamer should be avoided such as in sparse bone to ensure secure
implantation. Particularly with the maxilla, and in some of the mandibules, implant may need to beconsidered at this stage if the one is sparse.
VII. Final touches to the implant cavity
AQB reamer is used in the final steps of the cavity formation to determine the internal diameter (Fig.
3-3-9-a).
Connect the AQB finger driver to the AQB reamer for the final extension in the axial direction. It isimperative to stabilize the axis of the reamer till the final diameter of the cavity becomes 0.10 mm lessthan that of the implant body. Avoid use of this tool to the bones which are soft and sparse, as this canresult in over-expansion of the cavity. Where the AQB finger driver becomes difficult to operate with theneighboring teeth getting in the way, the length of the tool should be extended with the use of the AQB
reamer extension (Fig. 3-3-9-b). In addition where the AQB finger driver becomes too strenuous in its
operation, apply AQB free wrench adaptor to the AQB free-wrench to conduct rest of the procedure (Fig.
3-3-9-c).

Fig. 3-3-8
Confirm the depth and the diameter of the planting hole.
Insert AQB alarm gauge to the planting hole to confirm the diameterand the depth of the hole.

Fig. 3-3-9 - Completing the implant cavity
a. Employ AQB reamer to finalize the diameter of the hole.
b. Use of AQB reamer extension tool to elongate the AQB finer driver to avoid
getting in contact with the neighboring teeth.
c. If the operation becomes difficult to conduct with the fingers, employ AQB
wrench free adaptor to operate the AQB free wrench.
VIII.

Removal of gingival periosteal flap

Curve out a circle with a circumference corresponding to the implant body cervix, by using AQB circularknife (Fig. 3-3-10).
Restore the gingival periosteal flap to its original position to conduct temporary suture to limit themovement of the gingivae. Under the application of sufficient amount of saline solution, rotate the AQB
circular knife (300-600 rpm) to curve out the gingival periosteal flap covering the top of the cavity (byapplying the temporary suture at an equidistance from the centre of the cavity in the mesiodistal
direction, it can act as the guide for the cutting.)
Alternative tools for the removal include small scalpel, or with a gingival punch.

Fig. 3-3-10 - Remove gingival periosteal flap
Remove gingival periosteal flap in an arch-form with AQB circular knife.

IX.

Installation of AQB implant (One-piece type)AQB one-piece type to be installed into the cavity (Fig. 3-3-11-a,b)
The planting cavity should be thoroughly cleaned with the saline solution before carrying the AQB
implant attached with a silicon cap for its installation into the cavity. A non-metal forceps can be used as
an alternative to apply this into the cavity, or in a state that is attached to AQB fixer.
Implantation can be conducted with using either the AQB finger driver or with the AQB free-wrench.
A. AQB finger driver
Connect the AQB fixer joint or the AQB fixer to the AQB finger driver to subsequently fit the implant
body within the mouth, and install it by screwing it in a rotating motion to the right (Fig. 3-3-11-a).
B. AQB free-wrenchFirst fit the AQB free-wrench, attached with an AQB fixer, to the implant body within the oral cavity.
Next, place the tip of the AQB fixer support or the finger tip onto the hole of the fixer, and slowly rotate
the AQB free-wrench to the right to finally install the implant (Fig. 3-3-11-b).

Fig. 3-3-11-a,b Planting AQB implant (onepiece type)a. Installation with AQB finger-driverb. Installation with AQB free-wrench

The aim of the implant installation should be to cover the HA coating fully within the bone structure, andensure that there are no loose movements of the implant body. If the first attempt to implant had failed
due to reasons such as the cavity size had been too small, it should be cleaned with saline solution toremove blood serum or body fluids and prevent it from drying out before attempting for the second time.

Connect with wrench freeFig. 3-3-12

Connect with fixer

AQB fixer extension