Cement Retained Restorations

Cement-retained restorations
Prosthetic and laboratory procedures
Astra Tech Implant System

for integrated esthetics
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 t 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.
Single
Cement-retained
ZirDesign TiDesign Cast-to Abutment Direct Abutment
Screw-retained
Cast-to Abutment
Partial
Cement-retained
ZirDesign TiDesign Cast-to Abutment Direct Abutment
Screw-retained
UniAbutment Angled Abutment Cresco
Ball Abutment Locator Abutment
Attachment-retained
Full
Removables
Bar-retained
UniAbutment Cresco
Fixed
Cement-retained
TiDesign Cast-to Abutment Direct Abutment
Screw-retained
UniAbutment Angled Abutment Cresco
R E S T O R AT I V E O V E R V I E W
Contents
Prosthetic and laboratory procedures for Astra Tech implant system cement-retained restorations. Restorative overview Abutment selection Astra Tech Implant System: key features Soft tissue sculpturing Healing Abutment Temporary Abutment 4 6 8 10 12 14
Implant-level impression Implant-level working model
18 22
ZirDesign abutment TiDesign abutment Cast-to Abutment Direct Abutment
26 34 40 48
Miscellaneous

One connection, two sizes One measuring system Torque Wrench Recommended torque Hex Screwdriver Cleaning and sterilization procedures
56 56 57 57 57 58
Abutment selection
Astra Tech implant system includes a wide range of abutments designed to successfully meet every clinical indication. In addition to simply connecting the crown to the implant, the abutments are designed to: Transfer forces to the implant, minimizing the risk of overload and fractures Establish and maintain healthy connective tissue and epithelial attachment Resolve dimensional and geometric discrepancies between crown and implant
Facts to consider when choosing abutment:

Conical Seal Design Minimizes micro-movements and micro-leakage Load distribution reducing peak stresses Quick and simple procedure
Indication single tooth, partial bridge or a full fixed bridge Upper or lower jaw Anterior or posterior region Implant angulations Marginal bone levels Soft tissue levels Occlusal interproximal space Adjacent teeth and roots Esthetic demands
Abutments designed for implant-level impression ZirDesign

Made of zirconia
Indications
Single and partial restorations Anterior, canine and premolar
Features and benets

When the highest esthetic demands are required. Can be customized to accommodate most cervical dimensions and subgingival margin location. Can be customized to accommodate most cervical dimensions, subgingival margin location and non-axial alignment. Angled versions available. Can be customized to accommodate most cervical dimensions, subgingival margin location and non-axial alignment. Can compensate for angulations up to 30. Suitable for cases with thin soft tissue. Screw-retained option for single tooth restorations.
TiDesign
Made of commercially pure titanium, grade 4
Single, partial and full jaw restorations Suitable for all positions in the mouth
Cast-to Abutment
Made of non-oxidizing gold alloy
Abutments designed for abutment-level impression Direct Abutment

Made of commercially pure titanium, grade 4
Indications
Features and benets

Easy to handleconventional crown and bridge technique. All parts included in a kit API Kit for prosthetic and laboratory procedures. Occlusal height can be adjusted. The prosthetic margin can be modied or altered. Possible to compensate up to 12 between two implants (without customization).
Benets of abutments designed for implant-level impression:

Freedom to customize for individual design and optimal esthetics Possibility to adapt the restorative margin to fit esthetic and biologic considerations Corrections of angulation problems Correction of cervical positions
Benets of abutments designed for abutment-level impression:

Simplified handling procedures, similar to crown and bridge Procedure performed by the clinician chair-side in the clinic for reduced treatment time
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.
Astra Tech BioManagement Complex

A holistic approach
To 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 existence cannot be determined by one single element alone. The terms biomechanics and biochemistry are no longer sufcient 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 t Connective Contour increased soft tissue contact zone and volume
8
OsseoSpeed more bone more rapidly

Building on the proven success of TiOblast, OsseoSpeed is the rst and only implant in the world with a chemically modied 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 uoride 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 benets of OsseoSpeed are proven and well-documented.
OsseoSpeed More and earlier bone formation Increased bone-to-implant contact ratio Stronger bone-to-implant interface Increased safety and reliability for all implant patients
MicroThread biomechanical bone stimulation

The 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 physiology, 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.
MicroThread Increases the functional load bearing capacity at least threefold Optimal load distribution reduces peak stresses Preserves marginal bone
Conical Seal Design a strong and stable t

The 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 at-to-at 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 simplies maintenance and ensures reliability in all clinical situations. Whats more, the tight and precisely tting implantabutment 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.
Conical Seal Design Enables a tight and stable connection between implant and abutment Minimizes micro-movements and micro-leakage Load distribution reduces peak stresses Quick and simple procedure Easy to connect no x-ray needed Self-guiding for precise seating
Connective Contour increased soft tissue contact zone and volume

The 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.
Connective Contour Increases connective soft tissue contact zone and volume Seals off and protects the marginal bone
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
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.
establish a certain biological width of the peri-implant mucosa. It is important that this process takes place undisturbed, without micromovements 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-term perspective, 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
With Astra Tech implant system you can count on optimal soft and hard tissues.
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.
10
Temporary Abutment or Healing Abutment?

The rst step toward an esthetic soft tissue appearance is to decide how to 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 sculpturing

When it comes to implant treatment, peri-implant soft tissue architecture 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 reected in the healthy soft tissue around the implant itselfthe result of a perfect, tight t 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 rst, 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.
Baseline
Five years follow-up
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 extremely well maintained at the 5-year follow-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 Prospective Study J Clin Periodontol 2005; 32:567-574
11
Healing Abutment
Abutment selection Diameters 4 6.5 mm Heights 2 6 mm Sterile Material Commercially pure titanium, grade 4
Healing Abutment is a solid one-piece component, designed to provide optimal esthetic results. The abutment is used for soft tissue contouring during the soft-tissue healing phase and can be used both for one-stage and two-stage surgery. Healing Abutment can be used in combination with a butterfly or a removable temporization.
One-stage surgery
Healing Abutment is placed at implant installation. After healing, the abutment is replaced by a permanent abutment.
Two-stage surgery
Marked with lines to identify connection size: 3.5/4.0 marked with 2 lines. 4.5/5.0 marked with 3 lines.
A cover screw is connected to the implant at installation and covered by the soft tissue until it is time to replace the cover screw with a Healing Abutment. After healing, the abutment is replaced by a permanent abutment.
Intended use
Single, partial or full jaw restorations Suitable for all positions in the mouth For intermediate use only
Features and benets

Soft tissue management Documented biocompatibility Different diameters and heights for maximized flexibility Design ensures flexibility in relation to soft tissue As an alternative, the Temporary Abutment with a temporary crown can be used during the soft tissue healing period.
Seating and tightening

The Healing Abutment is seated in the implant, secured and tightened using light finger force or the Torque Wrench. Recommended torque is 10 Ncm.
12
1.
2.
COMPONENTS: Healing Abutment Fixture Transfer Direct Abutment Healing Cap Hex Screwdriver
PROSTHETIC PROCEDURE
Healing Abutment installation

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.
3.
1.
Permanent abutment with healing cap or temporary crown

1. 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 recommendations 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 to ensure 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.
2.
13
Temporary Abutment
The Temporary Abutment is a two-piece component which functions as
Abutment selection Same design optimized for each connection size. Indexed and non-indexed Material Commercially pure titanium, grade 4
a customized base for temporary construction on implant-level. By using Temporary Abutment the soft tissue can be sculptured in an anatomically optimal shape, creating a good foundation for an esthetic final 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 soft tissue sculpturing and avoid unnecessary interference with the biological process, the customized design of Temporary Abutment should be as close to the final restoration as possible.
Intended use
Single, partial or full jaw restorations Suitable for all positions in the mouth
Features and benets

Easy to customize Optimal design for soft tissue management Allows for excellent esthetics results Retention elements for build-up Components optimized for narrow cases Available in indexed and non-indexed version for optimal treatment planning

The 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 finger force or the Torque Wrench. Recommended torque is 10 Ncm.
14
Lars Rasmusson DDS, PhD Department of Oral and Maxillofacial Surgery, Gteborg University, Sweden
1.
2.
Summary
A 35 years old woman fractured her right central incisor due to trauma. The tooth was extracted and an Astra Tech 4.5 x 13 mm fixture was placed for immediate functional loading. The primary stability was excellent and an impression was taken from implant level immediately after placement. A plastic crown was fused to a Temporary Abutment and screw-retained. 1. Temporary crown fused with resin to a Temporary Abutment. No risk of cement induced soft tissue inflammation. 2. The abutment + crown in place and tightened. 3. Buccal view. 4. The clinical situation after 3 weeks follow-up. 5. Radiograph at implant installation.
3.
5.
4.
15
1.
COMPONENTS: Temporary Abutment (abutment screw included) Guide Pin Hex Screwdriver
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 Screw access hole. Finalize the abutment.
2.
4.
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.
3.
5.
16
1.
L A B O R AT O R Y P R O C E D U R E
Customizing Temporary Abutment

1. Place the Temporary Abutment in the replica, check the fit and occlusal clearance. 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 perfect 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 restoration. 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.
2.
3.
4.
5.
6.
17
Implant-level impression
Abutments for implant-level impression:
Component Selection Implant Transfer or Implant Pick-up Short and long versions Material Stainless steel
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 offers several advantages: The quality of prosthetic planning and treatment can be enhanced Implant angulations can be compensated for at an early stage Individual anatomic designs can be performed through abutment selection and preparation The Implant Transfer or Implant Pick-up ensures precise and easy impression procedures
Implant Transfer
Intended use
Implant Transfer or Implant Pick-up is used for implant level impression Single, partial or full jaw impression Suitable for all positions in the mouth
Implant Pick-up
Features and benets

Astra Tech implant system offers the possibility to take both closed tray and open tray impressions: Implant Transfer for closed tray technique Implant Pick-up for open tray technique The transfers and pick-ups are two-piece components, available in different heights for different clinical situations. In order to achieve optimal results, impression should be carried out with a rigid impression tray. Implant Transfer has a laser marking indicating implant diameter.

The Implant Transfer and Implant Pick-up are seated in the implant and the pin is tightened using light finger force.
18
Professor Tord Berglundh DDS, PhD Department of Periodontology, The Sahlgrenska Academy, Gteborg University, Sweden
1.
2.
3.
Summary
Following 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 temporary abutment and immediately prior to impression. Please note the thickness of the mucosa that provides 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 performance of a non-angulated geometry of a ZirDesign abutment, the technique using the implant level impression offers the opportunity to perform corrections of unfavorable directions when indicated. The ceramic crown cemented to the ZirDesign abutment is illustrated in fig. 5.
4.
5.
19
1.
2.
COMPONENTS: Healing Abutment Implant Pick-up or Implant Transfer Implant Replica Hex Screwdriver
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 impression. This is most easily done by tightening the transfer into the Implant Replica and using it as a handle during the positioning. Check the impression 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 articulator.
3.
4.
5.
6. 1.
7.
8.
20
1.
Open tray impression

1. Tighten the Implant Pick-up securely in the implant. 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 disengaged 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.
2.
3.
Immediate placement
5. If immediate placement is preferred, an impression 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 transfer key the position of the pick-up is transferred to the pre-prepared working model. (see page 25).
4.
6.
Select shade
6. Determine the correct shade. The selected shade and details of the patients oral situation is sent to the dental laboratory.
5.
21
Implant-level working model

Abutments for implant-level impression:
Replica Selection Design optimized for each implant diameter Material Stainless steel
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 offers several advantages: The quality of prosthetic planning and treatment is enhanced Implant angulations is compensated for at an early stage Individual anatomic designs can be performed through abutment selection and preparation Implant Pick-up and Implant Transfer ensures precise and easy impression procedures When working with an implant-level impression, replicas are used to replicate the diameter of the installed implant:
Implant Replica 3.5/4.0 Implant 3.5 Implant 4.0 Implant 4.5 Implant 5.0
Implant Replica 4.5/5.0
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 benets

Precise replication of the implant positioned in the mouth Retention for stable position in the stone material
22
Christian Erneklint DT / Assistant professor Dept. of Prosthetic Dentistry and Dental Material Science Gteborg University, Sweden
1. 1.
2. 2.
3. 3.
Summary
To ensure an optimal final result, control the impression 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 properly in the impression and let it set (fig. 2). 4. Ensure that the silicone is only applied on the isolated areas. Remove the mask and check it for correct fit. Pour the stone material, using alfa-hemihydrate 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. 4.
23
1.
2.
COMPONENTS: Implant Pick-up or Implant Transfer Implant Replica Hex Screwdriver
3.
5.
Working model closed 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.
4.
Placing Implant Transfer

6.
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.
6.
7.
8.
24
1.
2.
Working model open tray impression

1. 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 important 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.
3. 1.
4.
Immediate placement
If immediate placement is preferred, an impression 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.
5.
6.
25
ZirDesign
ZirDesign is a two-piece component, fabricated in zirconia and is easily
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
customized, providing an anatomically designed prosthetic solution with high esthetics. The color of the abutment offers a perfect base to create outstanding esthetic porcelain work. ZirDesign works with all existing crown materials and the crown is preferably seated with glass-ionomer or composite cement. ZirDesign abutments are also available without predesign, ZirAbutment, which follows the same handling procedures.
Indicated use
Single or partial restorations Anterior, canine and premolar regions Can be customized to accommodate different cervical dimensions and subgingival margin location
Features and benets

When the highest esthetic results are required Documented biocompatibility Zirconia with high mechanical strength Indexing for easy positioning on all implant diameters Pre-designed for quick and easy customization Color resembling natural tooth shade Fire-on technique for esthetic modification
Contraindication
Not recommended for use in the molar regions

The 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.
26
Gary Krueger DDS, CDT Prosthodontist, Encinitas, CA, USA
1.
2.
Summary
In collaboration with Steve Wheeler, DDS, Oral Surgeon, Encinitas, CA and Lee Culp, CDT, Mosaic Studios, Bradenton, FL. 3. 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.
4.
27
1.
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.
2.
3.
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 tightened with light finger force. 3. Outline the soft-tissue margin, the correct vertical 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.
3.
4. 5.
5.
28
6.
Customizing abutment
ZirDesign abutments can be prepared hand-held or 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 manufactured for zirconia/zirconiumoxide (e.g. Bredent). It is also possible to use a water-cooled high-speed unit. Avoid excessive heat development during grinding to prevent micro-cracks. Provide ample water cooling during grinding of the abutment. A wet sponge can be used during grinding to ensure 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. Maintain the strength and retention of the preparation by leaving as much material as possible on the buccal side when reducing the lingual side.
7.
3.
8. Prepare the abutment to support the design of the crown restoration. Standard guidelines for 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 angulations and still give sufficient support as long as retention is achieved.
8. 5.
9.
29
Optimal abutment design

C.
1 mm 100120
A.
10. Design the preparation with a shoulder or a 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.
D.
B.
0.81 mm 12 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 in creating 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 a silicon rubber wheel and diamond paste.
30
11.
12.
Customized abutment
11. Polish the ZirDesign abutment. Any inadvertent 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 articulator for correct preparation and occlusal clearance. Use the silicone key to help achieve correct design. When the desired shape for the ZirDesign abutment 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-cured acrylic 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.
Mer mask
13.
Preparing for crown fabrication

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.
14.
31
15.
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
16. 17.
1617. ZirDesign abutment may be individualized 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 recommendation. ZirDesign abutment Coefficient of thermal linear expansion: 10.6x10-6 K-1 Keep the surface of the abutment just above the implant, free from porcelain, to ensure a good fit between the components and in order to create and maintain natural, healthy soft tissue.
1.
Cleaning and sterilization

1. Before installation the ZirDesign 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. 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.
32
2.
Abutment installation
2. Remove the temporary restoration and install the ZirDesign abutment. To ensure correct position 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 a suitable composite material.
3.
4. 5.
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 instructions for use.
5.
6.
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.
7.
33
TiDesign
TiDesign abutment system is designed to meet clinical demands for
Abutment selection Straight versions 3 different diameters 2 different marginal heights Angled version for each connection size Material Commercially pure titanium, grade 4
customized restorations. The system offers an opportunity to create individual solutions regarding function and esthetics following the principles of traditional restorative procedures used on natural teeth. The abutment is a two-piece component, pre-designed for fast and simple handling. The design and dimension of TiDesign is well-suited for cases when compensation for deviations between implants or misalignment, dictated by anatomic conditions are necessary. TiDesign abutments are also available without pre-design, Profile BiAbutment, which follows the same handling procedures.
Indicated use
Laser marked with implant dimension and abutment diameter.
Can be customized to accommodate different cervical dimensions, subgingival margin location and non-axial alignment
Features and benets

Timesaving due to minimized grinding When high esthetic results are required Documented biocompatibility Different marginal heights Angular corrections compensation for non-parallel implants Indexing for easy positioning Pre-designed for easy handling Laser mark for simplified abutment selection

The TiDesign 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.
34
Professor Lyndon Cooper DDS, PhD Department of Prosthodontics, The University of North Carolina at Chapel Hill School of Dentistry Chapel Hill, N.C. USA
1.
Summary
Following 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 periimplant mucosa without soft tissue impingement of the implant/abutment interface and a lack of inflammation or bleeding. Restoration begins with placement of a TiDesign abutment (25 Ncm) that positions the restorative margin correctly from the implant/abutment interface 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).
2.
3. 3.
4. 4.
5.
35
1.
2.
COMPONENTS: Healing Abutment or Temporary Abutment Implant Transfer or Implant Pick-up Implant Replica TiDesign (abutment screw included) Hex Screwdriver Grinding Handle
Working model
1. Replicate the clinical situation by fabricating a high quality stone, type IV working model with soft tissue mask and Implant Replicas. Note: Make sure the soft tissue material covers at least 2 mm of the Implant Replica.
3.
4.
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.
5.
6.
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.
7. 6.
8. 8.
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 reduction, 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.
36
9.
10.
9. Customize the abutments 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 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 for bridge fabrication

11. 12.
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.
13.
14.
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.
15.
16.
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 framework to the clinic for try-in.
37
1.
Temporary restoration
For 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 subsequent work will be carried out on a new model. Make sure that this new model provides information 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-in
1. 2.
1. Try-in the framework in the mouth to confirm a passive fit and an appropriate design for functional 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
3. 5.
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 tissue and into the implant remains the same as it was originally.
4.
Clean and prepare the customized TiDesign abutments and bridge for delivery to the clinic.
38
1.

Before 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 abutment according to the autoclave manufacturers instruction for use. 1. Remove the healing abutments.
2.
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.
3.
4.
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.
5.
39
Cast-to Abutment
Cast-to Abutment is recommended for fabrication of a customized abutment using regular wax-up and cast-to technique. It provides great flexibility for creating excellent individualized esthetics even if the soft tissue is very thin. Cast-to Abutment is also useful when you have to solve complicated cases, such as when compensation for misalignment and angulations of implants is necessary.
Abutment selection Design optimized for each connection size. Indexed and non-indexed
Intended use
Single, partial and full jaw restorations Suitable for all positions in the mouth Can be customized to accommodate to most cervical dimensions, subgingival margin location and non-axial alignment
Material Non-oxidizing gold alloy: Au 60%, Pt, 24%, Pd 15%, Ir 1% Melting range: 1400 1460C/25522660F Coefcient of thermal linear expansion: 25 500C 12.3 (10 6/C) 25 600C 12.7 (10 6/C)
Features and benets

When high esthetic results are required Can be customized for optimal esthetic restoration Can compensate for angulations up to 30 degrees Screw-retention option for a single tooth Available in two versions; indexed and non-indexed for optimal treatment planning Possibility for porcelain modification for esthetic demands

The Cast-to 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.
40
Dr. Helmut G. Steveling* Dr. Luis Gallardo-Lpez** * Department of Oral and Maxillofacial Surgery, University of Heidelberg ** Catholic University of Honduras, Department of Oral Surgery
1.
Summary
The emergence profile of implant-supported restorations has become increasingly important in the dentistry field in recent years. In addition to correct placement of dental implants in the maxilla, it is also 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 surrounding the restoration. In order to create an ideal soft tissue situation, a provisional restoration has to be applied. After this, the final restoration is made with 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.
41
1.
COMPONENTS: Healing Abutment or Temporary Abutment Implant Transfer or Implant Pick-up Implant Replica Cast-to Abutment (abutment screw included) Hex Screwdriver Grinding Handle
Working model
1. Replicate the clinical situation by fabricating a high quality stone, type IV working model with soft tissue mask and replica. Note: Make sure the soft tissue material covers at least 2 mm of the replica. Place the Cast-to Abutment into the replica, which comprises the base for a customized abutment build-up.
2.
3.
Wax-up and customizing abutment

3.
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 angulations 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. 0.6 mm 5. Check the wax-up for occlusal and lingual clearance, allowing enough crown material in all directions.
4.
5.
42
6.
7.
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 casting temperature that is below the solidus (1400C/2552F) of the Cast-to Abutment.
8.
9.
Material Non-oxidizing gold alloy: Au 60%, Pt, 24%, Pd 15%, Ir 1% Melting range: 1400-1460C/2552-2660F Coefcient of thermal linear expansion: 25500C 12.3 (10-6/C) 25600C 12.7 (10-6/C)
The Cast-to Abutment absorbs a lot of heat during burnout 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
10.
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 final adjustments.
43
11.
12.
Crown restoration
11. Block the screw access holes with suitable material. 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.
13.
14.
3.

Before installation, the Cast-to 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 abutment according to the autoclave manufacturers instruction for use.
1.
2.
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.
44
3.
Cementation
3. Cement the crown onto the abutment. 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. Final customized Cast-to Abutment with crown restoration.
Fire-on technique
4.
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 expansion 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.
3.
Cast-to Abutment Coefcient of thermal linear expansion: 25500C 12.3 (10-6/C) 25600C 12.7 (10-6/C)
1.
2.
2. Opaque and build-up pink porcelain to the Cast-to Abutment when working with esthetically demanding cases.
0.6 mm
45
3.
Screw-retained abutment
3. Design a customized Cast-to Abutment with screw 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 the abutment, 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.
4.
3.
Temporary restoration
For 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 subsequent 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 laboratory with porcelain firing and finishing.
1.
Try-in
1. Try-in of the framework in the mouth should confirm a passive fit and an appropriate design for functional contacts and an optimal soft-tissue situation. The customized Cast-to-Abutments and the framework are sent back to the dental technician for final porcelain build-up.
46
1.
Final bridge restoration

1. Finalize the bridge restoration and the customized Cast-to Abutments. Prepare the restoration for delivery to the clinic.

Before installation, the Cast-to Abutments 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 abutment according to the autoclave manufacturers instruction for use. The prosthetic procedure for a bridge restoration is similar to a crown restoration with some additional considerations: 1. Remove the Healing Abutment.
1.
2.
3. 4.
2. A transfer key is recommended to ensure the accurate positioning of the Cast-to 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 optimal soft tissue situation. 4. Tighten the abutment screws using the Hex Screwdriver or Torque Wrench. Recommended torque is 25 Ncm.
5.
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.
47
Direct Abutment
Abutment-level impression
Direct Abutment is designed to meet the clinicians demands for convenAbutment selection 3 diameters 4 different heights
tional procedures and restorative simplicity. The abutments are available in different diameters and heights, mimicking preparations of natural teeth, which provides the opportunity create great esthetics for all teeth positions. All necessary components are delivered in a practical API kit with all parts included.
Intended use
Features and benets

Material Commercially pure titanium, grade 4
Documented biocompatibility Conventional crown and bridge technique Snap-on impression at abutment level Special versions designed for narrow cases Freedom to position the restorative margin Possibility to adjust occlusal height API all parts included in a kit for prosthetic and laboratory procedures Flat side for anti-rotation of single crowns
Contraindication
Direct Abutment is not recommended for cases with extensive misalignment or problems with angulations.

The Direct Abutment is seated in the implant, secured and tightened using the Hex Screwdriver or Torque Wrench. Recommended torque is 25 Ncm.
48
David L. Guichet DDS Private Practice Prosthodontics Orange, California, USA Part-time faculty Prosthodontics, UCLA School of Dentistry
1.
2.
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 Abutment, 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 Fixture MicroThread 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.
3.
4. 4. 5.
49
1.
COMPONENTS: Direct Abutment API Kit Direct Abutment Carrier Impression Pick-up Direct Abutment Replica Healing Cap Burnout Cylinder Hex Screwdriver
Abutment selection
1. Measure the thickness of the soft tissue using the Abutment Depth Gauge mm. Use the corresponding gauge for Implant 3.5/4.0 and 4.5/5.0 respectively. 2. Select the ideal size of Direct Abutment considering diameter and vertical height.
2.

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-autoclave 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.
3.
4. Install the abutment into the implant. 5. Fit the Torque Wrench directly on the carrier and tighten the abutment. Press downwards on the carrier during this procedure. Recommended torque is 25 Ncm.
4.
5.
50
6.
7.
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 snapping it into place. 9. Use a closed tray impression technique. Inject elastomeric impression material and take the impression according to regular working procedures.
8.
9.
Color-codingImpression Pick-up Direct Abutment 4 white Direct Abutment 5 grey Direct Abutment 6 blue
10.
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 combination 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.
11.
51
1. 1.
3.
Working model
1. Seat the Direct Abutment Replica in the Impression 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.
2. 2.
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.
4.
5.
6. 1.
7.
8.
Final crown restoration

9. Final result. Clean and prepare the crown for delivery to the clinic. (Image: opposite page.)
52
9.
1.

Clean 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 glass-ionomer, composite or phosphate cement 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 instruction for use. If preferred, the Direct Abutment can be sandblasted to increase the retention of the cement. 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 tissue and into the implant remains the same as it was originally.
2. 2.
3.
Occlusal reduction abutment

3.
The 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. 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.
4.
53
1.
2.
Occlusal reduction replica

The 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 Impression 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.
3.
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.
1.
2.
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 the implant firmly, using the Carrier. Recommended torque is 25 Ncm.
3.
4.
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.
54
1.
Customized abutment
If 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.
1.
2.
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.
3.
4.
Direct Abutment retrieval, using DA 4 Metal Carrier or SRS 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.
55
One connection, two sizes

All Astra Tech implants have an internal
M 1.6
SMALL
double hex design, 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
M2
Aqua
3.5 S 4.0 S
color coded: Small - Aqua
LARGE
Large - Lilac For your convenience, abutment screws

4.5 5.0 5.0 S
Lilac
are packaged with the abutments.
One measuring system

The 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). This applies to all abutments and components that t into the implants.
The Abutment Depth Gauge has two tips that are clearly marked with bands for measuring
SMALL LARGE
the mucosal height over the implant level in millimeters. To use, the tips should be inserted into the conical opening of the implant.
Aqua
Lilac
56
Torque Wrench
The Torque Wrench has a dual function: torque control and ratchet wrench. In the restorative situation the torque control can be used to seat the abutments.
Torque control function
Recommended torque
Use light finger force, 10 Ncm, for seating during try-in. The recommended torque for final seating of the abutment, used for cement-retained restorations, is 25 Ncm: ZirDesign TiDesign Cast-to Abutment Direct Abutment
1. Attach the appropriate Torque Wrench Bit.
2. Adjust to the desired torque.
Torque Wrench Kit The Torque Wrench Kit contains: Torque Wrench Instrument Torque Wrench Dismantle Tool Torque Wrench Lubricant 5 bits that fit the different components used in the restorative procedures
3. Begin tightening the screw.
Hex Screwdriver
Prosthetic and laboratory procedures are performed with ease, requiring only a limited numbers of instruments. The Hex Screwdriver is compatible with all components with a hex friction fit, including the abutment screw that is packed together with all abutments for cementretained restorations, Temporary Abutment and Healing Abutment.
4. Tighten until the handle snaps away.
57
Cleaning and sterilization procedures

Before installation the abutments must undergo a cleaning and sterilization procedure. The cleaning should preferably take place in an ultrasonic unit with a mixture of dishwashing detergent and water.
Abutment Healing Abutment
Material
Commercially pure titanium, grade 4
Sterilization procedure
Sterile when delivered.
Temporary Abutment TiDesign abutment

(Prole BiAbutment)
Commercially pure titanium, grade 4
Steam sterilization with a pre-vacuum cycle. Temperature: 134C/274F Exposure time: 3 minutes
Direct Abutment
ZirDesign abutment
(ZirAbutment)
Zirconia
A cold sterilization procedure is recommended. Note: Zirconia should not be sterilized in a steam-autoclave. The process can affect the mechanical properties of the material.
Cast-to Abutment
Non-oxidizing gold alloy
Steam sterilization with a pre-vacuum cycle. Temperature: 134C/274F Exposure time: 3 minutes minimum
58
59
Astra Tech BioManagement Complex

A successful implant system cannot be determined by one single feature alone. Just as with nature, there must be several interdependent features working together. The following combination of key features is unique to Astra Tech:
OsseoSpeed
OsseoSpeed more bone more rapidly MicroThread biomechanical bone stimulation Conical Seal Design a strong and stable t Connective Contour increased soft tissue contact
zone and volume
MicroThread
Conical Seal Design
Connective Contour
Australia Astra Tech Pty Ltd. Suite 1, 53 Grandview St, Pymble NSW 2073 Tel: +61 2 9488 3500. Fax: +61 2 9440 0744 Austria Astra Tech GesmbH Schlohofer Strae 4/4/19, AT-1210 Wien Tel: +43-(0)1-2146150. Fax: +43-(0)1-2146167 www.astratechdental.at BeNeLux Astra Tech B.V. Signaalrood 55, NL - 2718 SG Zoetermeer Tel: +31 79 360 1955 /+32 3 232 81 50 Fax: +31 79 362 3748 www.astratechdental.nl Canada Astra Tech Inc. 2425 Matheson Blvd East, 8th Floor Mississauga, ON L4W 5K4 Tel: +1 905 361 2844 www.astratechdental.com Denmark Astra Tech A/S Husby All 19, DK- 2630 Taastrup Tel: +45 43 71 33 77. Fax: +45 43 71 78 65 www.astratechdental.dk Finland Astra Tech Oy PL 96, FI -02231 Espoo Tel: +358 9 8676 1626. Fax: +358 9 804 4128 www.astratechdental.fi
France Astra Tech France 7, rue Eugne et Armand Peugeot, TSA 90002 FR- 92563 Rueil Malmaison Cedex Tel: +33 1 41 39 02 40. Fax: +33 1 41 39 02 44 www.astratech.fr Germany Astra Tech GmbH An der kleinen Seite 8. DE-65604 Elz Tel: +49 6431 9869 0. Fax: +49 6431 9869 500 www.astratechdental.de Italy Astra Tech S.p.A. Via Cristoni, 86, IT-40033 Casalecchio di Reno (BO) Tel: +39 051 29 87 511. Fax: +39 051 29 87 580 www.astratechdental.it Japan Astra Tech Division, AstraZeneca K.K. Tokyo Regional Office Koraku Mori Bldg. 11F, 1- 4-14, Koraku Bunkyo -ku, Tokyo 112- 0004 Tel: +81 3 5840 1113. Fax: +81 3 5840 1160 Norway Astra Tech AS Postboks 160, NO -1471 Lrenskog Tel: +47 67 92 05 50. Fax: +47 67 92 05 60 www.astratechdental.no Poland Astra Tech Sp. z o.o. ul. Orna 58, PL -02-937 Warszawa Tel: +48 22 853 67 06. Fax: +48 22 853 67 10 www.astratechdental.com
Spain Astra Tech S.A. Calle Ciencias n 73 derecha. Nave 9, Polgono Industrial Pedrosa, ES- 08908 LHospitalet de Llobregat Tel. Servicio al cliente: +34.902.101.558 Tel: +34.932.643.560. Fax: +34.933.363.231 www.astratechdental.es Sweden Astra Tech AB P.O. Box 14, SE-431 21 Mlndal Tel: +46 31 776 30 00. Fax: +46 31 776 30 17 www.astratechdental.se Switzerland Astra Tech SA Avenue de Svelin 18, P.O. Box 54 CH-1000 Lausanne 20 Tel: +41 21 620 02 30. Fax: +41 21 620 02 31 www.astratech.ch United Kingdom Astra Tech Ltd. Brunel Way, Stonehouse, Glos GL10 3SX Tel: +44 1453 791763. Fax: +44 1453 791001 www.astratechdental.co.uk USA Astra Tech Inc. 890 Winter Street, Waltham, MA 02451 Tel: +1- 800 -531-3481. Fax: +1- 781-890 -6808 www.astratechdental.com Other Markets Astra Tech AB, Export Department P.O. Box 14, SE- 431 21 Mlndal, Sweden Tel: +46 31 776 30 00. Fax: +46 31 776 30 23 www.astratechdental.com
Astra Tech AB, P.O. Box 14, SE-431 21 Mlndal, Sweden. Tel: +46 31 776 30 00. Fax: +46 31 776 30 10. www.astratechdental.com
tuvemark / Printed in Sweden by
78709-USX-0705

Cement Retained Restorations

Caricato da

Informazioni sul documento

Copyright

Formati disponibili

Condividi questo documento

Condividi o incorpora il documento

Opzioni di condivisione

Hai trovato utile questo documento?

Questo contenuto è inappropriato?

Copyright:

Formati disponibili

Cement Retained Restorations

Caricato da

Copyright:

Formati disponibili

Cement-retained restorations

Prosthetic and laboratory procedures

Astra Tech Implant System

ZirDesign TiDesign Cast-to Abutment Direct Abutment

ZirDesign TiDesign Cast-to Abutment Direct Abutment

UniAbutment Angled Abutment Cresco

Ball Abutment Locator Abutment

TiDesign Cast-to Abutment Direct Abutment

Implant-level impression Implant-level working model

ZirDesign abutment TiDesign abutment Cast-to Abutment Direct Abutment

Facts to consider when choosing abutment:

Abutments designed for implant-level impression ZirDesign

Features and benets

Abutments designed for abutment-level impression Direct Abutment

Features and benets

Benets of abutments designed for implant-level impression:

Benets of abutments designed for abutment-level impression:

Astra Tech BioManagement Complex

OsseoSpeed more bone more rapidly

MicroThread biomechanical bone stimulation

Conical Seal Design a strong and stable t

Connective Contour increased soft tissue contact zone and volume

Predictable successful results

Temporary Abutment or Healing Abutment?

Soft tissue sculpturing

Why accept bone loss?

Five years follow-up

Features and benets

Seating and tightening

Healing Abutment installation

Permanent abutment with healing cap or temporary crown

Features and benets

Seating and tightening

Customizing Temporary Abutment

Features and benets

Seating and tightening

Closed tray impression

Open tray impression

Implant-level working model

Implant Replica 4.5/5.0

Features and benets

COMPONENTS: Implant Pick-up or Implant Transfer Implant Replica Hex Screwdriver

Working model closed tray impression

Placing Implant Transfer

Working model open tray impression

Features and benets

Seating and tightening

Gary Krueger DDS, CDT Prosthodontist, Encinitas, CA, USA

Optimal abutment design

Preparing for crown fabrication

Cleaning and sterilization

Features and benets

Seating and tightening

4. Check for fit without the soft tissue mask.

Preparing for bridge fabrication

Transfer key and try-in

Cleaning and sterilization

Features and benets

Seating and tightening

Wax-up and customizing abutment

Invest, burnout and cast

Cleaning and sterilization

Final bridge restoration

Cleaning and sterilization