Straumann Screw Retained Hybrid Restorations
Straumann Screw Retained Hybrid Restorations
Straumann Screw Retained Hybrid Restorations
Clinical case 18
Product overview 24
Removable Fixed
new
Maxilla
new
Mandible
LOCATOR on 2 implants Bar with pre-fabricated/ Fixed screw-retained resto- Fixed screw-retained
individualized parts ration on 4 implants, posteri- restoration on > 6 implants
> 3 implants or tilted avoiding mandibular
nerve
The new Straumann Bone Level Tapered Implant provides an optimized choice for implant
treatment. It represents a unique combination of mechanics and biology for ease of use and
enhanced primary stability. The unique Roxolid material has been specifically designed for
dental implantology and delivers outstanding mechanical results. Combined with the SLActive
surface, Straumann delivers an excellent implant system with excellent osseointegration and
healing properties.
The new Straumann Screw-retained Abutment provides a wide range of prosthetic options for
screw-retained restorations. A low abutment profile as well as various angulations and gingiva
heights offer you flexibility to provide an individual solution for edentulous patients, including
the restoration of posterior-tilted implants3. For final restorations the new CARES software
offers a choice of bar designs for maximum flexibility.
The new Straumann Pro Arch for fixed edentulous restorations combines several
treatment steps which reduce complexity without compromising the outcome.
From planning and implant placement to the final restoration, the entire treat-
ment is seamless and less demanding for the patient.
1 Implant planning
2D conventional implant and prosthetic planning based on (CB)
CT scanning or x-rays
3D digital implant planning with coDiagnostiX software for
predictable results and treatment efficiency
2 Surgical procedure
Well-documented Straumann Bone Level Implants with
tapered design for improved primary stability
Unique Roxolid material with excellent mechanical properties21
Outstanding SLActive surface designed to deliver increased
predictability even in challenging protocols4,15-20
Straumann Pro Arch Guide to support placement of
tilted implants
Internal CrossFit connection
3 Prosthetic treatment
Abutments with a low-profile design, additional abutment
angulations and universal abutment connector
Abutment portfolio allows immediate temporization to deliver
teeth within a short period of time
High-end final restorations with the option for custom-milled
bar designs provided either by Straumann or Createch
Planning phase
For optimal and long-lasting results, a prosthetic-driven planning phase is essen-
tial, and it should be executed in collaboration with all partners involved.
During the planning phase the following aspects need to be considered:
Proper diagnosis and treatment planning, including the consideration of your pa-
tients chief complaints as well as an evidence-based implant/prosthetic design
will result in a successful treatment. These factors can significantly improve the
patients quality of life22.
Planning and implant preparation for multi-unit and single-unit restorations can
either be done via conventional methods or with the help of digital planning
softwares (e. g. coDiagnostiX). In this treatment guide, the focus will be on the
conventional procedure with an open-flap approach.
1b
2 2. ImplantpositionconsideringAnterior-Posterior(AP)-spreadforbio-
mechanical stability
A
Prerequisites:
Remaining dentition removed
Flap opened and ready for implant placement
Acrylic guide prepared by dental lab
1 Intraoral verification:
1. Toensureaproperimplantposition,itisrecommend-
ed to use the Straumann Pro Arch Guide.
8 8. Use the Straumann Bone Level Bone Profiler to prepare the bone
coronally to the implant shoulder in cases where the bone inter-
feres with the abutments emergence profile. For more details
see Appendix B: Straumann Bone Level Bone Profiler.
11 11. Use the acrylic guide throughout the procedure to verify implant
position and orientation.
10
Do not keep the Protective Caps in the patients mouth for more
than 30 days. Prepare sufficient space in the patients temporary
fixed bridge until the final prosthesis is placed.
11
14 14. Use the acrylic guide to check the alignment and position of the
Titanium Copings. Once the position is ensured make sure the
occlusal set up fits with the prepared prosthesis.
Use impression material to fix the Titanium Copings to the
acrylic guide.
15 15. Use the acrylic guide to transfer the clinical situation to the dental
lab.
16. The dental lab adapts the temporary restoration based on all infor-
mation provided. Make sure to prepare sufficient space in the
temporary restoration to fit in the Titanium Copings.
12
18 18. Finalize and polish the temporary restoration in the dental lab.
19. Place the temporary restoration in the patients mouth and t ighten
the Occlusal Screws to 15 Ncm using the SCS Screwdriver along
with the Ratchet and the Torque Control Device.
1 Open-tray impression
1. Place the Impression Post accurately into the abutment and
hand-tighten the Guide Screw.
13
Please note: All Impression Posts are intended for single use only to ensure opti-
mal fit and precise impression taking for each patient.
Hydrocolloid is not suitable for this application due to its low tensile strength.
14
3 3. Scan the dental situation with the help of the Straumann CS2
Scanner.
15
6 6. In the dental office, place the final restoration into the patients
mouth.
In CARES Visual software the following framework designs for fixed screw-
retained restorations are currently available:
CARES Screw-retained Bridge CARES Basic Fixed Bar CARES Advanced Fixed Bar
16
8 8. Send the impression and order sheet to your local CARES Scan&
Shape supplier and follow their instructions.
9. Produce the final restoration based on the custom-milled frame-
work.
10. In the dental office, place the final restoration into the patients
mouth.
For proper care at home, instruct the patient to clean the space between gingiva
and fixed bridges, especially around the implants on a regular basis. Dental floss,
bushy dental floss or interdental brushes are recommended.
1 2
Pre-operative situation Study model, surgical stent and interim fixed bridge
prepared by the dental lab
3 4
5 6
18
Straumann BL RC Implant with SLActive surface Screw-retained Abutment, 30 angled, placed onto
placed at #24 the implant
9 10
11 12
Titanium Temporary Copings, non-engaging, placed Titanium Temporary Copings, non-engaging, placed
intra-orally, facial view intra-orally, occlusal view
19
Block-out technique to protect screw channels Blu-Mousse application to identify the emergence
of the Temporary Abutments
15 16
Blu-Mousse set and pick up Trimming of impression material in the dental lab
17 18
20
Interim fixed bridge registration with study model Trimming interim fixed bridge for intra-oral pick up
21 22
Passivity and fit check on study model Temporary Copings in place and screw channels
blocked out with guttapercha
23 24
Anterior Temporary Copings blocked out, verify ac- Acrylic material intra-oral pick up
cess and passivity
21
Posterior abutments blocked out and pick up Security of intra-oral pick up verified
27 28
29 30
Fit check of study model Interim fixed bridge initial seating, occlusal view
22
Interim fixed bridge, close screw access holes Interim fixed bridge, post-operative, f acial view: note
buccal flange extension, adaptation to maxillary ridge,
and relation to mandibular natural dentition
33 34
For the final fixed bridge, Straumann CARES Bars 4 months later, the final fixed bridge is delivered to
are used as a framework the patient
pre post
23
24
023.2748
Abutment, POM, Crown, D3.5mm
25
4.6mm
26
Intended use: The Straumann Pro Arch Guide is used for visual and three-dimensional orien-
tation of the implant angulation (mesial/distal) and oral parallelization.
Indication: The surgical and prosthetic procedure is the placement of multiple implants in
combination with Screw-retained Straight or Angled Abutments.
Product description: The Straumann Pro Arch Guide is used in edentulous jaws for surgical
implant placement. The template of the Pro Arch Guide can be easily bent to adapt to the dental
arch. It is secured by drilling into the symphysis with a 2.2mm Pilot Drill and a pin in the jaw.
The drilling depth for the bone cavity of the pin is 10mm. The drilling depth can be checked
optically using the depth markings on the drills or using the optional depth stop system.
The slider is used to position the template for drilling. Drill the implant sites according to the
surgical protocol. Each drill is aligned parallel to the template surface and at the implantation
angle. Make sure the Pro Arch Guide is properly assembled, clean and sterile. Never use poten-
tially contaminated components.
Warnings and precautions: Take the following precautions prior to or during treatment:
Position the patient in such a way that the danger of aspiration of components is mini-
mized. All components that are used intraorally must be secured to prevent aspiration or
swallowing.
Do not use damaged or blunt instruments. Always inspect the instruments before use.
If the laser markings are illegible, the device must be replaced.
Do not use more than 20 times.
27
The Bone Level Bone Profiler is used to remove bone coronally to the implant shoulder in the
following situations:
deeply placed implants,
angulated/tilted implants,
scalloped or sloped alveolar ridge
Important: Use the Bone Level Bone Profilers only if the bone walls interfere with the abut-
ments emergence profile.
The Straumann Bone Level Bone Profiler system consists of the following components:
28
3 3. Insert the Bone Profiler into the dental hand-piece. Without turning
the Bone Profiler, place it over the Guiding Cylinder and slide it
down until the Bone Profiler is 1mm away from the bone. Once
in position, drill into the bone not exceeding the maximum ro-
tational speed of 200 rpm. Use intermittent drilling technique
with ample irrigation with sterile precooled physiological saline
solution.
Important: When drilling keep the Bone Profiler and the Guiding
Cylinder axially aligned and do not apply any bending forces.
Continue drilling until the Bone Profiler reaches the stop collar
of the Guiding Cylinder.
29
4a
5a
30
024.4226, 024.4226S
024.4242, 024.4242S
024.4244, 024.4244S
024.2236, 024.2236S
024.2234, 024.2234S
024.2222, 024.2222S
024.2224, 024.2224S
024.2226, 024.2226S
024.2242, 024.2242S
024.2244, 024.2244S
024.2246, 024.2246S
024.4246
024.4246S *
022.2745
022.2746
022.2753
022.2747
022.2748
022.2754
022.2749
022.2750
022.2755
Screw-retained Abutments
022.2756
022.2751
022.2752
022.2757
022.2758
022.4745
022.4746
022.4751
022.4747
022.4748
022.4752
022.4753
022.4749
022.4750
022.4754
022.4755
* Bone Profiler 2 may only be needed if the implant is placed deeper than 3mm subcrestally; otherwise use Bone Profiler 1. 31
1 based on Dawson A et al. : The SAC Classification in Implant Dentistry, ITI 2009, Classification of Restorative Cases, Edentulous Maxilla/Mandible2In
general maxillary implant-supported/retained overdentures are considered advanced restorations3 Compared to existing Straumann Multi-base port-
folio 4 Benic GI et al. : Titanium-zirconium narrow-diameter versus titanium regular-diameter implants for anterior and premolar single crowns: 1-year
results of a randomized controlled clinical study. Journal of Clinical Periodontology 2013; [Epub ahead of print] 5 Freiberger I et al. : Non-Interventional
Study on Success and Survival of TiZr Implants. European Association of Osseointegration 20th Annual Scientific Meeting, Copenhagen, Denmark, Oc-
tober 2012: Poster presentation. Other Source: Data base Non-interventional study, data on file. 6 Rupp F et al. : Enhancing surface free energy and
hydrophilicity through chemical modification of microstructured titanium implant surfaces. Journal of Biomedical Materials Research A, 76(2):323-334,
2006.7DeWild M : Superhydrophilic SLActive implants. Straumann document 151.52, 20058 Maniura K : Laboratory for Materials Biology Interac-
tions Empa, St. Gallen, Switzerland Protein and blood adsorption on Ti and TiZr implants as a model for osseointegration. EAO 22nd Annual Scientific Meet-
ing, October 17 19 2013, Dublin9 Schwarz F et al. : Bone regeneration in dehiscence-type defects at non-submerged and submerged chemically modified
(SLActive) and conventional SLA titanium implants: an immunohistochemical study in dogs. J Clin. Periodontol. 35.1 (2008): 64 75.10 Rausch-fan X et
al. : Differentiation and cytokine synthesis of human alveolar osteoblasts compared to osteoblast-like cells (MG63) in response to titanium surfaces. Dental
Materials 2008 Jan;24(1):102-10. Epub 2007 Apr 27.11 Schwarz F et al. : Histological and immunohistochemical analysis of initial and early osseous inte-
gration at chemically modified and conventional SLA titanium implants: Preliminary results of a pilot study in dogs. Clinical Oral Implants Research, 11(4):
481-488, 2007.12 Lang, NP et al. : Early osseointegration to hydrophilic and hydrophobic implant surfaces in humans. Clin Oral Implants.Res 22.4 (2011):
34956.13 Raghavendra S et al. : Int. J. Oral Maxillofac. Implants. 2005 MayJun;20(3):42531.14 Oates TW et al. : Enhanced implant stability with a
chemically modified SLA surface: a randomized pilot study. Int. J. Oral Maxillofac. Implants. 2007;22(5):755760.15 Schwarz F et al. : Bone regeneration in
dehiscence-type defects at chemically modified (SLActive) and conventional SLA titanium implants: a pilot study in dogs. J Clin.Periodontol. 34.1 (2007):
788616 Lai HC et al. : Bone apposition around two different sandblasted, large-grit and acid-etched implant surfaces at sites with coronal circumfer-
ential defects: An experimental study in dogs. Clin. Oral Impl. Res. 2009;20(3):24753.17 Buser D et al. : Stability of Contour Augmentation and Esthetic
Outcomes of Implant-Supported Single Crowns in the Esthetic Zone: 3-Year Result of a Prospective Study With Early Implant Placement Post Extraction.
J Periodontol. 2011 March; 82(3): 342-9.18 Buser D et al. : Long-term Stability of Early Implant Placement with Contour Augmentation. J Dent Res. 2013
Dec;92(12 Suppl):176S-82S.19 Nicolau P et al. : Immediate and early loading of Straumann SLActive implants: A Five Year Follow-up. Presented at the 19th
Annual Scientific Meeting of the European Association of Osseointegration 6-9 October 2010, Glasgow20 International Diabetes Federation. http://
www.idf.org/diabetesatlas/21 Norm ASTM F67 (states min. tensile strength of annealed titanium). Data on file for Straumann cold-worked titanium and
Roxolid Implants22Wismeijer D et al. : ITI Treatment Guide: Loading protocols in Implant Dentistry Edentulous Patients, Volume 4, 2010, page 223
Patient Consideration23 Wismeijer D et al. : ITI Treatment Guide: Loading protocols in Implant Dentistry Edentulous Patients, Volume 4, 2010, page 54
Treatment Options for the Edentulous Arch 24 Straumann Roxolid Implants will be delivered with the Loxim Transfer Piece, which is connected to the
implant with a snap-in mounting. After insertion of the implant, the Loxim can be released by hand or with the help of tweezers.
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