Cement Retained Restorations

7/30/2019 Cement Retained Restorations

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Cement-retained restorationsProsthetic and laboratory procedures


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By choosing Astra Tech implant system you

are teaming up with nature the best partner

you can have in implant therapy.

Our system is developed with a biological

and biomechanical approach, every detail is

carefully designed to fit together and work in harmony

with human hard and soft tissue. The result is long-term esthetics.

Astra Tech is a company in the AstraZeneca Group, one of the worlds

leading pharmaceutical companies, and we have an innovative spirit

and a strong commitment to science and documentation. The excellent

long-term results of our implant system have been proven in numerous

clinical studies.

Astra Tech Implant System for integrated esthetics


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Cement-retained ZirDesign

TiDesign

Cast-to Abutment

Direct Abutment

Cast-to Abutment

Single

Partial

UniAbutment

Angled Abutment

Cresco

ZirDesign

TiDesign

Cast-to Abutment

Direct Abutment

Removables

Fixed

UniAbutment

Angled Abutment

Cresco

TiDesign

Cast-to Abutment

Direct Abutment

Ball Abutment

Locator Abutment

UniAbutment

Cresco

Cement-retained

Screw-retained

R E S T O R A T I V E O V E R V I E W

Screw-retained

Cement-retained

Screw-retained

Attachment-retained

Bar-retainedFull


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Contents

Prosthetic and laboratory

procedures for Astra Tech

implant system cement-retained

restorations.

Restorative overview 4

Abutment selection 6

Astra Tech Implant System: key features 8

Soft tissue sculpturing 10

Healing Abutment 12

Temporary Abutment 14

Implant-level impression 18

Implant-level working model 22

ZirDesign abutment 26

TiDesign abutment 34

Cast-to Abutment 40

Direct Abutment 48

Miscellaneous

One connection, two sizes 56

One measuring system 56

Torque Wrench 57

Recommended torque 57

Hex Screwdriver 57

Cleaning and sterilization procedures 58


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Abutment selection

Astra Tech implant system includes a wide range o abutments designed to

successully meet every clinical indication. In addition to simply connecting

the crown to the implant, the abutments are designed to:

Transer orces to the implant, minimizing the risk o

overload and ractures

Establish and maintain healthy connective tissue and

epithelial attachment

Resolve dimensional and geometric discrepancies between

crown and implant

Facts to consider when choosing abutment: Indication single tooth, partial bridge or a ull fxed bridge

Upper or lower jaw

Anterior or posterior region

Implant angulations

Marginal bone levels

Sot tissue levels

Occlusal interproximal space

Adjacent teeth and roots

Esthetic demands

Conical Seal Design

Minimizes micro-movements and

micro-leakage

Load distribution reducing peak

stresses

Quick and simple procedure

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Abutments designed for

implant-level impressionIndications Features and benefits

ZirDesignMade of zirconia

Single and partial restorations Anterior, canine and premolar

When the highest esthetic demands arerequired. Can be customized to accommodatemost cervical dimensions and subgingivalmargin location.

TiDesignMade of commercially puretitanium, grade 4

Single, partial and full jaw restorations Suitable for all positions in the mouth

Can be customized to accommodate mostcervical dimensions, subgingival marginlocation and non-axial alignment.Angled versions available.

Cast-to AbutmentMade of non-oxidizing gold alloy


Can be customized to accommodate mostcervical dimensions, subgingival marginlocation and non-axial alignment.Can compensate for angulations up to 30.Suitable for cases with thin soft tissue.Screw-retained option for single toothrestorations.

Benefits of abutments designed for implant-level impression: Freedom to customize or individual design and optimal esthetics

Possibility to adapt the restorative margin to ft esthetic and

biologic considerations

Corrections o angulation problems

Correction o cervical positions

Benefits of abutments designed for abutment-level impression: Simplifed handling procedures, similar to crown and bridge

Procedure perormed by the clinician chair-side in the clinic or reduced

treatment time

Abutments designed forabutment-level impression

Indications Features and benefits

Direct AbutmentMade of commercially puretitanium, grade 4


Easy to handleconventional crown andbridge technique.All parts included in a kit API Kit forprosthetic and laboratory procedures.Occlusal height can be adjusted.The prosthetic margin can be modified oraltered.

Possible to compensate up to 12 between twoimplants (without customization).


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Astra Tech BioManagement Complex

A holistic approachTo design a successful implant system, one needs not only a great deal of

knowledge about biology and mechanics, but also an understanding of

what happens when the two interact. Early on in the development of the

Astra Tech implant system, we realized the value of a holistic approach.

That is why the Astra Tech implant system was uniquely based not only

on a biological but also a biomechanical approach. With the introduction

of the OsseoSpeed surface, we have taken this to the next level by

incorporating biochemistry. Just as in nature, a successful existencecannot be determined by one single element alone. The terms

biomechanics and biochemistry are no longer sufficient as there must

be several interdependent features working together. This interaction is

what we call the Astra Tech BioManagement Complex, which is a unique

combination of the following features:

OsseoSpeed more bone more rapidly

MicroThread biomechanical bone stimulation

Conical Seal Design a strong and stable fit

Connective Contour increased soft tissue contact zone and volume

A successful implant system

cannot be determined by

one single feature alone.

Just as with all natural

systems, the delicate

balance is maintained by

the interaction of different

but equally important

features.


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OsseoSpeed more bone more rapidly

Building on the proven success of TiOblast

, OsseoSpeed

is the firstand only implant in the world with a chemically modified titanium

surface, providing unique nanoscale topography, that stimulates early

bone healing and speeds up the bone healing process. The result of the

micro-roughened titanium surface treated with fluoride is increased

bone formation and stronger bone-to-implant bonding. Together with

MicroThread on the implant neck, OsseoSpeed provides true growing

power in action for more reliable and effective treatment. The clinical

benefits of OsseoSpeed are proven and well-documented.

MicroThread biomechanical bone stimulationThe neck of Astra Tech implants are designed with MicroThread

minute threads that offer optimal load distribution and lower stress

values. This design is based on a thorough understanding of bone physio-

logy, vital to optimal implant design. Since bone tissue is designed to

carry loads, dental implants must be developed to mechanically stimulate

the surrounding bone in order to preserve it, taking into consideration

that the critical point of the implant-bone interface is located at the

marginal cortical bone where peak stresses occur.

Conical Seal Design a strong and stable fitThe Conical Seal Design is a conical connection below the marginal

bone level that transfers the load deeper down in the bone. Compared to

conical connections above the marginal bone level and flat-to-flat designs,

Conical Seal Design reduces peak stresses and thereby preserves the

marginal bone. It also seals off the interior of the implant from

surrounding tissues, minimizing micro-movements and micro-leakage.

Conical Seal Design simplifies maintenance and ensures reliability in all

clinical situations. Whats more, the tight and precisely fitting implant-

abutment relation of the Conical Seal Design makes abutment connection

a quick and simple procedure. The abutment is self-guiding and the

installation procedure is non-traumatic, eliminating the risk of bone

damage.

Connective Contour increased soft tissue contact zoneand volumeThe Connective Contour is the unique contour that is created when you

connect the abutment to the implant. This contour allows for an increased

connective soft tissue contact zone both in height and volume, which

integrates with the transmucosal part of the implant, sealing off and

protecting the marginal bone.

Conical Seal Design

Enables a tight and stableconnection between implant andabutment

Minimizes micro-movements andmicro-leakage

Load distribution reduces peakstresses

Quick and simple procedure

Easy to connect no x-ray needed

Self-guiding for precise seating

OsseoSpeed

More and earlier bone formation

Increased bone-to-implant contactratio

Stronger bone-to-implant interface

Increased safety and reliability forall implant patients

MicroThread

Increases the functional loadbearing capacity at least threefold

Optimal load distribution reducespeak stresses

Preserves marginal bone

Connective Contour

Increases connective soft tissuecontact zone and volume

Seals off and protects the marginalbone


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Provided with the right conditions,nature itself takes care of the soft

tissue sculpturing. The prerequisites

are maintained marginal bone levels

and healthy soft tissues.

With Astra Tech implant system you

can count on optimal soft and

hard tissues.

Predictable successful results

The establishment and maintenance of a soft tissue seal around the

transmucosal part of an implant (i.e. the abutment) is vital for implant

treatment success. The formation of the soft tissue barrier around the

abutment is fundamentally a result of wound healing. Thus, during healing

a barrier epithelium will form adjacent to the abutment and, apical to this

epithelium, a zone of connective tissue will form and attach to the titanium

surface on the abutment to protect the underlying bone tissue. The barrier

epithelium and the connective tissueimplant interface will consequently

establish a certain biological width of the peri-implant mucosa. It is

important that this process takes place undisturbed, without micro-

movements and micro-leakage in the abutment-implant connection, since

this will disturb the healing process and compromise the long term result.

Initial bone healing and long term marginal bone stability are affected by

the implant design and surface properties. Optimal biomechanical and

biochemical stimuli from the implant surface are of utmost importance

for the bone healing process. The long-term marginal bone stability is

primarily dependent on biomechanical stimulation from the implant,

particularly around the implant neck.

This means that a successful clinical result, in both a short-and long-termperspective, is related to the features of the implant. Failing to control these

factors may cause problems such as black triangles between teeth and, in a

worst case scenario, the implant might be lost. Infection or irritation of the

soft tissue can also disturb the healing process and the long term result.

These problems might be caused by factors not related to the implant as

such, but to a lack of maintenance and care by the patient or by his or her

general health status. Very often the problems are caused by the same

factors or circumstances that led to the initial tooth loss.

Our way of safeguarding a reliable, predictable and esthetic result both in

the short and long-term, is with the Astra Tech BioManagement Complex.


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Temporary Abutment or Healing Abutment?

The first step toward an esthetic soft tissue appearance is to decide howto handle the temporary restoration. Depending on patient requirements,

different temporary solutions are available:

Healing Abutment

Permanent abutment with Healing Cap or a temporary crown

Customized Temporary Abutment

These solutions will support the creation and maintenance of a natural soft

tissue contour, which has a decisive impact on the esthetic result.

A temporary restoration can be installed during soft tissue healing or after

it has occurred. You can read more about temporary restorations on the

following pages.

Soft tissue sculpturingWhen it comes to implant treatment, peri-implant soft tissue architec-

ture and texture, in combination with maintained marginal bone levels,

are absolute prerequisites for long lasting esthetic success. Under the

right conditions, nature itself does the major part of the job. Astra Tech

implant system is designed to provide nature with the right conditions;

all of the systems parts work together for reliable clinical success. In fact,

the system offers unrivalled, documented results when it comes to the

maintenance of marginal bone integrity and soft tissue health. The proof

is reflected in the healthy soft tissue around the implant itselfthe resultof a perfect, tight fit at the conical implant-abutment interface.

Why accept bone loss?The maintenance of the marginal bone is crucial both from a functional

as well as an esthetic point of view. Yet, some bone loss is commonly

accepted as an unavoidable consequence of implant treatment. Some

implant suppliers even claim that it is positive and necessary in order to

establish a biological width. At Astra Tech, we have never accepted this

approach because there is no reason for you or your implant patients to

accept bone loss. Preserving marginal bone levels and establishing the

biological width at the abutment level are really all about ensuring the

right stimulation of the bone and promoting healthy soft tissue. Like the

proverbial question, Which came first, the chicken or the egg?, healthy

soft tissue and maintained marginal bone is interdependent. One cannot

exist without the other, because while an important task of the soft tissue

is to protect the bone, the bone must be maintained to help support the

soft tissue, a necessary symbiosis.

Five years follow-upBaseline

Radiographic and histological

analyses show the best evidence of

establishment and maintenance of

osseointegration. The peri-implant

mucosal health is excellent and no

soft tissue complications occur.

The marginal bone levels are ex-

tremely well maintained at the 5-yearfollow-up.

Palmer, R. M. et al. A 5-year Prospective

Study of Astra Single Tooth Implants.

Clin Oral Impl Res 2000;11:179-182

Wennstrm, J.L. et al. Implant-supported

Single- tooth Restorations: A 5-Year Prospec-

tive Study

J Clin Periodontol 2005; 32:567-574


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Healing Abutment

Healing Abutment is a solid one-piece component, designed to provide

optimal esthetic results. The abutment is used or sot tissue contouring

during the sot-tissue healing phase and can be used both or one-stage

and two-stage surgery. Healing Abutment can be used in combination with

a buttery or a removable temporization.

One-stage surgeryHealing Abutment is placed at implant installation. Ater healing,

the abutment is replaced by a permanent abutment.

Two-stage surgeryA cover screw is connected to the implant at installation and covered by the

sot tissue until it is time to replace the cover screw with a Healing Abutment.

Ater healing, the abutment is replaced by a permanent abutment.

Intended use Single, partial or ull jaw restorations

Suitable or all positions in the mouth

For intermediate use only

Features and benefits Sot tissue management

Documented biocompatibility

Dierent diameters and heights or maximized exibility

Design ensures exibility in relation to sot tissue

As an alternative, the Temporary Abutment with a temporary crown can be

used during the sot tissue healing period.

Seating and tighteningThe Healing Abutment is seated in the implant, secured and tightened using

light fnger orce or the Torque Wrench. Recommended torque is 10 Ncm.

Abutment selection

Diameters 4 6.5 mm

Heights 2 6 mm

Sterile

Material

Commercially pure titanium,

grade 4

12

Marked with lines to identify

connection size:

3.5/4.0 marked with 2 lines.

4.5/5.0 marked with 3 lines.


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1. 2.

3. 1.

COMPONENTS:

Healing Abutment Fixture Transfer

Direct Abutment

Healing Cap

Hex Screwdriver

2.

3.

PROSTHETIC PROCEDURE

Healing Abutmentinstallation

1. Install the Healing Abutment with the Hex

Screwdriver. The friction fit will allow easy and

secure handling of the Healing Abutment. Use

light finger force for the seating. Recommended

torque is 10 Ncm. Suture around the Healing

Abutment for a good soft tissue adaptation and

a tight seal.

2. Remove the Healing Abutment after the healing

period.

3. Take an impression as soon as possible after

the Healing Abutment has been removed.

Permanent abutmentwith healing cap or

temporary crown1. The permanent abutment can be used as a

base for the temporary restoration. The abutment

is used in combination with a healing cap or

a temporary crown cemented with temporary

cement. The abutment should be sterilized before

installation. This is a soft tissue friendly procedure

since you dont have to change abutment. Tighten

the abutment according to the standard recom-

mendations using the Torque Wrench.

2. Adjust the healing cap or temporary crown

and ensure that there is no occlusal contact.

Confirm that the healing cap or temporary crown

is seated all the way down on the abutment toensure a tight and secure fit. The healing cap can

also be used as a base to fabricate a temporary

restoration.

Seat with eugenol free temporary cement to avoid

the risk of changes in the chemical composition of

the final cement.

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Temporary Abutment

The Temporary Abutment is a two-piece component which unctions as

a customized base or temporary construction on implant-level. By using

Temporary Abutment the sot tissue can be sculptured in an anatomically

optimal shape, creating a good oundation or an esthetic fnal result.

Temporary Abutment can easily be customized chair-side by the clinician

or in the laboratory by the dental technician. In order to support optimal

sot tissue sculpturing and avoid unnecessary intererence with the

biological process, the customized design o Temporary Abutment should

be as close to the fnal restoration as possible.

Intended use Single, partial or ull jaw restorations


Features and benefits Easy to customize

Optimal design or sot tissue management

Allows or excellent esthetics results

Retention elements or build-up

Components optimized or narrow cases Available in indexed and non-indexed version

or optimal treatment planning

Seating and tighteningThe Temporary Abutment is seated in the implant, secured and tightened

with the Abutment Screw using the Hex Screwdriver or Torque Wrench.

Recommended torque is 25 Ncm. For short-term temporization, the abutment

is seated in the implant, secured and tightened with the abutment screw using

light fnger orce or the Torque Wrench. Recommended torque is 10 Ncm.

Abutment selection

Same design optimized

for each connection size.

Indexed and non-indexed

Material


grade 4

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Temporization

1. Adjust the Temporary Abutment and build it up

with composite chair-side in the clinic.

A prefabricated tooth can also be used.

2. Use a Guide Pin to create the Abutment Screwaccess hole. Finalize the abutment.

Note: For optimal soft tissue healing, polish

the surface of the customized abutment until it is

smooth.

3. The customized abutment is seated in the

implant, secured and tightened with the abutment

screw, using the Hex Screwdriver or Torque

Wrench. Recommended torque is 25 Ncm. For

short term temporization, the abutment is seated

in the implant, secured and tightened with the

abutment screw, using light finger force or Torque

Wrench. Recommended torque is 10 Ncm.

4. Cover the screw head with rubber or cotton

and block the screw access hole with a suitable

material such as composite.

5. Final temporary restoration.

If high esthetics or a long-term temporization is

required, it is possible to fabricate the temporary

restoration in the dental laboratory.

1.

4.

5.

2.

3.

COMPONENTS:

Temporary Abutment(abutment screw included)

Guide Pin

Hex Screwdriver


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LABORATORY PROCEDURE

Customizing TemporaryAbutment

1. Place the Temporary Abutment in the

replica, check the fit and occlusal c learance.

Mark the abutment to prepare for adjustments.

2. Cut down the Temporary Abutment to fit the

clinical situation.

3. Cover the Temporary Abutment with opaque

material. A bonding agent is used to obtain per-

fect bonding between the Temporary Abutment,

the opaque and the acrylic material. Attach the

prepared prefabricated tooth to the silicon key.

4. Block the screw access hole with a guide pin

and attach the prepared prefabricated tooth to

the Temporary Abutment with acrylic or composite

material. It is also possible to use a cold cure

technique or a layering technique.

5. Grind, polish and finalize the temporary resto-

ration. The temporary restoration is secured to the

implant with the abutment screw (included in the

Temporary Abutment package).

6. Final customized Temporary Abutment. Access

to the Abutment Screw makes it easy to perform

the clinical check-ups during the healing process.

1.

3.

5.

6.

2.

4.


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Implant-level impression

Abutments for implant-level impression: Temporary Abutment (when used in the laboratory)

ZirDesign

TiDesign

Cast-to Abutment

The restorative procedure starts with an implant-level impression.

Impression at implant-level oers several advantages:

The quality o prosthetic planning and treatment can be enhanced

Implant angulations can be compensated or at an early stage

Individual anatomic designs can be perormed through abutment

selection and preparation

The Implant Transer or Implant Pick-up ensures precise and easy

impression procedures

Intended use Implant Transer or Implant Pick-up is used or implant level impression

Single, partial or ull jaw impression


Features and benefitsAstra Tech implant system oers the possibility to take both closed tray and

open tray impressions:

Implant Transer or closed tray technique

Implant Pick-up or open tray technique

The transers and pick-ups are two-piece components, available in

dierent heights or dierent clinical situations. In order to achieve optimal

results, impression should be carried out with a rigid impression tray.

Implant Transer has a laser marking indicating implant diameter.

Seating and tighteningThe Implant Transer and Implant Pick-up are seated in the

implant and the pin is tightened using light fnger orce.

Component Selection

Implant Transfer or Implant Pick-up

Short and long versions

Material

Stainless steel

Implant Transfer

Implant Pick-up

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SummaryFollowing healing after implant surgery using either

one-stage or two-stage techniques, the maturation

of the peri-implant mucosa will allow the removal of

the healing abutment and the access to obtain an

impression from the implant level. Fig.1 illustrates

the clinical conditions after the removal of a tempo-

rary abutment and immediately prior to impression.

Please note the thickness of the mucosa that pro-

vides sufficient vertical dimensions for epithelial and

connective tissue attachment to the abutment. Also

note the outline of the mucosal margin, which, in

this case of a single tooth replacement, is controlled

by the attachment level of the adjacent teeth

(fig. 2).

The impression at the implant level is obtained using

either the Implant Transfer (fig. 3) or the Implant

Pick-up (fig. 4). Although the direction of the implant

in the current illustrated case allows the perfor-

mance of a non-angulated geometry of a ZirDesign

abutment, the technique using the implant level

impression offers the opportunity to perform correc-

tions of unfavorable directions when indicated. The

ceramic crown cemented to the ZirDesign abutment

is illustrated in fig. 5.

Professor Tord Berglundh

DDS, PhD

Department of Periodontology,

The Sahlgrenska Academy,

Gteborg University, Sweden

19

1.

3.

2.

4.

5.


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Closed tray impression

1. Before placing the Implant Transfer, make sure

the pin engages the threads in the apical part of

the transfer. The pin should not be visible below

the indexing. If the pin is visible this could prevent

the Implant Transfer from being seated correctly.

2. Use the pin as a carrier to seat the transfer into

the implant.

3. Tighten the Implant Transfer securely into the

implant. Make sure the internal hex is correctly

engaged before tightening the pin. Secure the pin

using light finger force.

4. Prepare a rigid impression tray with space

for the transfer, without interfering with the tray.

Inject elastomeric impression material around the

Implant Transfer and into the impression tray as

soon as possible after the Temporary Abutment or

Healing Abutment has been removed.

5. Take the impression.

6. Lift the tray after the impression material has

set. Unscrew the Implant Transfer.

78. Reposition the Implant Transfer in the impres-

sion. This is most easily done by tightening the

transfer into the Implant Replica and using it as a

handle during the positioning. Check the impres-

sion for correct and stable retention of the Implant

Transfer.

Perform the first registration of jaw relations

to enable mounting of the working model and

opposing model into the ar ticulator.

1.

4.3.

5.

2.

1.

8.

COMPONENTS:

Healing Abutment Implant Pick-up or Implant Transfer

Implant Replica

Hex Screwdriver

6.

7.


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Open tray impression

1. Tighten the Implant Pick-up securely in theimplant. Make sure the internal hex is correctly

engaged before tightening the implant guide pin.

Secure the guide pin with the Hex Screwdriver,

using light finger force.

2. Use a standard or customized impression tray.

Make sure the guide pin can penetrate the tray

without interfering with it. The prepared hole is

covered with wax, which is penetrated by the

guide pin during impression-taking.

3. Inject the elastomeric impression material

around the Implant Pick-up and onto the

impression tray as soon as possible after the

Healing Abutment has been removed.

4. Place the tray filled with impression material

intraorally. Make sure the guide pin penetrates

through the hole made in the tray. Unscrew the

guide pin after the impression material has set.

Make sure that the guide pin is completely dis-

engaged from the implant before lifting the tray.

Check the impression for correct and stable

retention of the Implant Pick-up. Perform the first

registration of jaw relations to enable mounting

of the working model and opposing model into

the articulator.

Immediate placement

5. If immediate placement is preferred, an impres-

sion can be taken before implant installation and

a working model can be prepared. The stone

material is removed from the working model at the

implant position. At implant installation a Implant

Pick-up is tightened into the implant and a transfer

key is attached to the pick-up. By using the trans-

fer key the position of the pick-up is transferred to

the pre-prepared working model. (see page 25).

Select shade

6. Determine the correct shade. The selected

shade and details of the patients oral situation is

sent to the dental laboratory.

1.

2. 3.

4.

5.

6.


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Implant-level working model

Abutments for implant-level impression: Temporary Abutment (when used in the laboratory)

ZirDesign

TiDesign

Cast-to Abutment

The restorative procedure starts with an implant-level impression.

Impression at implant-level oers several advantages:

The quality o prosthetic planning and treatment is enhanced

Implant angulations is compensated or at an early stage

Individual anatomic designs can be perormed through abutment

selection and preparation

Implant Pick-up and Implant Transer ensures precise and easy

impression procedures

When working with an implant-level impression, replicas are used to replicate

the diameter o the installed implant:

Implant Replica 3.5/4.0 Implant 3.5

Implant 4.0

Implant Replica 4.5/5.0 Implant 4.5

Implant 5.0

Implant 4.5 and 5.0 have the same replica since these two implants have the

same inside diameter.

Intended use Implant Replica is used to replicate the corresponding implant

Features and benefits Precise replication o the implant positioned in the mouth

Retention or stable position in the stone material

Replica Selection

Design optimized for

each implant diameter

Material

Stainless steel

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1.

Summary

To ensure an optimal final result, control the impres-

sion and place the selected replica in the impression

pick-up (fig. 1). Make sure that the components fit

correctly together. Secure with the guide pin, use a

Hex Screwdriver and tighten manually.

Prepare for the gingival mask by isolating the area

around the pick-up. Apply the silicone mask prop-

erly in the impression and let it set (fig. 2).

Ensure that the silicone is only applied on theisolated areas. Remove the mask and check it for

correct fit. Pour the stone material, using alfa-hemi-

hydrate stone, into the impression, (fig. 3). For

maximal retention, make sure that the replica is

completely covered with material. After the stone

has hardened, unscrew the Guide Pin and remove

the stone model carefully from the impression.

Control the new working model (fig. 4) and try out

the selected cement-retained abutment.

2.

3.

4.

Christian Erneklint

DT / Assistant professor

Dept. of Prosthetic Dentistry and Dental Material Science

Gteborg University, Sweden

23

1.

2.

3.

4.


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Working modelclosed tray impression

1. The impression tray with the Implant Transfer is

received at the dental laboratory. It is important

that the clinician communicates the information

about placed implant diameter to the dental

technician for correct replica selection.

Placing Implant Transfer

Placing the Implant Transfer in the impression is

done by tightening the transfer into the Implant

Replica and using it as a handle during positioning.

23. Make sure the pin engages the threads in

the apical part of the Implant Transfer. The pin

should not be visible below the indexing. If the pin

is visible, this could prevent the Implant Transfer

from being seated correctly. Tighten the Implant

Transfer securely into the replica. Make sure the

internal hex is correctly engaged before tightening

the pin. Secure the pin using light finger force.

45. Position the Implant Transfer in the impression.

Check the impression for correct and stable

retention of the Implant Transfer.

6. Fabricate a soft tissue mask directly in the

impression. Make sure the soft tissue mask covers

at least 2 mm of the Implant Replica. The soft

tissue mask permits easy access for submucosal

contouring and verification of component seating.

Pour high-quality stone material (type IV stone)

into the impression tray. For correct expansion

of the stone material follow the manufacturers

instructions for use. It is important to use stone

material which features smooth surfaces, excellent

flow, low expansion and an exact reproduction of

fine details.

7. Lift the tray when the stone material has set.

8. Unscrew the Implant Transfer. A high-quality

stone working model with a soft tissue mask and

Implant Replica has been fabricated.

COMPONENTS:

Implant Pick-up or Implant Transfer Implant Replica

Hex Screwdriver

3.

4.

1. 2.

6.

8.

5.

7.6.


25/60

25

Working model

open tray impression1. The impression tray with elastomeric impression

material and the Implant Pick-up is received at the

dental laboratory. It is important that the clinician

passes the information about placed implant

diameter to the dental technician for correct

replica selection.

2. Pull back the guide pin to place the Implant

Replica. Seat the replica on the Implant Pick-up

and tighten the guide pin. To avoid disturbing

the pick-up in the impression material, hold the

replica with a firm grip with a pair of pliers when

tightening the guide pin.

3. Fabricate a soft tissue mask directly in the

impression. Make sure the soft tissue material

covers at least 2 mm of the Implant Replica.

The soft tissue mask permits easy access for

submucosal contouring and verification of

component seating. Pour high-quality stone

material (type IV stone) into the impression tray.

For correct expansion of the stone material follow

the manufacturers instructions for use. It is impor-

tant to use stone material which features smooth

surfaces, excellent flow, low expansion and exact

reproduction of fine details.

4. A high-quality working model with a soft tissue

mask and Implant Replica has been fabricated.

Immediate placement

If immediate placement is preferred, an impres-

sion can be taken before implant installation and

a working model is prepared. The stone material

is removed from the working model at the position

of the implant. At implant installation a Implant

Pick-up is tightened into the implant and a transfer

key is attached to the pick-up (see page 21). By

using the transfer key the position of the pick-up is

transferred to the pre-prepared working model.

5. Seat the Implant Replica on the Implant Pick-up

and tighten the guide pin.

6. Position the transfer key on the pre-prepared

working model. Make sure the pick-up and replica

do not interfere with the model. Pour stone material

around the replica. The model can be used to

fabricate a temporary solution for immediate

placement.

1.3. 4.

1. 2.

5. 6.


26/60

ZirDesignImplant-level impression

ZirDesign is a two-piece component, abricated in zirconia and is easily

customized, providing an anatomically designed prosthetic solution with

high esthetics. The color o the abutment oers a perect base to create

outstanding esthetic porcelain work. ZirDesign works with all existing

crown materials and the crown is preerably seated with glass-ionomer

or composite cement. ZirDesign abutments are also available without pre-

design, ZirAbutment, which ollows the same handling procedures.

Indicated use Single or partial restorations

Anterior, canine and premolar regions

Can be customized to accommodate dierent

cervical dimensions and subgingival margin location

Features and benefits When the highest esthetic results are required

Documented biocompatibility

Zirconia with high mechanical strength

Indexing or easy positioning on all implant diameters

Pre-designed or quick and easy customization Color resembling natural tooth shade

Fire-on technique or esthetic modifcation

Contraindication Not recommended or use in the molar regions

Seating and tighteningThe ZirDesign abutment is seated in the implant, secured and tightened

with the abutment screw using the Hex Screwdriver or Torque Wrench.

Recommended torque is 25 Ncm.

Abutment selection

The design is optimized for each

connection size.

Marginal height: 3.5 mm

Material

Zirconia (yttria-stabilized)

Coefficient of thermal linear

expansion:10.6 x 10-6 K-1

Bending strength:1000 1300 MPa

Fracture toughness: 9-10 MPa m1/2

Modulus of elasticity: 210 GPa

Color: Ivory

26


27/60

1.

2.

3.

4.

Gary Krueger

DDS, CDT

Prosthodontist, Encinitas, CA, USA

Summary

In collaboration with Steve Wheeler, DDS, Oral

Surgeon, Encinitas, CA and Lee Culp, CDT, Mosaic

Studios, Bradenton, FL.

24-year old female, implant placement 4 months

after extraction. No bone or tissue grafts.

1. Soft tissue healing around the Healing

Abutment at 3 weeks.

2. Removal of the Healing Abutment and soft tissue

contour ready for impression.

3. Facial view of the ZirDesign abutment.

4. Final crown 6 weeks after cementation, note the

interdental papillae.

5. Radiograph at second stage surgery before the

implant is uncovered.

5.

27


28/60

28

COMPONENTS:

Healing Abutment or Temporary Abutment Implant Pick-up or Implant Transfer

Implant Replica

ZirDesign (abutment screw included)

Hex Screwdriver


Working model

1. Replicate the clinical situation by fabricating

a high quality stone, type IV working model with

soft tissue mask and Implant Replica.

Note: Make sure the soft tissue material covers at

least 2 mm of the Implant Replica.

Treatment planning

A full wax-up of the restoration can be

fabricated as a guide for achieving optimally

esthetic final results.

Produce a silicone key from the lingual and the

buccal side of the full wax-up. By using a silicon

key it is easier to achieve an accurate preparation

and occlusal clearance of the abutment during

grinding.

2. Position the ZirDesign abutment in the Implant

Replica, secure and tighten it with the Abutment

Screw Design (included in the abutment package).

During the working procedure the screw is tight-

ened with light finger force.

3. Outline the soft-tissue margin, the correct verti-

cal dimension and the mesial-distal width on the

abutment with a fine-tip permanent marker.

4. Buccal view of the ZirDesign abutment with the

margin marked.

5. Approximal view of the ZirDesign abutment

with margin marked.

1.

3.

5.

3.

2.

4. 5.


29/60

29

Customizing abutment

ZirDesign abutments can be prepared hand-heldor secured in the Implant Replica. The Grinding

Handle can also be used.

Note: Use water cooling to avoid micro-cracks.

Do not overheat the component.

Accurate preparation and occlusal clearance of

the abutment is easier to achieve by using

a silicone key during grinding.

6. Grind the abutment by using sintered diamond

disks, diamonds or grinders especially manufac-

tured for zirconia/zirconiumoxide (e.g. Bredent).

It is also possible to use a water-cooled high-speed

unit. Avoid excessive heat development duringgrinding to prevent micro-cracks. Provide ample

water cooling during grinding of the abutment.

A wet sponge can be used during grinding to en-

sure permanent wetting of the area to be ground.

To avoid inhalation of grinding dust, use a mask

and exhaust equipment.

7. Reduce the lingual side by using a diamond

disc or a disc manufactured for zirconia. Main-

tain the strength and retention of the preparation

by leaving as much material as possible on the

buccal side when reducing the lingual side.

8. Prepare the abutment to support the design

of the crown restoration. Standard guidelinesfor crown preparation apply which means that

demands on retention and stability must be met.

During the working procedure and try-in, remove

the abutment axially without bending or turning.

9. Customize the abutment in order to achieve

optimal retention and stability, according to the

clinical situation. Follow standard guidelines for

tooth preparation used when performing regular

crown- and bridgework.

The abutment can be prepared to meet angula-

tions and still give sufficient support as long as

retention is achieved.

6.

5.

3.

7.

8. 9.


30/60

30

A.C.

D.

12 mm

B.

0.81 mm

Optimal abutment design

10. Design the preparation with a shoulder ora chamfer to support the all-ceramic crown.

Be sure to keep rounded inner corners.

A. When preparing for an all-ceramic crown

the shoulder or chamfer preparation should be

between 100120 to support the crown.

B. Maintain a margin of 0.81 mm.

C. Avoid sharp edges and corners to ensure a

good fit between the abutment and all-ceramic

crown. Try to keep the edges rounded with a

radius of 1 mm.

D. The abutment is designed for flexibility increating an ideal soft tissue margin. Maintain the

prosthetic margin just below the soft tissue level

(12 mm).

Note: To ensure the strength and perfect fit of the

ZirDesign abutment:

Do not grind the component below the widest

diameter

Maintain a minimum thickness of the remaining

walls of at least 0.5 mm (except for the insical

area where it can be thinned out)

Any inadvertent grinding below the final crown

margin should be polished, preferably using asilicon rubber wheel and diamond paste.

1 mm100120


31/60

31

13.

14.

Customized abutment

11. Polish the ZirDesign abutment. Any inadver-tent grinding below the final crown margin should

be polished, preferably using silicon rubber wheel

and diamond paste.

12. Place the customized abutment in the working

model and check it in the ar ticulator for correct

preparation and occlusal clearance. Use the

silicone key to help achieve correct design.

When the desired shape for the ZirDesign abut-

ment has been confirmed, the crown restoration

can be fabricated.

A transfer key can be made to simplify positioning

of the abutment in the mouth. Use a material that

is stable and maintains the shape. Light-curedacrylic or pattern resin can be used to fabricate

the transfer key. The key should give a distinct

relation to the abutment, not engaging more than

23 mm of its height. Openings in the key should

permit access to the abutment screws.

Preparing for crownfabrication

13. Block the screw access hole with a suitable

material, such as block-out wax.

14. Apply a die spacer to the final customized

abutment if required. The thickness of the die

spacer should be according to the crown material

and cement used. Apply a spacer up to a

maximum of 1 mm from the preparation margin.

12.

Mer mask

11.


32/60

32

Crown fabrication

15. Fabricate a crown on the abutment.The ZirDesign abutment works with all existing

crown materials. It is important to work with

high quality materials to ensure a precise fit

and an esthetic result. Follow the manufacturers

instruction for use.

Clean and make the customized abutment and the

all-ceramic crown ready for delivery to the clinic.

Sandblast with aluminum oxide 50 m with 2 bar

pressure over the crown margin.

Note: Zirconia cannot be etched. To bond to

the abutment, keep the surface rough. This will

provide the necessary mechanical retention.

Fire-on technique

1617. ZirDesign abutment may be individual-

ized to a perfect anatomical shape and natural

shade by minor porcelain modification around the

margin. Use a porcelain that corresponds with the

abutment coefficient of thermal linear expansion,

according to the porcelain manufacturers recom-

mendation.

ZirDesign abutment

Coefficient of thermal linear expansion:

10.6x10-6 K-1

Keep the surface of the abutment just above theimplant, free from porcelain, to ensure a good fit

between the components and in order to create

and maintain natural, healthy soft tissue.


Cleaning and sterilization

1. Before installation the ZirDesign abutment must

undergo a cleaning and sterilization process. The

cleaning should preferably take place in an ultra-

sonic unit with a mixture of dishwashing detergent

and water.

Note: Do not steam-autoclave the ZirDesign

abutment (or ZirAbutment). This process

can affect the mechanical properties of zirconia.

A cold sterilization procedure is recommended.

16.

1.

15.

17.


33/60

33

5.

7.

2. Abutment installation

2. Remove the temporary restoration and installthe ZirDesign abutment. To ensure correct posi-

tion try-in the crown or use a transfer key before

final tightening of the abutment screw.

Note: If a try-in is performed, make sure to remove

the abutment axially without bending or turning.

Use finger light torque for seating during try-in.

3. Tighten the abutment in the implant with the

abutment screw. Recommended torque for final

seating is 25 Ncm. Use the Hex Screwdriver or

Torque Wrench.

4. Cover the screw head with rubber or cotton

before the screw entrance hole is filled with asuitable composite material.

Cementation

5. Cement the crown onto the abutment.

The permanent cementation can be done with

glass-ionomer or composite cement depending

on type of restoration. The cementation technique

should be adapted to the restoration of choice

according to the cement manufacturers instruc-

tions for use.

Note: Zirconia cannot be etched. To bond to

the abutment, keep the surface rough. This will

provide the necessary mechanical retention.

6. Remove excessive cement.

7. Final restoration.

3.

5.

4.

6.


34/60


35/60

3.

4.

Professor Lyndon Cooper

DDS, PhD

Department of Prosthodontics,

The University of North Carolina

at Chapel Hill School of Dentistry

Chapel Hill, N.C. USA

SummaryFollowing planning for tooth replacement that

included diagnostic waxing on articulated study

casts and tomography to identify the position of the

inferior alveolar nerve, an Astra Tech 4.5 x 13 mm

implant was placed by a one-stage procedure into

the left mandibular first premolar site.

After 8 weeks of healing, excellent soft tissue

healing around the Zebra Healing Abutment is

observed (fig. 1) and osseointegration is clinically

confirmed. After the Healing Abutment is removed,

the soft tissue integration is fully revealed (fig. 2).

Note the supracrestal development of healthy peri-

implant mucosa without soft tissue impingement ofthe implant/abutment interface and a lack of inflam-

mation or bleeding.

Restoration begins with placement of a TiDesign

abutment (25 Ncm) that positions the restorative

margin correctly from the implant/abutment inter-

face and retains a minimum dimension of

1.5 mm biological width along the abutment

surface (fig. 3).

An aluminous core ceramic crown is fabricated and

cemented onto the abutment using glass ionomer

cement with the margin located minimally beyond

the peri-implant mucosal sulcus (fig. 4).

Radiograph of the abutment in place (fig. 5).

35

1.

2.

3.

4.

5.


36/60

36

1.

5.

4.

6.

6.


Working model



soft tissue mask and Implant Replicas.


least 2 mm of the Implant Replica.

Abutment selection

2. Measure the soft tissue mask using the

Abutment Depth Gauge mm to be able to select

the appropriate TiDesign abutments. Use the

corresponding gauge for Implant 3.5/4.0 and

4.5/5.0 respectively.

Marginal height buccal 1.5 and 3.0 mm

Marginal height lingual 2.5 and 4.0 mm

Abutment diameters 4.5, 5.5 and 6.5 mm Angled version

Marginal height 3.5 mm

3. Tighten the appropriate TiDesign abutments in

the implant replicas and check for fit with the soft

tissue mask.

4. Check for fit without the soft tissue mask.


5. Outline the soft-tissue margin, the correct

vertical dimension and the mesial-distal width on

the abutments, using a fine tip permanent marker.

6. Unscrew the abutments from the working model

and mount them in the Grinding Handle.

The handle works as a support during grinding.

7. TiDesign abutment with marked lingual reduc-

tion, mounted in the Grinding Handle.

8. Grind the abutments using grinders especially

manufactured for titanium (e.g. Bredent).

The vertical dimension is reduced with a disk.

3.

COMPONENTS:

Healing Abutment or Temporary Abutment Implant Transfer or Implant Pick-up

Implant Replica

TiDesign (abutment screw included)

Hex Screwdriver

Grinding Handle

7.

2.

8.8.


37/60

37

9.

12.11.

13.

9. Customize the abutments in order to achieve

optimal retention and stability, according to the

clinical situation. Follow standard guidelines fortooth preparation used in regular crown and

bridgework. A chamfer or shoulder preparation

is recommended. Create the crown margin, which

is normally placed 1-2 mm below the soft tissue

margin. The abutments can be prepared to meet

angulations and still give sufficient support as long

as retention is created.

10. Place the abutments in the working model and

check for optimal design.

11. Make sure there is occlusal clearance and

that the abutments have sufficient space to be able

to create an esthetic bridge restoration.

Preparing forbridge fabrication

12. Block the screw access holes with a suitable

material such as block-out wax. The customized

abutments are painted with cement spacer.

The thickness of the cement spacer should be

according to the crown material and cement used.

Make sure to stay 1mm away from the customized

margin.

Bridge fabrication

13. Fabricate the bridge framework. A metal

framework fabricated on the abutments using

regular wax-up technique is recommended.

14. Invest and cast the framework according to

the manufacturers instructions for use.

15. Devest and grind the framework and make

sure there is an optimal fit on the abutments in the

working model.

Transfer key and try-in

16. A transfer key can be made to simplify the

abutment positioning in the mouth. Use a material

which is stable and retains its shape. Light-cured

acrylic, pattern resin or a low noble alloy can be

used to fabricate the transfer key. The key should

give a distinct relation to the abutment, not engaging

more than 2 3 mm of its height. Openings in the

tray should permit access to the abutment screws.

A try-in can be performed.

Send the customized abutments with the frame-

work to the clinic for try-in.

14.

15. 16.

10.


38/60

38

1.

2.

3. 5.

4.


Temporary restorationFor optimal soft-tissue sculpturing, a temporary

restoration should be supplied. It can be altered

during the healing phase for correct soft-tissue

guidance. If the abutments are left in the mouth

together with a temporary bridge, an impression

should lift the bridge framework and the sub-

sequent work will be carried out on a new model.

Make sure that this new model provides informa-

tion about the soft tissues surrounding the bridge.

This is important for a correctly outlined porcelain

build-up. The bridge is completed in

the laboratory.

Try-in1. Try-in the framework in the mouth to confirm

a passive fit and an appropriate design for func-

tional contacts and optimal soft-tissue situation.


Porcelain build-up

1. Prepare the framework for porcelain build-up

by cleaning, sandblasting and adding the opaque

material.

23. Build up the porcelain according to the

manufacturers instruction for use.

4. Final bridge restoration.

Finalize abutments

5. Sandblast, grind or polish the abutments

according to the clinicians preference. When

sandblasted, the retention to the cement increases.

Sandblast the part above the margin using

aluminum oxide, grit size: 50 m.

Keep 0.5 1 mm around the margin polished

and make sure the surface against the soft tissueand into the implant remains the same as it was

originally.

Clean and prepare the customized TiDesign

abutments and bridge for delivery to the clinic.

1.


39/60

39

1.

2.

5.

3.


Cleaning and sterilizationBefore installation the TiDesign abutment must

undergo a cleaning and sterilization process.

The cleaning should preferably take place in an

ultrasonic unit with a mixture of dishwashing

detergent and water. Steam-autoclave the abut-

ment according to the autoclave manufacturers


1. Remove the healing abutments.

Abutment installation

2. A transfer key is recommended to ensure the

accurate positioning of the TiDesign abutments.Tighten the abutment screws using the Hex

Screwdriver.

3. Try-in the bridge in the mouth. The try-in should

confirm a passive fit and an appropriate design

for functional contacts and an optimal soft tissue

situation.

4. Tighten the abutment screws using the Hex

Screwdriver or Torque Wrench. Recommended

torque is 25 Ncm.

Cementation

5. Cement the bridge onto the abutments.The permanent cementation can be done with

glass-ionomer, composite or phosphate cement

depending on the type of restoration. Temporary

cement can also be used.

The cementation technique should be adapted to

the restoration of choice according to the cement

manufacturers instructions for use.

4.


40/60

Cast-to AbutmentImplant-level impression

Cast-to Abutment is recommended or abrication o a customized abutment

using regular wax-up and cast-to technique. It provides great exibility or

creating excellent individualized esthetics even i the sot tissue is very thin.

Cast-to Abutment is also useul when you have to solve complicated cases,

such as when compensation or misalignment and angulations o implants

is necessary.

Intended use Single, partial and ull jaw restorations


Can be customized to accommodate to most cervical dimensions,

subgingival margin location and non-axial alignment

Features and benefits When high esthetic results are required

Can be customized or optimal esthetic restoration

Can compensate or angulations up to 30 degrees

Screw-retention option or a single tooth

Available in two versions; indexed and non-indexed oroptimal treatment planning

Possibility or porcelain modifcation or esthetic demands

Seating and tighteningThe Cast-to Abutment is seated in the implant, secured and tightened with

the Abutment Screw using the Hex Screwdriver or Torque Wrench.


Abutment selection

Design optimized for each

connection size.

Indexed and non-indexed

Material

Non-oxidizing gold alloy:

Au 60%, Pt, 24%, Pd 15%, Ir 1%

Melting range:

1400 1460C/25522660F

Coefficient of thermal

linear expansion:

25 500C 12.3 (10 6/C)25 600C 12.7 (10 6/C)

40


41/60

1.

Summary

The emergence profile of implant-supported restora-

tions has become increasingly important in the

dentistry field in recent years. In addition to correct

placement of dental implants in the maxilla, it isalso important to take into account the bone mass

condition and morphology of the periodontium.

For the past five years the University of Heidelberg

has used abutments (the Cast-to Abutment) with

a ceramic bevel to create the emergence profile

of Astra Tech implant-carried restorations.With a

castable abutment from Astra Tech, after casting

a fusible metal alloy, a ceramic step of individual

color and form was placed in the cervical area.

Through this procedure, we consider not only the

esthetic qualities of the restoration, but also the

possibility of optimum hygiene of the soft tissue sur-

rounding the restoration. In order to create an ideal

soft tissue situation, a provisional restoration has to

be applied. After this, the final restoration is madewith a crafted subgingival ceramic bevel fixed to

the abutment. The prosthetic option on the abutment

is a metal-ceramic or a full-ceramic crown.

By adapting the emergence profile to the cross

section of the tooth to be replaced, significantly

better hygiene is possible compared to a rounder

cross section, resulting in completely non-irritated

soft tissue.

1. Healing Abutment.

2. Soft tissue situation.

3. The abutment after installation with a fused

ceramic bevel.

4. Restoration after cementation.

5. Radiological control after 5 years.

2.

3.

4.

5.

Dr. Helmut G. Steveling*

Dr. Luis Gallardo-Lpez**

* Department of Oral and MaxillofacialSurgery, University of Heidelberg

** Catholic University of Honduras,

Department of Oral Surgery

41


42/60

42

0.6 mm


Working model



soft tissue mask and replica.


least 2 mm of the replica.

Place the Cast-to Abutment into the replica, which

comprises the base for a customized abutment

build-up.

Wax-up andcustomizing abutment

2. Adjust the vertical dimension of the abutment to

suit the clinical situation.

3. Wax-up and customize the abutment in order to

achieve optimal retention and stability, according

to the clinical situation. Follow standard guidelines

for tooth preparation, used in regular crown and

bridgework. A chamfer or shoulder preparation is

recommended. Create the crown margin, which

is normally placed 12 mm below the soft tissue

margin.

The abutment can be prepared to meet angula-

tions and still give sufficient support as long as

retention is present.

4. Make sure the wax-up is thick enough to avoid

a miscast. Approximate wax thickness is 0.6 mm.

5. Check the wax-up for occlusal and lingualclearance, allowing enough crown material in all

directions.

COMPONENTS:

Healing Abutment or Temporary Abutment Implant Transfer or Implant Pick-up

Implant Replica

Cast-to Abutment (abutment screw included)

Hex Screwdriver

Grinding Handle

1.

3.

4.

3.

2.

5.


43/60

43

6.

9.

7.

10.

8.

Invest, burnout and cast

6. Prepare the Cast-to Abutment for investing.Position the wax sprue to the thickest part of the

wax-up to avoid a miscast.

7. Invest the customized abutment. Pour the

investment material and let the investment fill the

screw access hole from underneath and up.

Note: Do not use a wetting agent during

investment of the Cast-to Abutment.

8. Burn-out and cast the abutment according to

the alloy manufacturers recommendation. Use an

alloy compatible with the Cast-to Abutment alloy.

Note: The cast-on alloy must have a castingtemperature that is below the solidus

(1400C/2552F) of the Cast-to Abutment.

Material

Non-oxidizing gold alloy:

Au 60%, Pt, 24%, Pd 15%, Ir 1%

Melting range:

1400-1460C/2552-2660F


25500C 12.3 (10-6/C)

25600C 12.7 (10-6/C)

The Cast-to Abutment absorbs a lot of heat duringburnout and casting. Make sure to compensate

for this by:

Increasing the time for the burnout and

preheating procedures

Raising the temperature slowly and increase

the final burn-out temperature by approximately

100C

Customized abutment

9. Devest the customized Cast-to Abutment using

glass beads. Make sure the screw access hole is

free from investment material.

10. Grind the abutment and make the finaladjustments.


44/60

44

Crown restoration

11. Block the screw access holes with suitablematerial. Fabricate the crown restoration of

choice. Apply cement space according to the

crown restoration.

12. Different crown materials can be used for

single tooth or bridge restorations on implants in

combination with the Cast-to Abutment.

Finalizing abutment

13. Sandblast, grind or polish the abutment

according to the clinicians preference. When

sandblasted, retention to the cement increases.

Sandblast the part above the margin using

aluminum oxide, grit size: 50 m.Keep 0.51 mm around the margin polished and

make sure the surface against the soft tissue and

into the implant remains the same as they were

originally.

14. Final customized Cast-to Abutment. Clean and

make the customized Cast-to Abutment and crown

ready for delivery to the clinic.



Before installation, the Cast-to Abutment must


The cleaning should preferably take place in

an ultrasonic unit with a mixture of dishwashing

detergent and water. Steam-autoclave the abut-



1. Remove the Healing Abutment or temporary

restoration.

2. Tighten the abutment in the implant with the

Abutment Screw. Recommended torque for final

seating is 25 Ncm. Use the Hex Screwdriver or

Torque Wrench.

11.

3.

12.

13. 14.

1. 2.


45/60

45

0.6 mm

Cementation

3. Cement the crown onto the abutment.The permanent cementation can be done with







4. Final customized Cast-to Abutment with crown

restoration.


Fire-on technique

For esthetically demanding cases or when screw

access is required, it is possible to do porcelain

modification on the Cast-to Abutment.

1. Fire the porcelain onto the cast-on alloy, which

has the same coefficient of thermal linear expan-

sion as the porcelain. If porcelain is fired directly

onto the Cast-to Abutment, cracks will occur. The

thickness of the cast-on alloy needs to be at least

0.6 mm after grinding.

Cast-to Abutment


25500C 12.3 (10-6/C)

25600C 12.7 (10-6/C)

2. Opaque and build-up pink porcelain to the

Cast-to Abutment when working with esthetically

demanding cases.

3.

3.

4.

1. 2.


46/60

46

Screw-retained abutment

3. Design a customized Cast-to Abutment withscrew access hole if required. This will allow

easy access to the abutment screw after clinical

installation.

Bridge restoration

The laboratory procedure for a bridge restoration

is similar to a crown restoration with some

additional considerations:

4. A transfer key can be made to simplify the

abutment positioning in the mouth. Use a material

which is stable and keeps its shape. Light-cured

acrylic, pattern resin or a low noble alloy can be

used. The key should give a distinct relation to theabutment, not engaging more than 23 mm of its

height. Openings in the key should permit access

to the abutment screws.

A try-in can be performed. The framework,

together with the customized abutments is sent to

the clinic for try-in.


Temporary restoration

For optimal soft-tissue sculpturing, a temporaryrestoration should be supplied. It can be altered

during the healing phase for correct soft-tissue

guidance. If the abutments are left in the mouth

together with a temporary bridge, an impression

should lift the bridge framework and the sub-

sequent work will be carried out on a new model.

Make sure that this new model gives information

about the soft tissues surrounding the bridge. This

is important for a correctly outlined porcelain

build-up. The bridge is completed in the labora-

tory with porcelain firing and finishing.

Try-in

1. Try-in of the framework in the mouth shouldconfirm a passive fit and an appropriate design

for functional contacts and an optimal soft-tissue

situation.

The customized Cast-to-Abutments and the frame-

work are sent back to the dental technician for

final porcelain build-up.

3.

4.

3.

1.


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Final bridge restoration1. Finalize the bridge restoration and the custom-

ized Cast-to Abutments. Prepare the restoration for

delivery to the clinic.



Before installation, the Cast-to Abutments must


The cleaning should preferably take place in an

ultrasonic unit with a mixture of dishwashingdetergent and water. Steam-autoclave the abut-



The prosthetic procedure for a bridge restoration

is similar to a crown restoration with some

additional considerations:

1. Remove the Healing Abutment.


2. A transfer key is recommended to ensure the

accurate positioning of the Cast-to Abutments.

Tighten the abutment screws using theHex Screwdriver.

3. Try-in the bridge in the mouth. The try-in should

confirm a passive fit and an appropriate design

for functional contacts and optimal soft tissue

situation.

4. Tighten the abutment screws using the

Hex Screwdriver or Torque Wrench.


Cementation

5. Cement the bridge onto the abutments.

The permanent cementation can be done withglass-ionomer, composite or phosphate cement






1. 2.

5.

3. 4.

1.


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Direct AbutmentAbutment-level impression

Direct Abutment is designed to meet the clinicians demands or conven-

tional procedures and restorative simplicity. The abutments are available in

dierent diameters and heights, mimicking preparations o natural teeth,

which provides the opportunity create great esthetics or all teeth positions.

All necessary components are delivered in a practical API kit with all parts

included.

Intended use Single, partial and ull jaw restorations


Features and benefits Documented biocompatibility

Conventional crown and bridge technique

Snap-on impression at abutment level

Special versions designed or narrow cases

Freedom to position the restorative margin

Possibility to adjust occlusal height

API all parts included in a kit or prosthetic and laboratory procedures

Flat side or anti-rotation o single crowns

ContraindicationDirect Abutment is not recommended or cases with extensive

misalignment or problems with angulations.

Seating and tighteningThe Direct Abutment is seated in the implant, secured and tightened using

the Hex Screwdriver or Torque Wrench. Recommended torque is 25 Ncm.

Abutment selection

3 diameters

4 different heights

Material


grade 4

48


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4.

David L. Guichet

DDS

Private Practice Prosthodontics

Orange, California, USA

Part-time faculty Prosthodontics,

UCLA School of Dentistry

Summary

Working with the Direct Abutment is almost as simple

as working with conventional restorative dentistry.

As one of the first clinicians using the Direct Abut-

ment, Dr. Guichet has completed several cases.

The clinical procedures and the successful outcome

of a single-unit restoration using the Direct Abutment

is demonstrated in this case.

1. Healing Abutment placed on FixtureMicroThread 3.5 in upper right lateral

incisor (12).

2. Fine healing is apparent after removal of the

Healing Abutment.

3. Direct Abutment in place showing appropriate

height. Optional height adjustment not necessary.

4. An esthetic result is achieved using the

Direct Abutment Kit and regular crown and bridge

working procedures.

5. Radiograph of Direct Abutment in place.

5.

49

1.

2.

3.

4.


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50

1.

2.

3.

5.


Abutment selection

1. Measure the thickness of the soft tissue usingthe Abutment Depth Gauge mm. Use the corre-

sponding gauge for Implant 3.5/4.0 and 4.5/5.0

respectively.

2. Select the ideal size of Direct Abutment consid-

ering diameter and vertical height.


The Direct Abutment Kit is delivered non-sterile.

Before installation the Direct Abutment and the

Carrier must undergo a cleaning and sterilization

process. The cleaning should preferably take

place in an ultrasonic unit with a mixture of

dishwashing detergent and water. Steam-auto-

clave the abutment according to the autoclave

manufacturers instruction for use.

Note: Do not autoclave the Impression Pick-up.

3. Attach the Carrier to the Direct Abutment

after sterilization. Verify the orientation of the

flat surfaces and seat firmly. The abutment has

a lasermark for easy identification.


4. Install the abutment into the implant.

5. Fit the Torque Wrench directly on the carrierand tighten the abutment. Press downwards on

the carrier during this procedure. Recommended

torque is 25 Ncm.

COMPONENTS:

Direct Abutment API Kit Direct Abutment

Carrier

Impression Pick-up

Direct Abutment Replica

Healing Cap

Burnout Cylinder

Hex Screwdriver

4.


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51

6.

8. 9.

10.

11.

6. As an alternative, the Torque Wrench Bit Hex

may be used for all Direct Abutment 5 and 6.

For Direct Abutment 4 and Ultra, the

Direct Abutment Metal Carrier 4, can

be used.

7. Retrieve the Carrier.

Abutment-level impression

8. Take an impression at abutment-level. Align the

flat surface of the abutment with the raised dot on

the Impression Pick-up and seat firmly by snap-

ping it into place.

9. Use a closed tray impression technique.

Inject elastomeric impression material and take

the impression according to regular working

procedures.

Color-codingImpression Pick-up

Direct Abutment 4 white

Direct Abutment 5 grey

Direct Abutment 6 blue

Note: Impression Pick-up cannot be used when

occlusal reduction is more than 1 mm, or when

the tapered aspect or shoulder have been

customized.

Temporization

When working with Direct Abutment the abutment

can be used as a temporary solution in combina-

tion with a healing cap or a crown cemented with

temporary cement. This is a softtissue friendly

procedure since you dont have to change

abutments.

10. Snap the Healing Cap onto the Direct

Abutment. Align the flat surface of the abutment

to the beveling of the Healing Cap. For further

retention, temporary cement can be used.

Make sure the cap is seated all the way down

on the abutment to ensure a tight and good fit.

11. The Healing Cap can also be used as a base

to fabricate a temporary restoration. Seat with

eugenol free temporary cement to avoid the risk

of changes in the chemical composition of the

final cement.

7.


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5.4.


Working model1. Seat the Direct Abutment Replica in the Impres-

sion Pick-up. Verify the orientation of the flat

surface to ensure the correct position. The replicas

have laser markings to simplify identification.

2. Replicate the clinical situation by fabricating a

high quality stone, type IV working model with a

soft tissue mask and Direct Abutment Replica.

Note: Make sure a soft tissue material covers at

least 2 mm below the margin of the abutment.

Crown fabrication

3. Position the Direct Abutment Burnout Cylinder

on the replica. Align the flat surface of the replica

with the chimney of the Burnout Cylinder. The

Burnout Cylinder has a built-in cement space. If a

regular wax-up is made onto the abutment use a

proper cement spacer on the replica to block out

the retention groove.

4. Fabricate the crown restoration, following

regular working procedures for PFM crown.

Wax-up the framework on the Burnout Cylinder.

Make sure to cover the cylinder with a wax layer

to allow the plastic in the cylinder to expand

during burnout procedures. Invest and burnout.

Note: Do not burnout the wax and plastic too

quickly. It is important to allow the plastic material

in the Burnout Cylinder to boil and melt out from

the investment material. This is different from wax

that just melts and burns at very low temperature.

5. Devest the framework using glass or plastic

beads.

6. Adjust and make the final corrections to the

framework. Prepare the framework for porcelain

build-up.

7. Porcelain build-up.

8. Make final adjustments, glaze and complete

the crown.

Final crown restoration

9. Final result. Clean and prepare the crown for

delivery to the clinic. (Image: opposite page.)

3.1.

2.

1.

2.

1.6. 7.

8.


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Cleaning and sterilizationClean and sterilize the crown according to the

crown manufacturers instruction for use.

Cementation

1. Cement the crown onto the abutment.

The permanent cementation can be done with


depending on the type of cement. Temporary

cement can also be used. The cementation

technique should be adapted to the restoration

of choice according to the cement manufactures


If preferred, the Direct Abutment can be sand-

blasted to increase the retention of the cement.

Sandblast the part above the margin using alu-

minum oxide, grit size: 50 m. Keep 0.5 1 mm

around the margin polished and make sure the

surface against the soft tissue and into the implant

remains the same as it was originally.

Occlusal reductionabutment

The Direct Abutment allows for quick and easy

reduction of the occlusal height. The laser-etched

band on the abutment and corresponding replicaprovide precise indicators when 1 mm reduction

is sufficient.

2. Reduce the abutment just below the laser

marking, remove the marking on the abutment.

The technician will reduce the Abutment Replica

just above the laser markingkeep the laser

marking on the replica. This will ensure a perfect

fit of the final crown.

Note: The design allows up to 1 mm reduction, at

the laser marking, while maintaining the friction

grip of the Carrier.

3. Take an impression using the Impression

Pick-up and a closed tray.

Note: It is important to inform the dental

technician about the occlusal reduction.

4. The Healing Cap can be used on the abutment

with reduced height.

3.

2.

4.

9. 1.

2. 3.


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1. 2.

3.

2.

3.

1.

4.


Occlusal reduction replicaThe Direct Abutment allows for quick and easy

reduction of the occlusal height. The laser-etched

band on the abutment and corresponding replica

provide precise indicators when 1 mm reduction

is sufficient.

1. Reduce the Abutment Replica just above the

laser markingkeep the marking on the replica.

The clinician has reduced the abutment just below

the laser marking and removed the marking on

the abutment. This will ensure a perfect fit of the

final crown.

2. Seat the Direct Abutment Replica in the Impres-

sion Pick-up. Verify the orientation of the flat

surface to ensure the correct position. The replicas

have laser markings to simplify identification.

Replicate the clinical situation by fabricating a

high quality stone, type IV working model with

soft tissue mask and Direct Abutment Replica.

3. Fabricate the crown restoration following

standard working procedures.



Use he following procedure when more extensive

modification of the Direct Abutment is required

or a customization of the restorative margin is

needed.

1. Customize Direct Abutment to optimal shape.

2. Grind to eliminate the snap-on groove.

Note: The groove must be removed to prevent

fracture when the stone model is separated from

the impression.

3. Connect the abutment and tighten it into theimplant firmly, using the Carrier. Recommended

torque is 25 Ncm.

Note: The Carrier may not provide full retention

on the customized abutment.

4. Take a standard crown and bridge impression

and ensure shoulder exposure.

Note: The Impression Pick-up cannot be used after

extensive modification of the abutment.


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1. 2.

3. 4.

1.LABORATORY PROCEDURE

Customized abutmentIf a more extensive modification is required or a

customization of the restorative margin is needed,

it is still possible to use Direct Abutment. However,

it is not possible to use the Direct Abutment

Replica.

1. Pour a conventional stone model. Fabricate

the crown restoration following standard working

procedures.

Note: The Burnout Cylinder cannot be used after

modification of the abutment.


Direct Abutment retrieval,using Carrier

1. Attach the Carrier to the Direct Abutment. Verify

the orientation of the flat surface and seat firmly.

2. Use the Torque Wrench to simplify retrieval

by pressing it firmly down onto the Carrier and

retrieve the abutment using a counter clockwise

motion.

Direct Abutment retrieval,using Hex Screwdriver

When working with Direct Abutment, diameter 5

or 6, a Hex Screwdriver can be used for retrieval.

3. Place the Hex Screwdriver into the hex

entrance. Unscrew the abutment. The Torque

Wrench can also be used.

Direct Abutment retrieval,using DA 4 Metal Carrier orSRS Wrench

When working with Direct Abutment, diameter 4,

the DA 4 Metal Carrier or SRS Wrench can be

used for retrieval.

4. Seat the DA 4 Metal Carrier or SRS Wrench

on the tapered portion of Direct Abutment.

Retrieve the abutment. The Carrier can be

connected to the Torque Wrench.


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SMALL LARGE

Aqua Lilac

One connection, two sizes

All Astra Tech implants have an internal

double hexdesign, which allows for

indexing. The Conical Seal Design

implant-abutment connection is an

important feature of the Astra Tech

implant system. To minimize the

number of components, the connection

comes in two different sizes which are

color coded:

Small - Aqua Large - Lilac

For your convenience, abutment screws

are packaged with the abutments.

One measuring systemThe measuring system is straightforward, easy to use and

easy to understand.

All measurements are indicated in millimeters and the

starting point is always at the implant level (starting at 0).

T

Cement Retained Restorations

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