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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
6
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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
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.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
Single, partial and full jaw restorations Suitable for all positions in the mouth
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.
13
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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
Suitable or all positions in the mouth
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
Commercially pure titanium,
grade 4
14
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PROSTHETIC PROCEDURE
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
Suitable or all positions in the mouth
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
18
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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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PROSTHETIC PROCEDURE
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
22
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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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24
PROSTHETIC PROCEDURE
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.
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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.
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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
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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.
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COMPONENTS:
Healing Abutment or Temporary Abutment Implant Pick-up or Implant Transfer
Implant Replica
ZirDesign (abutment screw included)
Hex Screwdriver
LABORATORY PROCEDURE
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.
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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.
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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
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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.
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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.
PROSTHETIC PROCEDURE
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.
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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.
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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.
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36
1.
5.
4.
6.
6.
LABORATORY PROCEDURE
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.
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.
Customizing abutment
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.
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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.
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38
1.
2.
3. 5.
4.
PROSTHETIC PROCEDURE
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.
LABORATORY PROCEDURE
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.
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39
1.
2.
5.
3.
PROSTHETIC PROCEDURE
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
instruction for use.
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.
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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
Suitable or all positions in the mouth
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.
Recommended torque is 25 Ncm.
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)
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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
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42
0.6 mm
LABORATORY PROCEDURE
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.
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.
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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
Coefficient 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 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.
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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.
PROSTHETIC PROCEDURE
Cleaning and sterilization
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 abut-
ment according to the autoclave manufacturers
instruction for use.
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.
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0.6 mm
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.
LABORATORY PROCEDURE
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
Coefficient of thermal linear expansion:
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.
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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.
PROSTHETIC PROCEDURE
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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LABORATORY PROCEDURE
Final bridge restoration1. Finalize the bridge restoration and the custom-
ized Cast-to Abutments. Prepare the restoration for
delivery to the clinic.
PROSTHETIC PROCEDURE
Cleaning and sterilization
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 dishwashingdetergent and water. Steam-autoclave the abut-
ment 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.
Abutment installation
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.
Recommended torque is 25 Ncm.
Cementation
5. Cement the bridge onto the abutments.
The permanent cementation can be done withglass-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.
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
Suitable or all positions in the mouth
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
Commercially pure titanium,
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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1.
2.
3.
5.
PROSTHETIC PROCEDURE
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.
Cleaning and sterilization
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.
Abutment installation
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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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.
LABORATORY PROCEDURE
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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PROSTHETIC PROCEDURE
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
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 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.
LABORATORY PROCEDURE
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.
PROSTHETIC PROCEDURE
Customizing abutment
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.
PROSTHETIC PROCEDURE
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