procedures & products NOBELESTHETICS including Procera
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 14001 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 13485:1996 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.
Table of Contents Beautiful Teeth Now...4 Implant/Abutment Interface Diameter...5 Impression Techniques....6 Temporization...11 Abutment Selection...15 Type of Restoration...16 Procera Abutment...18 Snappy Abutment...21 Easy Abutment...24 Esthetic Abutment....28 Single Tooth Abutment NOBELREPLACE NP...31 GoldAdapt Engaging...33 Procera Implant Bridge...35 Multi-unit Abutment...39 GoldAdapt Non-Engaging...42 Gold Abutment Bar/Gold Coping Bar...44 Ball Abutment Titanium....47 FAQ...50 Manual Torque Wrench...52 OsseoSet...54 Cleaning and Sterilization Recommendation...55 Torque Guide...56 Product Reference Guide....57 3
Beautiful Teeth Now Congratulations! You have made an excellent choice. Welcome to the Nobel Biocare family. Nobel Biocare is providing dentists with more choices than ever before. But our goals remain the same: To ensure that your patients leave the treatment room satisfied, comfortable, with beautiful teeth, and with a renewed quality of life. To help your practice run more smoothly, efficiently and profitably. This manual is designed to provide quick access to important information regarding treatments, procedures and options for: Brånemark System Mk III Groovy NobelSpeedy Groovy Brånemark System Mk III Brånemark System Mk IV NobelReplace Tapered Groovy NobelReplace Straight Groovy NobelSpeedy Replace Replace Select Tapered Replace Select Straight NobelDirect Posterior The focus of this manual is on the clinical procedures. Additional information on the prosthetic components are found in the NobelEsthetics Prosthetic Products Catalog. For more detailed information on the laboratory procedures, please see the Dental Laboratory Procedure manual. For information about Procera, go to the Procera Laboratory Procedure manual or the Procera Interactive Training CD. For information on clinical procedures for NobelPerfect Groovy, NobelDirect Groovy and NobelDirect Oval. Please see the NobelPerfect Groovy and the NobelDirect Groovy manuals. Nobel Biocare solutions are designed to facilitate: Immediate Function Short & long-term Easy Esthetics Patient comfort and can also be used in Nobel Biocare s pioneering NobelGuide treatment method. See the NobelGuide Manuals/CD for more details. 4
Implant/Abutment Interface Diameter Our products are organized according to a platform concept, which facilitates treatment planning. Narrow Platform (NP) for situations in which there is limited inter-dental space or a narrow crest. Regular Platform (RP) for cases ranging from single anterior tooth loss to complete edentulism. Wide Platform (WP) where additional loading can be expected or whenever a wider diameter implant/abutment is considered preferable. 6.0 Platform (6.0) where additional loading can be expected or whenever an even wider diameter implant/abutment is considered preferable. External Connection Brånemark System Mk III Groovy* NobelSpeedy Groovy** Brånemark System Mk III* Brånemark System Mk IV Internal Connection NobelReplace Tapered Groovy NobelReplace Straight Groovy NobelSpeedy Replace Replace Select Tapered Replace Select Straight One-Piece Implants NobelDirect Posterior External Connection NP 3.5 mm interface RP 4.1 mm interface WP 5.1 mm interface Internal Connection NP 3.5 mm interface RP 4.3 mm interface WP 5.0 mm interface 6.0 6.0 mm interface NOBELDIRECT Posterior RP 4.3 mm WP 5.0 mm 6.0 6.0 mm Interface Diameter Interface Diameter *For RP 3.75 and RP 4 implants, use RP prosthetic components ** For WP 5 and WP 6 implants, use WP prosthetic components 5
Impression Techniques To restore an implant, the laboratory model needs to have either an implant replica or abutment replica. The only exception is with abutments that are modified in the mouth; these are reproduced in stone or acrylic in procedures identical to preparations on natural teeth. Impression Implant Level The purpose of the implant level impression is to crossreference the position of the implant platform in relation to other implants, teeth and soft tissue contours. The implant level impression is generally made when a one-stage procedure is utilized, or the indexing of implant position is desired, before soft tissue closure at the time of implant placement. However, an implant level impression may also be made after second-stage surgery, after a healing abutment or temporary restoration has been in place and the soft tissue has healed. The implant level impression coping is connected to the implant and the impression is made with an elastic material with either an open or closed tray. Information from the implant platform is transferred via the impression coping and implant replica to the stone model. The implant replica allows restorative components to be seated and removed from the dental cast during abutment selection and fabrication of the provisional or final restoration. Note: For implants that are greater than 25 divergent, the open tray technique must be used. 6
Closed Tray Technique 1. Place the impression coping over the implant. Use the Unigrip Screwdriver and tighten the screw (for NobelReplace only). The Impression Coping Closed Tray Plastic NobelReplace, which is intended to be used for single units and short span bridges with parallel implants, is pressed into the implant. 2. Block out the Unigrip hole on the guide pin (for NobelReplace only). A radiograph may be taken to verify proper seating of the impression coping. 3. Inject a heavy body impression material (polyether material or polyvinylsiloxane) around each impression coping and into the tray. Record the impression. 4. Remove the impression. 5. Remove the impression coping and thread it onto the corresponding implant replica. 6. Place the impression coping implant replica assembly into its corresponding location in the impression and send to the dental laboratory for model fabrication. 1. 5. 6. 2. Open Tray Technique An alternative technique for taking an implant level impression. This is useful when: It is preferred to have the impression coping retained in the impression material to avoid uncertainty with re-seating. The lack of implant parallelism would make tray removal difficult using the closed tray technique. The height of the implant level impression coping is significantly below the occlusal plane. 1. Place the impression coping over the implant and tighten the guide pin using the Unigrip Screwdriver. 2. 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, it may be closed off using baseplate wax, with the guide pins indenting or perforating the wax. 3. Inject impression material around each impression coping and fill the tray; seat the impression tray fully so that the tips of all the guide pins are identified. After the impression material has set, unscrew each guide pin. Pull each guide pin with cotton pliers to verify full disengagement. Remove the impression tray. 4. Attach the appropriate implant replicas to the impression copings for model fabrication. Note: It is important that no forces are transferred to the impression coping while fastening the replica; this could twist the position of the coping in the impression material. A firm grip on the replica while tightening the guide pin will help prevent any dislodgement of the impression coping from it s reference position. 1. 3. 4. 7
Product List for Clinical Procedures External Connection Internal Connection Impression Coping Implant Level Closed Tray Alternatives for internal connection: Low Profile Plastic Impression Coping Implant Level Open Tray Implant Replica Instrumentation Prosthetic Kit Includes: Manual Torque Wrench Prosthetic Screwdriver Machine Unigrip 20 mm Screwdriver Machine Unigrip 30 mm Screwdriver Machine Multi-unit 21 mm Impression Abutment Level The impression techniques (closed or open tray) are the same for straight and angled Multi-unit abutments and all platforms (NP/RP/WP). The abutment level impression coping is connected to the Multi-unit abutment and the impression is made with an elastic material with either an open or closed tray. Information from the abutment is transferred via the impression coping and abutment replica to the stone model. The abutment replica allows restorative components to be seated and removed from the dental cast during fabrication of the provisional or final restoration. Note: For implants that are greater than 25 divergent, the open tray technique must be used. 8
Closed Tray Technique 1. Place the impression coping and rotate it into position on the abutment until complete seating is achieved. 2. Inject a heavy body impression material (polyether material or polyvinylsiloxane) around each impression coping and into the tray. Record the impression. 3. Remove the impression. 4. Remove the impression copings from the abutment and attach the abutment replicas to each coping. 5. Place the impression coping abutment replica assembly into its corresponding location in the impression and send to the dental laboratory for model fabrication. 5. 1. 4. Open Tray Technique 1. Place the impression coping on the abutment and tighten the guide pin using the Unigrip Screwdriver. 2. 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, it may be closed off using baseplate wax, with the guide pins indenting or perforating the wax. 3. Inject impression material around each impression coping and fill the tray; seat the impression tray fully so that the tips of all the guide pins are identified. After the impression material has set, unscrew each guide pin. Pull each guide pin with cotton pliers to verify full disengagement. Remove the impression tray. 4. Attach the appropriate implant replicas to the impression copings for model pouring. Note: It is important that no forces are transferred to the impression coping while fastening the replica; this could twist the position of the coping in the impression material. A firm grip on the replica while tightening the guide pin will help prevent any dislodgement of the impression coping from its reference position. 1. 3. 4. Impression techniques on abutment level for Snappy Abutment, Easy Abutment and Ball Abutment Titanium, see pages 21, 24 and 47. 9
Product List for Clinical Procedures Impression Coping Closed Tray Multi-unit External Connection Internal Connection Impression Coping Open Tray Multi-unit Abutment Replica Multi-unit Instrumentation Prosthetic Kit Includes: Manual Torque Wrench Prosthetic Screwdriver Machine Unigrip 20 mm Screwdriver Machine Unigrip 30 mm Screwdriver Machine Multi-unit 21 mm 10
Temporization Depending on the final restoration planned, several alternatives in provisional restorations are possible. It is best to have a temporization strategy to meet patient requirements during different phases of treatment planning. One-Stage Function As for crown & bridge, temporization may be performed in many different ways, from the use of a standard acrylic crown, adjusted chairside, to a lab-processed temporary crown. It is important to have a smooth contour on the provisional crown to avoid irritating the soft tissue. Care should be taken not to contaminate the surgical site with impression material or cement. For the Snappy Abutments, Easy Abutments, Esthetic Abutments and Multi-unit Abutments, temporary copings are available using the same principles as for crown & bridge. In some situations, Nobel Biocare Temporary Abutments can be used for the temporary prosthesis. For single unit temporary restorations there is an Immediate Temporary Abutment available. 11
Two-Stage Function Before implants are uncovered For the totally edentulous patient after implant insertion, use the existing denture that has been adjusted and relined. For the partially edentulous patient after implant insertion, use suitable conventional temporization procedures. After implants are uncovered Provisional restorations can be made on temporary components as the needs of the patient and the treatment plan dictate. Indexing at the time of implant placement, can allow the fabrication of an abutment and/or provisional restoration to be delivered at the time of implant uncovering. Temporary Restorations For fabrication of temporary restorations, there are several options. For cemented restorations, using the Snappy Abutments, Easy Abutments, Esthetic Abutments and Procera Abutments, temporary crowns or bridges are made with the same techniques used for natural teeth. For Multi-unit Abutments, provisional restorations can be fabricated by processing acrylic or composite to temporary copings. 1. Immediate Temporary Abutment Immediate Temporary Abutments and Copings are used for single unit implant supported temporary dental restorations, made chair-side. The Immediate Temporary Abutment consists of two parts, an abutment and a plastic coping. 1. The abutment is mounted onto the implant and tightened with the Screwdriver Machine Multi-unit and Manual Torque Wrench Prosthetic to 35 Ncm. 2. The abutment post is adjusted for height and clearance if necessary. 3. The plastic coping is tried-in and relieved for clearance if necessary. 4. A temporary crown is fabricated with traditional methods using either acrylic or composite. Warning: Do not use with Polyurethane cements. The cement will not cure. 4. 3. 12
Temporary Abutments/Copings The standard temporary abutments and copings, used for the fabrication of provisional restorations, are made of titanium or plastic. The retentive groove on the abutments/copings will help to bind acrylic material when building a provisional construction. 1. Provisional restorations may be made either at a dental laboratory or chair-side. The provisional restoration is fabricated directly on the temporary abutments/copings. For the direct chair-side method, an acrylic template for the provisional restoration can be made from either a wax-up or denture tooth set-up representing the planned restoration. 1. Fasten the temporary abutments/copings in the mouth or on the model. Use guide pins that extend beyond the occlusal plane. 2. Make holes in the acrylic template to allow the guide pins and temporary abutments/copings to protrude. 3. Examine undercuts associated with adjacent natural teeth and block out as necessary. 4. Fill the acrylic template with acrylic and seat over the guide pins and temporary abutments/copings. 5. After setting, loosen the guide pins to remove the restoration. 6. Laboratory protection analogs can be attached to the bottom of the abutments/copings to protect the base during trimming and polishing procedures. 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 material. 5. 4. 6. 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. 13
Product List for Clinical Procedures Immediate Temporary Abutment Includes: Plastic Coping Immediate Temporary Abutment External Connection Internal Connection Temporary Abutment Engaging Titanium with Abutment Screw 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 Instrumentation Prosthetic Kit Includes: Manual Torque Wrench Prosthetic Screwdriver Machine Unigrip 20 mm Screwdriver Machine Unigrip 30 mm Screwdriver Machine Multi-unit 21 mm 14
Abutment Selection If the final restoration is to meet the esthetic and functional demands of the dentist and patient, selecting the proper abutment is crucial. In some cases, the dentist makes the abutment selection and sends an abutment level impression to the laboratory. However in many cases, the dentist takes an impression at fixture level to facilitate the abutment choice. Try-in Abutments In order to facilitate the abutment selection there are now plastic Try-in Abutments available with internal or external connections. These are intended to be momentarily placed into an implant (intra-orally) or implant replica (dental laboratory) to aid the clinician or dental technician in the selection of an appropriate shape and size abutment for the patient. The Try-in Abutments are available for Snappy Abutments, straight and angled Esthetic Abutments and angled Multi-unit Abutments. A soft tissue measuring tool is included along with the Try-in Abutment. Try-in Abutments for External Connection Indications The Abutment Try-ins are indicated for partially or fully edentulous patients receiving implant treatment with NobelReplace or Brånemark System Implants. Cleaning and Sterilization The Abutment Try-ins are reusable by the dentist or laboratory. They may be cleaned and sterilized prior to patient use as required in compliance with established routines at the hospital/clinic. Try-in Abutments for Internal Connection Cement-Retained Cement-retained restorations on implants follow the same basic protocol as tooth-supported crowns and fixed partial denture restorations. While the abutments are screw-retained in to the implants, the restoration is cemented over the abutments. The use of temporary cement is recommended for ease of retrievability. Note: Do not use temporary cement for Procera Crowns or Procera Bridge Zirconia. Screw-Retained A screw-retained restoration is retained by screws that enter through the occlusal or cingulum area of the restoration. The screw passes through the crown and threads into the abutment screw. The restoration is retrievable by the dentist. 15
Type of Restoration Single Tooth Restoration Cement-Retained Procera Abutment Zirconia or Titanium Snappy Abutment Titanium Easy Abutment Titanium Esthetic Abutment Angled, Straight Titanium Single Tooth Abutment Titanium GoldAdapt Engaging External NP/RP/WP External NP/RP/WP External NP/RP/WP External NP/RP/WP Internal NP External NP/RP/WP Internal NP/RP/WP/6.0 Internal NP/RP/WP/6.0 Internal NP/RP/WP/6.0 Internal NP/RP/WP/6.0 Internal NP/RP/WP/6.0 Octagon 4.8 Multiple Unit Restoration Cement-Retained Procera Abutment Zirconia or Titanium External NP/RP/WP Internal NP/RP/WP/6.0 Octagon 4.8 Snappy Abutment Titanium External NP/RP/WP Internal NP/RP/WP/6.0 Easy Abutment Titanium External NP/RP/WP Internal NP/RP/WP/6.0 Esthetic Abutment Angled, Straight Titanium External NP/RP/WP Internal NP/RP/WP/6.0 GoldAdapt Engaging External NP/RP/WP Internal NP/RP/WP/6.0 the interface part is not illustrated 16
Single Tooth Restoration Screw-Retained GoldAdapt Engaging External NP/RP/WP Internal NP/RP/WP/6.0 Multiple Unit Restoration Screw-Retained Multi-unit Abutment Titanium Multi-unit Angled Abutment Titanium GoldAdapt Non-Engaging Procera Implant Bridge Titanium External NP/RP/WP External NP/RP External NP/RP/WP External NP/RP/WP Internal NP/RP/WP Internal NP/RP Internal NP/RP/WP/6.0 Internal NP/RP/WP/6.0 Octagon 4.8/6.5 Overdenture Restoration Bar-Retained Ball-Retained Gold Abutment Bar Multi-unit Abutment Titanium Multi-unit Angled Abutment Titanium Ball Abutment Titanium External RP Internal NP/RP External NP/RP/WP Internal NP/RP/WP External NP/RP Internal NP/RP External RP Internal NP/RP Gold Coping Bar the interface part is not illustrated 17
Procera Abutment Zirconia, Titanium Single Tooth and Multiple Unit Restorations Cement-Retained Indications Single or multiple implant restorations Fully edentulous or partially edentulous arch 1. Impression 1. Place the impression coping implant level onto the implant. To transfer the position of the implant to a working model, take an impression on implant level (see the chapter: Impression Techniques). 2. Connect the temporary restoration (see the chapter: Temporization), or healing abutment and send the impression to the dental laboratory. 2. Laboratory Procedure Wax-up technique The Procera Abutment wax-up kit with different platform replicas is used to create a wax-up pattern. After scanning the wax-up pattern with Procera Scanner, the data is transferred to a production facility via Internet. 3D CADD technique Procera 3D CADD program is used to create a computerized design for Procera Abutment. The contour, alignment and finish line are designed on the screen. When the design is completed, data is transferred to the production facility via Internet. 3. Procera Production Facility The abutment is produced and returned to the laboratory. 18
4. Laboratory Procedure In the laboratory the abutment is scanned for a Procera Crown or Procera Bridge Zirconia, which after production will be veneered with NobelRondo porcelain. Note: When designing/preparing Procera Abutment Zirconia, make sure that the thickness of the ceramic material is at least 0.8 mm. This thickness limit is applicable up to a height of 3 mm above implant level. 5. Abutment Connection 3. Remove the temporary restoration or healing abutment from the implant. Ensure that the implant platform is free from any soft-tissue or bone remnants. 4. Insert the abutment screw into the screw access channel using the Unigrip Screwdriver. Position the abutment/screw assembly into the implant and secure the screw in the implant until resistance is felt. A radiograph can be helpful to confirm accurate seating of the abutment. Note: When using the Procera Abutment with external connection on compatible hex implants, use the screw supplied with the abutment. 5. Tighten the abutment screw to 35 Ncm using the Manual Torque Wrench Prosthetic and Unigrip Machine Screwdriver. 6. Cementation of Final Restoration 6. 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. 7. Cement the restoration using permanent cement. 19
Procera Abutment Octagon Procera Abutments are also available in both titanium and zirconia for Straumann Regular Neck 4.8 mm implants Procera Abutment Octagon. Simply follow the normal laboratory procedure for Procera Abutment and the clinical procedure for Straumann implants. Product List for Clinical Procedures External Connection Internal Connection Procera Abutment Includes: Abutment Screw Impression Coping Implant Level Closed Tray Alternatives for internal connection: Low Profile Plastic Impression Coping Implant Level Open Tray Implant Replica Note: For temporary components see page 14. Instrumentation Prosthetic Kit Includes: Manual Torque Wrench Prosthetic Screwdriver Machine Unigrip 20 mm Screwdriver Machine Unigrip 30 mm Screwdriver Machine Multi-unit 21 mm 20
Snappy Abutment Titanium Cement-Retained Single Tooth and Multiple Unit Restorations Note: The NobelDirect Posterior Implant has an integrated abutment portion, which is identical to the Snappy Abutment and thus uses the same prosthetic components. Indications The abutments are ideal for posterior, partially edentulous restorations and single implant restorations 1. Abutment Connection 1. Insert the abutment screw into the screw access channel using the Unigrip Screwdriver. Position the abutment/screw assembly into the implant and secure the screw until resistance is felt. A radiograph can help to confirm accurate seating of the abutment to the implant. 2. Tighten the abutment screw to 35 Ncm using the Manual Torque Wrench Prosthetic and Unigrip Machine Screwdriver. 2. Impression 3. Using light finger pressure, press the impression coping onto the Snappy Abutment. A snap will indicate that the impression coping is fully engaged and well adapted to the margin of the Snappy Abutment. Note the plastic tabs inside the impression coping fit into the top of Snappy Abutment. 4. 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. 5. Insert the Abutment Replica Snappy Abutment into the Impression Coping and send the impression to the dental laboratory for model and prosthetic fabrication. 21
3. Temporary Restoration 6. Clean and remove any debris from the Snappy Abutment. Use the Manual Torque Wrench Prosthetic to verify the tightening to 35 Ncm of the abutment screw. 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. 4. Laboratory Procedure In the laboratory a model is made and the restoration is produced. Alternatives: Procera Crown veneered with NobelRondo Procera Bridge Zirconia veneered with NobelRondo Plastic/Temporary Coping Snappy Abutment in a cast restoration 5. Cementation of Final Restoration 7. Remove the healing cap or temporary prosthesis using the Unigrip Screwdriver. 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. 22
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 Instrumentation Prosthetic Kit Includes: Manual Torque Wrench Prosthetic Screwdriver Machine Unigrip 20 mm Screwdriver Machine Unigrip 30 mm Screwdriver Machine Multi-unit 21 mm 23
Easy Abutment Titanium Cement-Retained Single Tooth and Multiple Unit Restorations Indications The abutments are ideal for posterior, partially edentulousrestorations and single implant restorations 1. Abutment Connection 1. Insert the abutment screw into the screw access channel using the Unigrip Screwdriver. Position the abutment/ screw assembly into the implant and tighten the screw until resistance is felt. A radiograph can help to confirm accurate seating of the abutment to the implant. 2. Tighten the abutment screw to 35 Ncm using the Manual Torque Wrench Prosthetic and Unigrip Machine Screwdriver. 35 Ncm 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 3. Mount the purple screw access plug in the Easy Abutment screw access channel using a perioprobe. If the top of the abutment has been modified, block out the channel with wax, cotton or other appropriate material. 4. Using light finger pressure, 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. 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. 24
5. Use the included centrix injection tip to slowly inject impression material into the hole on top of the impression cap. Continue until the impression material extrudes out of the lateral vent holes of the impression cap. Note: For best results, care should be taken to avoid bottoming out the injection tip inside the snap-on impression cap. 6. 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. The screw access plug is often picked up in the impression material. Remove the screw access plug from the impression with an explorer. 7. Insert the Abutment Replica Easy Abutment into the impression cap and send the impression to the dental laboratory. 3. Temporary Restoration 8. Clean and remove any debris from the Easy Abutment. Use the Manual Torque Wrench Prosthetic to verify the tightening to 35 Ncm of the abutment screw. Provisionalize the Easy Abutment using the temporary coping, or use the healing cap that is included in the Easy Abutment package. Remove the screw access plug and place the healing cap using the Unigrip Screwdriver without over-tightening. 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 Procedure In the laboratory a model is made and the restoration is produced. Alternatives: Procera Crown veneered with NobelRondo Procera Bridge Zirconia veneered with NobelRondo Ceramic Coping Easy Abutment with NobelRondo Plastic Coping Easy Abutment in a cast restoration 25
5. Cementation of Final Restoration 9. Remove the temporary prosthesis or healing cap using the Unigrip Screwdriver. 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. 26
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 Instrumentation Prosthetic Kit Includes: Manual Torque Wrench Prosthetic Screwdriver Machine Unigrip 20 mm Screwdriver Machine Unigrip 30 mm Screwdriver Machine Multi-unit 21 mm 27
Esthetic Abutment Titanium Cement-Retained Single Tooth and Multiple Unit Restorations The following description is based on straight Esthetic Abutments. The same procedures are used for the 15 Esthetic Abutments. 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. Indications Single or multiple implant restoration Fully edentulous or partially edentulous arch 1. Abutment Connection 1. Insert the abutment screw into the screw access channel using the Unigrip Screwdriver. Position the abutment/screw assembly into the implant and tighten the screw in the implant until resistance is felt. A radiograph can help to confirm accurate seating of the abutment. 2. Tighten the abutment screw to 35 Ncm using the Manual Torque Wrench Prosthetic and Unigrip Machine Screwdriver. Modification, 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 copious water irrigation. 2. Impression 3. Take a standard C&B impression. 4. Send the impression to the dental laboratory. 28
3. Temporary Restoration Clean and remove any debris from the Esthetic Abutment. Use the Manual Torque Wrench Prosthetic to verify the tightening to 35 Ncm of the abutment screw. Provisionalize the Esthetic Abutment using the plastic/temporary coping. Warning: Do not use with polyurethane cements. The cements will not cure. 4. Laboratory Procedure In the laboratory, a model is made and a restoration is produced. Alternatives: Procera Crown veneered with NobelRondo Procera Bridge Zirconia veneered with NobelRondo Plastic/Temporary Coping Esthetic Abutment in a cast restoration. 5. Cementation of Final Restoration 5. 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. 6. Cement the restoration using provisional or permanent cement. Note: Only use permanent cement when cementing ceramic crowns or bridges. 29
Product List for Clinical Procedures Esthetic Abutment Includes: Abutment Screw External Connection Internal Connection 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 Instrumentation Prosthetic Kit Includes: Manual Torque Wrench Prosthetic Screwdriver Machine Unigrip 20 mm Screwdriver Machine Unigrip 30 mm Screwdriver Machine Multi-unit 21 mm 30
Single Tooth Abutment NOBELREPLACE NP Titanium Cement-Retained Single Tooth Restoration Indications Single implant restoration with limited interdental space 1. Impression 1. Place the impression coping implant level onto the implant. To transfer the position of the implant to a working model, take an impression implant level (see the chapter: Impression Techniques). 2. Connect the healing abutment or temporary restoration (see the chapter: Temporization), and send the impression to the laboratory. 2. Laboratory Procedure In the laboratory, 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 3. Remove the temporary restoration or healing abutment from the implant. Ensure that the implant platform is free from any soft tissue or bone remnants. 4. Insert the abutment screw into the screw access channel of the abutment using the Unigrip Screwdriver. Position the abutment/screw assembly into the implant and tighten the screw in the implant until resistance is felt. If a template has been produced, use this for guiding the abutment into the right position. A radiograph can help to confirm accurate seating of the abutment. 5. Tighten the abutment screw to 35 Ncm using the Manual Torque Wrench Prosthetic and Unigrip Machine Screwdriver. 31
4. Cementation of Final Restoration 6. Gently seat the restoration on the abutment and check both the occlusion and the interproximal tooth contacts. The restoration should be in light occlusion and excursive contact should be minimal. 7. Cement the restoration using provisional cement or permanent cement. Note: Only use permanent cement when cementing ceramic crowns. Product List for Clinical Procedures Internal Connection Single Tooth Abutment NOBELREPLACE NP Impression Coping Implant Level Closed Tray Implant Replica Note: For temporary components see page 14 Instrumentation Prosthetic Kit Includes: Manual Torque Wrench Prosthetic Screwdriver Machine Unigrip 20 mm Screwdriver Machine Unigrip 30 mm Screwdriver Machine Multi-unit 21 mm 32
GoldAdapt Engaging Screw-Retained Single Tooth Cement-Retained Single Tooth and Multiple Unit Restorations This instructions is for screw-retained restorations only. Indications Single or multiple implant restorations Screw access hole location through occlusal surface of posterior teeth or cingulum of anterior teeth without angle correction Limited interocclusal space Limited interdental space 1. Impression 1. Place the impression coping implant level onto the implant. To transfer the position of the implant to a working model, take an impression implant level (see the chapter: Impression Techniques). 2. Connect the healing abutment or temporary restoration (see the chapter: Temporization), and send the impression to the laboratory. 2. Laboratory Procedure In the laboratory a model is made, a GoldAdapt is connected and a conventional C&B restoration is made. 3. Connection of Final Restoration 3. Remove the temporary restoration or healing abutment from the implant. Ensure that the implant platform is free from any soft tissue or bone remnants. 4. Insert the abutment screw into the screw access channel of the restoration using the Unigrip Screwdriver. Position the restoration/screw assembly into the implant and tighten the screw in the implant until resistance is felt. A radiograph can help to confirm accurate seating of the abutment. 5. Check both the occlusion and the interproximal contacts. The restoration should be in light occlusion and excursive contact should be minimal. 6. Tighten the abutment screw to 35 Ncm using the Manual Torque Wrench Prosthetic and Unigrip Machine Screwdriver. 7. Fill the screw access channel with a suitable material such as gutta percha, silicone or temporary filling material. 33
Product List for Clinical Procedures GoldAdapt Engaging Includes: Abutment Screw External Connection Internal Connection Impression Coping Implant Level Closed Tray Alternatives for internal connection: Low Profile Plastic Impression Coping Implant Level Open Tray Implant Replica Note: For temporary components see page 14 Instrumentation Prosthetic Kit Includes: Manual Torque Wrench Prosthetic Screwdriver Machine Unigrip 20 mm Screwdriver Machine Unigrip 30 mm Screwdriver Machine Multi-unit 21 mm 34
Procera Implant Bridge Titanium Screw-Retained Multiple Unit Restoration Indications Fully edentulous or partially edentulous arch Implant level or abutment level 1a. Impression Implant Level 1. Place impression copings implant level onto the implants using guide pins for connection. To transfer the position of the implant to a working model, take an impression at implant level (see the chapter: Impression Techniques). 2. Connect the temporary restoration (see the chapter: Temporization) or healing abutment and send the impression to the laboratory. 1b. Impression Abutment Level 1. Place the Impression Copings Multi-unit onto the Multi-unit Abutments. To transfer the position of the abutment to a working model, take an impression on abutment level (see the chapter: Impression Techniques). 2. Connect the temporary restoration (see the chapter: Temporization) or healing cap and send the impression to the laboratory. 2. Laboratory Procedure In the laboratory, a model is made and a resin framework is produced and is sent to a Procera production facility. 3. In Procera Production Facility The framework is milled from a solid piece of titanium and returned to the laboratory. 4. Laboratory Procedure The restoration is completed using conventional methods. 35
5a. Connection of Final Restoration on Implant Level 3. Remove the temporary restoration or healing abutments from the implants. Ensure that the implants are free from any soft tissue or bone remnants. 4. Connect the restoration to the implants with abutment screws. Start with the mid region post and tighten the following screws alternating left and right sides. 5. Tighten the abutment screws to 35 Ncm using the Manual Torque Wrench Prosthetic and Unigrip Machine Screwdriver. 6. 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 on compatible hex implants, use screw intended for the Brånemark System platform. 5b. Connection of Final Restoration on Abutment Level 3. Remove the temporary restoration or healing caps from the abutments. 4. Connect the restoration to the abutments with prosthetic screws. Start with the mid region post and tighten the following screws alternating left and right sides. 5. Tighten the prosthetic screws to 15 Ncm using the Manual Torque Wrench Prosthetic and Unigrip Machine Screwdriver. 6. Fill the screw access channel with a suitable material such as gutta percha, silicone or temporary filling material. 15 Ncm Procera Implant Bridge Octagon The Procera Implant Bridge is also available at implant level for Straumann Regular Neck 4.8mm and Wide Neck 6.5 mm implants Procera Implant Bridge Octagon. You simply follow the normal laboratory procedure for Procera Implant Bridge and the clinical procedure for Straumann implants. 36
Product List for Clinical Procedures Procera Implant Bridge - at Implant or Abutment Level Does not include Abutment Screws/Prosthetic Screws External Connection Internal Connection Implant Level Components Abutment Screw Impression Coping Implant Level Closed Tray Alternatives for internal connection: Low Profile Plastic 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 37
Product List for Clinical Procedures External Connection Internal Connection Abutment Replica Multi-unit Healing Cap Multi-unit Available as regular/wide Note: For temporary components see page 14. Instrumentation Prosthetic Kit Includes: Manual Torque Wrench Prosthetic Screwdriver Machine Unigrip 20 mm Screwdriver Machine Unigrip 30 mm Screwdriver Machine Multi-unit 21 mm 38
Multi-unit Abutment Titanium Screw-Retained Multiple Unit Restoration Indications Multiple unit screw-retained restoration Fully edentulous or partially edentulous arch Desire for greater ease of retrievability 1a. Abutment Connection Straight Multi-unit Abutment 1. Use the pre-mounted plastic holder to place the abutment into the implant and screw the abutment into the correct position. 2. If necessary, shorten the holder with a pair of scissors. 3. When the abutment is seated, the disposable plastic holder should be removed with a slight bending movement. A radiograph can be helpful to confirm accurate seating of the abutment. 4. 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 1. The abutment is placed over the implant by using the pre-mounted abutment holder. Please note that there are several possible positions to place the abutment. 2. Tighten the abutment screw using a Unigrip Screwdriver until resistance is felt. A radiograph can help to confirm accurate seating of the abutment. 3. The disposable holder is then unscrewed from the abutment by turning it counter-clockwise. 4. Tighten the abutment screw to 15 Ncm using the Manual Torque Wrench Prosthetic and Unigrip Machine Screwdriver 35 Ncm Note: Be sure not to exceed 15 Ncm. 39
2. Impression 5. Place the impression coping abutment level onto the abutment. To transfer the position of the abutment to a working model, take an impression at abutment level (see the chapter: Impression Techniques). 6. Connect the temporary restoration (see the chapter: Temporization), or healing cap and send the impression to the dental laboratory. 3. Laboratory Procedure 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 7. Remove the temporary restoration or healing caps from the abutments. 8. Connect the restoration to the abutments with prosthetic screws. Start with the mid region post and tighten the following screws alternating left and right sides. 9. Tighten the prosthetic screws to 15 Ncm using the Manual Torque Wrench Prosthetic and Unigrip Machine Screwdriver. 10. Fill the screw access channel with a suitable material such as gutta percha, silicone or temporary filling material. 15 Ncm 40
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 Note: For temporary components see page 14. Instrumentation Prosthetic Kit Includes: Manual Torque Wrench Prosthetic Screwdriver Machine Unigrip 20 mm Screwdriver Machine Unigrip 30 mm Screwdriver Machine Multi-unit 21 mm 41
GoldAdapt Non-Engaging Screw-Retained Multiple Unit Restoration Indications Multiple implant restoration screw-retained Limited interocclusal space Screw access hole location through occlusal surface of posterior teeth or cingulum of anterior teeth without angle correction Implants with less than 40 overall divergence to allow path of insertion 1. Impression 1. Place the impression copings implant level onto the implant. To transfer the position of the implants to a working model, take an impression implant level (see the chapter: Impression Techniques). 2. Connect the temporary restoration (see the chapter: Temporization), or healing abutments and send the impression to the dental laboratory. 2. Laboratory Procedure In the laboratory a model is made, GoldAdapts are connected and a conventional C&B restoration is made. 3. Connection of Final Restoration 3. Remove the temporary restoration or healing abutments from the implants. Ensure that the implant platforms are free from any soft-tissue or bone remnants. 4. Insert the abutment screws into the screw access channels of the restoration using a Unigrip Screwdriver. Position the restoration/screw assembly into the implants and tighten the screws in the implants until resistance is felt. A radiograph can be helpful to confirm accurate seating of the abutment. 5. Check both the occlusion and the interproximal contacts. The restoration should be in light occlusion and excursive contact should be minimal. 6. Tighten the abutment screws to 35 Ncm using the Manual Torque Wrench Prosthetic and Unigrip Machine Screwdriver. 7. Fill the screw access channels with a suitable material such as gutta percha, silicone or temporary filling. 42
Product List for Clinical Procedures GoldAdapt Non-Engaging Includes: Abutment Screw External Connection Internal Connection Impression Coping Implant Level Closed Tray Alternatives for internal connection: Low Profile Plastic Impression Coping Implant Level Open Tray Implant Replica Note: For temporary components see page 14. Instrumentation Prosthetic Kit Includes: Manual Torque Wrench Prosthetic Screwdriver Machine Unigrip 20 mm Screwdriver Machine Unigrip 30 mm Screwdriver Machine Multi-unit 21 mm 43
Gold Abutment Bar/ Gold Coping Bar Overdenture Restoration Bar-Retained Indications Fully edentulous arch Financially compromised patients Extensive bone or soft tissue loss Compromised patient manual dexterity Necessity for soft tissue support Phonetic concerns Implant Supported Overdenture Maxilla: 6 to 8 implants Mandible: 4 or more implants The number of implants is important, but not the only factor, in determining the load potential Resilient Tissue Supported Overdenture Maxilla: 4 or more implants Mandible: 2 or more implants 1a. Impression Implant Level 1. Place the Impression Copings Bar onto the implants. To transfer the position of the implants at a working model, take an impression with a custom tray at implant level. 1b. Impression Abutment Level 1. Place the Impression Copings Bar Multi-unit onto the abutments. To transfer the position of the abutments to a working model, take an impression with a custom tray on abutment level (see the chapter: Impression Techniques). 2. Laboratory Procedure In the laboratory a model is made and an occlusal rim with incorporated gold abutments/gold copings is produced. 3. Jaw Relationship 2. Secure the occlusal rim to the implants or abutments with abutment screw/prosthetic screw or short guide pins. 3. Record the jaw relationship. 44
4. Laboratory Procedure The bar is soldered to the gold abutments/gold copings and a tooth set-up in wax is produced. 5. Clinical Try-in 4. Evaluate wax try-in. 6. Laboratory Procedure In the laboratory the overdenture is processed. 7a. Connection of Final Restoration Implant Level 5. Tighten the abutment screws to 35 Ncm using Manual Torque Wrench Prosthetic and Unigrip Machine Screwdriver. 6. Deliver the denture. Adjust the retention. Verify the occlusal relationships, confirm resiliency and hinge axis movement. 7b. Connection of Final Restoration Abutment Level 7. Check the tightness of the abutment screws. Tighten the prosthetic screws to 15 Ncm using Manual Torque Wrench Prosthetic and Unigrip Machine Screwdriver. 8. Deliver the denture. Adjust the retention. Verify the occlusal relationships, confirm resiliency and hinge axis movement. 15 Ncm 45
Product List for Clinical Procedures Gold Abutment Bar Includes: Abutment Screw External Connection Internal Connection Gold Coping Bar Multi-unit Includes: Prosthetic Screw Impression Coping Bar Implant Level Closed Tray Implant Replica Impression Coping Bar Closed Tray Multi-unit Abutment Replica Multi-unit Instrumentation Prosthetic Kit Includes: Manual Torque Wrench Prosthetic Screwdriver Machine Unigrip 20 mm Screwdriver Machine Unigrip 30 mm Screwdriver Machine Multi-unit 21 mm 46