Attachment-retained restorations

Attachment-retainedrestorationsClinical and laboratory procedures1

Welcome to the world of Astra Tech DentalOur goal is to provide you with the freedom of unlimited possibilities when it comes toimplant therapy. We develop products and solutions to help make your job as simple aspossible, but we never compromise on reliable long-term function and esthetics.The Astra Tech Implant System is developed with a biological and biomechanicalapproach. Every detail is carefully designed to fit together and work in harmony with eachother and with nature. The implant system is proven clinically to maintain marginal bonelevels which has been demonstrated in excellent long-term results.To support you in the use of the Astra Tech Implant System, we offer education seminars,training programs and materials for you and all members of your treatment team. Thismanual provides a step-by-step overview for attachment-retained restorations.

ContentsClinical and laboratoryprocedures for attachmentretainedrestorations utilizingthe Astra Tech Implant System .Restorative overview 4Overdenture treatmentIntroduction 5Indications and contraindications 6Treatment planning 6Abutment selection 7Locator attachmentComponents and instruments 8Locator Core Tool 9Locator Abutment installation 10Creating a new overdenture 11Converting an existing denture – with lab support 14Converting an existing denture – chairside 17Ball attachmentComponents and instruments 19Ball Abutment installation 20Creating a new denture 21Converting an existing denture – with lab support 25Converting an existing denture – chairside 28Bar attachmentComponents and instruments 30UniAbutment installation 31This manual is designed for useby dental professionals who haveundergone at least basic prostheticand in-clinic training. Staying currenton the latest trends and treatmenttechniques in implant dentistrythrough continued education is theresponsibility of the clinician.Abutment-level impression 32Bar fabrication 33Product care and maintenance 35Torque Guide 36Cleaning and sterilization 37References 383

RESTORATIVE OVERVIEWSingleCement-retained• Atlantis abutments• Direct Abutment • TiDesign • ZirDesign • CastDesign Screw-retained• CastDesign PartialCement-retained• Atlantis abutments• Direct Abutment • TiDesign • ZirDesign • CastDesign Screw-retained• Cresco • UniAbutment• Angled AbutmentNon-splinted• Locator Abutment• Ball AbutmentFullAttachment-retainedSplinted• UniAbutment• Cresco Cement-retainedScrew-retained• Atlantis abutments• Direct Abutment • TiDesign • CastDesign • Cresco • UniAbutment• Angled Abutment4

OVERDENTURE TREATMENTIntroductionIntroductionThe Astra Tech Implant System is designed to meet various clinicalsituations found in partially dentate and edentulous patients. It hasbeen thoroughly investigated in numerous technical, experimental andprospective clinical studies and the extensive research and documentationhave yielded a simple, flexible and reliable implant system that is clinicallyproven to maintain marginal bone levels. A variety of prosthetic treatmentoptions including overdentures can be undertaken using Astra Techimplants as anchorage units.There are several indications for overdenture treatment in connection withimplant treatment. Functional, esthetic, phonetic and hygienic requirementsin certain clinical situations support the use of the overdenture as atreatment option. The presence of at least one implant in each quadrant ofthe jaw, combined with a suitable attachment system, makes overdenturetreatment a viable alternative when treating totally edentulous jaws.Non-splinted attachmentsin the lower jawOverdenture treatment in the lower jawIn the lower jaw, the installation of a fixed bridge restoration is oftenpossible; however, patients sometimes prefer to have an overdenture forreasons of economics. Clinical studies with the Astra Tech Implant Systemshow that the survival rate of implants in the lower jaw is the same foroverdentures as for fixed bridge restorations, regardless of the retainingsystem.Based on clinical results, the following protocol is recommended in thelower jaw:• Minimum 2 implants, splinted or non-splintedOverdenture treatment in the upper jawIn the upper jaw, the clinical result and long term predictability is moredependent on the mode of implant support and the design of the denture.A prefabricated or customized bar, splinting four or more implants can helpto ensure equally good results as in the lower jaw.Based on clinical results, the following protocol is recommended in theupper jaw:• Minimum 4 implants, splintedSplinted attachmentsin the lower jawSplinted attachmentsin the upper jaw5

OVERDENTURE TREATMENTTreatment planningIndications for overdenture treatment• An unfavorable jaw relation which makes treatment with a fixed bridgerestoration difficult• Esthetic problems, e.g. the need for lip support in the upper jaw• Phonetic problems due to loss of alveolar bone in the upper jaw• Patient dissatisfaction with removable denture due to oral irritations and/or loss of bone for denture fixation• A bridge option makes satisfactory oral hygiene impossible or extremelydifficult to achieve• Edentulous patients with a cleft palate• Economic constraintsContraindications for overdenture treatment• At least one implant in each quadrant cannot be achieved• Untreatable, prosthesis-related stomatitis• Certain general illnesses and forms of medication are relativecontraindications for implant treatment (e.g. osteoporosis, uncontrolleddiabetes, cortisone treatment, radiotherapy)Factors to considerFactors which govern the planning of the overdenture treatment are thenumber and length of the implants, together with quality and quantity of theanchoring bone tissue.In cases where there are three or more implants, greater accuracy isrequired in order to achieve proper distribution of loading on implants andmucosa.To ensure an optimal restorative treatment, make sure that the followingconditions are met:• Parallel implants• Rigid bar connector without large distances between implants• Appropriate length of extension bars, not too long• Adequate resilience of the mucosa. The mucosa should not be too soft• Provide an even load on the mucosa when the prosthesis is in functionCreating an overdentureCreating an attachment-retained overdenture can be made in differentways.1. Creating a complete new overdenture at the laboratory.2. When the existing denture is judged suitable for further function:– Laboratory conversion of an existing denture– Chairside retrofitting of an existing dentureImplants should be as parallelas possible to ensure optimalresults.Adjust the extension bars toappropriate length. Extensionbars should be short to avoidlever forces.6

OVERDENTURE TREATMENTAbutment selectionAbutments designed forattachment-retained restorationsIndication andintended useFeatures and benefitsPageLocator AbutmentTitanium• Non-splintedrestorations in themandible• Designed to accommodate the maximumdenture-baring area• Self-aligning design with exceptional durability• Available in multiple vertical height optionsstarting as low as 2.0 mm• Available in multiple retention options andreplaceable• Up to 40° angle correction8Ball AbutmentTitanium• Non-splinted restorationsin the mandible• Designed to accommodate the maximumdenture-bearing area• Eliminates wear on the implant ball abutmentand minimizes the need for maintenance• Available in multiple retention options andreplaceable1920º or 45º UniAbutmentTitanium• Splinted restorations inthe mandible/maxillain combination with abarNote: It iscontraindicated touse 45° UniAbutmentas the only supportfor restorations on 3implants or less. Forthese situations at leastone support should be a20°UniAbutment.• The design offers flexibility in the clinicalsituation for implants placed in non-parallelsituations by maintaining an axis of withdrawalfor implants converging or diverging up toangles of 90°• Available in 45° or 20° tapered top cones3020º or 45º Cresco Insertfrom a Cresco API kitTitanium• Splinted restorations inthe mandible/maxillain combination with abar• Cresco Precision Method corrects castingdistortions to help ensure a passive fit• Available in choice of alloy fabrication• Available in a convenient API kit(All Parts Included)• Framework screw holes can be angled upto 17°For moreinformationaboutCresco technique,see theCresco manual.7

LOCATOR ATTACHMENTComponents and instrumentsLocator attachmentWith Locator you can offer your patients an excellent implant-supported overdenture solution.Locator provides long-term stability and ease of use, minimizing the time needed to adjust loosedentures. Its low vertical height is ideal for all overdenture patients. Cases with angulationproblems and limited occlusal space can be easily corrected using Locator.Taking into consideration clinical documentation available, non-splinted Locator Abutments areindicated in the lower jaw only.Locator components and instruments you will needLocator AbutmentAvailable for connection sizes:3.5/4.0 and 4.5/5.0Height: 0.5 – 5 mm.Processing CapLocator InsertsThe Locator inserts come with fivedifferent retentive holding force levels.* for non-parallel implantsBlue Pink Clear Red Green*680 grams 1361 grams 2268 grams 680 grams 1361–1814 gramsLocator Abutment Pick-upLocator Abutment ReplicaBlock-out SpacerLocator Core ToolLocator Torque Wrench BitTorque Wrench8

LOCATOR ATTACHMENTLocator Core Tool321Using the Locator Core ToolThe Locator Core Tool is made up of three tools inone:1. Locator Abutment Driver for tightening ofabutment.2. Locator Insert Seating Tool for seating an insertinto the titanium processing cap.3. Locator Insert Removal Tool for catching andpulling the used insert out of the permanent metalhousing.CLINICAL PROCEDURELocator Insert Removal Tool – PreparingLoosen the insert removal tool by making three fullturns counterclockwise. You will see a visible gap.RemovingTo remove an insert from the titanium metal housing,place the tip into the nylon insert and push to thebottom. Then tilt the tool so that the sharp edge of thetip grabs hold of the insert. Pull the insert out of thecap.DiscardingTo discard the insert from the tip of theLocator Core Tool, point the tool down and awayfrom you and tighten the Insert Removal Tool backonto the Locator Core Tool. This will activate theremoval pin and dislodge the insert from the tip endof the Insert Removal Tool.9

LOCATOR ATTACHMENTAbutment installationCLINICAL PROCEDUREAbutment selectionThe height of the Locator Abutment selectedshould be based on the highest level of tissuemeasured with the Abutment Depth Gauge.This will allow the retention groove to be at theappropriate supragingival height.Abutment installationInstall the Locator Abutment into the implantmanually.SeatingManually seat the abutment using theLocator Abutment Driver part of theLocator Core Tool.Final tighteningTorque the Locator Abutment using theLocator Torque Wrench Bit together with theAstra Tech Torque Wrench for final tightening.Recommended torque:25 Ncm25 Ncm10

LOCATOR ATTACHMENT-RETAINED OVERDENTURECreating a new overdentureCreating a new overdenturePlacing Locator Abutment Pick-upFirmly attach the Locator Abutment Pick-up toeach Locator Abutment. The pick-up should havestable friction retention.CLINICAL PROCEDUREImpression takingTake the abutment-level impression in a customizedimpression tray with an elastomeric impressionmaterial.Remove the impression once the impression materialhas set.Verifying impressionThe black processing inserts of the pick-ups shouldbe clearly visible within the impression. Send theimpression to the laboratory.11

LOCATOR ATTACHMENT-RETAINED OVERDENTURECreating a new overdentureLABORATORY PROCEDUREWorking ModelFirmly place the Locator Abutment Replica in theLocator Abutment Pick-up.Fabricate a working model with the Locator Abutment Replica and high-quality stone material.ProcessingPlace the spacer over the head of eachLocator Abutment Replica providing primary softtissue support and a resilient situation. Firmly attachthe Locator Processing Cap to each replica andprocess and cure it into the overdenture.Remove the overdenture and discard the spacerafter the acrylic has cured.FinishingAdd acrylic as necessary. Use a burr to removeexcess acrylic, and polish the overdenture base.Send the final overdenture with theLocator Processing Cap and insert to the clinician.12

LOCATOR ATTACHMENT-RETAINED OVERDENTURECreating a new overdentureRemovingRemove the black processing insert using theLocator Insert Removal Tool.CLINICAL PROCEDUREInsertingPress the preferred Locator insert into theProcessing Cap’s metal housing, using theInsert Seating Tool.Final resultSeat the overdenture over the Locator abutments.Verify that the required retention is obtained.Gradual increase of retention is alwaysrecommended. It is best to start with low retention.13

LOCATOR ATTACHMENT-RETAINED OVERDENTUREConverting an existing denture with lab supportCLINICAL PROCEDUREConverting an existing denturewith lab supportMarkingFirmly attach the Locator Abutment Pick-up to eachLocator Abutment. The pick-up should have stablefriction retention.Mark the top of the pick-up using articulating paper,denture pencil, pressure-indicating paste, etc.ReamingPlace the existing denture over the Locator AbutmentPick-up and remove. A landmark will now be visibleon the denture.Use an acrylic laboratory burr to relieve the denturebase in the indicated areas. Ream enough roomto accommodate passive fit when seated over thepick-up.Impression-takingTake an impression using the existing denture asan impression tray with an elastomeric impressionmaterial. Remove the impression once the impressionmaterial has set.Verifying the impressionThe black processing inserts of the pick-ups shouldbe clearly visible within the impression. Make areline if needed.Send the impression to the laboratory forprocessing.14

LOCATOR ATTACHMENT-RETAINED OVERDENTUREConverting an existing denture with lab supportWorking modelFirmly place the Locator Abutment Replica in theLocator Abutment Pick-up.Fabricate a working model with the Locator Abutment Replica and high-quality stone material.LABORATORY PROCEDUREProcessingPlace the spacer over the head of eachLocator Abutment Replica providing primary softtissue support and a resilient situation. Firmly attachthe Locator Processing Cap. Process and cure itinto the overdenture. Remove processed denture anddiscard the spacer once acrylic has set.FinishingAdd acrylic as necessary. Use a burr to removeexcess acrylic, and polish the overdenture base.Send the final overdenture with the Locator Inserts tothe clinician.15

LOCATOR ATTACHMENT-RETAINED OVERDENTUREConverting an existing denture with lab supportCLINICAL PROCEDURERemovingRemove the black processing insert using theLocator Insert Removal Tool.InsertingPress the preferred Locator insert into theProcessing Cap’s metal housing, using theInsert Seating Tool.Final resultSeat the overdenture over the Locator abutments.Verify that the required retention is obtained.Gradual loading is always recommended. It is bestto start with low retention.16

LOCATOR ATTACHMENT-RETAINED OVERDENTUREConverting an existing denture – chairsideConverting an existing denture– chairsidePlacingPlace the spacer over the head of eachLocator Abutment providing primary soft tissuesupport and a resilient situation. Firmly attach theLocator Processing Cap.CLINICAL PROCEDUREMarkingMark the top of the Processing Cap using articulatingpaper, denture pencil, pressure-indicating paste, etc.ReamingPlace the existing denture over the Processing Capand remove. A landmark will now be visible on thedenture.Use an acrylic laboratory burr to relieve the denturebase in the indicated areas. Ream enough roomto accommodate passive fit when seated over theProcessing Cap.ProcessingFill relieved areas in the denture with acrylic ofchoice and seat the denture over the Processing Capswithout compressing the soft tissue too much. Followmanufacturer’s recommendations for use. Removeprocessed denture once acrylic has set.17

LOCATOR ATTACHMENT-RETAINED OVERDENTUREConverting an existing denture – chairsideCLINICAL PROCEDUREFinishingAdd acrylic as necessary. Use a burr to removeexcess acrylic, and polish the overdenture basebefore removing the black processing insert.RemovingRemove Spacer from the Locator Abutment. Removethe Processing Insert from the Processing Cap in theoverdenture using the Locator Insert Removal Tool.InsertingPress the preferred Locator insert into theProcessing Cap’s metal housing, using theInsert Seating Tool.Verify that the required retention is obtained.Gradual loading is always recommended. It is best tostart with low retention.Final resultSeat the overdenture over the Locator abutments.Verify that the required retention is obtained.Gradual increase of retention is alwaysrecommended. It is best to start with low retention.18

BALL ATTACHMENTComponents and instrumentsBall attachmentThe clinical process for the ball attachment is quick and easy. The Clix Metal Housing is curedinto the denture and custom retention is achieved with the plastic insert, snapped into thehousing. The Clix Inserts are available in three different strengths, offering optimal retention forevery individual situation.The Clix attachment is designed to virtually eliminate wear on the Ball Abutment and minimizethe need for maintenance. Changing the Clix Inserts to alter the retention is done easily.Taking into consideration clinical documentation available, non-splinted Ball Abutments areindicated in the lower jaw only.Ball attachment components and instruments you will needBall AbutmentClix FemaleClix InsertsInserts come with differentretentive holding force levels.750 1150 1500grams grams gramsBall Abutment Pick-upBall Abutment ReplicaBall WrenchTorque WrenchClix Insertion ToolParalleling Mandrel, Female19

BALL ATTACHMENTInstallationCLINICAL PROCEDUREAbutment selectionThe height of the Ball Abutment selectedshould be based on information using theAbutment Depth Gauge. The highest point of the softtissue margin should be at or slightly ”apical” to thetapered neck of the Ball Abutment.Abutment InstallationSeat the Ball Abutment into the implant with theBall Wrench.Final TighteningTorque the Ball Abutment into the implant with theBall Wrench in combination with the Torque Wrench.Recommended torque:25 Ncm25 Ncm20

BALL ATTACHMENT-RETAINED OVERDENTURECreating a new overdentureCreating a new overdenturePlacing the Ball Abutment Pick-upFirmly attach the Ball Abutment Pick-ups and check toensure that they are securely in place. The pick-upsshould have a stable friction retention.Verify that there is adequate space in the tray forimpression material and the Ball Abutment Pick-up. It isessential to have enough space around the copings toachieve good retention within the impression material.CLINICAL PROCEDUREImpression takingTake the abutment-level impression using acustomized impression tray and an elastomericimpression material. Remove the impression once theimpression material has set.Verifying the impressionThe pick-ups should be captured in the impressionand be clearly visible. If the pick-ups remainseated on the Ball Abutments, remove and re-seatthem in the impression. Send the impression to thelaboratory.21

BALL ATTACHMENT-RETAINED OVERDENTURECreating a new overdentureLABORATORY PROCEDUREWorking modelPlace the Ball Abutment Replicas firmly into theBall Abutment Pick-up.Fabricate a working model with the Ball AbutmentReplica and high-quality stone material.ParallelingPlace the O-ring spacer over the ball of theBall Abutment Replica providing primary soft tissuesupport and a resilient situation. Determine a commonpath of insertion for the ball attachment-retainedoverdenture by using the Paralleling Mandrel and asurveyor.MountingMount the Paralleling Mandrel in the surveyor withthe O-ring upwards. Insert the Clix Female in theParalleling Mandrel.Secure the component by moving the O-ring downtowards the Clix Female.BlockingApply an A-silicone block-out material into theClix Female. Lower the Clix Female and connectto the Ball Abutment Replica.22

BALL ATTACHMENT-RETAINED OVERDENTURECreating a new overdentureRemovingBlock out any undercuts under and around theattachment by using the A-silicone material.Remove expelled excess block-out material. Keepthe outside of the Clix Female clear for the acrylicresin retention. Release the Clix Female from theParalleling Mandrel by moving the O-ring upwards.Repeat the procedure for next ball attachment.LABORATORY PROCEDUREProcessingFinal working model with the Clix Females in place.InvestingMake a wax-up with a teeth set-up on the model.Prepare for investing. Polymerize the prosthesis withthe Clix Females.Remove the O-ring spacer after polymerization.FinishingFinalize the ball attachment-retained overdenture.Add acrylic if necessary. Use a burr to removeexcess acrylic, and polish the overdenture.Send the overdenture back to the clinician forplacement.23

BALL ATTACHMENT-RETAINED OVERDENTURECreating a new dentureCLINICAL PROCEDUREFinal resultSeat the overdenture over the Ball Abutments.Verify that the required retention is obtained.Gradual increase of retention is alwaysrecommended. It is best to start with low retention.Adjusting the retentionRemovingIf the required retention is not obtained, remove theClix Insert by using a reversed conical burr or a hotinstrument. Do not damage the retentive metal ledgeof the housing.InsertingPress a new Clix Insert over the Clix Insertion Tool.Press the Clix Insert into the housing part of theClix Female.24

BALL ATTACHMENT-RETAINED OVERDENTUREConverting an existing denture with lab supportConverting an existing denturewith lab supportPlacing the Ball Abutment Pick-upFirmly attach the Ball Abutment Pick-ups and check toensure that they are securely in place. The pick-upsshould have a stable friction retention.CLINICAL PROCEDUREMarking and reamingMark the top of the pick-up using articulating paper,denture pencil, etc. Place the existing denture overthe Ball Abutment Pick-ups and remove. A landmarkwill now be visible on the denture.Use an acrylic laboratory burr to relieve the denturebase in the indicated areas. Ream enough roomto accommodate passive fit when seated over theBall Abutment Pick-up. It is essential to have enoughspace around the copings to achieve good retentionwithin the impression material.Impression-takingTake an impression using an elastomeric impressionmaterial. Remove the impression once the impressionmaterial has set.Verifying the impressionThe pick-ups should then be captured in theimpression and clearly visible. If the pick-ups remainseated on the Ball Abutments, remove and re-seatthem in the impression. Send the impression to thelaboratory.25

BALL ATTACHMENT-RETAINED OVERDENTUREConverting an existing denture with lab supportLABORATORY PROCEDUREWorking ModelPlace the Ball Abutment Replica firmly into theBall Abutment Pick-up.Fabricate a working model with theBall Abutment Replica and high-quality stonematerial.PlacingPlace the O-ring spacer on the replica providingprimary soft tissue support and a resilient situation.ProcessingSecurely seat the Clix Female. Process and cure theClix Female into the overdenture. Remove processedoverdenture once the acrylic has set.FinishingAdd acrylic as necessary. Use a burr to removeexcess acrylic, and polish the overdenture.Send the final overdenture to the clinician.26

BALL ATTACHMENT-RETAINED OVERDENTUREConverting an existing denture with lab supportFinal resultSeat the overdenture over the Ball abutments.Verify that the required retention is obtained.Gradual increase of retention is recommended.It is best to start with low retention.CLINICAL PROCEDUREAdjusting the retentionRemovingIf the required retention is not obtained, remove theClix Insert by using a reversed conical burr or a hotinstrument. Do not damage the retentive metal ledgeof the housing.InsertingPress a new Clix Insert over the Clix Insertion Tool.Press the Clix Insert into the housing part ofthe Clix Female.27

BALL ATTACHMENT-RETAINED OVERDENTUREConverting an existing denture – chairsideCLINICAL PROCEDUREConverting an existing denture– chairsidePlacing Clix FemalePlace the O-ring spacer around the Ball Abutmentproviding primary soft tissue support and a resilientsituation. Securely seat the Clix Female.MarkingMark the top of the Clix Female using articulatingpaper, denture pencil, pressure-indicating paste, etc.ReamingPlace the existing denture over the Clix Femaleand remove. A landmark will now be visible on thedenture.Use an acrylic laboratory burr to relieve the denturebase in the indicated areas. Ream enough roomto accommodate passive fit when seated over theClix Female.ProcessingFill relieved areas with acrylic of choice and seatdenture over the Clix Female without compressingthe soft tissue too much. Follow manufacturer’srecommendations for use. Remove processedoverdenture once acrylic has set. Add acrylic ifnecessary. Use a burr to remove excess acrylic, andpolish the overdenture.Remove the O-ring spacers.28

BALL ATTACHMENT-RETAINED OVERDENTUREConverting an existing denture – chairsideFinal resultSeat the overdenture over the Ball Abutments.Verify that the required retention is obtained.Gradual increase of retention is recommended. It isbest to start with low retention.CLINICAL PROCEDUREAdjusting the retentionRemovingIf the required retention is not obtained, remove theClix Insert by using a reversed conical burr or a hotinstrument. Do not damage the retentive metal ledgeof the housing.InsertingPress a new Clix Insert over the Clix Insertion Tool.Press the Clix Insert into the housing part of theClix Female.29

BAR ATTACHMENTComponents and instrumentsProfile Bar SystemWith the Profile Bar System you can offer your patients a customized cast bar with built-inretention system.The metal housings are cured into the denture and custom retention is achieved by using plasticinserts that snap into the housing. The inserts are available in three different strengths, offeringoptimal retention for each individual situation. Changing the inserts to alter retention can bedone in seconds.Profile Bar System components and instruments you will need20° UniAbutmentProfile Bar SystemInsertsReduced Normal Increasedretention retention retentionSemi-Burnout CylinderBridge Screw20° UniAbutment Pick-up20° UniAbutment ReplicaHex ScrewdriverTorque Wrench30

UNIABUTMENTInstallationAbutment selectionSelect the appropriate abutment using theHealing Abutment Uni. The bands correspond tomillimeters as well as to the available UniAbutmentheights. The Abutment Depth Gauge can also beused.CLINICAL PROCEDURERemovingRemove the Healing Abutment Uni using theHex Screwdriver.Abutment installationSeat the self-guiding UniAbutment manually withthe pre-mounted Carrier.Final tighteningRemove the Delivery Cap. Use the Torque Wrench,preset at 15 Ncm for final tightening. The presettorque is reached when the handle snaps away.Recommended torque:15 Ncm15 Ncm31

UNIABUTMENTAbutment-level impressionCLINICAL PROCEDUREReleasingRelease the Carrier manually by unscrewing it withthe Delivery Cap, or turn the Torque Wrench upsidedown and turn it counter-clockwise.Seating UniAbutment Pick-upSelect the appropriate Abutment Pick-up. Make surethe pick-up is in the correct position before tighteningthe abutment guide pins with the Hex Screwdriverusing light finger force.Impression-takingUse a standard or customized impression tray. Makean opening in the tray for the guide pins. Coverthe hole with wax. Make sure the guide pin canpenetrate the hole and wax without interfering withthe tray during impression-taking.Inject the elastomeric impression material around theabutment pick-up and into the impression tray andplace intraorally.32

UNIABUTMENTBar fabricationWorking modelPlace the UniAbutment Replica in theUniAbutment Pick-up. Check the impression forcorrect and stable retention of the abutment replicas.Tighten the replica into the impression tray.Fabricate a working model with the abutmentreplicas and high-quality stone material.LABORATORY PROCEDUREBar fabricationPlace the Semi-Burnout Cylinder on the replica andtighten it with a Laboratory Bridge Screw. The plasticpart of the cylinders are cut back to appropriatedimensions.CustomizingReduce the bar height, leaving a minimum of 2.5 mmto ensure a proper fit of the inserts.Note: Do not grind the retention surface of the bar.Attach the bar to the plastic sleeve with a materialthat has a low polymerization shrinkage.WaxingCover the plastic parts of the cylinders with a thinlayer of wax to get an accurate casting.33

UNIABUTMENTBar fabricationLABORATORY PROCEDUREProcessingApply casting sprues outside the functional areas ofthe bar.Invest, burnout and cast with an appropriate metalalloy according to standard working procedures.Finish and thoroughly polish the bar. Protect themargins of the cylinders during grinding andpolishing by using the Polishing Protectors.Note: It is important to use an alloy compatiblewith the alloy in the cylinder base of theSemi-Burnout Cylinder.Spacing and blockingPlace the bar restoration on the UniAbutment Replicasand tighten with the Laboratory Bridge Screws. Pressthe green plastic spacer onto the bar. The spacer isused to enable positioning of the Profile Bar Insertafter polymerization of the overdenture.Block out the undercuts and leave the spacers free.Cover the upper free areas of the bar and theSemi-Burnout Cylinders.PolymerizingPlace the housings on the spacers before investingof the overdenture. Make sure the housings are fullyseated.Process the acrylic resin and finish the prosthesis asusual.(If preferred, duplicate this model to avoid damage tothe master model during deflasking.)FinishingAfter polymerization the spacers are easily removed.Send the overdenture, bar and bridge screwstogether with the remaining Profile Bar Systemcomponents to the clinician for placement.34

UNIABUTMENTBar fabricationInsertingInstall the Profile Bar Insert into the housing with thesupplied Insertion Tool. The Profile Bar Insert shouldsnap in audibly.CLINICAL PROCEDUREInstallationAttach the cleaned bar to the UniAbutments withthe Bridge Screws using the screwdriver. Tighten thescrews using the screwdriver and Torque Wrench.Recommended torque for final seating:15 Ncm15 NcmFinal resultSeat the overdenture over the bar. Verify that therequired retention is obtained.Care and maintenanceReplace the Profile Bar Insert, if the required retentionis not obtained.To remove the Profile Bar Insert from the over -denture, push it laterally with a flat instrument.The Profile Bar Insert will fall out of the metal housing.Position the new insert with the desired retention onthe supplied Insertion Tool and press it in position.Verify that the required retention is obtained.35

TORQUE GUIDERecommended tightening torqueType of productTorque – NcmX-Small Small LargeCover ScrewManual* Manual*Manual*Healing AbutmentHealing Abutment UniProHeal CapHealing Cap AngledManual** Manual** Manual**TempDesign Temporary Abutment– 15 1520°/45° Cresco Insert forAstra Tech Implant System 20°/45° UniAbutment– 15 15Bridge ScrewsCresco Bridge Screw– 15 15Atlantis abutment forAstra Tech Implant System ZirDesign TiDesign CastDesign Angled Abutment15*** 20 25Direct Abutment Ball AbutmentLocator Abutment– 25 25* Only light finger force (5–10 Ncm) using a manual screwdriver or contra angle preset at 25 rpm and 5–10 Ncm torque.** Only light finger force (5–10 Ncm) using a manual screwdriver. Do not use a Ratchet Wrench or Torque Wrench.*** Note: Available for TiDesign , Atlantis abutment in titanium, and Atlantis GoldHue abutment.36

CLEANING AND STERILIZATION PROCEDURESNon-sterile abutmentsBefore installation, the abutments must undergo a cleaning and sterilization procedure.The cleaning should preferably take place in an ultrasonic unit with a mixture ofdishwashing detergent and water. For sterilization procedures, follow the instructions below.AbutmentLocator abutmentSterilization procedureSteam sterilization with a pre-vacuum cycle(134°C/270–275°F for 3 minutes).Sterile abutmentsProduct Sterilization PackageHealing AbutmentUniAbutmentThe product is sterilized by irradiation andintended for single use only.The product is sterilized by irradiation andintended for single use only.The Healing Abutment is delivered in a sterile plasticcontainer.The UniAbutment is packed pre-mounted with adisposable carrier in stainless steel. The carrier alsoserves as an installation device, together with a plasticinsertion head.Ball AbutmentThe product is sterilized by irradiation andintended for single use only.The Ball Abutment is delivered in a sterile plasticcontainer.37

REFERENCESReferences on overdenturesBakke M, Holm B, Gotfredsen K.Masticatory function and patient satisfactionwith implant-supported mandibular overdentures:a prospective 5-year study.Int J Prosthodont 2002;15(6):575-81.(Ref. No. 78148)Chaffee NR, Felton DA, Cooper LF, Palmqvist U, Smith R.Prosthetic complications in an implant-retainedmandibular overdenture population: initial analysis ofa prospective study.J Prosthet Dent 2002;87(1):40-4.Cooper LF, Moriarty JD, Guckes AD, Klee LB, Smith RG,Almgren C, et al.Five-year prospective evaluation of mandibularoverdentures retained by two microthreaded, TiOblastnonsplinted implants and retentive ball anchors.Int J Oral Maxillofac Implants 2008;23(4):696-704.Cooper LF, Scurria MS, Lang LA, Guckes AD,Moriarty JD, Felton DA.Treatment of edentulism using Astra Tech implants andball abutments to retain mandibular overdentures.Int J Oral Maxillofac Implants 1999;14(5):646-53.(Ref. No. 75155)Gotfredsen K.Implant supported overdentures-the Copenhagenexperience.J Dent 1997;25 Suppl 1:S39-42.Gotfredsen K, Holm B.Implant-supported mandibular overdentures retainedwith ball or bar attachments: a randomized prospective5-year study.Int J Prosthodont 2000;13(2):125-30.(Ref. No. 75355)Gotfredsen K, Holm B, Sewerin I, Harder F,Hjorting-Hansen E, Pedersen CS, et al.Marginal tissue response adjacent to Astra DentalImplants supporting overdentures in the mandible.Clin Oral Implants Res 1993;4(2):83-9.(Ref. No. 75058)Makkonen TA, Holmberg S, Niemi L, Olsson C,Tammisalo T, Peltola J.A 5-year prospective clinical study of Astra Tech dentalimplants supporting fixed bridges or overdentures in theedentulous mandible.Clin Oral Implants Res 1997;8(6):469-75.(Ref. No. 75181)Davis DM, Packer ME.Mandibular overdentures stabilized by Astra Techimplants with either ball attachments or magnets:5-year results.Int J Prosthodont 1999;12(3):222-9.(Ref. No. 79028)Davis DM, Packer ME.The maintenance requirements of mandibularoverdentures stabilized by Astra Tech implants usingthree different attachment mechanisms-balls, magnets,and bars; 3-year results.Eur J Prosth Rest Dent 2000;8(4):131-4.von Wowern N, Gotfredsen K.Implant-supported overdentures, a prevention of boneloss in edentulous mandibles? A 5-year follow-up study.Clin Oral Implants Res 2001;12:19-25.(Ref. No. 75358)Yusuf H, Ratra N.Observations on 25 patients treated with ball-retainedoverdentures using the Astra Tech implant system.Eur J Prosth Rest Dent 1996;4(4):181-3.38

Astra Tech BioManagement Complex A successful implant system cannot be determined by one single featurealone. Just as in nature, there must be several interdependent featuresworking together. The following combination of key featuresis unique to the Astra Tech Implant System :OsseoSpeed 79015-USX-0911 © 2009 Astra Tech• OsseoSpeed — more bone more rapidly• MicroThread — biomechanical bone stimulation• Conical Seal Design — a strong and stable fit• Connective Contour — increased soft tissue contactzone and volumeMicroThread Conical Seal Design Connective Contour AustraliaAstra Tech Pty Ltd.Suite 1, 53 Grandview St, Pymble NSW 2073+61 2 9488 3500. +61 2 9440 0744www.astratechdental.com.auAustriaAstra Tech GesmbHSchloßhofer Straße 4/4/19, AT-1210 Wien+43-(0)1-2146150. +43-(0)1-2146167www.astratechdental.atBeneluxAstra Tech Benelux B.V.Signaalrood 55, NL-2718 SG Zoetermeer+31 79 360 1955/+32 3 232 81 50+31 79 362 3748/ +32 3 213 30 66www.astratechdental.nlCanadaAstra Tech Inc.2425 Matheson Blvd East, 8th FloorMississauga, ON L4W 5K4+1 905 361 2844www.astratechdental.comDenmarkAstra Tech A/SRoskildevej 163, 1. th., DK-2620 Albertslund+45 43 71 33 77. +45 43 71 78 65www.astratechdental.dkEast AsiaAstra TechSuite 15.02, 15th Floor Menara PanGlobalNo. 8 Lorong P Ramlee, MY-50250, Kuala LumpurMalaysia+60 3 27 11 2531. +60 3 27 11 2532www.astratechdental.comFinlandAstra Tech OyPL 96, FI-02231 Espoo+358 9 8676 1626. +358 9 804 4128www.astratechdental.fiFranceAstra Tech France7, rue Eugène et Armand Peugeot, TSA 90002FR-92563 Rueil Malmaison Cedex+33 1 41 39 02 40. +33 1 41 39 02 44www.astratechdental.frGermanyAstra Tech GmbHAn der kleinen Seite 8. DE-65604 Elz+49 6431 9869 0. +49 6431 9869 500www.astratechdental.deItalyAstra Tech S.p.A.Via Cristoni, 86, IT-40033 Casalecchio di Reno (BO)+39 051 29 87 511. +39 051 29 87 580www.astratechdental.itJapanAstra Tech K.K.1-7-16 Sendagaya, Shibuya-ku, Tokyo 151-0051+81 3 5775 0515. +81 3 5775 0571www.astratech.jpNorwayAstra Tech ASPostboks 160, NO-1471 Lørenskog+47 67 92 05 50. +47 67 92 05 60www.astratechdental.noPolandAstra Tech Sp.z o.o.ul. Orężna 58, PL-02-937 Warszawa+48 22 853 67 06. +48 22 853 67 10www.astratechdental.plPortugalAstra TechLagoas Park, Edifício 8 – 1º pisoPT-2740-268 Porto Salvo+351 21 421 2273. +351 21 421 0234www.astratechdental.ptSpainAstra Tech S.A.Calle Ciencias nº 73 derecha. Nave 9,Polígono Industrial Pedrosa,ES-08908 L´Hospitalet de LlobregatServicio al cliente: +34.902.101.558+34.932.643.560. +34.933.363.231www.astratechdental.esSwedenAstra Tech ABP.O. Box 14, SE-431 21 Mölndal+46 31 776 30 00. +46 31 776 30 17www.astratechdental.seSwitzerlandAstra Tech SAAvenue de Sévelin 18, P.O. Box 54CH-1000 Lausanne 20+41 21 620 02 30. +41 21 620 02 31www.astratechdental.chUnited KingdomAstra Tech Ltd.Brunel Way, Stonehouse, Glos GL10 3SX+44 845 450 0586. +44 1453 791001www.astratechdental.co.ukUSAAstra Tech Inc.590 Lincoln Street, Waltham, MA 02451+1-800-531-3481. +1-781-890-6808www.astratechdental.comOther MarketsAstra Tech AB, Export DepartmentP.O. Box 14, SE-431 21 Mölndal, Sweden+46 31 776 30 00. +46 31 776 30 23www.astratechdental.comA company in theAstraZeneca GroupAstra Tech AB, Aminogatan 1, P.O. Box 14, SE-431 21 Mölndal, Sweden. +46 31 776 30 00. +46 31 776 30 10.www.astratechdental.com