basic information on the prosthetic procedures - Kokomo

The ITI (International Team for Implantology) is academic partner of Institut Straumannin the areas of research, development and education.

Content 1. Straumann ® Bone Level Implant –Straumann expertise applied at bone level 32. General <strong>information</strong> 42.1 CrossFit Connection 42.2 Prosthetic options 62.3 Abutment overview 82.4 Coding 103. Preoperative planning 123.1 Wax-up/Set-up 123.2 X-ray template with reference spheres 123.3 Custom-made drill template 133.4 Thermoplastic drill template 144. Soft tissue management 154.1 Soft tissue management solutions 154.2 Prefabricated Healing Abutment 164.3 Customizable Healing Abutment 194.4 Temporary Abutment 215. Impression taking 285.1 Options for impression taking 285.2 Open tray impression 295.3 Closed tray impression 335.4 Bite registration 376. Restoration 396.1 CrossFit PLAN Set/PLAN Abutment 396.2 Anatomic (and Meso) Abutment 426.3 Gold Abutment for crown 496.4 Gold Abutment for bridge 616.5 CARES Abutment 716.6 Cementable Abutment 846.7 Multi-Base Abutment 996.8 Abutment for bars 1176.9 LOCATOR ® Abutment 1277. Aids and instruments 1437.1 SCS Screwdriver 1437.2 Polishing Aid 1447.3 Ratchet and Torque Control Device 1457.4 Assembling the Ratchet and the Torque Control Device 1477.5 Tightening an abutment to 35 Ncm 1498. About sterilization 1519. Important guidelines 15210. Index 153

Purpose of this guideThis guide describes the essential steps required for the fabrication andinsertion of prosthetic restorations for Straumann ® Bone Level implants.For detailed <strong>information</strong> regarding implantation and soft tissue managementsee “Straumann ® Bone Level Implant Line: Basic <strong>information</strong> on the surgicalprocedures” (Art. No. 152.754).See also DVD „Surgical and Prosthetic Procedures with the Straumann ® Bone LevelImplant“ (Art. No. 150.760) for additional <strong>information</strong>.NoteDifferent procedures apply for dental technicians and prosthodontists. Suchprocedures are marked with a color code in the respective chapters of this guide:Lab procedureProsthetic procedureNot all products shown are available in all markets.Purpose of this guide

1. Straumann ® Bone Level Implant –Straumann expertise applied at bone levelThe Straumann ® Bone Level Implant provides you with a solution for all bone level treatments, with Straumann expertiseand quality built in. Its design is based on the latest technology and scientific know-how in implant dentistry. Moreover,it respects key biological principles, brings predictable esthetic results and offers simple handling in all indications.Consistent Emergence ProfilesExperience simplified soft tissuemanagement from start to finishCrossFit ConnectionBone Control DesignFeel the fit of the self-guiding connectionOptimize crestal bone preservation byadhering to biological principlesBone Control DesignThe unique Bone Control Design isbased on key biological principles andthorough scientific research to supportcrestal bone preservation and stablesoft tissue margins. It features the followingstrengths:p Fast osseointegration with theSLActive surface technologyp Optimal transmission of forces intothe bone through the biomechanicalimplant designp Consideration of the biologicaldistance with a horizontal distanceof micro gap to bonep Reduction of micro movements whilecontrolling the micro gap through aconical connectionConsistent Emergence ProfilesThe prosthetic components of theStraumann ® Bone Level Implant line aredesigned to facilitate highly estheticrestorations that perfectly mimic naturalteeth. These implant line components,designed to match the abutment profiles,allow you to easily attain estheticresults through soft tissue management.CrossFit ConnectionThe prosthetic connection is intuitive,self-guiding and easy to grasp. TheCrossFit Connectionp provides a clear-cut insertion throughthe guidance by 4 grooves and thedeep, conical connection.p ensures precision against rotationthrough orthogonal fit betweenimplant and abutment.p gives prosthetic flexibility withmechanical long-term stabilitythrough its conical connection.1. Straumann ® Bone Level Implant – Straumann expertise applied at bone level

2. General <strong>information</strong>2.1 crossFit ConnectionThe Straumann ® Bone Level Implant features a new intuitiveimplant-abutment connection that is self-guiding and enablessimple positioning. It allows clear-cut insertion with allcomponents and provides outstanding protection againstrotation as well as long-term stability.Precision and simplicity: 4 groovesThe CrossFit Connection features 4 grooves forthe repositioning of prosthetic components.This configuration is characterized by:ppppsimple implant alignmentclear-cut and guided component insertionflexibility in the placement of angled prostheticcomponentsoptimal protection against rotation ensured byorthogonal implant-abutment fitFigure 1: Internal connection viewed from above, showingthe 4 internal grooves.Figure 2: Abutment insertion, step 1.The abutment is placed on the 4 grooves in the implant.2. General <strong>information</strong>

Figure 3a: Abutment insertion, step 2.The abutment is turned in until it is aligned with the4 implant grooves.Figure 3b: Abutment insertion, step 3.The abutment then falls into the final position.Figure 4: Abutment in place, showing the preciseorthogonal fit between implant and abutment.Reliability and flexibility: Conical connectionThe CrossFit Connection features a cone with improved mechanical properties,providing more flexibility for prosthetic treatments.The conical prosthetic connection provides:ppppreduced micro movements and minimized microgapoutstanding mechanical long-term stability and optimized stress distributionexact implant-abutment fitsimplified impression taking even with divergently positioned implants2. General <strong>information</strong>

2.2 Prosthetic optionsGold Abutment, for crownScrew-retainedCARES Ceramic AbutmentSingle crownAnatomic AbutmentMeso AbutmentGold Abutment, for crownCement-retainedCARES Ceramic AbutmentCARES Titanium AbutmentCementable AbutmentGold Abutment, for bridgeScrew-retainedMulti-Base AbutmentBridgeAnatomic AbutmentMeso AbutmentGold Abutment, for crownCement-retainedCARES Ceramic AbutmentCARES Titanium AbutmentCementable Abutment2. General <strong>information</strong>

Retentive anchorLOCATOR ® AbutmentAbutment for Bars, GoldBarAbutment for Bars, TitaniumRemovable overdenturesMulti-Base AbutmentCustomized barGold Abutment, for bridgeAnatomic AbutmentTelescopeMeso AbutmentGold Abutment, for crown2. General <strong>information</strong>

2.3 Abutment OverviewAnatomic AbutmentMeso AbutmentGold Abutment,for crownGold Abutment,for bridgeCARESCeramicAbutmentSingle crownScrew-retained v vCement-retained v v v vBridgeScrew-retainedvCement-retained v v v vRemovable overdenturesTelescope v v vRetentive anchorBarvImpressionImplant level v v v v vAbutment levelMaterial* Titanium Titanium Ceramicor ® Ceramicor ® ZirconiaPage 42 42 49 61 71*See <strong>information</strong> on sterilization conditions on page 151.2. General <strong>information</strong>

Healing abutment Impression post Implant analog TemporaryabutmentAbutmentvv v v v vvScrew headScrew head2. General <strong>information</strong>11

3.3 Custom-made drill templateA custom-made drill template can facilitate planning and the preparation of the implant bed and enables precise use of thecutting instruments. The basis of planning when making this surgical template should be the desired prosthetic result.With these components, a surgical drill template can be produced in the usual manner:Art. No. Article Dimensions049.810V4 Drill sleeve with collar height 10 mmoutside Ø 3,5 mminside Ø 2,3 mm049.818V4 Stepped pin for 049.810 height 16 mmØ 2,2/3,5 mm049.816V4 Pin for 049.810 height 16 mm,Ø 2,2 mm049.817V4 Pin for 049.810 height 10 mm,Ø 2,2 mm049.819V4 Pin for 049.810 height 16 mm,Ø 3,5 mmThe Straumann brochure “Surgical fabrication and use of a custom-made drilling template“(Art. No. 152.290) contains two fabrication methods with step by step instructions.Vacuum-formed template with integral pins asX-ray reference.Vacuum-formed template with integrated drillsleeve as drilling template.3. Preoperative planning13

4. Soft tissue managementThe Straumann ® Bone Level Implant line puts a strong emphasis on esthetic considerations. It offers tailormadesolutions that allow for natural soft tissue shaping and maintenance in all indications. A versatileportfolio of healing and temporary abutments is available, including customizable products made ofpolymer for easy and fast processing.4.1 Soft tissue management solutionsHealing AbutmentTemporary AbutmentPrefabricated healing abutment(titanium)p. 16–18Customizable healing abutment(polymer)p. 19–20(polymer with titanium inlay)p. 21–274. Soft tissue management15

4.2 Prefabricated healing abutmentIntended usep Soft tissue managementp Closure of implant connection for submerged and non-submerged healingCharacteristicsSimplep One-piece designp Color-coded and laser-markedp Anatomically shaped emergence profiles, matching impression post and finalabutmentsReliablep Tight connection Prosthetic procedure: p. 17–18164. Soft tissue management

Prosthetic procedure4.2.1 Prefabricated Healing Abutment – Prosthetic procedure1Step 1 – Insertionp Insert the healing abutment with the SCS screwdriver. Thefriction fit secures the healing abutment to the instrumentduring insertion and ensures safe handling.p Hand-tighten the healing abutment. The cone-in-conedesign provides a tight connection between the twocomponents.2Step 2 – Wound closurep Adapt the soft tissue and suture it back tightly around theabutment.4. Soft tissue management17

Prosthetic procedureOptional: Bottle-shaped and Customizable Healing AbutmentThe bottle-shaped healing abutment pre-shapes the softtissue by allowing for a slight excess of mucosa duringhealing. The insertion of the final restoration pushes theformed tissue outward, supports the creation of a naturallyshaped peri-implant soft tissue.The customizable healing abutment allows for individual softtissue management.NoteDo not use the customizable healing abutment for longerthan 6 months.Healing abutments are delivered non-sterile and can besterilized prior to use (see instructions, p. 151).184. Soft tissue management

4.3 Customizable Healing AbutmentIntended usep Individual soft tissue management for esthetic casesp Closure of implant connection during healing phaseCharacteristicsSimplep Polymer material allows for easy and quick chair-side modificationp Easy-to-achieve esthetics due to gingiva-colored and modifiable polymermaterialReliablep CrossFit ConnectionNoteDo not use for longer than 6 months Prosthetic procedure: p. 204. Soft tissue management19

Prosthetic procedure4.3.1 Customizable Healing Abutment – Prosthetic procedure1aStep 1 – Customizingp Individualize the healing abutment on an analogaccording to the mouth situation. Heatless wheels andnew cross-toothed millers are recommended for grinding.1bp To avoid smearing of the polymer, adjust the bur speedproperly (low rpm number, little pressure).Step 2 – Insertionp Hand-tighten the healing abutment in the implant with theSCS screwdriver and temporarily seal the screw channel(e.g. with composite).204. Soft tissue management

4.4 Temporary AbutmentIntended usep Individual soft tissue management for esthetic casesp Screw- or cement-retained temporary crownsp Cement-retained temporary bridgesCharacteristicsSimplep Polymer material allows for easy and quick chair-side modificationp Easy-to-achieve esthetics due to tooth-colored and modifiable polymer materialReliablep Precise fit and high stability due to reinforcement with titanium inlayp Connexion CrossFitNoteDo not use for longer than 6 months.Place temporary restoration out of occlusion.The temporary abutment can be shortened vertically no more than 6 mmand in the lower end be reduced radially no more than 0,5 mm(NC temporary abutment) and 1 mm (RC temporary abutment) respectively.Lab procedure: p. 22–27Prosthetic procedure: p. 22–274. Soft tissue management21

Lab procedureProsthetic procedure4.4.1 Temporary Abutment – ProcedureOption A: Screw-retained temporary crown1aStep 1 – Customizingp Individualize the temporary abutment on an analogaccording to the mouth situation. Heatless wheels andnew cross-toothed millers are recommended for grinding.p To avoid smearing of the polymer, adjust the bur speedproperly (low rpm number, little pressure).1bNoteFor optimal adhesion of the temporary veneering material,roughen or sandblast the upper section of the abutment orintegrate a means of retention.224. Soft tissue management

Lab procedureProsthetic procedure2aStep 2 – First insertionp Hand-tighten the temporary abutment in the implant/implant analog with the SCS screwdriver and temporarilyseal the screw channel (e.g. with cotton).2b2cp Use a standard technique to fabricate the temporaryrestoration (e.g. prefabricated crown form or vacuumformedsheet technique as shown here).2d4. Soft tissue management23

Lab procedureProsthetic procedure3Step 3 – Finishingp Remove excess acrylic, reopen the screw channel andfinish the temporary restoration.4Step 4 – Final insertionp Clean the polished temporary restoration, place it onthe implant and tighten the screw with a torque between15 Ncm and 35 Ncm using the SCS screwdriver alongwith the ratchet and the torque control device (see instructionsin chapter 7.5, p. 149).pCover the screw head with absorbent cotton or guttaperchaand seal the screw channel with temporaryveneering material (e.g. composite).244. Soft tissue management

Lab procedureProsthetic procedureOption B: Cement-retained temporary crown1aStep 1 – Customizingp Individualize the temporary abutment on an analogaccording to the mouth situation. Heatless wheels andnew cross-toothed millers are recommended for grinding.p To avoid smearing of the polymer, adjust the bur speedproperly (low rpm number, little pressure).1bNoteFor optimal adhesion of the cement-retained temporarycrown, roughen or sandblast the upper section of theabutment.4. Soft tissue management25

Lab procedureProsthetic procedure2aStep 2 – Fabricating the cement-retained temporarysingle crownp Use a standard procedure to fabricate the cementretainedsingle crown (e.g. grind out a prefabricatedplastic tooth).2b264. Soft tissue management

Lab procedureProsthetic procedure3aStep 3 – Placing the customized abutmentp Place the abutment on the implant and tighten the screwwith a torque between 15 Ncm and 35 Ncm using theSCS screwdriver along with the ratchet and the torquecontrol device (see instructions in chapter 7.5, p. 149).3bpCover the screw head with absorbent cotton or guttaperchaand seal the screw channel temporarily (e.g. withabsorbent cotton).4Step 4 – Cementing the temporary single crownp Coat the internal configuration of the crown with temporarycement and cement it on the temporary abutment.4. Soft tissue management27

5. impression taking5.1 Options for impression takingImpressions for the Straumann ® Bone Level Implant can be taken by either of the two followingprocedures:Open tray techniqueClosed tray techniquep. 29–32 p. 33–36Straumann ® Bone Level ImplantThe technique used depends on the user’s preference and the clinical situation. Both techniques aredescribed in the following chapters.285. Impression taking

5.2 Open tray impressionIntended usep Open tray impression techniqueCharacteristicsSimplep Color-coded components corresponding to prosthetic connectionp Slender emergence profile accommodates space limitationsp Guide screw can be tightened either by hand or with the SCS screwdriverReliablep High precision impression components give an exact replica of the intraoralsituationp Clear-cut tactile response from the prosthetic connection verifies proper seatingof componentsNoteOpen tray impression procedure requires a custom-made tray with perforations.Impression posts are intended for single use only to ensure optimal fit and preciseimpression taking for each patient.Prosthetic procedure: p. 30–31Lab procedure: p. 325. Impression taking29

Prosthetic procedure5.2.1 Open tray impression – Prosthetic procedure1Step 1 – Positioning the impression postp Ensure sufficient access to the implant site in orderto avoid pinching in the gingival tissue. Be awarethat the sulcus may collapse rapidly once the healingcomponents have been removed.p Clean the internal configuration of the implant thoroughlyfrom blood, tissue, etc. prior to the impression procedure.p Place the impression post accurately into the implant andhand-tighten the guide screw.p In case of occlusal space limitation, the length of theimpression post can be reduced by one retention ringafter the guide screw has been removed.305. Impression taking

Prosthetic procedure2aStep 2 – Impression takingp Make perforations in the custom-made impression tray(light cured resin) according to the individual situation sothat the positioning screw of the impression post sticks out.2bpTake the impression using an elastomeric impressionmaterial (polyvinyl siloxane or polyether rubber).NoteDue to its low tensile strength, hydrocolloid is not suitable forthis application.2cp Uncover the screws before the material is cured.p Once the material is cured, loosen the guide screws andremove the tray.2d5. Impression taking31

Lab procedure5.2.2 Open tray impression – Lab procedure1aStep 1 – Analog repositioning and fixingp Reposition and fix the analog in the impression using theguide screw. To avoid inaccuracies when connecting, theanalog must be positioned exactly in line with the groovesof the impression post before screwing in.1b1cNoteWhen tightening the screw, grasp the retentive section of theanalog securely to prevent the impression post from rotating.This is especially important with a shortened post.2Step 2 – Fabricating the master castp Fabricate the master cast using standard methods andtype 4 dental stone (DIN 6873). A gingival mask shouldalways be used to ensure that the emergence profile ofthe crown is optimally contoured.325. Impression taking

5.3 Closed tray impressionIntended usep Closed tray impression techniqueCharacteristicsSimplep Color-coded components corresponding to prosthetic connectionp Slender emergence profile to accommodate space limitationsp No additional preparation (i.e. perforation) of tray requiredReliablep High precision impression components give an exact replica of the intraoralsituationp Clear-cut tactile response from the prosthetic connection verifies proper seatingof componentsNoteImpression posts are intended for single use only to ensure optimal fit and preciseimpression taking for each patient.Prosthetic procedure: p. 34–35Lab procedure: p. 365. Impression taking33

Prosthetic procedure5.3.1 Closed tray impression – Prosthetic procedure1aStep 1 – Positioning the impression postp Ensure sufficient access to the implant site in orderto avoid pinching in the gingival tissue. Be awarethat the sulcus may collapse rapidly once the healingcomponents have been removed.p Clean the internal configuration of the implant thoroughlyfrom blood, tissue, etc. prior to the impression procedure.p Place the impression post accurately into the implantand tighten the guide screw hand-tight (using the SCSscrewdriver).NoteEnsure that the lateral planar areas of the post are facingmesial and distal.1bp Place the polymer impression cap on top of the fixedimpression post. Ensure that the color of the capcorresponds to the color of the positioning screw inthe post and that the arrows are aligned with the oralvestibulardirection.p Push the impression cap in apical direction until it clicks.The impression cap is now firmly seated on the impressionpost.345. Impression taking

Prosthetic procedure2aStep 2 – Impression takingp Take the impression using an elastomeric impressionmaterial (polyvinyl siloxane or polyether rubber).NoteDue to its low tensile strength, hydrocolloid is not suitable forthis application.2bp Once the material is cured, carefully remove the tray.The impression cap remains in the impression materialand therefore is automatically pulled off from theimpression post with the removal of the tray.2cp Unscrew and remove the impression post and send ittogether with the impression tray to the dental technician.5. Impression taking35

Lab procedure5.3.2 Closed tray impression – Lab procedure1aStep 1 – Analog fixing and impression postrepositioningp Mount the impression post on the analog using the guidescrew. To avoid inaccuracies when connecting, theanalog must be positioned exactly in line with the groovesof the impression post before screwing it in.1bNoteEnsure that the color code of the guide screw correspondsto the color code of the analog and that the color code ofthe analog corresponds to the color code of the polymercap in the impression material.1cp Reposition the impression post in the tray.p Smoothly push the impression post until you feel the tactileresponse of engagement. It is now firmly seated on theimpression cap in the impression tray.2Step 2 – Fabricating the master castp Fabricate the master cast using standard methods and atype 4 dental stone (DIN 6873). A gingiva mask shouldalways be used to ensure that the emergence profile ofthe crown is optimally contoured.365. Impression taking

Prosthetic procedure5.4 Bite registrationTo simplify bite registration after impression taking, plastic bite registration aids are available in various heights.For repositioning on the master cast, the bite registration aids have a flat side laterally.1Step 1 – Insertionp Insert the bite registration aids into the implants.Each component is fitted with a snap mechanismthat holds it in the internal configuration.NoteProtect the components against aspiration (e.g. use athroat pack or a thread).5. Impression taking37

Prosthetic procedure2aStep 2 – Shorteningp Shorten the bite registration aids (if needed) and applythe bite registration material. To ensure the repositioningfrom the mouth to the master cast, the occlusal area andthe lateral flat side of the bite registration aids must beadequately surrounded with the registration material.NoteBite registration aids must be shaped out of the mouth. Ifthey need to be shortened occlusally due to lack of space,ensure that the lateral flat side is not ground off.2b3Step 3 – Positioningp To transfer the bite, put the bite registration in the analogson the master cast. Fix the bite wax model and mount themaxilla and mandible casts on the articulator.385. Impression taking

6. Restoration6.1 CrossFit PLAN SET/PLAN abutmentIntended usep Intra- and extra-oral planning of prosthetic restorationCharacteristicsSimplep Color-coded, well-marked and easily readable PLAN abutmentsp Comprehensive PLAN set containing all PLAN abutments arranged clearlyp Easy handling with the SCS screwdriverReliablep Proper seating of PLAN abutments verified through the clear-cut response fromthe prosthetic connectionp PLAN abutments fabricated of sterilizable polymer materialNoteClean and moist-heat-sterilize PLAN abutments after intra-oral use.Do not sterilize the cassette or its components.Replace non-functional PLAN abutments.Lab procedure: p. 40Prosthetic procedure: p. 40–416. Restoration39

Lab procedureProsthetic procedure6.1.2 CrossFit PLAN Set/PLAN abutment selectionThe Straumann ® CrossFit PLAN Set allows for optimal planning of the restoration in the mouth and on the model. It givesthe dentist and the dental technician greatest flexibility in cooperative planning and minimizes the quantity of stock abutments.The PLAN set contains all PLAN abutments available for the Straumann ® Bone Level Implant (anatomic, cementable,gold, Multi-Base, LOCATOR ® ).1aStep 1 – Selecting the right abutmentp Open the PLAN set, pick up a PLAN abutment andsecure it with the SCS screwdriver (empty mold forinstruments built in).1bp Place the PLAN abutment on the implant (intra-oral use)or implant analog (extra-oral use). This will aid in checkingdimensions (rings on PLAN abutments indicate gingivaheight), axial alignment and screw axis of the potentialrestoration.2Step 2 – Ordering the stock abutmentp Once the best fitting PLAN abutment is determined,order the corresponding stock abutment (titanium, gold)using the allocation chart on the PLAN set inlay card.40 6. Restoration

Prosthetic procedure6.1.3 Cleaning and sterilizing PLAN abutmentspppClean the PLAN abutments thoroughly with water or ethanol after intra-oral use.After cleaning, moist-heat-sterilize (autoclave) PLAN abutments 18 minutes at134 °C (273 °F).Refer to the manufacturer’s specifications for the heat-sterilization device.NoteDo not sterilize PLAN abutments more than 20 times.Do not g-sterilize PLAN abutments.Do not sterilize the cassette or its components.6. Restoration41

6.2 Anatomic (and meso) AbutmentIntended usep Cement-retained restorationsCharacteristicsSimplep Less grinding necessary due to prepared mucosa marginsp Adaptation to natural soft tissue contour due to prepared mucosa margins indifferent heightsp Oval shape resembles emergence profile of a natural toothReliablep CrossFit ConnectionNoteNot suitable for direct ceramic veneering.A minimum height of 3 mm above the mucosa margin of the abutment mustbe maintained in order to maintain proper stability of the abutment.The cement margin must not be more than 2 mm below the mucosa.Use a new basal screw for the final insertion of the abutment.Lab procedure: p. 43–47Prosthetic procedure: p. 48426. Restoration

Lab procedure6.2.1 Anatomic (and Meso) Abutment – Lab procedureThe following case describes the fabrication of a cement-retained single crown by using the anatomic abutment.1aStep 1 – Fabricating the master cast and wax-upp Fabricate the master cast including a gingiva mask withthe corresponding implant analog (see instructions inchapter 5, p. 28).1bp For optimal esthetic planning, model a full anatomicalwax-up.1cp Make a silicone key over the full wax-up in order todefine the optimal shape of the customized abutment.6. Restoration43

Lab procedure2aStep 2 – Preparing the Anatomic or Meso Abutmentp The anatomic abutment and the meso abutment (p. 45)consist of titanium and can be modified as required.NoteTo maintain proper stability of the abutment, a minimumheight of 3 mm above the mucosa margin of the abutmentmust be maintained.2bp The anatomic abutment after modification.446. Restoration

Lab procedureIf the anatomic abutment does not fit your individual demands or if you prefer grinding the mucosa margins yourself, you canuse the meso abutment. The processing of the meso abutment corresponds to the one of the anatomic abutment.2c 2d 2e6. Restoration45

Lab procedure3Step 3 – Fabricating the superstructureFabricate the superstructure on the modified abutment usingthe standard modelling, casting and veneering methods.ppppPlace the modified abutment on the polishing aid/analogand hand-tighten the screw using the SCS screwdriver.Wax an individual resin cap onto the abutment.Contour a wax model according to the anatomicalcircumstances of the individual cast.Check the wax-up with the silicone key.466. Restoration

Prosthetic procedure6.2.2 Anatomic Abutment – Prosthetic procedureThe final restoration is delivered to the doctor’s office on the master cast.Step 1 – Preparationp Remove the healing cap or temporary restoration.p Remove the superstructure from the master cast andunscrew the abutment from the analog.p Clean and dry the interior of the implant and theabutment thoroughly.Step 2 – Final insertionp Position the cleaned abutment in the implant. Tighten thescrew to 35 Ncm using the SCS screwdriver along withthe ratchet and the torque control device (see instructionsin chapter 7.5, p. 149).p Close the SCS configuration of the screw with cotton andsealing compound (e.g. gutta-percha). This allows a laterremoval of the customized abutment in case a crownreplacement is required.p Cement the superstructure to the abutment.p Remove superfluous cement.48 6. Restoration

6.3 Gold Abutment for crownIntended usep Screw-retained or cement-retained crownsp Cement-retained bridges via mesostructure (custom abutment technique)p Telescopic crowns and telescopic bridgesCharacteristicsSimplep Easy wax-up and protection of the screw channel due to modelling aid(burn-out polymer)p Easy-to-achieve esthetics due to individual contouring of the emergenceprofile and adaptation to the margin of the gingival contourReliablep Superfluous cement easily removable by raising the cement margin using anindividually designed mesostructurep CrossFit ConnectionNoteNot suitable for direct splinting with other gold abutments. For screw-retainedbridges the gold abutment for bridge must be used (see instructions in chapter6.4, p. 61).Use a new basal screw for the final insertion of the abutment.Do not shorten the gold abutment for crown by more than 1.5 mm.Lab procedure: p. 50–59Prosthetic procedure: p. 606. Restoration49

Lab procedure6.3.1 Gold Abutment for crown – Lab procedureThe following case describes the fabrication of a cement-retained single crown by utilizing the custom abutment technique.1aStep 1 – Fabricating the master cast and wax-upp Fabricate the master cast including a gingiva mask withthe corresponding implant analog (see instructions inchapter 5, p. 28).1bp For optimal esthetic planning, model a full anatomicalwax-up.1cp Make a silicone key over the full wax-up in order todefine the optimal shape of the customized abutment.506. Restoration

Lab procedure2aStep 2 – Preparing the Gold Abutmentp Place the gold abutment on the analog and hand-tightenthe screw using the SCS screwdriver.2bp Shorten the modelling aid to the height of the occlusalplane according to the individual circumstances. Workingwith the modelling aid ensures a clean and sharp-edgedfinish of the screw channel.2c2dp Attach the gold abutment to the polishing aid foreasier handling during manipulation outside of themodel.6. Restoration51

Lab procedure3aStep 3 – Wax modellingp Contour a wax-up shape according to the individualanatomical situation. The silicone key shows the exactspace for the cement-retained crown, which will be madeover the customized abutment.3bp Make sure that the wax layer on the abutment issufficiently thick (at least 0,7 mm). Do not cover thedelicate margin of the abutment with wax.3cp Check the wax-up with the silicone key.3dNoteThe picture displays the optimal configuration of a customizedabutment, showing an ideal emergence profile. Thisconfiguration ideally adapts the crown contours to themargin of the gingival contour. For reasons of hygiene, thecement margin must not be more than 2 mm below thegingival level.526. Restoration

Lab procedure4Step 4 – Investmentp Invest the customized abutment according to standardmethods without using wetting agents.NoteIn order to avoid overflow of the cast-on alloy, thoroughlyclean the abutment prior to investment (removal of waxparticles, insulating agents with a cotton pellet or brushmoistened with alcohol).Always do the cast with the modelling aid. Otherwise,the dental casting alloy will not or only too thinly flow out atthe upper coping rim.Ensure that there is no wax on the delicate margin.The use of investment materials for rapid heating methods(speed investment materials) is not recommended.When processing the investment material, follow themanufacturers’ instructions. Observe the recommendedmixing ratio and preheating time exactly.6. Restoration53

Lab procedure5aStep 5 – Casting and devestmentp Cast the customized abutment.p Gently devest the customized abutment with ultrasound,water jet, pickling acid or a glass fiber brush.5bNoteFor the devestment of the gold abutment with sandblasting(maximum pressure: 2 bars; maximum alumina particle size:50 µm), the inner configuration has to be protected frominfiltration with sand with the polishing aid.5cp The wax-fixed polishing aid allows better fixation andprotects the pre-polished part of the gold abutment.546. Restoration

Lab procedure5dpThe gold abutment after sandblasting.5eNoteDo not sandblast the inner configuration of the gold abutment.6. Restoration55

Lab procedure6aStep 6 – Polishingp After trimming, polish the finished customized abutment.6bp The customized abutment is now ready for the fabricationof the cement-retained single crown.7aStep 7 – Fabricating the cement-retained single crownp Block out the screw channel and wax the frameworkdirectly over the customized abutment.p The silicone key shows the spatial relations for therestoration.566. Restoration

Lab procedure7bp Cast the framework in the conventional manner. Aftertrimming the cast, the metal crown fits precisely on thecustomized abutment.pThe silicone key shows the spatial relations for veneering.7cp Veneer the superstructure.6. Restoration57

Lab procedureCasting errors and incorrect handlingGround down toabutment levelNoteThe long-term success of the prosthetic work depends on theaccurate fit of the restoration.The entire procedure has to be repeated if…p … trimming through the cast-on alloy prohibits theCeramicor ® surface from being covered with ceramicveneering material (Ceramicor ® is a non-oxidizingalloy and does not allow ceramic bonding).Failed castingp… the cast-on gold did not flow out entirely.Casting beads andoverflow of alloyp …intruded casting metals and casting pearls cannot beremoved from the connection part of the gold abutment.58 6. Restoration

Lab procedureUsing alloys with castable Ceramicor ® componentsCeramicor ® is only suitable for cast-on proceduresCeramics can not be bonded directly to cast-on Cermicor ® components as thisalloy does not form bonding oxides.When selecting the casting alloy, ensure that it is compatible with the high-fusingalloy of the Ceramicor ® components. The melting range of the casting alloy mustnot exceed a liquidus temperature of 1350 °C/2462 °F.Ceramicor ® must not be cast on with base metal casting alloys because gold incombination with nickel or cobalt destroys the components.Suitable dental casting alloysp High noble alloysp Precious metal alloys with a minimum content of gold and platinum groupmetals of 25%p Palladium-based alloys with a minimum content of palladium of 50%ISO standard alloy typesAlloy types according to the following ISO standards are suitable for cast-onprocedures to the prefabricated Cermicor ® component:pppISO standard 9693ISO standard 1562ISO standard 8891NoteThe alloy manufacturer’s recommendation must be followed. Due to diffusion atthe alloy and the cast-on coping interface, components made from an unsuitablealloy may form phases with low-strength, reduced corrosion resistance or a lowermelting range.Ceramicor ® is a registered trademark of Cendres & Métaux SA(Biel-Bienne, Switzerland).6. Restoration59

Prosthetic procedure6.3.2 Gold Abutment for crown – Prosthetic procedureThe final restoration is delivered to the doctor’s office on the master cast.Step 1 – Preparationp Remove the healing cap or temporary restoration.p Remove the superstructure from the master cast andunscrew the abutment from the analog.p Clean and dry the interior of the implant and theabutment thoroughly.Step 2 – Final insertionOption A: Screw-retained crownp Position the cleaned abutment in the implant. Tighten thescrew to 35 Ncm using the SCS screwdriver along withthe ratchet and the torque control device (see instructionsin chapter 7.5, p. 149).p Close the SCS configuration of the screw with cottonand sealing compound (e.g. gutta-percha or composite).This allows later removal of the customized abutment incase a crown replacement is required.Option B: Cement-retained crownp Position the cleaned abutment in the implant. Tighten thescrew to 35 Ncm using the SCS screwdriver along withthe ratchet and the torque control device (see instructionsin chapter 7.5, p. 149).p Close the SCS configuration of the screw with cottonand sealing compound (e.g. gutta-percha or composite).This allows later removal of the customized abutment incase a crown replacement is required.p Cement the crown to the mesostructure.p Remove superfluous cement.NoteThe figure displays the optimal configuration of acustomized abutment, showing an ideal emergence profile.This configuration ideally adapts the crown contours tothe margin of the gingival contour. For reasons of hygiene,the cement margin must not be more than 2 mm belowthe gingival level.60 6. Restoration

6.4 Gold abutment for bridgeIntended usep Screw-retained bridgesp Screw-retained customized barsCharacteristicsSimplep Easy wax-up and protection of the screw channel due to modelling aid(burn-out polymer)p Easy-to-achieve esthetics due to individual contouring of the emergenceprofile and adaptation to the margin of the gingival contourReliablep No cement gapp One-screw solutionNoteNot suitable for single crowns. For single crowns the gold abutment for crownmust be used (see instructions in chapter 6.3, p. 49).Use a new basal screw for the final insertion of the abutment.Do not shorten the gold abutment for bridge by more than 2.5 mm.Lab procedure: p. 62–69Prosthetic procedure: p. 706. Restoration61

Lab procedure2aStep 2 – Preparing the gold abutmentsp Place the gold abutments for bridge on the analogs andhand-tighten the screws using the SCS screwdriver.2bp Shorten the modelling aids to the height of the occlusalplane according to individual circumstances. Workingwith the modelling aid ensures a clean and sharp-edgedfinish of the screw channel.2cp To avoid a deformation of the conical design of theconnection it is highly recommended to always attach thegold abutment to the polishing aid while working outsideof the model.6. Restoration63

Lab procedure3aStep 3 – Wax modellingp Contour a wax-up shape according to the individualanatomical situation.p Make sure that the wax layer on the abutment issufficiently thick (at least 0,7 mm). Do not cover thedelicate margin of the abutments with wax.3bpCheck the spatial conditions before casting the bridgeframework with the silicone key of the wax-up.646. Restoration

Lab procedure4Step 4 – Investmentp Check that the wax framework of the bridge is absolutelytension-free before investing the framework. This is accomplishedaccording to commonly known bridge techniques.p Invest the bridge framework according to standardmethods without using wetting agents.NoteIn order to avoid overflow of the cast-on alloy, thoroughlyclean the abutments prior to investment (removal of waxparticles, insulating agents with a cotton pellet or brushmoistened with alcohol).Ensure that there is no wax on the delicate margin.The use of investment materials for rapid heating methods(speed investment materials) is not recommended.When processing the investment material, follow themanufactures’ instructions. Observe the recommendedmixing ratio and preheating time exactly.6. Restoration65

Lab procedure5aStep 5 – Casting and devestmentp Cast the bridge framework.NoteThe long term success of the prosthetic work depends onthe accurate fit of the restoration. The entire procedure willhave to be repeated, if casting errors occur, similar to theexamples on p. 58.5bppAllow for enough cooling time of the casted bridgebefore the devestment.Gently devest the bridge framework with ultrasound,water jet, pickling acid or a glass fiber brush.For the devestment of the gold abutments with sandblasting(maximum pressure: 2 bars; maximum alumina particle size:50 µm), the inner configuration has to be protected frominfiltration from sand with the polishing aid.5cp The wax-fixed polishing aid allows better fixation andprotects the pre-polished part of the gold abutments.666. Restoration

Lab procedure5dNoteTo help ensure success of the restoration, a perfect prostheticfit in the internal connection of the implant is mandatory.Take particular care not to let the bridge reconstruction falldown onto any surface. Due to the weight of the bridgeconstruction, this might have a negative impact on the highprecision connection of the gold abutment. If the constructionfalls down at anytime, repeat the entire procedure.5e5fp Do not sandblast the inner configuration of the goldabutment.6. Restoration67

Lab procedure6aStep 6 – Preparation before veneeringp Remove the sprues and smooth the removal areas.p Check the spatial conditions with the silicone key.6bpControl tension-free fitting on the master cast(Sheffield test). If the bridge is not tension-free andtherefore wiggles, cut the bridge and resplint it ina tension-free manner.NoteIn order to take the bridge off the master cast, all basalscrews need to be removed first.6c686. Restoration

Lab procedure6dp Do an additional try-on of the tension-free fit of the frameworkin the mouth of the patient.7Step 7 – Veneeringp Veneer the superstructure.6. Restoration69

Prosthetic procedure6.4.2 Gold abutment for bridge – Prosthetic procedureThe final restoration is delivered to the doctor’s office on the master cast.Step 1 – Preparationp Remove the healing abutment or temporary restoration.p Remove the superstructure from the master cast and unscrewthe bridge from the analogs.p Clean and dry the interior of the implants and thebridgework thoroughly.p Check the tension free fit of the bridgework beforetightening it in the mouth of the patient.NoteDo not insert the bridge in case of movements due to tensionsin the bridgework.Step 2 – Final insertionp Position the cleaned bridgework in the implants.p Tighten the screws to 35 Ncm using the SCS screwdriveralong with the ratchet and the torque control device (seeinstructions in chapter 7.5, p. 149).p Close the SCS configuration of the screws with cottonand sealing compound (e.g. gutta-percha or composite).This allows later removal of the bridge work if needed.706. Restoration

6.5 CARES abutmentIntended usep Cement-retained crownsp Cement-retained bridges via mesostructurep Screw-retained crowns (ceramic abutments only)CharacteristicsSimplep Anatomic emergence profilep Gingival situation visible on the screenp Fast scan and design processp Cost and time savings in the dental labReliablep CrossFit Connectionp High performance materialsp Straumann ® warranty for CARES components 1Lab procedure: p. 73–80Prosthetic procedure: p. 76, 81–831Terms of the CARES warranty are located at the following link: www.straumann.com/CARES6. Restoration71

6.5.1 Technical RequirementsFor the use of Straumann ® CARES, the dental lab and/or the doctor needs the following components:ScannersinLab 1The multifunctional inLab CAD/CAM system includes a compact grinding unit withintegrated laser scanner 2 , controlled by a standard PC with sufficient computing power.inEos 1The scanner records the data from single-tooth models, dye models, complete jaw modelsas well as the opposing jaw for the occlusion. The scan of the dental model serves as thebasis for designing the abutment with the inLab 3D software.3D Camera of the Cerec 1 3 UnitThe Cerec 3 system is well suited to record the implant position directly in the patient’smouth.ScanbodyTo record the implant position during the scan process a scanbody is required.The scanbody consists of a scan post, which is directly screwed into the implant/implant analog, and a scan cap. A scanbody (scan post and scan cap) is includedin each CARES set.InLab 3D SoftwareThe abutment 3D software for designing the abutment shape is part of the inLab 3D software, available from authorized dentalequipment distributors.Internet connectionA broadband connection is recommended.1inLab, inEos and Cerec are registered trademarks of Sirona Dental Systems GmbH, D-64625 Bensheim, Germany.2With the inLab system, only the scanner can be used. The abutments can be produced only in the Straumann production center.726. Restoration

Lab procedure6.5.2 CARES abutment – Lab procedure6.5.2.1 Fabricating the model1aStep 1 – Fabricating the scan modelp Fabricate a master cast with the corresponding analog(see instructions in chapter 5, p. 28).Option A: Fabricate a duplicate model made fromscan plaster 1 .Option B: Cast the master cast directly by using scanplaster.1bppFor optimal esthetic planning, model a full anatomicalwax-up and scan it too.To determine the spacing available for further processing,the silicone key can be viewed on-screen. For moredetails, see chapter 6.5.2.3.1c1Information on suitable plasters can be obtained from Sirona Dental Systems GmbH, D-64625 Bensheim,Germany (http://www.sirona.com) or authorized dental equipment distributors.6. Restoration73

Lab procedure6.5.2.2 Scanning of the model situationOption A: Scanning with the inLab unit1Step 1 – Preparing the scan – duplicate modelp Position the scan post in the implant analog.p Insert the screw and hand-tighten it.p Snap the scan cap on top of the post.p Assure that the parts are placed correctly.p Duplicate the master cast including scanbody to producea scan model made from scan plaster.p Adjust the sector to be scanned to the available spaceon the model holder of the inLab.NoteFor an accurate scan, the scanbody must point upwardvertically, i.e. it must be visible without undercuts. The modelmust be mounted onto the model holder in such a way, thatit points towards clamping shank in the mesial direction.With a correctly positioned scanbody, there is no gap andno rotation between the scan post, implant analog, scancap and scan post.Scanbodies are intended for single use only, to ensureoptimal fit and precision.2Step 2 – Scanningp Put the scan model in the inLab and scan it with the laserscanner.distalmesial746. Restoration

Lab procedureOption B: Scanning with the inEos scanner1Step 1a – Preparing the scan – duplicate modelp Position the scan post in the implant analog.p Insert the screw and hand-tighten it.p Snap the scan cap on top of the post.p Assure that the parts are placed correctly.p Duplicate the master cast including scanbody to producea scan model made from scan plaster.Step 1b – Preparing the scan – scan spraypppppSpray the model.Position the scan post in the implant analog of themaster cast.Insert the screw and hand-tighten it.Snap the scan cap on top of the post.Assure that the parts are placed correctly.NoteAvoid direct spraying of the implant analog. Insert thescanbody into the master cast after spraying the model.With a correctly positioned scanbody, there is no gap andno rotation between the scan post, implant analog, scancap and scan post.Scanbodies are intended for single use only, to ensureoptimal fit and precision.Step 2 – Scanningp Adjust the model to be scanned on the model holder.p Put the scan model under the camera of the inEos.6. Restoration75

Prosthetic procedureOption C: Scanning with the Cerec 3 Unit 3D Camera1aStep 1a – Preparing the scan – without scan sprayp Remove the healing cap or temporary restoration.p Position the scan post in the implant.p Insert the screw and hand-tighten it.p Snap the scan cap on top of the post.p Assure that the parts are placed correctly.1bStep 1b – Preparing the scan – with scan sprayTo improve the contrast of the virtual impression, a scanspraymay be used.ppppppRemove the healing cap or temporary restoration.Spray the situation.Position the scan post in the implant.Insert the screw and hand-tighten it.Snap the scan cap on top of the post.Assure that the parts are placed correctly.NoteAvoid direct spraying of the implant. Insert the scan post and the scan cap into the mouth after spraying the site.With a correctly positioned scan post and scan cap, there is no gap and no rotation between the scan post,implant, scan cap and scan post.Scanbodies are intended for single use only, to ensure optimal fit and precision.2Step 2 – Scanningp Scan with the 3D Camera.766. Restoration

Lab procedure6.5.2.3 Designing the abutment shapep Shape the CARES abutment on screen, using theabutment 3D software. This software is part of the inLab3D design software.Design guidelinesp You can choose between 0 and max. 2 mm when settingthe cement line of the abutment.Menu: Settings – Parameter – Gingival depthppYou can view the virtual silicone key via the scanned fullwax-up.Menu: View – AntagonistFurther <strong>information</strong> and a step-by-step manual fordesigning CARES abutments can be found at thefollowing Straumann link:http://www.straumann.com/CARES6. Restoration77

Lab procedure6.5.2.4 Online orderingpppAfter you have finished the design, send your data overthe internet to the Straumann production center at thefollowing link:http://cares.straumann.comAfter the data transmission is completed, an emailconfirmation is sent.As soon as the data is tested and validated, you willreceive an order confirmation.NoteBefore the CARES abutment is fabricated at the Straumannproduction center, the data is subjected to an incominginspection.If the data record is found to contain errors or is incomplete,a message is sent to you for corrections to be made.A definitive order confirmation will be sent by Straumannonly after completing this step.78 6. Restoration

Lab procedure6.5.2.5 Manufacturing and deliveryFabricating the abutment at Straumannp Based on the design data, the customized CARESabutment is manufactured at the Straumann productioncenter.Delivery to the dental laboratoryp The CARES abutment is immediately delivered afterproduction.p In just a few working days, the dental laboratoryreceives the order.Delivery of the CARES abutment is available through thefollowing service providers:ppInternational: DHL (www.dhl.com)Switzerland: Swiss Post (www.post.ch)After the order has left the Straumann production center,you will receive an order tracking number together with thedelivery notification. With this number you can check thestatus of your order on the “track & trace” website of thecorresponding service provider.6. Restoration79

Lab procedure6.5.2.6 Product completion at the dental laboratoryOption A: Screw-retained crownCARES ceramic abutmentp Fabricate a screw-retained crown with a ceramic synchronizedto the thermal expansion coefficient of zirconia.p CARES ceramic abutments made of zirconia havea thermal expansion coefficient of 10,5 2 10 -6 /K(25 °C – 500 °C, 77 °F – 932 °F).NoteParticular attention must be given to an even layer thicknessof the porcelain veneered on the abutment.Option B: Cement-retained crownp Mount the CARES ceramic abutment on the implantanalog.p Use a standard procedure to fabricate the cementretainedsingle crown.p Veneer the structure.CARES titanium abutmentThe procedure for the CARES titanium abutment is the sameas the procedure for the cement-retained CARES ceramicabutment, ZrO 2, option B.80 6. Restoration

Prosthetic procedure6.5.3 CARES abutment – Prosthetic procedureThe final restoration is delivered to the doctor’s office on the master cast.1Step 1 – Preparationp Remove the healing cap or temporary restoration.p Remove the superstructure from the master cast andunscrew the abutment from the analog.p Clean and dry the interior of the implant and theabutment thoroughly.NoteUse transfer aids if the model contains more than oneabutment.Never use cement when the abutment is inserted into theimplant.CARES abutments made from zirconia are not autoclavableand must not be cleaned by steam blasting.6. Restoration81

Prosthetic procedureStep 2 – Final insertionCARES ceramic abutmentOption A: Screw-retained crownp Position the cleaned CARES ceramic abutment in the implant.Tighten the screw to 35 Ncm using the SCS screwdriveralong with the ratchet and the torque control device(see instructions in chapter 7.5, p. 149).p Close the SCS configuration of the screw with cotton andsealing compound (e.g. gutta-percha). This allows a laterremoval of the customized abutment in case a crownreplacement is required.Option B: Cement-retained crownp Position the cleaned CARES ceramic abutment in the implant.Tighten the screw to 35 Ncm using the SCS screwdriveralong with the ratchet and the torque control device(see instructions in chapter 7.5, p. 149).p Close the SCS configuration of the screw with cotton andsealing compound (e.g. gutta-percha). This allows a laterremoval of the customized abutment in case a crownreplacement is required.p Cement the superstructure to the abutment.p Remove superfluous cement.NoteUse only the special basal screws provided for the CARESceramic abutment.82 6. Restoration

Prosthetic procedureStep 2 – Final insertionCARES titanium abutmentOption B: Cement-retained crownp Position the cleaned CARES titanium abutment in the implant.Tighten the screw to 35 Ncm using the SCS screwdriveralong with the ratchet and the torque control device(see instructions in chapter 7.5, p. 149).p Close the SCS configuration of the screw with cottonand sealing compound (gutta-percha). This allows a laterremoval of the customized abutment in case a crownreplacement is required.p Cement the superstructure to the abutment.p Remove superfluous cement.NoteDirect ceramic veneering is not possible.Use only the basal screws provided for the CAREStitanium abutment.6. Restoration83

6.6 Cementable abutmentIntended usep Cement-retained crowns and bridgesCharacteristicsSimplep Flexible impression taking on implant or abutment levelp Easy handling of prefabricated copingsp Reduce adjustment work (e.g. height adjustment)p Easy choice of components thanks to color-codingReliablep CrossFit Connectionp Perfect fit due to prefabricated componentsp Proper fit of abutment level impression cap verified by clear-cut responseNoteCement margin must be no more that 2 mm below the gingiva.A minimum height of 3 mm above the mucosa margin of the abutment must bemaintained to ensure proper stability and retention of the restoration.Lab procedure: p. 92–96Prosthetic procedure: p. 86–91, 97–9884 6. Restoration

6.6.1 Cementable abutment codingNarrow CrossFitRegular CrossFitDiameter (D)3,5 mm(blue coding)5 mm(yellow coding)5 mm(grey coding)6,5 mm(brown coding)AH 4 mm(black marking)AH 5,5 mm(white marking)D = Diameter AH = Abutment Height GH = Gingiva HeightD4 mm5,5 mmAH1 mm2 mm3 mmGH6. Restoration85

Prosthetic procedureOption A: Impression taking on abutment level – Prosthetic procedure1aStep 1 – Abutment insertionp Select the appropriate size of the cementable abutmentusing the PLAN set (see instructions, in chapter 6.1, p. 39).1bp Thoroughly clean and dry the interior of the implant.p Position the abutment in the implant. Tighten the screw to35 Ncm using the SCS screwdriver along with the ratchetand the torque control device (see instructions in chapter7.5, p. 149).866. Restoration

Prosthetic procedure2Step 2 – Customizing the abutmentp Make height adjustments according to the individualsituation. This can be done down to the bottom of theblack/white ring.NoteThe abutment level impression does not carry any <strong>information</strong>of potential customizations. In this case, the abutmentlevel impression has to be taken without any auxiliaries. Werecommend taking the impression on implant level, and thenask the technician to customize the abutment according tothe individual situation.We recommend customizing the abutment right before thefinal crown is integrated, if the spatial surroundings allow it(no chewing forces against the abutment). Ask your dentallab to supply you with a grinding template.6. Restoration87

Prosthetic procedure3aStep 3 – Impression taking on abutment levelp Click the impression cap onto the abutment.p The white ring on the abutment indicates the abutmentheight (AH). It corresponds to the white arrow on top ofthe impression cap and the white clicking mechanisminside of the impression cap.pTake the impression using an elastomeric impressionmaterial (polyvinyl siloxane or polyether rubber).3bNoteDue to its low tensile strength, hydrocolloid materials are notsuitable for this application.886. Restoration

Prosthetic procedureChairside temporization of the abutmentTemporary copingProtective cap4aUsing the temporary coping*Step 4 – Preparationp Snap the temporary coping onto the abutment in themouth of the patient.4bppMark the appropriate height according to the individualsituation and shorten the coping as necessary.If you intend to provisionalize a bridge, remove therotational feature of the temporary coping.NoteDo not use Vaseline (aliphatic isolation agent) for insulationof the abutment.* Using the protective cap look at step 4, p. 916. Restoration89

Prosthetic procedure5aStep 5 – Creating the provisionalp Use a standard procedure to fabricate the provisional(e.g. prefabricated crown form or vacuum-formed sheettechnique). The retention rings ensure proper mechanicalbonding of the veneering material to the coping. Theplateau of the coping helps to prevent the veneeringmaterial from flowing under the abutment.5bp After the polymerization is completed, take the provisionalout of the mouth and place it on the analog.5cp Grind down and polish the emergence profile of thecoping and the restoration to achieve an even profile.To avoid tissue irritation, the interface needs to be smoothand flush with the restoration.906. Restoration

Prosthetic procedure6Step 6 – Inserting the provisionalp Close the SCS configuration of the screw with cotton andsealing compound (e.g. gutta-percha). This allows a laterremoval of the provisional.p Apply temporary cement to the inner part of the copingand cement it onto the abutment.NoteKeep the temporary restoration out of occlusion.Use temporary cement in order to remove the temporaryrestoration in due time.Temporary copings must not be kept longer than 28 daysin the mouth.4Using the protective capStep 4 – Cementing the protective capp Close the SCS configuration of the screw with cottonand sealing compound (e.g. gutta-percha). This allows alater removal of the provisional.p Apply temporary cement to the inner part of theprotective cap and cement it onto the abutment.NoteUse temporary cement in order to remove the temporaryrestoration in due time.Protective caps must not be kept longer than 28 days inthe mouth.6. Restoration91

Lab procedureLab procedure1aStep 1 – Fabricating the master castp Click the corresponding analog in the impression.NoteEnsure that the color code of the analog corresponds tothe color code of the impression cap.The white ring on the abutment indicates the abutmentheight (AH). It corresponds to the white arrow on top ofthe impression cap and the white clicking mechanisminside of the impression cap.1b2Step 2 – Preparationp Fabricate the master cast in a conventional manner(see instructions in chapter 5, p. 28).p Model a full anatomical wax-up for optimal estheticplanning. Use the corresponding burn-out coping as abasis for this wax-up.p Make a silicone key over the full wax-up in order todefine the optimal shape of the restoration.926. Restoration

Lab procedure4aStep 4 – Fabricating the crownp Select the burn-out coping and place it on the analog.4bpShorten it, if necessary.4cp Fabricate the superstructure on the (modified) abutmentusing standard modeling methods.4dpCheck the wax-up with the silicone key.94 6. Restoration

Lab procedure5aStep 5 – Casting and veneeringp Cast the framework using the standard casting methods.p Adjust the framework so that it can be attached tothe analog. Remove the clamping ring using a circularmotion. Do not harm the rotational faces nor the exactmargin fit.5bpCheck the spatial conditions with the silicone key.5cpVeneer the superstructure.6. Restoration95

Prosthetic procedureProsthetic procedureThe final restoration is delivered to the doctor’s office on the master cast.1Step 1 – Final insertionp Remove the temporary restoration in a conventionalmanner.p If necessary, do the required customization of theabutment by using the reduction coping from the dentaltechnician.p Clean the abutment thoroughly and remove all remainingtemporary cement.p Cement the crown to the abutment.p Remove superfluous cement.96 6. Restoration

Lab procedureOption B: Impression taking on implant levelTake the impression according to the instructions in chapter 5, p. 28.Lab procedure1Step 1 – Abutment insertionp Select the correct size of the cementable abutment byusing the PLAN set (see instructions in chapter 6.1, p. 39).p Hand-tighten the abutment on the analog in the mastercast.2aStep 2 – Customizingp Make height adaptations according to the individualsituation without harming the anti-rotational grooves.NoteThe ensure proper stability and retention of the restoration,a minimum height of 3 mm above the mucosa margin of theabutment must be maintained.Follow the corresponding steps as described for theimpression on abutment level (p. 92).2bp Apply the transfer aid and attach it to the adjacent teeth.p Deliver the customized abutment with the attached transferaid and the final restoration to the doctor’s office forinsertion.6. Restoration97

Prosthetic procedureProsthetic procedureThe final restoration is delivered to the doctor‘s office on the master cast.1Step 1 – Final insertionp Position the cleaned abutment in the implant. Tighten thescrew to 35 Ncm using the SCS screwdriver along withthe ratchet and the torque control device (see instructionsin chapter 7.5, p. 149).p Insert the abutment together with the transfer aid for abetter orientation.p Close the SCS configuration of the screw with cottonand sealing compound (e.g. gutta-percha). This laterallows removal of the abutment.p Cement the crown to the abutment.p Remove superfluous cement.98 6. Restoration

6.7 Multi-Base AbutmentIntended usep Screw-retained bridgesp Bar-retained implant-borne dentures in the mandible and maxillaCharacteristicsSimplep Flexible impression taking on implant or abutment levelp Easy choice of components thanks to color-codingp Highly flexible due to 30° cone and low occlusal heightReliablep CrossFit Connectionp Perfect fit due to prefabricated componentsp Proper fit of abutment level impression cap verified by clear-cut responseNoteDo not use the multi-base abutment for single-tooth restorations.Use new occlusal screws for the final insertion of the bar.Prosthetic procedure: p. 101–105, 114, 116Lab procedure: p. 106–113, 1156. Restoration99

6.7.1 Multi-Base abutment codingMulti-Base Abutment, straightNarrow CrossFitRegular CrossFitDiameter (D)3.5 mm(blue coding)4.5 mm(yellow coding)4.5 mm(grey coding)6.5 mm(brown coding)Multi-Base Abutment, angled 25°Narrow CrossFitRegular CrossFitD = DiameterGH = Gingiva HeightD1 mm2.5 2,5 mm4 mmGH1006. Restoration

Prosthetic procedureOption A: Impression taking on abutment level – Prosthetic procedure1aStep 1 – Abutment insertionp Select the appropriate size of the multi-base abutmentsusing the PLAN set (see instructions in chapter 6.1, p. 39).1bppClean and dry the interior of the implants thoroughly.Position the abutments in the implants. Tighten themto 35 Ncm using the SCS screwdriver along with theratchet and the torque control device (see instructions inchapter 7.5, p. 149).NoteDo not modify the abutments.6. Restoration101

Prosthetic procedure2aStep 2 – Impression taking on abutment levelp Click the impression caps or screw the impression postsonto the abutments. Check the proper fit of the impressioncap by rotating it on the abutment.p To ensure accuracy of the impression procedure, do notdamage the inner aspect of the impression cap.2bpTake the impression using an elastomeric impressionmaterial (polyvinyl siloxane or polyether rubber).NoteDue to its low tensile strength, hydrocolloid materials arenot suitable for this application.1026. Restoration

Prosthetic procedureChairside temporization of the abutmentsTemporary copingProtective cap3aUsing the temporary copingStep 3 – Preparationp Mount the temporary copings on analogs.p Mark the appropriate heights according to the individualsituation and shorten the copings as necessary.p Sandblast the copings and coat them with opaquer toavoid the titanium showing through.p Screw the copings onto the abutments in the patient’smouth and seal the screw channels (e.g. with cotton).3b3c6. Restoration103

Prosthetic procedure4aStep 4 – Creating the provisionalp Use a standard technique to fabricate the provisional(e.g. prefabricated crown form or vacuum-formed sheettechnique as shown here). The retention elements ensureproper mechanical bonding of the veneering material tothe coping.4b4cp Remove excess acrylic, reopen the screw channel andfinish the temporary restoration.1046. Restoration

Prosthetic procedure5Step 5 – Inserting the provisionalp Clean the polished temporary restoration, place it on theabutments and tighten the screw to 15 Ncm using theSCS screwdriver along with the ratchet and the torquecontrol device (see instructions in chapter 7.5, p. 149).p Cover the screw head with absorbent cotton or guttaperchaand seal the screw channel with temporaryveneering material (e.g. composite).NoteKeep the temporary restoration out of occlusion.3Using the protective capStep 3 – Mounting the protective capsp Hand-tighten the screws of the protective caps with theSCS screwdriver on the abutments.NoteDo not keep protective caps in the patient’s mouth longerthan 28 days.6. Restoration105

Lab procedureLab procedure for bridge restoration1aStep 1 – Fabricating the master castp Click the corresponding analogs into the impression orreposition and fix the analog in the impression using theguide screw.1bNoteEnsure that the color code of the analogs corresponds to thecolor code of the impression caps or posts.Impression material can get under the cap. In this case,remove the remains prior to repositioning the analogs.2Step 2 – Preparationp Fabricate the master cast in a conventional manner(see instructions in chapter 5, p. 28).p Model a full anatomical wax-up for optimal estheticplanning. Use the corresponding gold or burn-out copingsas a basis for the wax-up (here the procedure using agold coping is shown).p You can define the optimal shape of the restoration bymaking a silicone key over the full wax-up.1066. Restoration

Lab procedure3aStep 3 – Fabricating the bridgep Place the gold copings on the analogs and hand-tightenthe occlusal screws using the SCS screwdriver.NoteWhen using burn-out copings, do not over-tighten thecopings. This precaution prevents the wax framework fromundergoing excessive stress while loosening the occlusalscrew after the wax modellation.3bp Shorten the modelling aids to the height of the occlusalplane according to the individual situation. Working withthe modelling aid ensures a clean and sharp-edged finishof the screw channel.3cp Fabricate the superstructure on the abutments usingstandard modelling methods.p Make sure that the wax layer on the abutment issufficiently thick (at least 0.7 mm). Do not cover thedelicate margin of the copings with wax.6. Restoration107

Lab procedure3dp Check the spatial conditions before casting the bridgeframework with the silicone key of the wax-up.p Check the wax-up with the silicone key.4aStep 4 – Investmentp Check that the wax framework of the bridge is absolutelytension-free before investing the framework. This isaccomplished according to commonly known bridgetechniques.p Invest the bridge framework according to standardmethods without using wetting agents.1086. Restoration

Lab procedure4bNoteIn order to avoid overflow of the cast-on alloy, clean thecopings thoroughly prior to investment (removal of waxparticles, insulating agents with a cotton pellet or brushmoistened with alcohol).Ensure that there is no wax on the delicate margin.The use of investment materials for rapid heating methods(speed investment materials) is not recommended.4cWhen processing the investment material, follow themanufacturer’s instructions. Observe the recommendedmixing ratio and preheating time exactly.Make sure the screw channel and the internal configurationof the copings are filled with investmentmaterial from the bottom to the top in order to avoidair bubbles (see graphic).4d6. Restoration109

Lab procedureStep 5 – Casting and veneeringp Cast and devest the framework using standard methods(see also instructions in chapter 6.4.1, p. 66–67).NoteThe long term success of the prosthetic work depends onthe accurate fit of the restoration. The entire procedure willhave to be repeated, if casting errors occur, similar to theexamples on p. 58.pCheck the spatial conditions with the silicone key.5apControl for tension-free fitting on the master cast byapplying the Sheffield test. If the bridge is not tension-freeand wiggles, cut the bridge and resplint it tension-free.NoteIn order to take the bridge off the master cast, all occlusalscrews need to be removed first.5b1106. Restoration

Lab procedure5cp Do an additional try-on of the tension-free fit of theframework in the patient’s mouth.5dp Veneer the superstructure.6. Restoration111

Lab procedureLab procedure for bar restoration1aStep 1 – Fabricating the master castp Click the corresponding analogs into the impression orreposition and fix the analog in the impression usingthe guide screw.1bNoteEnsure that the color code of the analogs corresponds tothe color code of the impression caps or posts.Impression material can get under the cap. In this case,remove the remains prior to repositioning the analogs.112 6. Restoration

Lab procedure2Step 2 – Preparationp Before placing the copings we recommend mounting theocclusal screws onto the SCS screwdriver. After this stepplace the occlusal screws into the copings for bars.p Mount the copings onto the abutment and hand-tightenthe occlusal screws using the SCS screwdriver.3Step 3 and following steps – Fabrication of the barp Follow the steps described on p. 119–124 for thefabrication of the soldered gold bar or laser-weldedtitanium bar.NoteAlways use stabilization pins for the soldering of a gold bar.6. Restoration113

Prosthetic procedureProsthetic procedureThe final restoration is delivered to the doctor’s office on the master cast.1Step 1 – Final insertionp Remove the temporary restoration.p Clean the abutments thoroughly.p Check the tension free fit of the bridgework or barbefore tightening it in the patient’s mouth. Do not insertthe bridge or bar in case of movements due to tensionsin the bridgework or bar.p Tighten the occlusal screws to 15 Ncm using the SCSscrewdriver along with the ratchet and the torque controldevice (see instructions in chapter 7.5, p. 149).p For bridgework, close the SCS configuration of the screwswith cotton and sealing compound (e.g. gutta-percha orcomposite). This allows later removal of the bridge workif needed.114 6. Restoration

Lab procedureOption B: Impression taking on implant levelTake the impression according to the instructions in chapter 5, p. 28.Lab procedure for bridge and bar restoration1aStep 1 – Abutment insertionp Select the correct size of the multi-base abutments byusing the PLAN set (see instructions in chapter 6.1, p. 39).p Hand-tighten the abutments on the analogs in themaster cast.1bStep 2 and following steps – Fabrication of thebridge/barp Follow the corresponding steps described on p. 106, fffor the fabrication of the bridge.p Follow the corresponding steps described on p. 119–124for the fabrication of the soldered gold bar or laserweldedtitanium bar.NoteAlways use stabilization pins for the soldering of a gold bar.6. Restoration115

Prosthetic procedureProsthetic procedureThe final restoration is delivered to the doctor’s office on the master cast.1Step 1 – Final insertionp Position the cleaned abutments in the implants. Tightenthem to 35 Ncm using the SCS screwdriver along withthe ratchet and the torque control device (see instructionsin chapter 7.5, p. 149).p Check the tension-free fit of the bridgework/bar beforetightening it in the patient’s mouth. Do not insert thebridge/bar in case of movement due to tensions in thebridgework/bar.p Tighten the occlusal screws to 15 Ncm using the SCSscrewdriver along with the ratchet and the torque controldevice (see instructions in chapter 7.5, p. 149).p For bridgework, close the SCS configuration of the screwswith cotton and sealing compound (e.g. gutta-percha orcomposite). This allows later removal of the bridge work ifneeded.116 6. Restoration

6.8 Abutment for barsIntended usep Bar-retained implant-borne dentures in the mandible and maxillap Stabilisation and primary splinting of the implantsCharacteristicsSimplepppEffective one piece solution provides uncomplicated bar restorations forstandard situations.A 15° cone allows implant divergence flexibility up to 30°.Abutment can be easily shortened due to 7 mm distance from soft tissue level.Reliablep Flexible design for soldered and laser-welded bar constructions withprefabricated componentsNoteUse a new basal screw for the final insertion of the abutment.Lab procedure: p. 118–125Prosthetic procedure: p. 1266. Restoration117

Lab procedure6.8.1 Abutment for bars – Lab procedure1Step 1 – Fabricating the master castp Fabricate the master cast using standard methods andtype 4 dental stone (DIN 6873).2aStep 2 – Preparationp Place the abutment for bars on the analogs andhand-tighten the screw using the SCS screwdriver.2b1186. Restoration

Lab procedureSoldered gold bar(For the lab procedure of a laser-welded titanium bar continue at step 3 on p. 123.)3Step 3 – Placing the bar segmentsp Place the individual bar segments between theabutment units.NoteThe space between the bar and the gingiva must be atleast 2 mm. To achieve a good joint, the gap between theabutment and the bar should be as small as possible.4aStep 4 – Fixation of the bar segmentsp Use a residue-free burn-out plastic to fix the bar segmentsto the abutments.NoteDo not cover the basal screws.4b6. Restoration119

Lab procedure5Step 5 – Removing the bar frameworkp Carefully remove the bar framework after loosening thescrews.p Place the framework on the polishing aids and handtightenthe screws. The polishing aids ensure that theabutments are anchored accurately in the solderinginvestment during soldering.120 6. Restoration

Lab procedure6aStep 6 – Soldering the barNoteTo prevent possible distortion of the bar through unevenpreheating with the flame, preheat the soldering investmentto 500–600 ºC (932–1112 ºF) in a preheating furnace.6bppppAfter preheating, solder the invested bar according tostandard procedure.Once soldering is complete, cool down the investment toroom temperature.Devest and clean the bar in an ultrasonic bath.Remove the oxides and soldering flux residues in an acidbath.NoteDo not sandblast the framework.6cpCheck the fit.NoteStress-free repositioning of the bar on the implant analogsshould be possible without securing it with the screws.6. Restoration121

Lab procedure6dpShorten the bar in height if necessary and polish it.6epSend the finished bar with 4 new basal screws tothe doctor’s office.NoteAt this point the screws used for soldering are extremelyoxidized. Therefore, do not use them to secure the bar inthe mouth.See p. 126 for the prosthetic procedure.1226. Restoration

Lab procedureLaser-welded titanium bar3aStep 3 – Placing the bar segmentsp Fit the bar segments to the master cast, allowing for acertain gap that will be offset by the addition of titanium(see graphic 3b).NoteThe space between the bar and the gingiva must be atleast 2 mm.3b6. Restoration123

Lab procedure4aStep 4 – Welding of the segmentsp Weld the segments together with adequate argongas rinsing.4bpCheck the fit.4cpIf necessary, shorten the height of the bar and polish it.NoteStress-free repositioning of the bar on the implant analogsshould be possible without securing it with the screws.1246. Restoration

Lab procedure4dpSend the finished bar with 4 new basal screws tothe doctor’s office.NoteAt this point the screws used for soldering are extremelyoxidized. Therefore, do not use them to secure the bar inthe mouth.6. Restoration125

Prosthetic procedure6.8.2 Abutment for bars – Prosthetic procedureThe final restoration is delivered to the doctor’s office on the master cast.1Step 1 – Final insertionp Position the cleaned bar in the implants. Ensure the stressfreerepositioning of the bar on the implants.p Tighten the screw to 35 Ncm using the SCS screwdriveralong with the ratchet and the torque control device(see instructions in chapter 7.5, p. 149).1266. Restoration

6.9 LOCATOR ® AbutmentIntended usep Dentures retained by implants in the mandible and maxillaCharacteristicsSimplep Divergence compensation up to 40° between two implantsp Minimum component height for limited occlusal spaceReliablep Dual retention for optimal abutment-denture connectionp Excellent long-term performance due to high wear resistance of componentsThe LOCATOR ® components are a registered trademark of Zest Anchors, Inc.0473Manufacturer:Zest Anchors, Inc.Escondido, CA 92029USALab procedure: p. 128–131Prosthetic procedure: p. 132–1396. Restoration127

Lab procedure6.9.1 LOCATOR ® Abutment – Lab procedureOption A: Master cast from implant level impressionTake the impression according to the instructions in chapter 5, p. 28.1Step 1 – Selecting the abutment heightp Select the height of the LOCATOR ® abutment by determiningthe height of the replica gingiva at its highest point onthe master cast. The top margin of the abutment should be1 mm above the mucosa.NoteInserting the prosthesis is easier for the patient when theLOCATOR ® abutments are on the same horizontal level.2Step 2 – Abutment insertionp Screw the abutment hand-tight into the implant analogusing the LOCATOR ® driver.1286. Restoration

Lab procedureOption B: Master cast from abutment level impressionFor abutment level impression-taking, special LOCATOR ® analogs are used. The selection of the LOCATOR ® abutments hasalready been made by the prosthodontist.1Step 1 – Female analog insertionp Insert the LOCATOR ® female analogs into the LOCATOR ®impression copings.2Step 2 – Fabricating of the master castp Fabricate the master cast using standard methods andtype 4 dental stone (DIN 6873).6. Restoration129

Lab procedureConstruction of an overdenture with LOCATOR ® denture housingsYou can construct a new overdenture or upgrade an already existing and well-functioning overdenture with LOCATOR ®components.Option A: Construction of a new overdenture1Step 1 – Placing the white block out spacers anddenture capsppPlace one white block-out spacer over each abutment.Place the denture caps with the black processing malesonto the LOCATOR ® abutments, or the LOCATOR ®analogs in the master cast.2Step 2 – Overdenture constructionp Construct the overdenture according to the standardprocedure, adding the LOCATOR ® denture housing.p Return the completed overdenture to the doctor’s officewith the black processing males still in place.1306. Restoration

Lab procedureOption B: Upgrading an existing overdenture1Step 1 – Placing the white block out spacers anddenture capsppPlace one white block-out spacer over each abutment.Place the denture caps with the black processing malesonto the LOCATOR ® abutments, or the LOCATOR ®analogs in the master cast.2Step 2 – Hollowing out the denture basep Hollow out the existing denture base in the areas of theLOCATOR ® denture caps.3Step 3 – Overdenture rebasep Rebase the overdenture according to the standard procedure,adding the LOCATOR ® denture housing.p Return to the dentist the completed overdenture with theblack processing males still in place.6. Restoration131

Prosthetic procedure6.9.2 LOCATOR ® Abutment – Prosthetic procedure (standard)Impression takingOption B: Abutment level impression takingFor abutment level impression taking, special LOCATOR ® impression components are used. As a consequence, abutmentheights are selected by the doctor on the patient.1Step 1 – Selecting the abutment heightp Make sure the top of the implant is not covered by hardor soft tissue.NoteIt is imperative that all hard and soft tissue is removedfrom the implant shoulder to ensure correct seating of theLOCATOR ® abutment.pSelect the height of the LOCATOR ® abutment bydetermining the height of the gingiva at its highest point inthe patient‘s mouth. Choose the corresponding abutmenttissue cuff height or the next closest higher size available.NoteProsthesis insertion is easier for the patient if the LOCATOR ®abutments are on the same horizontal level.1326. Restoration

Prosthetic procedure2Step 2 – Abutment insertionp Screw the abutment into the implant hand-tight, using theLOCATOR ® driver.p Tighten the abutment to 35 Ncm using the ratchetalong with the torque control device (see instructions inchapter 7.5, p. 149) and the LOCATOR ® driver (p. 140).3Step 3 – Placing spacer and impression copingp Place a white block-out spacer ring on each abutment.The spacer ring is used to block out the area surroundingthe abutment.p Place the LOCATOR ® impression copings on theLOCATOR ® abutments.4Step 4 – Impression takingp Take the impression utilizing the mucodynamic technique(vinyl polysiloxane or polyether rubber).p Send the impression to the dental laboratory.6. Restoration133

Prosthetic procedureFinal restorationThe dental technician returns the completed LOCATOR ®overdenture to the doctor’s office for final placement.The finished denture is delivered with the black processingmales still in place.1Step 1 – Selecting the replacement malesp Implant divergence up to 10° for a single implant:ColorRetentionvvvbluepinkclear0,68 kg1,36 kg2,27 kgp Implant divergence between 10° and 20° for a singleimplant:ColorRetentionvvredgreen0,23 kg1,36–1,82 kgNoteAlways start with the lowest retention replacement males(p. 140).1346. Restoration

Prosthetic procedure2Step 2 – Removing the processing malesp Remove the black processing males from the housing(p. 140).3Step 3 – Inserting the replacement malep Insert the replacement male with the core tool (p. 140).4Step 4 – Inserting the finished denturep Insert the finished denture and check the occlusion.6. Restoration135

Prosthetic procedure6.9.3 LOCATOR ® Abutment – Prosthetic procedure (chairside)For an already existing and well-functioning overdenture, the LOCATOR ® system can be used in a chair-side procedure.1Step 1 – Selecting the abutment heightp Make sure the top of the implant is not covered by thegingiva.p Select the height of the LOCATOR ® abutment bydetermining the height of the gingiva at its highest point.The upper cylindric border should be 1 mm or more(next higher size available) above the mucosa.NoteProsthesis insertion is easier for the patient if the LOCATOR ®abutments are on the same horizontal level.2Step 2 – Inserting the abutmentp Screw the abutment into the implant by hand using theLOCATOR ® driver.p Tighten the abutment to 35 Ncm using the ratchetalong with the torque control device (see instructions inchapter 7.5, p. 149) and the LOCATOR ® driver attached(p. 140).3Step 3 – Placing the block-out spacerp Place a white block-out spacer ring on the abutments.The spacer is used to block out the area surrounding theabutment.1366. Restoration

Prosthetic procedure4Step 4 – Placing the denture capsp Place the denture caps with the black processing malesonto the LOCATOR ® abutments.5Step 5 – Hollowing out the denture basep Hollow out the existing denture base in the areas of theLOCATOR ® denture caps.NoteEnsure that the denture caps fixed on the abutments do nottouch the prosthesis.Step 6 – Filling the connecting holesp Fill the connecting holes with prosthetic resin fromlingual and anchor the caps in the denture (lightcure orselfcuring resin).p Remove any excess resin after curing and polish thedenture.NoteIf the white LOCATOR ® block-out spacer does not completelyfill the space between the gingiva and the denture caps,any remaining undercuts must be blocked out to preventresin flowing under the caps. This can be accomplished bystacking two or more LOCATOR ® block-out spacers.Once the resin has cured, remove the denture from themouth and discard the white LOCATOR ® block-out spacers.6. Restoration137

Prosthetic procedure7Step 7 – Selecting the replacement malesp Implant divergence up to 10° for a single implant:ColorRetentionvvvbluepinkclear0,68 kg1,36 kg2,27 kgp Implant divergence between 10° and 20° for a singleimplant:ColorRetentionvvredgreen0,23 kg1,36–1,82 kgNoteAlways start with the lowest retention replacement males.1386. Restoration

Prosthetic procedure8Step 8 – Removing the processing malesp To place the replacement males in the denture housing,remove the black processing males from the housing(p. 142).9Step 9 – Inserting the replacement malep Insert the replacement male with the core tool (p. 140).10Step 10 – Inserting the finished denturep Insert the finished denture and check the occlusion.6. Restoration139

6.9.4 LOCATOR ® Abutment – Further references1. Using the LOCATOR ® core toolThe LOCATOR ® core tool is a three-piece multifunction instrument.The tip is used for removing replacement males from the denture caps. To do this,the tip must be unscrewed by two full turns. A gap is visible between the tip andthe middle section.GapThe tip is passed in a straight line into the denture cap with a replacement male.The sharp edges of the tip hold the replacement male while it is being removed.The instrument is drawn out of the denture cap in a straight line.To remove the replacement male from the instrument, the tip must be screwedclockwise completely onto the middle section. This activates the loosening pininside the tip, which releases the replacement male.140 6. Restoration

The middle section of the LOCATOR ® core tool is used for inserting replacementmales into the denture caps. To do this, the tip is unscrewed. The exposed end ofthe replacement male is pressed into the denture cap. The replacement male isfixed firmly in the cap when a click is heard.The end (gold-colored) of the LOCATOR ® core tool is used by the dentaltechnician for screwing and unscrewing the LOCATOR ® abutments to and fromthe analogs.2. Determining the implant divergencesSnap the LOCATOR ® parallel posts onto the LOCATOR ® abutments. Use theLOCATOR ® angle measurement guide to determine the angulation of theLOCATOR ® abutments in relation to each other. Hold the angle measurementguide behind the placed parallel posts and read off the angle for each abutment.NoteChoose the appropriate LOCATOR ® replacement males according to theangulation measured for each abutment.Tie dental floss through the lateral holes of the angle measurement guide toprevent aspiration.6. Restoration141

3. Using the black processing maleBoth the LOCATOR ® female analog and the LOCATOR ® denture cap are suppliedwith a preassembled black processing male. The black processing male functionsas a space keeper for the various LOCATOR ® replacement males. For therelining of a LOCATOR-anchored overdenture, the LOCATOR ® replacement malesmust be removed from the denture caps and exchanged with black processingmales. The black processing males keep the denture in a stable vertical positionduring the relining procedure. When the relining of the denture is finished, theblack processing males are exchanged with the corresponding new LOCATOR ®replacement males.4. Important cleaning instructionsThe proper cleaning of the LOCATOR ® -borne denture and the LOCATOR ®abutments is a prerequisite to ensure the long-term performance of both theabutments and the nylon processing inserts. An accumulation of plaque on theabutment that imbeds into the nylon processing insert can abrade, over time,the titanium abutment to a smaller diameter and thus cause it to lose retention.According to the specific situation, the patient might be put on shorter recallappointments to monitor the proper cleaning of the denture and the abutments.142 6. Restoration

7. Aids and instruments7.1 SCS ScrewdriverThe SCS* screwdriver is used for the fixation of the prosthetic parts and healingcomponents. The star shape of the screwdriver tip connects to the top of thehealing components and abutment screw heads for safe pick-up and handling.*SCS = Screw Carrying SystemSCS screwdriver for manual useArticle: extra short, short, longLengths: 15 mm, 21 mm, 27 mmArt. Nos.: 046.400, 046.401, 046.402Material: Stainless steel7. Aids and instruments143

7.2 Polishing AidThe polishing aid is used during polishing and other lab procedures to protect theabutment’s prosthetic connection and to establish a convenient fixation extension.Art. Nos.: 025.2920, 025.4920Material: Stainless steel144 7. Aids and instruments

7.3 Ratchet and Torque Control DeviceThe ratchet (Art. No. 046.119) is a two-part lever arm instrument with a rotaryknob for changing the direction of force. It is supplied with a service instrument(Art. No. 046.108), which is used to loosen the headed screw. After loosening,the ratchet bolt can be removed from the body of the ratchet. The ratchet gapmust be disassembled for cleaning and sterilization.To apply a certain torque when tightening an abutment screw, use the ratchettogether with the torque control device (Art. No. 046.049) and the holding key(Art. No. 046.064).RatchetThe ratchet is used in combination with the torque control device to torque inall Straumann abutments and screws (it is the same ratchet used for placingStraumann implants manually).NoteThe ratchet and service instrument are packaged together.looped endflared partnutdirectionalarrowratchet disassembled7. Aids and instruments145

Torque control deviceConnected to the ratchet, the torque control device is usedto measure the value of Ncm (Newton centimeter) appliedwhen inserting Straumann abutments and screws.fluted endtorque scaletear dropService InstrumentThe Service Instrument is used to assemble and disassemblethe ratchet.Holding keyThe forked end of the holding key can be used to assembleand disassemble the ratchet. The pin can be used tostabilize drivers when abutments and screws are placed(also used for implant placement).pinforked end146 7. Aids and instruments

7.4 assembling the Ratchet and the Torque Control Device1aStep 1 – Looseningp Loosen the ratchet nut with the service instrument or theholding key.1b2aStep 2 – Removingp Unscrew and remove the internal bolt from the ratchetbody.2b7. Aids and instruments147

3a3bStep 3a – Insertionp Insert the ratchet body into the torque control device(flared part of the ratchet must be flush with fluted end oftorque control device).Step 3b – Insertionp Insert the internal bolt into the opposite end of the torquecontrol device. Tighten it firmly by hand.4aStep 4 – Tighteningp Tighten the nut of the ratchet with the service instrument orthe holding key. Do not overtighten.4bp The ratchet and torque control device are now assembledand ready for use.148 7. Aids and instruments

7.5 tightening an abutment to 35 Ncm1Step 1 – Insertion and tighteningp Insert the abutment into the implant.p Tighten the abutment screw by hand using the SCSscrewdriver.2Step 2 – Placing the ratchetp Place the looped end of the assembled ratchet withthe torque control device over the driver handle. Thedirectional arrow must be pointing clockwise (towards thetorque bar with tear drop). If not, pull the arrow out, flip itover, and let it snap in.3Step 3 – Stabilizing the ratchetp For stabilization, put the pin end of the holding key intothe coronal hole on the driver handle.7. Aids and instruments149

4Step 4 – Positioning of appropriate Ncm markp Use one hand to hold the holding key and use the otherhand to hold the torque bar. Grasp only the tear dropand move the torque bar to 35 Ncm mark.Step 5 – Removing the ratchetp After reaching the 35 Ncm mark, return the torque bar toits starting position.p Lift and remove the holding key, the ratchet with torquecontrol device and the driver.NoteProper care and maintenance are important to ensure correctfunction of the ratchet and torque control device. Alwaysclean and sterilize disassembled.For detailed instructions on how to care for these instruments,please refer to their package inserts.Recommended tightening torquesHand-tight 15 Ncm 15–35 Ncm 35 NcmClosure screwsHealing abutmentsTemporary copingsCopingsTemporary abutmentsFinal abutments1507. Aids and instruments

8. about sterilizationStraumann abutments and components are not sterile when delivered. Use the following procedure for sterilization prior touse.Material Method ConditionsTi, Ti alloyPEEK, PEEK with Ti inlayMetal alloy Ceramicor ®Composition in weight %:Au 60%, Pd 20%, Pt 19%, Ir 1%Autoclave, moist heat134 °C (273 °F) for 18 minZrO 2Dry heat 160 °C (320 °F) for 4 hNoteParts that have been modified or altered from their original state may require different sterilization procedures.To prevent tension cracks in PMMA products do not use the following: alcohol; UV radiation; sterilization; immersionin liquid for more than one hour; temperatures over 60 °C (140 °F).8. About Sterilization151

IMPORTANT GUIDELINES9. Important GUIDELINESDisclaimer of liabilityThe Straumann dental implant and other Straumann products arepart of an overall concept and may be used only in conjunctionwith the corresponding original components and instruments accordingto Institut Straumann AG’s instructions and recommendations.Use of products made by third parties, which are not distributedthrough Institut Straumann AG, in conjunction with the Straumann ®Dental Implant System will void any warranty or other obligation,expressed or implied, of Institut Straumann AG.Instructions as to the application of our products take place verbally,in writing, by electronic media or in hands-on trainings correspondingto the state of the art at the time of introduction of the product.The user of Straumann products is responsible for determining whetheror not any product is suitable for a particular patient and circumstances.Straumann disclaims any liability, expressed or implied, and bearsno responsibility for any direct, indirect, punitive or other damages,arising out of or in connection with any errors in professional judgmentor practice in the use or installation of Straumann products.The user is also obliged to study the latest developments of theStraumann ® Dental Implant System and their applications regularly.Please noteThe descriptions contained in this document are not sufficient forimmediate use of the Straumann ® Dental Implant System. Knowledgeof dental implantology and instruction in the handling of theStraumann ® Dental Implant System provided by an operator with therelevant experience are always necessary.AvailabilitySome of the products listed in this brochure are not available in allcountries.ValidityUpon publication of this brochure, all previous versions are superseded.CautionOur products must be secured against aspiration when used intraorally.Do not use damaged or blunt instruments.Units per packageUnless stated otherwise, there is one unit in each package.DocumentationFor detailed instructions on the Straumann ® Dental Implant Systemcontact your Straumann representative.Copyright and trademarksStraumann documents may not be reprinted or published, in wholeor part, without the written authorization of Institut Straumann AG.Straumann ® and/or other products and logos from Straumann ®that are mentioned here are trademarks or registered trademarks ofStraumann Holding AG and/or its affiliates.Definition SLActiveSand-blasted, Large grit, Acid-etched, chemically active andhydrophilicDefinition SLA ®Sand-blasted, Large grit, Acid-etchedExplanation of the symbols on labels and instruction leafletsLot/batch numberArticle numberSterile by gamma irradiationNon-sterileminLower temperature limitmaxmaxUpper temperature limitminTemperature limitXXXXColored warning labelsYELLOW = CAUTIONORANGE = WARNINGRED = DANGERCaution: Federal (USA) law restricts thisproduct to sale by or on the order of adentist or physicianDo not use on patientsDo not reuseRefer to instructions for useUse before expiry dateProtect from exposure to strong light or heatKeep away from sunlightStraumann products carry the CE mark andfulfill the requirements of the Medical DevicesDirective 93/42 EECConsult operating instructionsIndicates hazards or unsafe handlingwhich might cause minor injury ordamage to propertyIndicates hazards which might causeserious or fatal injuryIndicates hazards which might causeimmediate serious or fatal injury1529. Important Guidelines

10. Index AbutmentAnatomic 42Cementable 84for bars 117CARES 71Gold, for bridge 61Gold, for crown 49LOCATOR ® 127Meso 42Multi-Base 99PLAN 39Temporary 21AnchorageCement-retained 6Screw-retained 6AuxiliaryModelling aid 49, 61Polishing aid 144Scanbody 74Stabilization pin 113Connection 4Healing AbutmentBottle shape 18Conical 16Customizable 19InstrumentHolding Key 146Ratchet 145SCS Screwdriver 143Service Instrument for Ratchet 146Torque Control Device for Ratchet 146PlanningPLAN Set/Abutment 39Pre-operative 12PolymerImpression cap 88Healing Abutment 19Modelling aid 49, 61Protective Cap 89Temporary Abutment 21Temporary Coping 89ProstheticsAbutment Overview 8Prosthetic options 6Removable overdenture 6, 117, 127RestorationFinal 39, 42, 49, 61, 71, 84, 99, 117, 127Temporary 21Soft tissue management 15TemplateDrill 13Thermoplastic drill 14X-ray 12Tightening torque 15010. Index153

www.straumann.comInternational HeadquartersInstitut Straumann AGPeter Merian-Weg 12CH-4002 Basel, SwitzerlandPhone +41 (0)61 965 11 11Fax +41 (0)61 965 11 01Straumann products are CE marked 02/08 152.810/e A10208