Procedures & Products. NobelEsthetics
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1 Procedures & Products NobelEsthetics
2 First from Nobel Biocare. NobelPerfect, (NP, RP, WP), NobelDirect (NP, RP, WP), Brånemark System, NobelReplace and NobelSpeedy Implants. A complete assortment with FDA clearance for Immediate Function in all single, partial and fully edentulous restorations in the mandible and maxilla. Nobel Biocare AB and all production units are certified according to the Environmental Management System ISO The procedures described herein must only be performed using components and instruments provided by Nobel Biocare. Nobel Biocare has published disclaimers relating to patient data and purchasing conditions. The latest versions of these disclaimers are available on the NobelGuide area on the Nobel Biocare Extranet. Please ensure that you understand and accept these disclaimers. Nobel Biocare reserves the right to make any necessary alterations to the methods and procedures stated in this manual. Some products may not be available in all markets. Please contact your local Nobel Biocare office for current product assortment and availability. Nobel Biocare is in compliance with ISO 13485:2003 and Council Directive 93/42/EEC Canadian Medical Devices Regulation 0086 For USA only: Federal law restricts this device to sale by or on the order of a licensed dentist or physician. All products are subject to change without notice.
3 table of contents Table of Contents Introduction...4 Provisional Solutions...6 Using Permanent Abutments...8 Using Temporary Abutments...9 Solutions for Existing Teeth...12 Procera Crown...14 Procera Laminate...16 Procera Bridge Zirconia Procera Bridge Alumina...20 Permanent Implant Restorations Procera Esthetic Abutment...24 Procera Abutment...27 Snappy Abutment...30 Esthetic Abutment...33 Multi-unit Abutment Procera Implant Bridge Zirconia...40 Procera Implant Bridge Titanium Single Tooth Abutment NobelReplace...47 Easy Abutment...49 GoldAdapt Engaging...52 GoldAdapt Non-Engaging...54 Overdenture Restorations Gold Abutment Bar/Gold Coping Bar...56 Ball Abutment Titanium...59 Appendices...62 Terms you need to know Implant/Abutment Interface Diameter...65 Abutment Selection...66 Impression Techniques Implant Level...68 Impression Techniques Abutment level...72 Prosthetic Instrumentation...74 Torque Guide...76 Cleaning & Sterilization...77 FAQ...78 Index
4 provisional solutions Introduction Beautiful Teeth Now Congratulations! You have made an excellent choice. Nobel Biocare provides dentists with more choices than ever before. All our solutions are designed to facilitate our three core concepts: Immediate Function Easy Esthetics Soft Tissue Integration This NobelEsthetics manual contains easy instructions for our prosthetic solutions that will enable you to ensure your patients leave the treatment room satisfied and comfortable, with beautiful teeth and a renewed quality of life. Product News New products that you will find in this manual include: Procera Bridge Zirconia: bridge design within 25 mm L 60 mm. Precision- milled with proven strength. Procera Bridge Alumina: two- to four-unit bridges, particularly suitable for esthetic solutions in the anterior of the mouth. Procera Esthetic Abutment Selection Kit: predesigned Procera Esthetic Abutments in zirconia are available for the anterior, pre-molar or molar region in either straight or angled versions and high or low emergence profiles. Procera Implant Bridge: now available in zirconia for improved esthetics. 4
5 17143 GB 0203 New Installation: Insert into your CD-ROM drive. Follow the instructions on screen and accept the default settings. Upgrade: Check that your Procera Software is turned off. Insert into your CD-ROM drive. Follow the instructions on screen and accept the default settings. Date 2005/02/01 Nobel Biocare AB Procera is a registered trademark of Nobel Biocare AB. provisional solutions The focus of this manual is on prosthetic procedures. Additional information on the prosthetic components can be found in the NobelEsthetics Prosthetic Products Catalog. For more detailed information on laboratory procedures, please see the Dental Laboratory Procedure manual. For more information about Procera, go to the Procera Interactive Training CD. For information on prosthetic procedures for NobelPerfect Groovy, NobelDirect Groovy, NobelDirect Oval and the Brånemark System Zygoma, please see the relevant manual for each system. Introduction You can also have the prosthetic restoration ready before surgery by using the NobelGuide treatment concept. See the NobelGuide Manuals/CD for more details. Simplifie Tooth Preparation Techniques for Procera Crown Procera Software Version Build 54 5
6 provisional solutions Provisional Solutions Planning the Provisional Solution During the treatment planning for your patient s restoration, be sure to consider the entire treatment including the final prosthetic solution, as well as the provisional prosthetic solution. Depending on the final solution, there are several different methods and products used to create a provisional solution. Temporary Components Temporary abutments and temporary copings placed on permanent abutments are available for use with a provisional restoration. Provisional Restorations The provisional restoration can range from a standard acrylic crown/bridge that is adjusted chair-side to a labprocessed temporary crown/bridge. No matter what solution you provide, it is important to have a smooth contour on the provisional crown to avoid irritating the soft tissue. When preparing for a provisional restoration, be careful to remove any cement or impression material to avoid contaminating the surgical site. When using Immediate Function, a provisional restoration is placed at the time of implant insertion, providing the patient the ability to return to normal eating habits immediately after treatment. Immediate Function can be used if 35 Ncm in torque on the implants is achieved at the time of implant placement. Depending on the strategy for the final solution, use temporary abutments or temporary copings on permanent abutments, along with your choice of provisional prosthetic solution. The two-stage function is used when it is desirable to cover the implants to allow healing prior to placing a provisional restoration. Before implants are uncovered To create a provisional restoration for the totally edentulous patient, use the existing denture. Be sure to adjust and reline the denture. For the partially edentulous patient after implant insertion, use suitable conventional temporization procedures. After implants are uncovered As with the one-stage/immediate function, use temporary components as your planning strategy requires. Indexing at the time of implant insertion enables the fabrication and delivery of an abutment and/or provisional restoration at the time of implant uncovering. Principle Clinical Procedure for Connecting a Provisional Restoration For Screw-Retained Provisional Restorations: The provisional restoration is fastened with the corresponding abutment screw/prosthetic screw. Fill the screw access channel with a suitable material such as gutta-percha, silicone or temporary filling. For Cement-Retained Provisional Restorations: The provisional restoration must be cemented with retrievable temporary cement. Remove any excess cement and adjust the occlusion. 6
7 provisional solutions Using Permanent Abutments Procera Esthetic Abutment Snappy Abutment Single Multiple Temporary coping Page 24 Page 8 & 30 Provisional Solutions Esthetic Abutment Page 8 & 33 Easy Abutment Page 8 & 49 Multi-unit Abutment Page 10 & 36 Using Temporary Abutments Immediate Temporary Abutment Page 9 Temporary Abutment Non-Engaging Page 10 Temporary Abutment Engaging Page 10 7
8 provisional solutions Using Permanent Abutments Temporary Copings on Permanent Abutments Quick temporization on Abutments, ideal for Immediate Function. The provisional restoration is fabricated using a temporary coping on the abutment. For Multi-unit coping follow the procedures on page 9. Making Provisional Restoration The plastic coping is tried in. A temporary crown is fabricated with traditional methods using either acrylic or composite. Cement using provisional cement. Note: Do not use with polyurethane cements. The cement will not cure. Immediate Temporary Abutment The Immediate Temporary Abutment consists of two parts: an abutment and a plastic coping. Indications Single tooth implant restoration, made chair-side. 1. Abutment Connection The abutment is mounted onto the implant and tightened with the Screwdriver Machine Multi-unit and Manual Torque Wrench Prosthetic to 35 Ncm. 2. Making Provisional Crown The abutment post is adjusted for height and clearance if necessary. The plastic coping is tried in and relieved for clearance if necessary. A temporary crown is fabricated with traditional methods using either acrylic or composite. Cement using provisional cement. Warning: Do not use with polyurethane cements. The cement will not cure. 8
9 provisional solutions Temporary Abutments/Copings The temporary abutments and copings used for the fabrication of provisional screw-retained restorations are made of titanium or plastic. The retentive grooves on the abutments/copings will help to bind the acrylic material when constructing the provisional restoration. Provisional restorations may be made either at a dental laboratory or chair-side. For the direct chair-side method, an acrylic mold for the provisional restoration can be made. Temporary Abutment/Coping Plastic/Titanium Indications Non-Engaging Multi-unit implant restoration Indications Engaging Single tooth implant restoration Implant level Abutment level Using Temporary Abutments 1. Abutment Connection Connect and modify the Temporary Abutment/Coping. Block out undercuts on adjacent teeth if necessary. Fill the screw access hole with suitable material. 2. Making the Temporary Restoration Fill the plastic mold with temporary crown and bridge material and seat it. 9
10 provisional solutions Using Temporary Abutments 3. Remove the Restoration and make final adjustments Drill a hole through the mold and remove the material from the screw access holes. Loosen the screws to remove the restoration. Remove the mold. Make final adjustments. 4. Connection of Temporary Restoration The provisional restoration is fastened. Fill screw access channel with suitable material. 10
11 provisional solutions Product List for Clinical Procedures Immediate Temporary Abutment Includes: Plastic Coping Immediate Temporary Abutment Temporary Abutment Engaging Titanium with Abutment Screw External Connection Internal Connection Using Temporary Abutments Temporary Abutment Non-Engaging Titanium with Abutment Screw Temporary Abutment Plastic Engaging without Abutment Screw Temporary Abutment Plastic Non-Engaging without Abutment Screw Temporary Coping Multi-unit Titanium with Prosthetic Screw Temporary Coping Multi-unit Plastic without Prosthetic Screw 11
12 solutions for existing teeth Solutions for existing teeth Solutions for existing teeth Procera Crowns and Bridges and Laminates, combine optimal strength with excellent esthetics and significantly less labor and reduced chair-time compared with traditional techniques. More and more people around the world are choosing Procera products because they save time and money for you and the patient. Reduced chairtime means you can treat more patients every day. But it s the high quality of our solutions technically, biologically and esthetically that will really put a smile on your patients faces, building your reputation as you build their smiles. Procera Crowns and Bridges can be ordered from your laboratory with an individualized outer shape of the framework for optimal porcelain support and can be cemented with conventional methods. The objective of Nobel Biocare Procera Personalized Esthetics is to provide customized prosthetic components for case selection where there are high demands on esthetics and excellent fit. Procera Personalized Esthetics include: Procera Crown: alumina or zirconia coping, customized but still industrially produced, ensuring predictable results. Procera Laminate: alumina, the core is only 0.25 mm thick, yet able to mask discolored teeth. Procera Bridge Zirconia: designed to fit into a cylinder of 25 mm length 60 mm precision milled, with proven strength. Procera Bridge Alumina: two to four unit bridges, especially appropriate as an esthetic solution in the anterior. Preparation Instruments Procera needs only your conventional preparation techniques, a moderate chamfer margin and rounded internal line angles. Preparation kits are available for Procera restorations. The shapes are of standard design and can also be purchased separately from other suppliers. Each of the preparation kits includes the necessary diamond drills for preparation. Procera Preparation Kit Procera Laminate Preparation Kit 12
13 solutions for existing teeth Shade Selection It is essential to accurately document the color of the adjacent teeth using the Vita shade guide, as this will provide the optimum match for the veneering porcelain that is best-suited to Procera restorations. Subsequently, the NobelRondo procedure is an ideal alternative that offers unlimited possibilities for achieving customized esthetics in terms of the hue, chroma and value of the teeth. The six steps of shade selection with NobelRondo : 1. Selection of the NobelRondo shade group 2. Selection of the basic hue 3. Variations of color intensity 4. Inner structures of the tooth 5. Variations of lightness (value) and contrasts 6. Texture and shine of the tooth surface For more information see the NobelRondo Manual. Solutions for existing teeth Cementation The internal Procera surface roughness is similar to that of a porcelain surface after etching and thus provides exceptional cementation strength without further preparation. If cleaning is needed: sandblast using two to four bars of pressure utilizing aluminum oxide at an approximate distance of 10 mm: 110 µm 250 µm for zirconia products. 50 µm 110 µm for alumina products. Consider the translucency of the restoration and adhesive material when cementing in the anterior region. Apply the selected material in the Procera Crown or Procera Bridge. Seat the restoration using finger pressure. Gently remove any excess cement from the margins. 13
14 solutions for existing teeth Procera Crown Procera Crown Zirconia, Alumina Indications Any position in the mouth including the posterior. Procera Crown Alumina (0.4 mm) is indicated for use in the esthetic region of premolar to premolar. Natural teeth and implant restoration. 1. Preparation Procera Crown in the Anterior/Posterior Eliminate sharp edges, undercuts, slopes, and grooves. Prepare the tooth with a depth of 0.8 mm to 1.5 mm tooth reduction The preparation is characterized by thinned margins. Provide adequate space for the coping and the NobelRondo porcelain Procera Crown in the Posterior Keep the occlusal surface as even as possible. Avoid creating a deep fossa/cavity. Provide sufficient (1.5 mm to 2 mm) occlusal reduction. Use a chamfer bur to achieve a 5 to 15 taper during axial wall reduction. 2. Impression Take an ordinary C&B impression using your preferred impression material and method. Send the impression to the laboratory. 14
15 solutions for existing teeth 3. Laboratory Procedures A model is made and scanned for producing a Procera Crown, which after production will be veneered with NobelRondo. Procera Crown 4. Cementation Gently seat the restoration on the tooth and check both the occlusion and the interproximal contacts. The restoration should be in light occlusion. Excursive contact should be minimal. Cement the restoration using permanent cement. 15
16 solutions for existing teeth Procera Laminate Procera Laminate Alumina Indications Any position in the mouth where the preparation requirements can be met. 1. Preparation Use general veneer preparation techniques. The preparation is characterized by thinned margins. In general, you should perform a reduction in order to: Eliminate sharp line angles and edges. Establish tapered axial walls. Provide adequate space for the coping and the NobelRondo dental ceramic. Conservative reduction (0.5 mm to 0.7 mm) is recommended. Extend the palatal preparation by 1 mm (minimum) to 3 mm (maximum). You can extend the preparation beyond the contact points to a maximum of 1 mm Note! The laminate core is only 0.25 mm thick. 2. Impression Take a standard C&B impression. Send the impression to the dental laboratory. 3. Laboratory Procedures A model is made and scanned for producing Procera Laminate, which after production will be veneered with NobelRondo Alumina. 16
17 solutions for existing teeth 4. Bonding Note: Procera Laminate must be bonded Gently seat the Procera Laminate on the prepared teeth and evaluate proximal contacts, fit and esthetics prior to delivery. After intraoral try-in, clean the internal surface of the Procera Laminate by applying 37% phosphoric acid for seconds. Rinse with water and dry. Procera has been documented to adhesively bond to a phosphate modified resin luting. It is strongly recommended that you use such a system. Apply the various components from the adhesive system to the surface of the preparation and to the internal surface of the Procera Laminate according to the manufacture recommendations. Remove access, cure, and complete final cleaning according to the manufacturer recommendations. Procera Laminate 17
18 solutions for existing teeth Procera Bridge Zirconia Procera Bridge Zirconia Zirconia Indications Indicated for all positions in the mouth. A bridge designed to fit into a cylinder of 25 mm length 60 mm. Requires a minimum of 3 2 mm connector between units (Height Width) and a minimum cross-sectional area of 6.0 mm 2. Natural teeth and implant restorations. Contraindications Cases where the anterior/posterior cantilevers have a length of more than one unit. Cases with more than two pontics between supporting teeth/abutments. Bruxism. 60 mm 25 mm 1. Preparation Eliminate sharp edges, undercuts, slopes and grooves. The preparation is characterized by thinned margins. Establish tapered axial walls. Provide adequate space for the coping and NobelRondo porcelain. Procera Bridge in the anterior Prepare the tooth with a depth of 0.8 mm to 1.5 mm tooth reduction. The preparation is characterized by thinned margins. Prepare the teeth to allow a bridge with a connector height of at least 3 mm. Procera Bridge in the posterior Keep the occlusal surface as even as possible. Provide sufficient (1.5 mm to 2 mm) occlusal reduction. Use a chamfer bur to achieve a 5 to 15 taper during axial wall reduction. 18
19 solutions for existing teeth 2. Impression Take an ordinary C&B impression using your preferred impression material and method. Send the impression to the laboratory. Procera Bridge Zirconia 3. Laboratory Procedures The dies and model are scanned using the Procera Forte Scanner. The data is transferred to a Procera production facility. The bridge is milled from a presintered piece of zirconia, sintered to full density and returned to the laboratory. The restoration is completed using NobelRondo Zirconia veneering dental ceramic and sent to the clinic. 4. Cementation To save chair-time, the Procera Bridge Zirconia can be cemented using conventional crown and bridge cement or it can be bonded. 19
20 solutions for existing teeth Procera Bridge Alumina Procera Bridge Alumina Alumina Indications Indicated for use in the esthetic region, premolar to premolar. Two to four unit bridges. Requires a minimum of 3 2 mm connector between units (Height Width) and a minimum cross-sectional area of 6.0 mm 2. Natural teeth and implant restorations. Contraindications No cantilevers and maximum of one pontic between supporting teeth/abutments. Bruxism. 1. Preparation Eliminate sharp edges, undercuts, slopes and grooves. The preparation is characterized by thinned margins. Establish tapered axial walls. Provide adequate space for the coping and NobelRondo porcelain. Procera Bridge in the anterior Prepare the tooth with a depth of 0.8 mm to 1.5 mm tooth reduction. The preparation is characterized by thinned margins. Prepare the teeth to allow a bridge with a connector height of at least 3 mm. Procera Bridge in the posterior Keep the occlusal surface as even as possible. Provide sufficient (1.5 mm to 2 mm) occlusal reduction. Use a chamfer bur to achieve a 5 to 15 taper during axial wall reduction. 20
21 solutions for existing teeth 2. Impression Take an ordinary C&B impression using your preferred impression material and method. Send the impression to the laboratory. Procera Bridge Alumina 3. Laboratory Procedures The model is scanned using the Procera Forte Scanner. The data is transferred to a Procera production facility. The bridge is milled and sintered to full density and returned to the laboratory. The restoration is completed using NobelRondo Alumina veneering dental ceramic and sent to the clinic. 4. Cementation To save chair-time, the Procera Bridge Alumina can be cemented using conventional crown and bridge cement or it can be bonded. 21
22 permanent implant restorations Permanent Implant Restorations Permanent Implant Restorations With simple and predictable clinical procedures as outlined in the following pages, excellent esthetic results and improved long-term performance can be achieved. The Procera System provides completely individualized prosthetics with unbeatably precise fit for abutments and bridges. By combining the Procera manufacturing technique with alumina and zirconia ceramics, an unrivalled combination of biocompatibility, beauty and strength is guaranteed. Both alumina and zirconia refract and transmit light in much the same way as a natural tooth, thereby giving the restoration a natural looking appearance. In fact, the end result is often an improvement on nature. Our vast range of pre-produced prosthetics offers easy and beautiful esthetics for all indications whether it is single tooth, several teeth or overdenture solutions, cement-retained or screw-retained. Cement-Retained Single Multiple Overdenture Procera Esthetic Abutment Page 24 Procera Abutment Page 27 Snappy Abutment Page 30 Esthetic Abutment Page 33 Single Tooth Abutment Page 47 Easy Abutment Page 49 GoldAdapt Eng Page 52 22
23 permanent implant restorations Screw-Retained Multi-unit Abutment Procera Implant Bridge Single Multiple Overdenture Page 36 Page 40 Type of Restoration GoldAdapt Eng Page 52 GoldAdapt Non-Eng Page 54 Overdenture Gold Abutment Bar Page 56 Multi-unit Abutment + coping Page 36 Ball Abutment Page 59 23
24 permanent implant restorations Procera Esthetic Abutment Procera Esthetic Abutment Zirconia Indications Single tooth or multiple unit implant restorations. Single use only. Cement-retained. 1. Abutment Try-in Measure the height of the soft tissue and select the correct abutment according to the illustration chart. Place the clean and sterilized abutment on the implant. Slightly tighten the abutment screw using the Screwdriver Manual Unigrip. Check the shape and fit. Mark any area in need of modification. 2. Modification Remove the abutment and place it into the corresponding Protection Analog. Mount and tighten the Handle for Protection Analog. Note: When modifying the abutment, make sure that the thickness of the ceramic material is at least 0.8 mm up to a height of 3 mm above the implant level. Modify extra-orally, using a high-speed turbine with diamond drills and copious water irrigation. 24
25 permanent implant restorations 3. Temporary Restoration Connect the abutment to the implant, hand tighten. Try in a temporary crown of correct size. Fill the temporary crown with small amount of resin/composite. Place in correct position in mouth and light cure. Remove the crown and abutment. Make the final fill-up with composite outside the mouth thereby avoiding excess composite in the soft tissue. Polish the cervical area extra-orally. Procera Esthetic Abutment 4. Abutment Connection Connect the abutment to the implant. Note: A radiograph can help to confirm accurate seating of the abutment. Tighten the abutment screw to 35 Ncm using the Manual Torque Wrench Prosthetic and Screwdriver Machine Unigrip. 5. Final Restoration Follow established prosthetic procedures for the final restoration after a sufficient healing period. Prosthetic Alternatives: Procera Crown veneered with NobelRondo Procera Bridge veneered with NobelRondo 25
26 permanent implant restorations Procera Esthetic Abutment Illustration chart angled straight NP #1 # mm mm #3 # mm mm straight angled RP #5 # mm mm #7 # mm mm straight angled WP #19 # mm mm #17 10 # mm mm high low high low high low RP WP Internal Connection #9 #10 #13 #14 NobelReplace NP NobelReplace RP NobelReplace WP straight 6.5 mm mm straight mm mm External Connection Brånemark System NP #11 # #15 # Brånemark System RP Brånemark System WP angled 7.0 mm 6.8 mm angled mm mm high low high low Instrumentation Procera Esthetic Abutment Selection Kit Includes: Screwdriver Manual Unigrip 36 mm Handle for Protection Analog Protection Analog NP Protection Analog RP Protection Analog WP Instrumentation Prosthetic Kit Includes: Manual Torque Wrench Prosthetic Screwdriver Machine Unigrip 20 mm Screwdriver Machine Unigrip 30 mm Screwdriver Machine Multi-unit 21 mm 26
27 permanent implant restorations Procera Abutment Zirconia, Titanium Indications Single tooth or multiple implant restorations. Cement-retained. 1. Impression Place the impression coping onto the implant and take an implant level impression. Connect the temporary restoration or healing abutment and send the impression to the dental laboratory. Procera Abutment 2. Laboratory Procedures The dental technician designs the Procera Abutment. When the design is completed, data is transferred to the Procera production facility via the Internet. The abutment is produced and returned to the laboratory. In the laboratory the abutment is scanned for a Procera Crown or Procera Bridge, which after production will be veneered with NobelRondo. 27
28 permanent implant restorations Procera Abutment 3. Abutment Connection Note: If final preparation is needed, make sure that the thickness of the ceramic material is at least 0.8 mm and use the high-speed turbine with diamond drills and copious water irrigation. This thickness limit is applicable up to a height of 3 mm above the implant level. Ensure that the implant platform is free from any soft-tissue or bone remnants. Position the abutment/screw assembly into the implant and secure the screw in the implant using the Screwdriver Unigrip. A radiograph can be helpful to confirm accurate seating of the abutment. Note: When using the Procera Abutment with external connection to compatible hex implants, use the screw supplied with the abutment. Tighten the abutment screw to 35 Ncm using the Manual Torque Wrench Prosthetic and Screwdriver Machine Unigrip. 4. Cementation of Final Restoration Gently seat the restoration on the abutment and check both the occlusion and the interproximal contacts. The restoration should be in light occlusion. Excursive contact should be minimal. Fill the screw access channel. Cement the restoration using permanent cement. 28
29 permanent implant restorations Product List for Clinical Procedures Procera Abutment Includes: Abutment Screw External Connection Internal Connection Procera Abutment Impression Coping Implant Level Closed Tray Alternatives for internal connection: Low Profile Plastic Impression Coping Implant Level Open Tray Implant Replica Procera Abutment for other implant systems Procera Abutments are available in both zirconia and titanium for; Straumann Regular Neck 4.8 mm implants Camlog Implant Systems 3.3, 3.8, 4.3, 5.0, 6.0 mm Procera Abutments are available in titanium for; Astra Tech Implant System 3.5ST, 4.0ST, 4.5ST, 5.0ST mm Follow the laboratory procedures for Procera Abutment and the clinical procedures for each respective implant system. 29
30 permanent implant restorations Snappy Abutment Snappy Abutment Titanium Indications Single tooth or multiple unit implant restorations, ideal for posterior restorations. Cement-retained. Note: The NobelDirect Posterior Implant has an integrated abutment portion that is identical to the Snappy Abutment and thus uses the same prosthetic components. 1. Abutment Connection Position the abutment/screw assembly into the implant and secure the screw until resistance is felt using the Screwdriver Unigrip. A radiograph can help to confirm accurate seating of the abutment to the implant. Tighten the abutment screw to 35 Ncm using the Manual Torque Wrench Prosthetic and Screwdriver Machine Unigrip. 2. Impression Press the impression coping onto the abutment. A snap will indicate that the impression coping is fully engaged and well adapted to the margin of the abutment. Take a standard impression. When the impression is pulled, the impression coping will disengage from the Snappy Abutment and is picked up, in the impression. Send the impression to the dental laboratory for model and prosthetic fabrication. 30
31 permanent implant restorations 3. Temporary Restoration Clean and remove any debris from the Snappy Abutment. Use the Manual Torque Wrench Prosthetic to verify the tightening of the abutment screw to 35 Ncm. Provisionalize the Snappy Abutment chair-side using the plastic/temporary coping, or use the healing cap that is included in the Snappy Abutment package. Warning: Do not use Plastic/Temporary Coping Snappy Abutment with polyurethane cements. The cement will not cure. Snappy Abutment 4. Laboratory Procedures A model is made and the restoration is produced. Alternatives: Procera Crown veneered with NobelRondo. Procera Bridge Zirconia or Alumina veneered with NobelRondo. Plastic/Temporary Coping Snappy Abutment in a cast restoration. 5. Cementation of Final Restoration Remove the healing cap or temporary prosthesis. Verify the tightness to 35 Ncm and block out the screw access channel. Cement the restoration over the abutment. Use provisional cement if greater ease of retrievability is desired. Note: Only use permanent cement when cementing ceramic crowns or bridges. 31
32 permanent implant restorations Snappy Abutment Product List for Clinical Procedures Snappy Abutment Includes: Abutment Screw Healing Cap Impression Coping External Connection Internal Connection Impression Coping Snappy Abutment Abutment Replica Snappy Abutment Healing Cap Snappy Abutment Plastic/Temporary Coping Snappy Abutment Engaging/Non-Engaging 32
33 Esthetic Abutment Titanium Indications Single tooth or multiple unit implant restorations. Cement-retained. The abutment is designed with a scalloped margin that profiles natural soft tissue contours with various collar heights available based on the implant platform and system. permanent implant restorations Esthetic Abutment The following description is based on straight Esthetic Abutments. The same procedures that are used for 15º Esthetic Abutment. 1. Abutment Connection Position the abutment/screw assembly into the implant and tighten the screw until resistance is felt using the Screwdriver Unigrip. A radiograph can help to confirm accurate seating of the abutment to the implant. Tighten the abutment screw to 35 Ncm using the Manual Torque Wrench Prosthetic and Screwdriver Machine Unigrip. Modifications if needed Remove the abutment, place it on an implant replica and modify it with a carborundum disk and carbide bur. If the modification is made intra-orally, use profuse water irrigation. 2. Impression Take a standard C&B impression. Send the impression to the dental laboratory. 33
34 permanent implant restorations Esthetic Abutment 3. Temporary Restoration Clean and remove any debris from the Esthetic Abutment. Use the Manual Torque Wrench Prosthetic to verify the tightness of the abutment screw to 35 Ncm. Provisionalize the Esthetic Abutment using the plastic/temporary coping. Warning: Do not use with polyurethane cements. The cements will not cure. 4. Laboratory Procedures In the laboratory, a model is made and a restoration is produced. Alternatives: Procera Crown veneered with NobelRondo Procera Bridge veneered with NobelRondo Plastic/Temporary Coping Esthetic Abutment in a cast restoration. 5. Cementation of Final Restoration Verify the tightness to 35 Ncm and block out the screw access channel. Gently seat the restoration on the abutment and check both the occlusion and the interproximal contacts. The restoration should be in light occlusion. Excursive contact should be minimal. Cement the restoration using provisional or permanent cement. Note: Only use permanent cement when cementing ceramic crowns or bridges. 34
35 permanent implant restorations Product List for Clinical Procedures Esthetic Abutment Includes: Abutment Screw External Connection Internal Connection Esthetic Abutment Esthetic Abutment 15 Includes: Abutment Screw Impression Coping Implant Level Closed Tray Alternatives for internal connection: Low Profile Plastic Impression Coping Implant Level Open Tray Implant Replica Plastic/Temporary Coping Esthetic Abutment Available as straight/15 35
36 permanent implant restorations Multi-unit Abutment Multi-unit Abutment Titanium Indications Multiple unit restoration. Desire for greater ease of retrievability. Screw-retained. Note: There are specialy designed Multi-unit Abutments for Zygoma implants. Use the same prosthetic procedure as for ordinary Multi-unit Abutments. 1a. Abutment Connection Straight Multi-unit Abutment Use the premounted plastic holder to place the abutment onto the implant and screw the abutment into the correct position. If necessary, shorten the holder with a pair of scissors. When the abutment is seated, the plastic holder should be removed with a slight bending movement. A radiograph can be helpful to confirm accurate seating of the abutment. Tighten the abutment screw to 35 Ncm using the Manual Torque Wrench Prosthetic and Screwdriver Machine Multi-unit. 1b. Abutment Connection 17 and 30 Multi-unit Abutment The abutment is placed over the implant by using the premounted abutment holder. Please note that there are several possible positions in which to place the abutment. Tighten the abutment screw using a Screwdriver Unigrip until resistance is felt. A radiograph can help to confirm accurate seating of the abutment. The holder is then unscrewed from the abutment by turning it counter-clockwise. Tighten the abutment screw to 15 Ncm using the Manual Torque Wrench Prosthetic and Screwdriver Machine Unigrip. Note: Be sure not to exeed 15 Ncm. 36
37 permanent implant restorations 2a. Closed Tray Abutment Level Impression: Connect the impression coping to the abutment. Inject impression material and record the impression. Multi-unit Abutment After setting, remove the impression and disconnect the impression copings. Attach the abutment replicas to each coping. Place the impression coping abutment replica assembly into its corresponding location in the impression. Connect the temporary restoration (see chapter Provisional Solutions) or healing cap and send the impression to the dental laboratory. 2b. Open Tray Abutment Level Impression: Connect the impression coping on the abutment and tighten using the Screwdriver Unigrip. Relieve and perforate the impression tray to allow full seating of the tray and protrusion of the guide pins. If there is a large opening, close it with baseplate wax, with the guide pins indenting or perforating the wax. Inject impression material and seat the impression tray fully so that the tips of all the guide pins are identified. After setting, unscrew the guide pins and remove the impression tray. Connect the temporary restoration (see chapter Provisional Solutions) or healing cap and send the impression to the dental laboratory. 37
38 permanent implant restorations Multi-unit Abutment 3. Laboratory Procedures In the laboratory, a model is made and a restoration is produced. Alternatives: Procera Implant Bridge Gold Coping Multi-unit in cast restoration 4. Connection of Final Restoration Verify the tightness to 35 Ncm For angled abutments to 15 Ncm. Connect the restoration to the abutments with prosthetic screws. Start with the mid region post and tighten the other screws alternating left and right sides. Tighten the prosthetic screws to 15 Ncm using the Manual Torque Wrench Prosthetic and Screwdriver Machine Unigrip. Fill the screw access channel with a suitable material such as gutta-percha, silicone or temporary filling material. 38
39 permanent implant restorations Product List for Clinical Procedures External Connection Internal Connection Multi-unit Abutment Available as straight, 17, 30 Includes: Abutment Screw Prosthetic Screw Multi-unit for connection of Procera Implant Bridge Impression Coping Closed Tray Multi-unit Impression Coping Open Tray Multi-unit Abutment Replica Multi-unit Healing Cap Available as regular/wide 39Multi-unit Abutment
40 permanent implant restorations Procera Implant Bridge Zirconia Procera Implant Bridge Zirconia Zirconia Indications Implant level only. Multiple unit restorations. Indicated for all positions in the mouth. Screw-retained. A bridge, designed to fit into a cylinder of 30 mm length 60 mm. Requires a minimum of mm connector between units (Height Width) and a minimum cross-sectional area of 8 mm 2. Contraindications Cases where the mesial/distal cantilevers have a length of more than one unit. There should be no more than two pontics between the supporting implants. Bruxism. 60 mm 30 mm 1. Impression Place impression copings onto the implants. Take an impression to transfer the position of the implants to a working model. Connect the temporary restoration or healing abutments. Attach the appropriate implant replicas to the impression copings and send the impression to the laboratory. 2. Laboratory Procedures A model and a framework are produced and scanned using the Procera Forte Scanner. The data is transferred to a Procera production facility. The framework is milled from a presintered piece of zirconia, sintered to full density and returned to the laboratory. The restoration is completed using NobelRondo Zirconia veneering dental ceramic. 40
41 permanent implant restorations 3. Connection of Final Restoration Ensure that the implants are free from any soft tissue or bone remnants. Connect the restoration to the implants with abutment screws. Note: Abutment screws are not included. A radiograph may help to verify correct seating of the restoration. Tighten the abutment screws to 35 Ncm using the Manual Torque Wrench Prosthetic and Screwdriver Machine Unigrip. Fill the screw access channel with a suitable material such as gutta-percha, silicone or temporary filling material. Note: When using Procera Implant Bridge with external connection to compatible hex implants, use screw intended for the Brånemark System platform. Procera Implant Bridge Zirconia 41
42 permanent implant restorations Procera Implant Bridge Zirconia Product List for Clinical Procedures Procera Implant Bridge at Implant Level Does not include Abutment Screws Abutment Screw Impression Coping Implant Level Closed Tray Alternatives for internal connection: Low Profile Plastic External Connection Internal Connection Impression Coping Implant Level Open Tray Implant Replica Procera Implant Bridge for other implant systems Procera Implant Bridge is available in zirconia for; 3i 3.75 Lifecore Biomedical Restore 3.75 Zimmer Dental Taper-Lock 4.0 Sterngold Implamed
43 permanent implant restorations Procera Implant Bridge Titanium Titanium Indications Implant or abutment level. Multiple unit restorations. Screw-retained. 1a. Impression Implant Level Place impression copings onto the implants and take an implant level impression. Connect the temporary restoration or healing abutment and send the impression to the laboratory. Procera Implant Bridge Titanium 1b. Impression Abutment Level Place the Impression Coping Multi-unit onto the Multi-unit Abutments. Connect the temporary restoration (see the chapter: Provisional Solutions) or healing cap and send the impression to the laboratory. 2. Laboratory Procedures A model is made and a resin framework is produced and sent to a Procera production facility or scanned by using the Procera Forte scanner. The framework is milled from a solid piece of titanium and returned to the laboratory. The restoration is completed using conventional methods. 43
44 permanent implant restorations Procera Implant Bridge Titanium 3a. Connection of Final Restoration at Implant Level Ensure that the implants are free from any soft tissue or bone remnants. Connect the restoration to the implants with abutment screws using the Screwdriver Unigrip. Start with the mid region post and tighten the following screws alternating left and right sides. A radiograph can help confirm accurate seating. Tighten the abutment screws to 35 Ncm using the Manual Torque Wrench Prosthetic and Screwdriver Machine Unigrip. Fill the screw access channel with a suitable material such as gutta-percha, silicone or temporary filling material. Note: When using the Procera Implant Bridge with external connection on compatible hex implants, use screw intended for the Brånemark System platform. 3b. Connection of Final Restoration at Abutment Level Connect the restoration to the abutments with prosthetic screws. Start with the mid region post and tighten the other screws alternating left and right sides. Tighten the prosthetic screws to 15 Ncm using the Manual Torque Wrench Prosthetic and Screwdriver Machine Unigrip. Fill the screw access channel with a suitable material such as gutta percha, silicone or temporary filling material. 44
45 permanent implant restorations Product List for Clinical Procedures Procera Implant Bridge at Implant or Abutment Level Does not include Abutment Screws/Prosthetic Screws Implant Level Components Abutment Screw Impression Coping Implant Level Closed Tray Alternatives for internal connection: Low Profile Plastic External Connection Internal Connection Procera Implant Bridge Titanium Impression Coping Implant Level Open Tray Implant Replica Abutment Level Components Multi-unit Abutment Available as straight, 17, 30 Includes: Abutment Screw Prosthetic Screw Multi-unit Impression Coping Closed Tray Multi-unit Impression Coping Open Tray Multi-unit Abutment Replica Multi-unit Healing Cap Multi-unit Available as regular/wide 45
46 permanent implant restorations Procera Implant Bridge Titanium Procera Implant Bridge for other implant systems The Procera Implant Bridge is available at implant level for; Straumann Regular Neck 4.8 mm and Wide Neck 6.5 mm implants 3i 3.75 Lifecore Biomedical Restore 3.75 Zimmer Dental Taper-Lock 4.0 Sterngold Implamed 3.75 Follow the laboratory procedure for Procera Implant Bridge and the clinical procedure for each respective implant system Procera Implant Bridge is available at abutment level for; Ankylos Implant System 3.5, 4.5, 5.5, 7.0 mm Astra Tech Implant System 3.5ST, 4.0ST, 4.5ST, 5.0ST mm Camlog Implant System 3.3, 3.8, 4.3, 5.0, 6.0 mm Use Multi-unit Abutments designed for each implant system and connect the Multi-unit Abutments to the implants. Tighten the Multi-Unit for the Ankylos and Astra Tech systems to 25 Ncm and for the Camlog system to 30 Ncm. Take an abutment level impression, see instructions for Multi-unit abutments. Send the impression to the laboratory, which follows the normal laboratory procedures. Straumann is a registered trademark of Straumann Holding Company. Ankylos is a trademark of Dentsply Friadent Group. Astra Tech is a trademark of AstraZeneca Group. Camlog is a trademark of Camlog Biotechnologies Group. 3i is a trademark of Biomet Group. Lifecore Biomedical Restore is a trademark of Lifecore Biomedical Group. Zimmer Dental is a trademark of Zimmer Group. Sterngold Implamed is a trademark of Sterngold Group. 46
47 permanent implant restorations Single Tooth Abutment NobelReplace Titanium Indications Single tooth implant restoration with limited interdental space. Cement-retained. 1. Impression Place the impression coping implant level onto the implant and take an implant level impression. Connect the healing abutment or temporary restoration and send the impression to the laboratory. Single Tooth Abutment NobelReplace 2. Laboratory Procedures A model is made, the abutment is modified, if needed, and a restoration is made. Alternatives: Procera Crown veneered with NobelRondo. Conventional C&B. 3. Abutment Connection Remove the temporary restoration. Ensure that the implant platform is free from any soft tissue or bone remnants. Connect the abutment and tighten the screw using the Screwdriver Unigrip. A radiograph can help to confirm accurate seating of the abutment. Tighten the abutment screw to 35 Ncm using the Manual Torque Wrench Prosthetic and Screwdriver Machine Unigrip. 47
48 permanent implant restorations Single Tooth Abutment NobelReplace 4. Cementation of Final Restoration Block out screw access channel. Cement the restoration using provisional cement or permanent cement. The restoration should be in light occlusion and excursive contact should be minimal. Note: Only use permanent cement when cementing ceramic crowns. Product List for Clinical Procedures Single Tooth Abutment NobelReplace NP Internal Connection Impression Coping Implant Level Closed Tray Implant Replica 48
49 permanent implant restorations Easy Abutment Titanium Indications Single tooth or multiple unit implant restorations, ideal for posterior restorations. Cement-retained. Easy Abutment 1. Abutment Connection Connect the abutment and tighten using the Unigrip Screwdriver. A radiograph can help to confirm accurate seating of the abutment to the implant. Tighten the abutment screw to 35 Ncm using the Manual Torque Wrench Prosthetic and Screwdriver Machine Unigrip. Modifications if needed Remove the abutment, place it on an implant replica and modify it with a carborundum disk and carbide bur. If the modification is made intra-orally, use profuse water irrigation. Note: Occlusal reduction of the Easy Abutment must not exceed 1 mm or the abutment screw will be compromised. 2. Impression Insert the purple screw access plug in the Easy Abutment. If the top of the abutment has been modified, block out the channel with wax, cotton or other appropriate material. Press the impression cap onto the Easy Abutment. A snap will indicate that the impression cap is fully engaged and well adapted to the margin of the Easy Abutment. 49
50 permanent implant restorations Easy Abutment 2. Impression cont. Inject the impression material slowly into the hole on top of the impression cap. Continue until the impression material extrudes out of the lateral vent holes. Take a standard impression. When the impression is pulled, the impression cap will disengage from the Easy Abutment and will be picked up in the impression. Remove the screw access plug from the impression or from the abutment. Send the impression to the dental laboratory. Note: If the Easy Abutment has been modified, do not use the impression cap; instead, take a standard C&B impression and send to laboratory. 3. Temporary Restoration Verify the tightness of the abutment screw to 35 Ncm. Provisionalize the Easy Abutment using the temporary coping, or use the healing cap that is included in the Easy Abutment package. Never place the healing cap on the Easy Abutment unless the abutment screw has been tightened to 35 Ncm. Warning: Do not use Temporary Coping Easy Abutment with polyurethane cements. The cement will not cure. 4. Laboratory Procedures In the laboratory a model is made and the restoration is produced. Alternatives: Procera Crown veneered with NobelRondo. Procera Bridge Zirconia or Alumina veneered with NobelRondo. Ceramic Coping Easy Abutment with NobelRondo. Plastic Coping Easy Abutment in a cast restoration. 50
51 permanent implant restorations 5. Cementation of Final Restoration Remove the temporary prosthesis or healing cap using the Screwdriver Unigrip. Cement the restoration on the abutment. Use provisional cement if greater ease of retrievability is desired. Note: The screw access plug may be utilized to block out the screw access channel prior to cementation of the final restoration provided that the abutment has not been modified. Note: Only use permanent cement when cementing ceramic crowns or bridges. Easy Abutment Product List for Clinical Procedures External Connection Internal Connection Easy Abutment Includes: Abutment Screw Healing Cap Impression Coping Centrix Injection Tip Screw Access Plug Impression Cap Easy Abutment Includes: Centrix Injection Tip Screw Access Plug Abutment Replica Easy Abutment Healing Cap Easy Abutment Temporary Coping Easy Abutment Engaging Ceramic Coping Easy Abutment Engaging 51
52 permanent implant restorations GoldAdapt Engaging GoldAdapt Engaging Indications Screw-retained single tooth. Cement-retained single tooth and multiple unit implant restorations. Screw access hole location through occlusal surface of posterior teeth or cingulum of anterior teeth without angle correction. Limited interocclusal and/or interdental space. The instructions below are for screw-retained restorations. 1. Impression Place the impression coping implant level onto the implant and take an implant level impression. Connect the healing abutment or temporary restoration and send the impression to the laboratory. 2. Laboratory Procedures In the laboratory a model is made, a GoldAdapt is connected and a conventional C&B restoration is made. 3. Connection of Final Restoration Ensure that the implant platform is free from any soft tissue or bone remnants. Connect the abutment and tighten the screw using the Screwdriver Unigrip. A radiograph can help to confirm accurate seating of the abutment. Tighten the abutment screw to 35 Ncm using the Manual Torque Wrench Prosthetic and Screwdriver Machine Unigrip. Fill the screw access channel with a suitable material such as gutta-percha, silicone or temporary filling material. 52
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