Technical Information

Straumann® Dental Implant System

Basic Information

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 Contents

1. The Straumann® Dental Implant System 3

1.1 Overview 3
1.2 Implant lines 4
1.3 Implant-abutment connections 6
1.4 Material 8
1.5 Surface 8
1.6 Transfer piece 8

2. Indications and Contraindications 9

2.1 List of abbreviations 9
2.2 Implant types and bone dimensions 10

3. Preoperative Planning 12
3.1 Implant position 12
3.2 Planning aids 19

4. Surgical Procedures 24
4.1 Implant bed preparation 24
4.2 Opening the implant package 36
4.3 Placing the implant 38
4.4 Soft tissue management 42

5. Healing Phase 45
5.1 Healing phase duration 45

6. Additional Information on Instruments 46

6.1 Surgical instruments 46
6.2 Osteotomes 52
6.3 Cleaning and care of instruments 54

7. Appendix 55
7.1 Related documentation 55
7.2 Important guidelines 56

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 About this guide
This Basic Information for the Straumann® Dental Implant System provides dental practitioners and related
specialists with the essential steps regarding surgical treatment, planning, and procedure.

The manual is divided into the following main parts:

ѹ The Straumann® Dental Implant System
ѹ Indications and Contraindications
ѹ Preoperative Planning
ѹ Surgical Procedures
ѹ Healing Phase
ѹ Additional Information on Instruments
ѹ Appendix

For information on the Straumann® Bone Level Tapered Implant, please refer to the brochure Straumann® Bone
Level Tapered Implant, Basic Information (702167/en).

Information on the Straumann® Guided Implants and the Straumann® Guided Surgery System­can be found
in the brochure Straumann® Guided Surgery, Basic Information (702083/en).

For further information regarding surgical treatment procedures, please refer to the following treatment
guides or similar scientific publications:

ITI Treatment Guides

ѹ Volume 1: Implant Therapy in the Esthetic Zone – Single-Tooth Replacements
ѹ Volume 2: Loading Protocols in Implant Dentistry – Partially Dentate Patients
ѹ Volume 3: Implant Placement in Post-Extraction Sites – Treatment Options
ѹ Volume 4: Loading Protocols in Implant Dentistry – Edentulous Patients
ѹ Volume 5: Sinus Floor Elevation Procedures
ѹ Volume 6: Extended Edentulous Spaces in the Esthetic Zone
ѹ Volume 7: Ridge Augmentation Procedures in Implant Patients – A Staged Ap-
proach
ѹ Volume 8: Biological and Hardware Complications in Implant Dentistry
ѹ Volume 9: Implant Therapy in the Geriatric Patient
ѹ Volume 10: Implant Therapy in the Esthetic Zone – Current Treatment Modali-
ties and Materials for Single-tooth Replacements
ѹ Volume 11: Digital Workflows in Implant Dentistry

ITI Consensus Paper

Buser D./ Martin W./ Belser U.: Optimizing esthetics for implant restorations in
the anterior maxilla :anatomical and surgical considerations. Int J Oral Maxillofac
Implants, 2004; 19 Suppl: 43–61.

Additional information on the Straumann® Dental Implant System can be found

at www.straumann.com.

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 1. The Straumann® Dental Implant System
1.1 Overview
The Straumann® Dental Implant System offers a wide range of implant lines with diverse body
and neck designs and different materials. This Basic Information focuses on the Titanium and
Roxolid® Tissue Level and Bone Level implants with a parallel-walled endosteal design. These
implants can be placed with the instruments from the Straumann® Surgical Cassette while using
very similar surgical procedures.

Straumann® Dental Implant System - parallel-walled endosteal design

Tissue Level Implants Bone Level Implants

S SP NNC SPS BL

Straumann® Straumann® Straumann® Standard Straumann® Straumann®

Standard Standard Plus Plus Narrow Neck Standard Plus Short Bone Level
Implant (S) Implant (SP) CrossFit® ­Implant Implant (SPS) Implant (BL)
(NNC)

Straumann® Tissue Level and Bone Level Implants are available in three endosteal diameters:
∅ 3.3 mm, ∅ 4.1 mm, and ∅ 4.8 mm. A unified color code simplifies identification of instruments
and implants.

Color coding
yellow Endosteal implant diameter 3.3 mm
red Endosteal implant diameter 4.1 mm
green Endosteal implant diameter 4.8 mm

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 1.2 Implant lines
1.2.1 Straumann® Standard Implant – The classic Tissue Level Implant
Straumann® Standard Implants have a smooth neck section of 2.8 mm and are 2.8 mm

especially suitable for classic single-stage procedures, where the implant is placed
at soft tissue level and not covered with soft tissue during the healing phase.
The Standard Implant uses the Straumann® synOcta® connection together with
its corresponding prosthetic components, the Straumann® s­ ynOcta® portfolio
and the Straumann® Solid Abutment. The thread pitch on the Standard Implants
measures 1 mm for the ∅ 3.3 mm ­implants, and 1.25 mm for all other diameters.

1.2.2 Straumann® Standard Plus Implant – The implant for flexible placement
Straumann® Standard Plus Implants have a shorter smooth neck section of 1.8 mm
that allows flexible coronoapical implant placement in combination with trans- 1.8 mm
or subgingival healing. This offers the dental surgeon additional options that are
particularly useful in the anterior tooth region of the maxilla, where esthetic de-
mands are high. Similar to Straumann® Standard Implants, this implant type uses
the Straumann® synOcta® connection together with its corresponding prosthet-
ic components, the Straumann® synOcta® portfolio and the Straumann® Solid
Abutment. The thread pitch on the Standard Plus Implants measures 1 mm for the
∅ 3.3 mm implants, and 1.25 mm for all other diameters.

1.2.2.1 Straumann® Standard Plus Narrow Neck CrossFit® Implant

3.5 mm
The Narrow Neck CrossFit® (NNC) Implant is a 3.3 mm diameter implant with a
narrow prosthetic platform. Its internal connection provides expanded prosthetic
options and solutions for treatment in the upper and lower jaw, wherever space
is limited. The NNC Implant is a Standard Plus (SP) Tissue Level Implant with a
machined neck of 1.8 mm in height. With the introduction of Roxolid® material,
it was possible to incorporate an internal CrossFit® connection and, at the same
time, offer a strong small-diameter implant – resulting in added confidence for
the operator. The implant body and thread design is the same as the Straumann®
3.3 mm Bone Level NC Implant. Narrow Neck CrossFit® Implants use the Narrow
Neck CrossFit® (NNC) prosthetic components.

1.2.2.2 Straumann® Standard Plus 4 mm Implant

The Straumann® Standard Plus 4 mm Implant is Straumann’s shortest implant.
The implant features a Standard Plus design for easy oral hygiene in the posterior
regions, synOcta® internal connection compatibility with the existing Tissue
4.0 mm
Level prosthetic portfolio, and a Bone Level thread to increase the implant-to-
bone contact. The most advanced Straumann technology combined within a very
short implant.

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 1.2.3 Straumann® Bone Level Implant – Straumann expertise applied at
bone level
Straumann® Bone Level Implants are suitable for bone level treatments in com-
bination with trans- or subgingival healing. The implant’s rough surface extends
to the top of the implant and the connection is shifted inwards. The Bone Level
Implant uses a conical-cylindrical connection, the CrossFit® connection, togeth-
er with its corresponding prosthetic CrossFit® components from the Bone Level
product portfolio. A cylindrical outer contour and a thread pitch of 0.8 mm that
tapers off in the coronal part of the implant provide excellent primary stability.

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 1.3 Implant-abutment connections
1.3.1 Straumann® synOcta® Morse taper connection
The Straumann® synOcta® concept was introduced worldwide in 1999, using the
well-known Morse taper design principle developed in 1986. The mechanically
locking friction fit of the Straumann® synOcta® internal connection, with an 8°
cone and an octagon for the repositioning of prosthetic parts, shows improved
performance over traditional external connections. Abutment loosening, even in
screw-retained situations, has virtually been eliminated.

The Straumann® synOcta® connection is available for all Straumann® Standard and
Standard Plus, Implants with the Regular Neck (RN) and Wide Neck (WN) platform.

Tissue Level – Standard Plus (SP)

synOcta® at soft tissue level

1.3.2 Straumann® Narrow Neck CrossFit® connection

The Narrow Neck CrossFit® (NNC) Implant is a 3.3 mm diameter implant with a
narrow prosthetic platform. The NNC Implant is a Standard Plus (SP) Tissue Level
Implant with a machined neck of 1.8 mm in height. The implant body and thread
design is the same as the Straumann® 3.3 mm Bone Level NC Implant.

Tissue Level – Standard Plus (SP)

synOcta® at soft tissue level

Bone Level
Body and thread design same as
­Straumann® Bone Level NC Implant

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 1.3.3 Straumann® Bone Level CrossFit® connection
The CrossFit® connection of Straumann® Bone Level Implants ap-
plies the know-how and benefits from the Straumann® synOcta®
Morse taper connection to the connection requirements at bone
level. Similar to the Straumann® synOcta® connection, the mechan-
ically locking friction fit of the 15° conical-cylindrical CrossFit® con-
nection with four internal grooves has excellent long-term stability
under all loading conditions and virtually eliminates screw loosen-
ing. The CrossFit® connection is available for Straumann® Bone Level
Implants only.

Straumann® Bone Level ∅ 4.1 mm and ∅ 4.8 mm Implants have the

same connection, the Regular CrossFit® connection (RC), and share
the same secondary components. Straumann® Bone Level ∅ 3.3 mm
Implants feature the narrow CrossFit® connection (NC). The corre-
sponding secondary components are color-coded:
ѹ yellow = NC connection ∅ 3.3 mm ∅ 4.1 mm ∅ 4.8 mm

ѹ magenta = RC connection

Connection types
NNC: Narrow Neck CrossFit® ∅ 3.5 mm ∅ 3.5 mm

RN: Regular Neck ∅ 4.8 mm ∅ 4.8 mm

WN: Wide Neck ∅ 6.5 mm ∅ 6.5 mm

NC: Narrow CrossFit® ∅ 3.3 mm ∅ 3.3 mm

RC: Regular CrossFit® ∅ 4.1 and ∅ 4.1 mm ∅ 4.8 mm

∅ 4.8 mm

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 1.4 Material
Roxolid® is a groundbreaking material specifically 1000

designed for use in dental implantology. The titanium-­

~80% ~20 %

Tensile strength [MPa]

zirconium alloy is stronger than pure titanium1,2 and
800
has excellent osseointegration properties3-5. This
combination of properties is unique in the market, ~50%

since no other metallic alloy unifies high mechanical 600

strength and osteoconductivity.

400
Thanks to their outstanding biological and mechan- ASTM TiGr4¹ Straumann® Straumann®
ical properties, Roxolid® Implants offer more treat- TiGr4 Roxolid®²
cold worked²
ment options than conventional titanium implants.
Roxolid® shows a 20 % higher tensile strength than Straumann cold-worked
­titanium and a 80 % higher strength than standard titanium Grade 4.

1.5 Surface
SLActive® significantly accelerates the osseointegra-
tion process and delivers everything you expect from 70 %
Degree of new bone on the implant surface

a successful and patient-friendly implant treatment.

60 %
ѹ High success and survival rates in compromised
patients: diabetic, smokers, irradiated patients⁶-9 50 %

ѹ SLActive® reduces initial healing time to 40 %

3 – 4 weeks*10-14
30 %
ѹ Increased treatment predictability in critical
SLActive® SLA®
­protocols6-17 20 %

10 %
Most implant failures occur in the critical early peri-
od between weeks 2 and 4. Although similar healing 0%

patterns were observed for both SLA® and SLActive® 1 2 3 4 5 6

Healing periods in weeks
Implants, bone-to-implant contact (BIC) was greater
after 2 weeks and significantly greater after 4 weeks The SLActive® surface shows a faster integration into new bone after 4 weeks
(50 %) compared to the SLA® surface (30 %).¹⁰
for SLActive® (p-value < 0.05).10

1.6 Transfer piece

Features Benefits
The Bone Level Tapered Implants are delivered with … for easy handling without
Snap-in mounting …
the Loxim® Transfer Piece, which is connected to the counter-maneuvering

implant with a snap-in mounting. Blue color … … for high visibility

Compact dimensions … … for easy access

Height markings … … for correct implant placement

Pre-determined breaking
… avoids bone overcompression
point …

* Healing time defined by BIC and stability.

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 2. Indications and Contraindications
To obtain more information about indications and contraindications related to each implant,
please refer to the corresponding instructions for use. Instructions for use can also be found on
www.ifu.straumann.com

2.1 List of abbreviations

List of abbreviations
SCS = Screw Carrying System
HDD = Horizontal Defect Dimension
NNC = Narrow Neck CrossFit® connection (3.5 mm)
RN = Regular Neck (4.8 mm)
WN = Wide Neck (6.5 mm)
NC = Narrow CrossFit® connection (for Bone Level Implants)
RC = Regular CrossFit® connection (for Bone Level Implants)
S = Standard
SP = Standard Plus
BL = Bone Level
SPS = Standard Plus Short

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 2.2 Implant types and bone dimensions
Straumann® implants are available in the materials Roxolid® with the SLActive® or SLA® surface or titanium with an SLA®
surface. Refer to the specific IFU for intended use and indication information.

Some of the Straumann products listed here may not be available in all countries.

Specific indications for Straumann® Roxolid® Implants

Implant type Distinctive features Minimal Minimal Available

ridge gap width** lengths
width*
SP ∅ 3.3 mm NNC*** ▪ Small-diameter implant for narrow interdental spaces and bone 5.5 mm 5.5 mm 8 – 14 mm
ridges

S ∅ 3.3 mm RN ▪ Ideal in cases with restricted ridge width**** 5.5 mm 7 mm 8 – 16 mm

SP ∅ 3.3 mm RN 8 – 14 mm

BL ∅ 3.3 mm NC ▪ Small-diameter implant for narrow interdental spaces and ridges 5.5 mm 5.5 mm 8 – 14 mm
SLActive®/SLA®

S ∅ 4.1 mm RN ▪ For oral endosteal implant indications in the maxilla and man- 6 mm 7 mm 6 – 16 mm
dible, for functional and esthetic rehabilitation of edentulous and
partially edentulous patients

SP ∅ 4.1 mm RN 6 – 14 mm

SP ∅ 4.1 mm RN*** ▪ Open-end situations in the mandible with severely atrophic bone 6 mm 7 mm 4 mm
resorption (always splinted, one implant per unit)

BL ∅ 4.1 mm RC ▪ For oral endosteal implant indications in the maxilla and man- 6 mm 6 mm 8 – 14 mm
dible, for functional and esthetic rehabilitation of edentulous and
partially edentulous patients

* Minimal ridge width: Minimal orofacial ridge width, rounded to 0.5 mm

** Minimal gap width: Minimal mesial-distal gap width for a single-tooth restoration, between adjacent teeth, rounded to 0.5 mm
*** Only available in Roxolid®
**** T
 itanium ∅3.3 mm S and SP RN implants are to be used only in cases with partially dentate jaws, with implant-borne fixed constructions, combined with
∅ 4.1 mm implants and splinting of the superstructure

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 Specific indications for Straumann® Roxolid® Implants

Implant type Distinctive features Minimal Minimal Available

ridge gap width** lengths
width*
S ∅ 4.8 mm RN ▪ For oral endosteal implant indications in the maxilla and man- 7 mm 7 mm 6 – 14 mm
dible, for functional and esthetic rehabilitation of edentulous and
partially edentulous patients
▪ The S/SP ∅ 4.8 mm Implants are especially suited for wider inter-
dental spaces and ridges

SP ∅ 4.8 mm RN

SP ∅ 4.8 mm RN*** ▪ Open-end situations in the mandible with severely atrophic bone 7 mm 7 mm 4 mm
resorption (always splinted, one implant per unit)

S ∅ 4.8 mm WN ▪ For oral endosteal implant indications in the maxilla and man- 7 mm 8.5 mm 6 – 12 mm
dible, for functional and esthetic rehabilitation of edentulous and
partially edentulous patients
▪ The S/SP ∅ 4.8 mm Implants are especially suited for wider inter-
dental spaces and ridges
▪ S/SP Implants with a WN platform are designed for the reconst-
SP ∅ 4.8 mm WN ruction of teeth with a greater neck diameter

SP ∅ 4.8 mm WN*** ▪ Open-end situations in the mandible with severely atrophic bone 7 mm 8.5 mm 4 mm
resorption (always splinted, one implant per unit)

BL ∅ 4.8 mm RC ▪ For oral endosteal implant indications in the maxilla and man- 7 mm 7 mm 8–14 mm
dible, for functional and esthetic rehabilitation of edentulous and
partially edentulous patients
▪ BL ∅ 4.8 mm Implants are especially suited for wider interdental
spaces and ridges

* Minimal ridge width: Minimal orofacial ridge width, rounded to 0.5 mm

** Minimal gap width: Minimal mesial-distal gap width for a single-tooth restoration, between adjacent teeth, rounded to 0.5 mm
*** Only available in Roxolid®

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 3. Preoperative Planning
3.1 Implant position
The implant is the focal point of the dental restoration. It provides the basis for planning the
surgical procedure. Close communication between the patient, dentist, surgeon and dental tech-
nician is imperative for achieving the desired prosthetic result.

To establish the topographical situation, the axial orientation, and the choice of implants, we
recommend the following:
ѹ Make a wax-up/set-up on the previously prepared study cast.
ѹ Define the type of superstructure.

The wax-up/set-up can later be used as the basis for a custom-made X-ray or drill template and
for a temporary restoration.

Note: The implant abutments should always be loaded axially. Ideally, the long axis of the im-
plant is aligned with the cusps of the opposing tooth. Extreme cusp formation should be avoided.
It can lead to unphysiological loading.

The implant diameter, implant type, position and number of implants should be selected indi-
vidually, taking the anatomy and spatial circumstances (e.g. malpositioned or inclined teeth) into
account. The measurements given here should be regarded as minimum guidelines. Only when
the minimum distances are observed is it possible to design the restoration so that the necessary
oral hygiene measures can be carried out.

The final hard and soft tissue response is influenced by the position between the implant and
the proposed restoration. Therefore, it should be based on the position of the implant-abutment
connection. The implant position can be viewed in three dimensions:
ѹ Mesiodistal
ѹ Orofacial
ѹ Coronoapical

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 3.1.1 Mesiodistal implant position
The mesiodistal bone availability is an important factor for choosing the implant type and diameter as well as the inter­
implant distances in the case of multiple implants. The point of reference on the implant for measuring mesiodistal distanc-
es is always the shoulder, being the most voluminous part of the implant. Note that all distances given in this chapter are
rounded to 0.5 mm. The following basic rules are recommended:

Rule 1
Distance to adjacent tooth at bone level:
A minimal distance of 1.5 mm from the implant shoulder to the adjacent tooth at bone level (mesial and distal) is recommended.

S/SP Implants incl. NNC, SPS BL Implants

≥ 1.5 mm ≥ 1.5 mm

Rule 2
Distance to adjacent implants at bone level:
A minimal distance of 3 mm between two adjacent implant shoulders (mesiodistal) is recommended.

S/SP Implants incl. NNC, SPS BL Implants

≥ 3 mm ≥ 3 mm

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 3.1.1.1 Examples for single-tooth gaps
For single-tooth restoration, the implant is placed centered within the single-tooth gap. The
following examples show how Rule 1 is implemented.

Straumann® Standard and Standard Plus Implants

For Straumann® Tissue Level Implants, the gap size has to be considered for the selection of the
shoulder diameter (NNC, RN, WN). In order to make use of the gap width in conjunction with
Rule 1, the following approximation can be used.

Distance between adjacent teeth at bone level

0.5 mm Gap width 0.5 mm

The distance between adjacent teeth at bone level is

approximately 1 mm (2 × 0.5 mm) more than the gap
width. Hence, applying Rule 1, the gap width must be
2 mm wider than the implant shoulder.

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 S/SP Implants

Shoulder diameter Gap width Distance between adjacent

teeth at bone level
D (mm) amin (mm) bmin (mm)
∅ 3.5 (NNC) 5.5 6.5
∅ 4.8 (RN) 7 8

≥ 1.5 mm ≥ 1.5 mm ∅ 6.5 (WN) 8.5 9.5

Rule D + 2 mm D + 3 mm*

* Rule 1 applied on both implant sides

The Diagnostic T, applied in the patient’s mouth or on the cast, can be used to obtain an initial measurement
of the gap width for the choice of the implant shoulder diameter and prosthetic reconstruction.

Straumann® Bone Level Implants

For Straumann® Bone Level Implants, the distance between adjacent teeth at bone level determines the implant diameter.

BL Implants

Shoulder diameter Gap width Distance between adjacent

teeth at bone level
D (mm) amin (mm) bmin (mm)
BL ∅ 3.3 5.5 6.5
BL ∅ 4.1 6 7

≥ 1.5 mm ≥ 1.5 mm BL ∅ 4.8 7 8

Rule D + 2 mm D + 3 mm*

* Rule 1 applied on both implant sides

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 3.1.1.2 Examples of multiple-tooth gaps
The following examples show how Rules 1 and 2 are implemented in multiple-tooth gaps. The
measurement is made at bone level from the adjacent tooth to the center of the implant and be-
tween implant centers. The minimal ­distance of 3 mm between two adjacent implant shoulders
(Rules 2) is important to facilitate flap adaptation, avoid proximity of secondary components and
provide adequate space for maintenance and home-care.

Straumann® Standard and Standard Plus Implants

S/SP/TE Implants

a b c

D1 D2
≥ 3 mm

Shoulder diameter Shoulder diameter amin (mm) bmin (mm) cmin (mm) Lmin (mm)
D1 (mm) D2 (mm)
∅ 3.5 (NNC) ∅ 3.5 (NNC) 3 6.5 3 12.5
∅ 3.5 (NNC) ∅ 4.8 (RN) 3 7 4 14
∅ 3.5 (NNC) ∅ 6.5 (WN) 3 8 5 16
∅ 4.8 (RN) ∅ 4.8 (RN) 4 8 4 16
∅ 4.8 (RN) ∅ 6.5 (WN) 4 8.5 5 17.5
≥ 1.5 mm ≥ 1.5 mm
∅ 6.5 (WN) ∅ 6.5 (WN) 5 9.5 5 19.5

Straumann® Bone Level Implants

BL Implants

a b c

D1 D2

Shoulder diameter Shoulder diameter amin (mm) bmin (mm) cmin (mm) Lmin (mm)
D1 (mm) D2 (mm)
BL ∅ 3.3 BL ∅ 3.3 3 6.5 3 12.5
BL ∅ 3.3 BL ∅ 4.1 3 7 3.5 13.5
BL ∅ 3.3 BL ∅ 4.8 3 7 4 14
BL ∅ 4.1 BL ∅ 4.1 3.5 7 3.5 14
BL ∅ 4.1 BL ∅ 4.8 3.5 7.5 4 15
≥ 1.5 mm ≥ 3 mm ≥ 1.5 mm
BL ∅ 4.8 BL ∅ 4.8 4 7.5 4 15.5

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 3.1.2 Orofacial implant position
The facial and palatal bone must be at least 1 mm thick in order to ensure stable hard and soft
tissue conditions. The minimal orofacial ridge widths for individual implant types are given in
the indication tables in chapter 2.2. Within this limitation, a restoration-driven orofacial implant
position and axis should be chosen such that screw-retained restorations are possible.

Caution: An augmentation procedure is indicated where the orofacial bone wall is less than 1 mm
or a layer of bone is missing on one or more sides. This technique should be employed only by
dentists who have adequate experience in the use of augmentation procedures.

≥ 1 mm ≥ 1 mm

Bone layer at least 1 mm

in thickness

Choose the orofacial implant position and axis so that

the screw channel of the screw-retained restoration is
located behind the incisal edge.

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 3.1.3 Coronoapical implant position
Straumann® dental implants allow for flexible coronoapical implant positioning, depending on individual anatomy, implant
site, the type of restoration planned, and preference. In the anterior area, a deeper coronoapical implant position is better
for esthetic reasons. In this situation, the use of Straumann® Standard Plus or Bone Level Implants is recommended. The
following illustration shows the coronoapical implant position for these implants.

Straumann® Standard Implants S

Straumann® Standard Implants with a smooth neck section of 2.8 mm are submerged in the bone as far as the
margin of the SLA®/SLActive® surface.

Straumann® Standard Plus Implants

SP
Straumann® Standard Plus Implants with a smooth neck section of 1.8 mm are submerged in the bone as far
as the margin of the Straumann® SLA®/­SLActive® surface. Optionally they can be placed slightly deeper if
necessary.

Ideally, in the esthetic region, the implant shoulder should be positioned about 1 mm apical to the cemen-
to-enamel junction (CEJ) of the contralateral tooth or 2 mm subgingival of the prospective gingival margin.

Caution: If a Straumann® Tissue Level Implant is inserted deeper than the margin of the Straumann® SLA®/
SLActive® surface, the preparation depth must be increased accordingly (see Chapter 4.1.2).

Straumann® Bone Level Implants

BL
Straumann® Bone Level Implants are best set with the outer rim of the narrow 45° sloping edge (chamfer) at
bone level.

Ideally, in the esthetic region, the implant shoulder should be positioned about 3 – 4 mm subgingival of the
prospective gingival margin and with the correct implant orientation (See Chapter 4.3).

In a scalloped situation, place the mesial/distal point of the outer rim of the implant to bone level.
The lingual/palatal wall will then extend slightly over the top line of the implant. The buccal wall
is located somewhat below the implant edge.

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 3.2 Planning aids
3.2.1 Mesiodistal and orofacial space requirements

3.2.1.1 Diagnostic T for Straumann® Standard and Standard Plus Implants

By using the Diagnostic T in the patient’s mouth or on the cast, an initial impression of the spatial relations for
the choice of the implant shoulder diameter and prosthetic reconstruction can be obtained. The pictograms
on the instruments show which arm is used for which measurement.

Note: Currently, a Diagnostic T for Straumann® Bone Level Implants is not available.

Determining the implant shoulder diameter in a

X = Minimum occlusal space requirement single-tooth gap
(for the lowest prosthetic restoration option)
Y = Interproximal distance (gap width)
Z = Implant center to adjacent tooth (half the gap width)

Implant shoulders:
NNC = Narrow Neck CrossFit® (∅ 3.5 mm)
RN = Regular Neck (∅ 4.8 mm)
WN = Wide Neck (∅ 6.5 mm)

Determining the minimal distance between im-

plant axis and adjacent teeth

Minimum vertical space requirement for access

with surgical instruments

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 3.2.1.2 Straumann® Implant Distance Indicator
Two types of Implant Distance Indicators are available:
ѹ For Straumann® Standard and Standard Plus Implants (art. no. 046.148)
ѹ For Straumann® Bone Level Implants (art. no. 026.0901)

The disks of the Implant Distance Indicators display the shoulder diameters of Straumann® im-
plants. The Implant Distance Indicators can be used to check the available space before the start
of treatment or intraoperatively to mark the desired implant site.

After flap opening and precise

positioning of the disk(s) at the
planned implantation site, it is
possible to drill through the perfo-
ration in the disk(s) with the Round
Bur ∅ 1.4 mm (art. no. 044.022) or
the ∅ 1.6 mm Needle Drill (art. no.
026.0054) in order to mark the cen-
ter of the implant bed.

Intraoperative use of the Implant Round Bur, Needle Drill,

­Distance Indicator before flap opening ∅ 1.4 mm ∅ 1.6 mm

Implant Distance Indicator for Straumann® Standard and Standard Plus Implants

 Straumann® Implant Distance Indicator for

Straumann® Standard and Standard Plus
Implants (art. no. 046.148)

Leg label Disk diameter Corresponding implants

Leg 1 RN ∅ 4.8 ∅ 4.8 mm all Regular Neck (RN) Implants
Leg 2 RN ∅ 4.8 ∅ 4.8 mm all Regular Neck (RN) Implants
Leg 3 NNC ∅ 3.5 ∅ 3.5 mm all Narrow Neck CrossFit® (NNC) Implants
Leg 4 WN ∅ 6.5 ∅ 6.5 mm all Wide Neck (WN) Implants

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 Implant Distance Indicator for Straumann® Bone Level Implants

Art. no. 026.0901

Alternative Leg:
Art. no. 025.0044

Leg label Disk diameter Corresponding implants

Leg 1 BL ∅ 4.1 ∅ 4.1 mm Bone Level Implants ∅ 4.1 mm
Leg 2 BL ∅ 4.1 ∅ 4.1 mm Bone Level Implants ∅ 4.1 mm
Leg 3 BL ∅ 3.3 ∅ 3.3 mm Bone Level Implants ∅ 3.3 mm
Leg 4 BL ∅ 4.8 ∅ 4.8 mm Bone Level Implants ∅ 4.8 mm

3.2.2 Determining the vertical bone availability

The vertical bone availability determines the maximal allowable length of the implant that can
be placed. To make it easier in determining the vertical bone availability, the use of an X-ray
Template with X-ray Reference Spheres is recommended.

3.2.2.1 X-ray Reference Sphere

The X-ray Reference Sphere (art. no. 049.076V4) has a diameter of
5 mm. The image of the sphere on the X-ray provides the reference
value for the magnification scale. To prepare a reference sphere-
carrying template, the selected implant positions are marked on
the study cast. The X-ray Reference Spheres are fixed at the marked
points. The vacuum-formed template is then made with the spheres.
The subsequent X-ray shows the vertical bone availability and
mucosal thickness, from which the corresponding implant length
and type can be derived, in consideration of the enlargement factor.

Warning: Adhere to production requirements of the holding tem-

plate and ensure that the X-ray Reference Sphere is securely fixed
within the holding template.

21

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 3.2.2.2 X-ray Templates
The X-ray Templates are used for measurement and comparison.
They also assist the user in selecting the suitable implant type, diam- 1.0 : 1 ∅ 5.0 mm Straumann® Standard Implant ∅ 5.0 mm Straumann® Standard Plus Implant

eter and length. The following X-ray Templates are available:

∅ 3.3 mm ∅ 4.1 mm ∅ 4.8 mm ∅ 4.8 mm ∅ 3.3 mm ∅ 3.3 mm ∅ 4.1 mm ∅ 4.8 mm ∅ 4.8 mm
RN RN RN WN NNC RN RN RN WN

0 0 0
2 2 2
4 4 4
6 6 6
8 8 8
10 10 10
12 12 12
14 14 14
16 16 16

ѹ For Straumann® Standard and Standard Plus Implants (art. no.

150.215)
1.1 : 1 ∅ 5.5 mm Straumann® Standard Implant ∅ 5.5 mm Straumann® Standard Plus Implant

ѹ For Straumann® Bone Level Implants (art. no. 150.216) ∅ 3.3 mm

RN
∅ 4.1 mm
RN
∅ 4.8 mm
RN
∅ 4.8 mm
WN
∅ 3.3 mm
NNC
∅ 3.3 mm
RN
∅ 4.1 mm
RN
∅ 4.8 mm
RN
∅ 4.8 mm
WN

0 0 0
2 2 2
4 4 4
6 6 6
8 8 8
10 10 10
12 12 12

Similar to the distortions that occur in X-rays, the implant dimen-

14 14 14
16 16 16

05/20
150.215/F/03
sions are shown on the individual templates with the corresponding
distortion factors (1:1 to 1.7:1).
X-ray Template for Straumann® Standard and Standard Plus
150.215_X-Ray_TL.indd 2

150.216_X-Ray_BL_cha_v1
17/12/2020 12:36

Implants (art. no. 150.215)

Determining each magnification factor or scale is facilitated by
showing the X-ray Reference Sphere on the template (next to the
scale reference). 1.0 : 1 ∅ 5.0 mm Straumann® Bone Level Implant Straumann® Bone Level Implant ∅ 6.0 mm 1.2 : 1

1.0 : 1
∅ 3.3 mm ∅ 4.1 mm ∅ 4.8 mm ∅ 3.3 mm ∅ 4.1 mm ∅ 4.8 mm
NC RC RC NC RC RC

0
2
0
2 (049.076V4) = Ø 5.0 mm
The first stage consists of comparing the size of the X-ray Reference
4 4
6
8 6
10 8
12 10
14 12
16 14

Sphere on the patient’s X-ray with the size of the reference sphere
16

on the template. By superimposing the two pictures, the correct

1.1 : 1 ∅ 5.5 mm Straumann® Bone Level Implant Straumann® Bone Level Implant ∅ 6.5 mm 1.3 : 1
scale can be found. Next, the spatial relations around the implant 0
2∅ 3.3 mm
NC
∅ 4.1 mm
RC
∅ 4.8 mm
RC
∅ 3.3 mm
NC
∅ 4.1 mm
RC
∅ 4.8 mm
RC
0
2
4 4
position are determined and the implant length and insertion depth
0 0
2 2
4
6
8
6 4
6 6
10
12 8 8
10 8
are established. 10 10
14 12
16 14

12
16
12

05/20
14 14

150.216/E/01
16 16

Warning: Use only the X-ray Template specific to the implant type.
X-ray Template for Straumann® Bone Level Implants
150.216_X-Ray_BL.indd 2 17/12/2020 14:14

(art. no. 150.216)

1.1 : 1 (049.076V4) = Ø 5.5 mm

Example: scale 1.1:1 = reference sphere ∅ 5.5 mm

0 0
2 2
4 4
6 6
8 8
10 10
12 12
14 14
16 16

150.215.indd 2

22

702084.indd 22 08/03/2022 19:05

 To calculate the effective bone availability the following formula
should be used:
ndard Plus
t System X-ray Reference Sphere 5 mm ×
bone availability (X-ray*)
effective bone
availability
Reference sphere diameter
on the X-ray

* Taking into consideration all implant-related anatomical structures

(e.g. mandibular canal, maxillary sinus, etc.)

Example for a measured bone availability and reference sphere di-

(01) 07630031727435
ameter on the X-ray of 13 mm and 6 mm (+ 20 % distortion), respec-
(11) YYMMDD
tively. (10) XXXXX

150.215
5 mm × 13 mm
XXXXX
10.8 mm
6 mm

YYYY-MM-DD
Additional length of the drill tip:

ifu.straumann.com
Warning: Due to the construction and function of
the drills, the drill tip is a maximum of 0.4 mm lon-
Institut Straumann AG
ger than the implant
Peter insertion
Merian-Weg 12 depth. This additional
CH-4002
length must Basel,into
be taken Switzerland
consideration during the
www.straumann.com
05/20

planning phase.
150.215/F/03

0.4 mm
Etkon GmbH
Lochhamer Schlag 6
DE-82166 Gräfelfing, Germany

17/12/2020 12:36

23

702084.indd 23 08/03/2022 19:05

 4. Surgical Procedures

4.1 Implant bed preparation

The implant diameter, implant type, position and number of implants should be
selected individually taking the anatomy and spatial circumstances into account.
The specific measurements should be regarded as minimum guidelines.

Steps Instrumentation

1. Basic implant bed preparation

Basic implant bed preparation involves
ridge preparation and twist drilling. For
Needle Drill
Ridge preparation Twist Drilling, the endosteal diameter
Round Bur
of the implant (3.3/4.1/4.8 mm) – not
 ilot Drill 1 (2.2 mm)
P
Alignment Pin the implant type or the bone class –
Pilot Drill 2 (2.8 mm) determines which instruments have to
Depth Gauge
Twist drilling
Twist Drill PRO (∅ 3.5 mm) be used.
Depth Gauge
Twist Drill PRO (∅ 4.2 mm)
Depth Gauge

2. Fine implant bed preparation

Fine implant bed preparation involves
profile drilling and tapping, if required.
Profile drilling SP Profile Drill BL/NNC Profile Drill For tapping, the implant type (S/SP/BL)
and the bone class determine which in-
Tapping S/SP Tap BL/NNC Tap
struments have to be used.

Please note: Narrow Neck CrossFit® and Standard plus 4 mm Implants have a Stan-
dard Plus neck design, but both implant types require Bone Level tapping.

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 4.1.1 Basic implant bed preparation
After the gingiva is opened, the basic implant bed preparation begins with prepa-
ration of the alveolar ridge (Step 1) and marking of the implantation site with a
Round Bur or a Needle Drill (Step 2). The implant bed is then prepared with Pilot
Drills and Twist Drills (Steps 3 – 7), according to the endosteal implant diameter
chosen in the preoperative planning (see Chapter 3).

1 Step 1 – Prepare the alveolar ridge

Carefully reduce and smooth a narrow tapering ridge with a large
Round Bur. This will provide a flat bone surface and a sufficiently
wide area of bone.

Note: When choosing the implant length, the vertical reduction of

the bone has to be considered.

800 rpm max.

2 Step 2 – Mark the implantation site

Mark the implantation site determined during the implant position
planning with the ∅ 1.4 mm Round Bur or the ∅ 1.6 Needle Drill.
The Implant Distance Indicator can be used for this purpose. If the
Distance Indicator is used together with the Needle Drill to mark
the implant position, make sure not to drill more than 3 mm in order
to avoid any collision between the Needle Drill and the Distance
Indicator.

Widen and correct the position of the mark with the ∅ 2.3 mm or
the ∅ 3.1 mm Round Bur, if necessary.
800 rpm max.

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702084.indd 25 08/03/2022 19:05

 3 Step 3 – Mark the implant axis
With the ∅ 2.2 mm Pilot Drill, mark the implant axis by drilling to
a depth of about 6 mm – except for 4 mm SPS Implants, where the
drilling depth must not exceed 4 mm.

Insert the short side of the Depth Gauge with the Implant Distance
Indicator to check for correct implant axis orientation.

If necessary, correct unsatisfactory implant axis orientation in the

following step.

Note: The Implant Distance Indicator visualizes the shoulder diam-

800 rpm max.
eter of 4.8 mm (RN) and enables checking of the probable position
of the implant shoulder.

4 Step 4 – Prepare the implant bed to ∅ 2.2 mm

Pre-drill the implant bed to the final preparation depth with the
∅ 2.2 mm Pilot Drill.

Use the ∅ 2.2 mm Alignment Pin to check the implant axis and
preparation depth.

Caution: At this point take an X-ray, particularly with vertically re-

duced bone availability. The Alignment Pin is inserted into the drilled
area, which allows a comparative visualization of the drill hole in
relation to the anatomical structures.
800 rpm max.

5 Step 5 – Widen the implant bed to ∅ 2.8 mm

Continue with the implant bed preparation.

If necessary, correct the implant position with the ∅ 2.8 mm Pilot

Drill. Use the ∅ 2.8 mm Depth Gauge to check the preparation depth.

For an implant with an endosteal diameter of 3.3 mm, basic prepa-

ration ends here. Continue with the fine implant bed preparation.

600 rpm max.

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702084.indd 26 08/03/2022 19:05

 6 For ∅ 4.1 mm and ∅ 4.8 mm implants

Step 6 – Widen the implant bed to ∅ 3.5 mm

Continue with the ∅ 3.5 mm Straumann® Twist Drill PRO and check
the final preparation depth with the ∅ 3.5 mm Depth Gauge.

For an implant with an endosteal diameter of 4.1 mm, basic prepa-

ration ends here. Continue with the fine implant bed preparation.

500 rpm max.

7 For ∅ 4.8 mm implants

Step 7 – Widen the implant bed to ∅ 4.2 mm

Continue with the ∅ 4.2 mm Straumann® Twist Drill PRO and check
the final preparation depth with the ∅ 4.2 mm Depth Gauge.

Continue with the fine implant bed preparation.

400 rpm max.

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702084.indd 27 08/03/2022 19:05

 The following table summarizes the use of instruments for the basic implant bed preparation according to the endosteal
implant diameter. All drills are available in a short and a long version (see also Chapter 6). The table lists the short drills only.

Instrumentation for basic implant bed preparation Endosteal ∅ (mm)

Step Art. no. Product max. rpm ∅ 3.3 ∅ 4.1 ∅ 4.8

1 Ridge preparation 044.004 Round Bur, ∅ 3.1 mm 800

026.0054 Needle Drill, ∅ 1.6 mm

2 Mark implant 044.022 Round Bur, ∅ 1.4 mm

800
position 044.003 Round Bur, ∅ 2.3 mm

044.004 Round Bur, ∅ 3.1 mm

Pilot Drill 1, short,

044.210 800
∅ 2.2 mm
3 Mark implant axis
Depth Gauge, with Implant
046.455
Distance Indicator, ∅ 2.2/2.8 mm
Pilot Drill 1, short,
044.210 800
4 Prepare implant ∅ 2.2 mm
bed to ∅ 2.2 mm Alignment Pin, ∅ 2.2 mm,
046.799
straight
Pilot Drill 2, short,
5 Prepare implant 044.214 600
∅ 2.8 mm
bed to ∅ 2.8 mm
046.800 Depth Gauge, ∅ 2.8 mm

Twist Drill PRO, short,

044.250 500
6 Prepare implant ∅ 3.5 mm
bed to ∅ 3.5 mm Depth Gauge
046.802
∅ 3.5 mm
Twist Drill PRO, short,
044.254 400
7 Prepare implant ∅ 4.2 mm
bed to ∅ 4.2 mm Depth Gauge
046.804
∅ 4.2 mm

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702084.indd 28 08/03/2022 19:05

 4.1.2 Fine implant bed preparation
The fine implant bed preparation encompasses profile drilling and subsequent tapping. Instrumentation depends on the
implant type, the endosteal implant diameter, and the bone class.

Profile drilling
The Profile Drill prepares the implant bed for a specific Straumann® implant.
ѹ Straumann® Standard Plus and Bone Level Implants require profile drilling with specific instruments. This is indepen-
dent of the bone class. Due to the unflared neck portion, Standard Plus ∅ 4.8 mm RN Implants are inserted without
profile drilling.
ѹ Straumann® Standard Implants are inserted without profile drilling.

When inserting a Straumann® Standard Plus Im­plant up to the implant shoulder level (see Chapter 3), the preparation depth
must be 2 mm deeper than the indicated implant length. (Example: The preparation depth for a 10 mm SP Implant inserted
up to shoulder level must be 12 mm.) The Profile Drill should also be used deeper for fine implant bed preparation. Examples
are illustrated below

Straumann® Standard Plus Profile Drill Straumann® Bone Level Profile Drill Straumann® Narrow Neck CrossFit® Profile Drill
Insertion depth Insertion depth on Insertion depth on Insertion depth on
on SLActive®/SLA® implant shoulder SLActive® surface implant shoulder
surface margin level margin level

Insert the Straumann® Standard Plus Profile Insert the Straumann® Bone Level Profile Drill Insert the Straumann® Bone Level Profile Drill
Drill according to the planned insertion depth according to the planned insertion depth of according to the planned insertion depth of
of the implant. the implant. the implant

400 rpm max. 300 rpm max. 300 rpm max

The Drill Extender (art. no. 040.563) can be used with

Profile Drills to increase the overall instrument length
by 15 mm. This helps to gain access between long
crowns of adjacent teeth. Drill Extender

Short drill with

Drill Extender

Short drill

29

702084.indd 29 08/03/2022 19:05

 Tapping
Tapping prepares the implant bed for a specific thread type. It is an optional step that gives the
surgeon the flexibility to adjust the surgical protocol to the bone class to help achieve optimal
primary stability. It is recommended in dense bone in order to keep the insertion torque in a
desirable range.

Tap for Adapter

Coupling for Adapter

Depth mark

12 mm
10 mm
Label for implant type
8 mm
6 mm

Cutting head

Taps are used in the coronal area only or over the depth
of max. 12 mm.

15 rpm max.

Caution: Straumann® Taps are to be used only for the corresponding implant type!

Please note: For NNC and SP 4 mm Implants, the corresponding diameter BL Taps must be used.

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702084.indd 30 08/03/2022 19:05

 The Straumann® Taps can be used with a dental handpiece or with a Straumann® Ratchet as
shown below.

Tapping with Handpiece Tapping with Ratchet

Connect the Tap for Adapter to the Handpiece via the For tapping with the Ratchet connect a Ratchet Adapter
Handpiece Adapter. Do not exceed 15 rpm. to the Tap for Adapter. After inserting the Tap into the ca-
vity, the Ratchet is placed on its coupling and the thread is
tapped with a ­slow rotating movement. The Holding Key
is used as a stabilizer to maintain the direction of tapping
during the procedure.

Holding Key

Handpiece

Holding Key

Handpiece Adapter
Ratchet Adapter

Tap for Adapter Tap for Adapter

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 4.1.3 Examples for fine implant bed preparation: Straumann® Standard and Standard Plus Implants

1
Step 1 – Standard Plus Profile Drill
Shape the coronal part of the implant bed with the Standard Plus
Profile Drill.

Insert the Standard Plus Profile Drill up to the planned implant

shoulder level.

Note: For Standard Implants, profile drilling is not required.

400 rpm max.

2
Step 2 – Tapping the thread in dense bone
Tap the implant bed with the S/SP Tap according to the endosteal
diameter, in case of too high insertion torques.

Please note that Standard plus 4 mm Implants and NNC Implants

require the corresponding diameter BL Taps.

15 rpm max.

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702084.indd 32 08/03/2022 19:05

 Straumann® Bone Level Implants

1
Step 1 – Bone Level Profile Drill
Prepare the implant bed with the Straumann® Bone Level Profile
Drill. Insert the Profile Drill up to the planned implant shoulder level.

300 rpm max.

2
Step 2 – Tapping the thread in dense bone
Tap the implant bed with the BL Tap according to the endosteal di-
ameter, in case of too high insertion torques in dense bone.

15 rpm max.

33

702084.indd 33 08/03/2022 19:05

 The following table summarizes the use of Profile Drills and Taps for the fine implant bed preparation for all Straumann®
implants.

Instrumentation for fine implant bed preparation Straumann® Standard Implant

Max. Thread S S S S
Art. no. Product
rpm pitch ∅ 3.3 RN ∅ 4.1 RN ∅ 4.8 RN ∅ 4.8 WN

034.332 SP Profile Drill, short, ∅ 3.3 mm, RN

034.333 SP Profile Drill, short, ∅ 4.1 mm, RN 400

044.084 SP Profile Drill, short, ∅ 4.8 mm, WN

034.351 S/SP Tap, ∅ 3.3 mm, for Adapter 1

034.352 S/SP Tap, ∅ 4.1 mm, for Adapter 15 1.25

034.353 S/SP Tap, ∅ 4.8 mm, for Adapter 1.25

034.327 BL/NNC Profile Drill, ∅ 3.3 mm, short

034.328 BL Profile Drill, ∅ 4.1 mm, short 300

034.329 BL Profile Drill, ∅ 4.8 mm, short

034.348 BL/NNC Tap, ∅ 3.3 mm, for Adapter 0.8

034.349 BL Tap, ∅ 4.1 mm, for Adapter 15 0.8

034.350 BL Tap, ∅ 4.8 mm, for Adapter 0.8

34

702084.indd 34 08/03/2022 19:05

 Required step   Recommended in case of high insertion torque

Straumann®
Straumann® Standard Plus Implant
Bone Level Implant

4 mm 4 mm 4 mm

SP SP BL BL BL
SP ∅ 4.1 RN SP ∅ 4.8 RN SP ∅ 4.8 WN
∅ 3.3 NNC ∅ 3.3 RN ∅ 3.3 NC ∅ 4.1 RC ∅ 4.8 RC

* Due to the unflared neck portion, the Straumann® Standard Plus ∅ 4.8 mm RN Implants are inserted without profile drilling.

35

702084.indd 35 08/03/2022 19:05

 4.2 Opening the implant package
Sterile barrier system: Blister

1 Step 1 – Open the blister and remove the vial

Note: The blister ensures the sterility of the implant. Do not open
the blister until immediately prior to implant placement.

2 Step 2 – Open the vial

Turn the lid in a counterclockwise direction.

SLActive® only: Keep the vial upright to prevent the liquid from
flowing out.

Note: If the implant carrier is not firmly attached to the lid, screw
in the lid once again.

3 Step 3 – Detach the implant carrier

Detach the implant carrier from the lid by pulling it off manually.

Note (for SLActive® only): After the implant is removed from the
solution, the chemical activity of SLActive® is ensured for 15 minutes.

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702084.indd 36 08/03/2022 19:05

 Sterile barrier system: Vial

1 Step 1 – Open the safety cap

Open the safety cap of the sterile vial.

Note: The vial ensures the sterility of the implant.

2 Step 2 – Remove the implant from the carrier

Simultaneously pull down the implant carrier and lift the implant
out of the i­mplant carrier (while keeping your arms steady).

37

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 4.3 Placing the implant
A Straumann® implant can be placed either manually with the Ratchet or with the aid of the
Handpiece. A maximum speed of 15 rpm is recommended. The following step-by-step instruc-
tions show how a Straumann® Bone Level Implant is placed with the Handpiece (left column on
the following pages) and how a Straumann® Standard Plus Implant is placed with the Ratchet
(right column).

Implant placement with Handpiece Implant placement with Ratchet

1 1

Step 1 – Attach the Handpiece Adapter Step 1 – Attach the Ratchet Adapter
Hold the enclosed part of the implant Hold the enclosed part of the implant
carrier. Attach the Handpiece Adapter. carrier. Attach the Ratchet Adapter.
A click will be heard when the Adapter A click will be heard when the Adapter
is attached correctly. is attached correctly.

2 2

Step 2 – Remove the implant from the Step 2 – Remove the implant from the
carrier carrier
Simultaneously pull down the implant Simultaneously pull down the implant
carrier and lift the implant out of the carrier and lift the implant out of the
implant carrier (keep your arms steady). implant carrier (keep your arms steady).

38

702084.indd 38 08/03/2022 19:05

 3 3

Step 3 – Place the implant Step 3 – Place the implant

Place the implant with the Handpiece Place the implant with the Ratchet into
into the implant bed. Move the implant the implant bed. Move the implant into
into its final position with a maximum its final position with a maximum of
of 15 rpm turning it clockwise. 15 rpm turning it clockwise.

Caution: Vertical position corrections Caution: Vertical position corrections

using reverse rotations (counterclock- using reverse rotations (counterclock-
wise) may lead to a decrease in primary wise) may lead to a decrease in primary
stability. stability.

Caution: An insertion torque of 35 Ncm is recommended. If 35 Ncm is achieved before the implant
has assumed its final ­position, check that the implant bed preparation is correct to avoid bone
overcompression.

The Loxim® is provided with a pre-determined breaking point to prevent damage to the inner
configuration of the implant, thus ensuring the integrity of the interface for mounting the pros-
thesis.

Step 4 – Correct implant orientation for Straumann® implants

with CrossFit® connection
While approaching the final implant position, make sure that the
drilled holes on the blue transfer part are oriented exactly orofacial-
ly. This positions the four protrusions of the internal connection for
ideal prosthetic abutment orientation. A quarter turn to the next
4 drilled hole corresponds to a ­vertical displacement of 0.2 mm. The
drilled holes also show the depth of the implant shoulder in the
bone.

Caution: Avoid vertical position corrections using reverse rotations

(counterclockwise). This can cause loosening of the transfer part and
may lead to a decrease in primary stability.

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 Additional information for implants with the Loxim® Transfer Piece

Release aid for the Loxim® Transfer Piece

For situations in which any removal force is to be avoided, a release aid for the
Loxim® can be used. Place the release aid onto the implant shoulder and hold it in
place while detaching the Adapter with the Loxim®.

Release aid S for Loxim® (for SC), 026.0073

Release aid N for Loxim® (for NNC and NC), 026.2558

Release aid R/W for Loxim® (for RC, RN and WN), 026.4558

Step 5 – Remove the instruments with Step 5 – Remove the instruments with
­Loxim® ­Loxim®
Loxim® can easily be re-inserted to fin- Loxim® can easily be re-inserted to fin-
ish an uncompleted implant placement ish an uncompleted implant placement
until the implant is fully inserted. If the until the implant is fully inserted. If the
implant needs to be removed during implant needs to be removed during
implantation surgery, Loxim® allows implantation surgery, Loxim® allows
for counterclock­wise turns. for counterclock­wise turns.

After insertion, the Loxim® is detached Remove the Ratchet while holding the
with the Adapter. Adapter at the bottom, and then de-
tach the Adapter-Loxim® assembly.

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702084.indd 40 08/03/2022 19:05

 Important additional information
An insertion torque of 35 Ncm is recommended. If 35 Ncm is achieved before the
implant has reached its final position, make sure the implant bed preparation is
correct to avoid bone overcompression.

Warning: If the implant has to be removed after implant placement, the retention
of the Loxim® in the implant may be reduced. Always secure the implant against
aspiration when removing the implant.

The Loxim® is provided with a pre-determined breaking point to prevent damage

to the implant’s inner configuration, thus ensuring the integrity of the interface
to mount the prosthesis. If the Loxim® breaks during implant insertion, one part
remains in the Adapter and the other part in the implant. Both parts can be re-
moved with tweezers.

To extract the implant after breakage at the pre-determined breaking point, sim-
ply take out the broken part of the Loxim® from the Adapter and re-insert the
Adapter on the Loxim® part remaining in the implant. Counterclockwise turns will
remove the implant.

The part of the Loxim® below the pre-determined breaking point is not secured in
the Adapter and, additionally, needs to be secured against aspiration when taking
out the implant.

Caution: The broken part of the Loxim® no longer protects against high torque.
Therefore, it is not to be used to advance the placement of the implant.

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 4.4 Soft tissue management
After implantation, the implant is closed – hand-tightened – with an SCS Closure Screw, Healing Cap or Healing
Abutment to protect the implant (for SCS Screwdrivers see Chapter 6.1.8). The surgeon can choose between
submucosal and transmucosal healing and has many options available for soft tissue management through a
set of secondary h
­ ealing components.

4.4.1 Submucosal healing

For submucosal healing (healing under closed mucoperiosteal flap) the use of a Closure Screw, shorter Healing
Cap or Healing Abutment is recommended. Submucosal healing is suggested in esthetic indications and for
implantations with simultaneous guided bone restoration (GBR) or membrane technique. A second surgical
procedure is required for uncovering the implant and inserting the desired secondary component.

1 1 Step 1 – Inserting the Closure Screw after first

­surgery
Ensure that the internal configuration of the implant
is clean and bloodless.

Pick up the Closure Screw with the SCS Screwdriver.

The friction fit will secure the Closure Screw to the
instrument during insertion and will allow safe han-
dling.

Hand-tighten the Closure Screw. The design will pro-

vide a tight connection between the two compo-
nents.

Note: All Closure Screws are delivered sterile and

ready to use.

Subsequent loosening is made easier by applying

chlor­hexidine gel or sterile Vaseline® to the Closure
Screw before it is screwed into the implant.

2 2 Step 2 – Wound closure

Adapt the mucoperiosteal flaps carefully and suture
together with interrupted sutures.

Make sure a tight seal is formed over the implant.

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702084.indd 42 08/03/2022 19:05

 3 3 Step 3 – Reopening and removal: second surgery
Locate the implant.

Make a small crestal incision down to the Closure

Screw.

Spread the flap slightly and remove the Closure Screw

with the SCS Screwdriver.

4 4 Step 4 – Insertion and wound closure

Rinse the exposed internal connection of the implant
­thoroughly with sterile saline solution.

Insert a suitable secondary component.

Adapt the soft tissue and suture it back tightly with-

out ­tension around the secondary component.

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 4.4.2 Transmucosal healing
A versatile portfolio of Healing Caps and Healing Abutments is available for all Straumann® implants, enabling
soft-tissue sculpturing during transmucosal healing. They are recommended for intermediate use. After the
soft-tissue healing phase they are replaced with the appropriate temporary or final restoration.

1 1
Step 1 – Insertion
Ensure that the internal configuration of the implant
is clean and bloodless.

Insert the Healing Cap or Healing Abutment with the

SCS Screwdriver. The friction fit secures the compo-
nents to the instrument during insertion and ensures
safe handling.

Hand-tighten the Healing Cap or Healing Abutment.

The design will provide a tight connection between
the two components.

Subsequent loosening is made easier by applying

chlorhexidine gel or sterile Vaseline® to the Healing
Cap or Healing Abutment before they are screwed
into the implant.

2 2
Step 2 – Wound closure
Adapt the soft tissue and suture it back tightly around
the ­abutment.

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 5. Healing Phase
5.1 Healing phase duration
For the delayed loading surgical protocol, it is recommended to follow the healing time durations
as indicated below:

Situation Healing phase

SLActive® SLA®
▪ Good bone quality and adequate bone quantity At least 3 – 4 weeks At least 6 weeks
▪ Implants with a diameter of 4.1 mm or 4.8 mm and a
­Straumann® SLActive®/SLA® surface length of ≥ 8 mm
▪ Cancellous bone quality At least 8 weeks At least 12 weeks
▪ Implants with a diameter of 2.9 mm
▪ Implants with a diameter of 3.3 mm
▪ Implants with a Straumann® SLActive®/SLA® surface
length of 6 mm
▪ Straumann® Standard Plus Short Implant 10 – 12 weeks n. a.
▪ Straumann® SLActive®/SLA® surface is not completely Healing phase corresponding to the
in contact with the bone situation
▪ Bone augmentation measures* are necessary
* This technique should be employed only by dentists who have adequate experience in
the use of augmentation procedures.

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 6. Additional Information on Instruments
6.1 Surgical instruments
Instruments must be checked for completeness and function. An
adequate stock of implants and spare sterile instruments should
always be available. The instruments must be disassembled for
sterilization. Well-maintained instruments prevent infections from
developing that could endanger both the patients and the practice
team.

To avoid contamination of the operation field, all the instruments

ndard Plus and materials employed must be sterile. To prevent contamination

of the sterile instruments, they should be removed from the Surgi-

System
cal Cassette with the sterile Instrument Tweezers and put into the
handle or Ratchet. The Instrument Tweezers (art. no. 046.110) were
developed and shaped specially to allow round instruments to be
gripped securely.

All steps related to the maintenance of Straumann® surgical in-

struments are part of a dental practice hygiene plan (see also
Straumann® Surgical and Prosthetic Instruments, Care and Mainte-
nance (702000/en)).
(01) 07630031727435
(11) YYMMDD
(10) XXXXX

6.1.1 Depth marks on Straumann® instruments 12 mm

150.215 10 mm
Straumann® instruments have depth marks in 2 mm intervals that 8 mm
6 mm
correspond to the available implant lengths. The marks on drills are
XXXXX 4 mm
continuous between 10 mm and 12 mm. The lower edge of the mark
1 2 3 4 5 6 7
corresponds to 10 mm and the upper edge to 12 mm.
YYYY-MM-DD
1. Pilot Drill 1, ∅ 2.2 mm
2. Alignment Pin, ∅ 2.2 mm
ifu.straumann.com 3. Pilot Drill 2, ∅ 2.8 mm
4. Twist Drill PRO, ∅ 3.5 mm
5. Twist Drill PRO, ∅ 4.2 mm
Institut Straumann AG
6. S
 traumann® Standard Plus Implant, ∅ 4.1 RN, length 10 mm
Peter Merian-Weg 12 7. Straumann® Bone Level ­Implant, ∅ 4.1 RC, length 10 mm
CH-4002 Basel, Switzerland
www.straumann.com
05/20
150.215/F/03

0.4 mm
Etkon GmbH
Lochhamer Schlag 6
DE-82166 Gräfelfing, Germany

Warning: Due to the function and design of the drills, the drill tip is 17/12/2020 12:36
0.4 mm longer than the insertion depth of the implant.

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 6.1.2 Single-patient Drills
Single-patient drills are indicated for the preparation of the implant bed for Straumann® dental
implants. They are supplied sterile and are to be used for one operation only and for one patient
only. Single-patient drills can minimize the risk of infection for the patient.

For more information, please refer to Straumann® Single-patient Instruments, Surgical User Guide
(702173/en).

6.1.3 Straumann® Drill Stop – Precise depth control

The Straumann® Drill Stop provides precise control over drilling depth during implant bed prepa-
ration for the placement of Straumann® dental implants. Delivered in sterile sets, the Drill Stops
are ready to use. The Straumann® Drill Stop is designed for single-patient use only and must be
used in conjunction with the single-patient drills specifically designed for them.

Note: Straumann® Drill Stops are not indicated for:

ѹ Extraction sites, where the bone cavity is often wider than the diameter necessary to hold
the Drill Stop.
ѹ Use with drill templates, due to the interference with the template.

For more information, please refer to Straumann® Drill Stop, Basic Information (702874/en).

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 6.1.4 Straumann® Modular Cassette
The Straumann® Modular Cassette is used for the secure storage and reprocessing of surgical
and auxiliary instruments of the Straumann® Dental Implant System. The Straumann® Modu-
lar Cassette works with any Straumann® implant line, including with the Straumann® Guided
Surgery workflow.

For information on how to equip the Cassette, please see the brochure Straumann® Modular
Cassette Selection Guide (702824/en).

For more technical information, please see the brochure Straumann® Modular Cassette - Basic
Information (702527/en).

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 6.1.5 Ratchet

Ratchet
The Ratchet (art. no. 046.119) of the Straumann® Dental Implant System is a two-part lever arm instrument with a rotary
knob for changing the direction of force.

The Ratchet is required for the following operations:

ѹ Manual thread tapping
ѹ Manual placement of implants into their final position in the implant bed
ѹ Manual screwing of healing caps and closure screws*.
ѹ Screwing of abutments and occlusal screws*.
*Combined with the torque control device for defined torque

Service Instrument
The Ratchet is supplied with a Service Instrument, which is used to loosen or tighten the retaining screw.

Ratchet disassembled
After loosening, the Ratchet bolt can be removed from the body of the Ratchet. It must be disassembled for cleaning and
sterilization.

Direction indicator Retaining screw Ratchet bolt

Ratchet body

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 6.1.6 Torque Control Device

The Torque Control Device (art. no. 046.049) is an instrument for determining the torque applied to various screw connec-
tions. A specific force/torque (Ncm) is transferred to the screw connection by means of a torque bar mounted on the ratchet.
A calibration mark shows the measured tightening torque.

If the torque bar is aligned with the zero mark at rest, the precision of the displayed tightening torque is within ± 2 Ncm. The
torque bar must not be bent beyond the calibration mark on the scale, otherwise the precision can no longer be guaranteed
or the bar may break.

Recommended torque values are defined by optimal conditions for the specific screw connections of the Straumann® System.
The individual clinical situation (bone quality, implant length, implant type, implant sur­face, time of application of force, etc.)
also has to be considered apart from the recommended torque values.

Handle
Torque bar

Assembled Torque Control Device and Ratchet

Calibration mark 15/35 Ncm

stop

Maximum torque - reference mark on the scale

Recommendations for correct torque with the

Straumann® Dental Implant System Bone graft System
Connection Recommended torque Connection Recommended torque
Abutment Basal screw 35 Ncm
35 Ncm
(incl. angled abutments)
Mucosa cylinder 35 Ncm
Closure screws 15 Ncm
Bone graft abutment 15 Ncm
Healing caps 15 Ncm
Occlusal screws 15 Ncm

50

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 6.1.7 Holding Key
The Holding Key can be used to stabilize the Ratchet.

Stabilizing the Ratchet

Use the pivot of the Holding Key to stabilize the Ratch-
et during implant insertion or during tapping.

6.1.8 SCS Screwdriver and AS Screwdriver

SCS Screwdriver for ratchet SCS Screwdriver for handpiece AS Screwdriver for ratchet AS Screwdriver for handpiece
extra-short (15 mm), extra-short (20 mm), extra-short (15 mm), extra-short (20 mm),
short (21 mm), long (27 mm) short (26 mm), long (32 mm) short (21 mm), long (27 mm) short (26 mm), long (32 mm)

Note: All the AS (Angled Solution) components are identified via a green color coding. Please note that the SCS
and AS components are not intercompatible.

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 6.2 Osteotomes
6.2.1 Instrument set for bone condensation
ѹ Indicated in cases with cancellous bone (bone classes 3 and 4).
ѹ Reinforces bone radially to give improved primary stability to the implant.
ѹ Before the instruments are used, it is advisable to mount the depth stops in order not to exceed the pre-
determined working depth. These are mounted onto the instrument using an SCS screwdriver.
ѹ Instruments of increasing diameter are introduced manually using gentle rotary movements or, if necessary,
lightly tapping with a hammer in accordance with the desired implant length and implant diameter.
ѹ Insert the implant carefully without applying extra force.

Note: The instruments with diameters of 2.2 mm, 2.8 mm, 3.5 mm and 4.2 mm match the implant diameters
of the Straumann® Dental Implant System. They are available as straight or angled models, which facilitates
access in the posterior region.

Osteotomes for bone Insert Osteomes to the desired implant length using gentle rotary movements.
­condensation

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 6.2.2 Instrument set for transalveolar sinus floor elevation
Indicated in cases with inadequate vertical bone. By tapping on the osteotomes
with a mallet, the sinus floor can be fractured and elevated.

ѹ The bone is prepared using the twist drills (∅ 2.2 mm/2.8 mm/3.5 mm/4.2 mm)
in accordance with the desired implant diameter. The surgeon feels his or her
way very carefully down to the cortical bone of the sinus floor (minimum dis-
tance 1 mm). This process requires precise radiological planning.
ѹ Before the instruments are used, it is advisable to mount the depth stops in or-
der not to exceed the pre-­determined working depth. These are mounted onto
the instrument using an SCS screwdriver.
ѹ First, the sinus floor is fractured, which requires precise radiological planning.
The use of depth stops is also recommended in order not to exceed the pre-de-
termined working depth. The instrument is introduced by lightly tapping with
a hammer in accordance with the desired implant length. Osteotomes for sinus floor elevation
ѹ During elevation, autologous and/or alloplastic filling or bone material should
also be applied to the implant bed. The material introduced acts like a cushion,
lifting the mucous membrane in accordance with the principles of hydraulics.
ѹ Insert the implant carefully without applying extra force.

Note: The instruments with diameters of 2.2 mm, 2.8 mm, 3.5 mm and 4.2 mm
match the implant diameters of the Straumann® Dental Implant System. They
are available as straight or angled models, which facilitates access in the posterior
region.

6.2.3 Depth stops for osteotomes

All osteotomes have clear laser marks for depths of 6 mm, 8 mm, 10 mm, 12 mm and
14 mm. In addition, adjustable depth stops facilitate depth checking.

Depth stops for osteotomes

53

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 6.3 Cleaning and care of instruments
Careful treatment of all instruments is of the utmost importance. Even slight damage, for instance to the drill
tips (e.g., when the drills are “thrown” into a metal bowl) impairs cutting performance and thus the clinical re-
sult. With correct and careful care, the high quality of the material and excellent workmanship ensure that the
cutting instruments (drills, taps etc.) can be used repeatedly (up to a maximum of ten times is recommended).
The Surgery Tracking Sheet for Straumann Cutting Instruments (152.755/en). helps to give an overview of how
often the individual instruments have already been used.

Instruments with high cutting performance are a basic requirement for successful implantation. The following
should therefore be remembered:

ѹ Never allow instruments to land on their tips.

ѹ Use each instrument only for its intended purpose.
ѹ Never let surgical residues (blood, secretion, tissue residues) dry on an instrument; clean immediately after
surgery.
ѹ Thoroughly clean off incrustations with soft brushes only. Disassemble instruments, clean cavities especially
well.
ѹ Never disinfect, clean (also ultrasound) or sterilize ­instruments made of different materials together.
ѹ Use only cleaning agents and disinfectants intended for the material and follow the instructions for use of
the manufacturer.
ѹ Rinse disinfectants and cleaning agents very thoroughly with water.
ѹ Never leave or store instruments moist or wet.

You will find detailed information in the brochure Straumann® Surgical and Prosthetic Instruments, Care and
Maintenance (702000/en).

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 7. Appendix
7.1 Related documentation
Note: Our detailed documentation will help you in carefully planning and performing your implant-based
restorations:
ѹ Prosthetic Procedures for the Narrow Neck CrossFit® Implant – Straumann® Narrow Neck CrossFit® Implant
Line (702058/en)
ѹ Straumann® synOcta® Prosthetic System, Basic Information (702163/en)
ѹ Cement-retained Crowns and Bridges with the Solid Abutment System: Straumann® Solid Abutment Prosthetic
System (152.254/en)
ѹ Straumann® Bone Level Prosthetic Procedures, Basic Information (702061/en)

Instrument care and maintenance

ѹ Well maintained instruments are a basic requirement for successful treatment. You will find detailed infor-
mation in the brochure Straumann® Surgical and Prosthetic Instruments, Care and Maintenance (702000/en).

The Straumann® Guarantee

ѹ As a Swiss company, we attach the greatest importance to manufacturing products of the highest quality.
The Straumann® Guarantee regulates replacement of all components of the Straumann® Dental Implant
System. You will find detailed information in the brochure Straumann® Guarantee (152.360/en).

Explantation
ѹ For explantation guidelines please refer to Guidance for Implant Removal, Basic Information (702085/en). The
components required for explanation can be found in our current product catalog.

References
The Straumann® Dental Implant System has been comprehensively clinically documented. You can find ref-
erences to the current research literature on our website www.straumann.com or by contacting your local
Straumann representative.

Courses and training

Continuing education ensures long-term success! Please ask your Straumann representative directly for informa-
tion on the Straumann® Dental Implant System courses and training. Further information at www.straumann.com.

55

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 7.2 Important guidelines
Please note
Practitioners must have appropriate knowledge and instruction in the handling of the Straumann CADCAM
products or other Straumann products (“Straumann Products”) for using the Straumann Products safely and
properly in accordance with the instructions for use.

The Straumann Product must be used in accordance with the instructions for use provided by the manufac-
turer. It is the practitioner’s responsibility to use the device in accordance with these instructions for use and
to determine whether the device fits the patient's individual situation.

The Straumann Products are part of an overall concept and must be used only in conjunction with the cor-
responding original components and instruments distributed by Institut Straumann AG, its ultimate parent
company and all affiliates or subsidiaries of such parent company (“Straumann”), except if stated otherwise
in this document or in the instructions for use for the respective Straumann Product. If use of products made
by third parties is not recommended by Straumann in this document or in the respective instructions for use,
any such use will void any warranty or other obligation, express or implied, of Straumann.

Availability
Some of the Straumann Products listed in this document may not be available in all countries.

Caution
In addition to the caution notes in this document, our products must be secured against aspiration when used
intraorally.

Validity
Upon publication of this document, all previous versions are superseded.

Documentation
For detailed instructions on the Straumann Products contact your Straumann representative.

Copyright and trademarks

Straumann® documents may not be reprinted or published, in whole or in part, without the written authori-
zation of Straumann.
Straumann® and/or other trademarks and logos from Straumann® mentioned herein are the trademarks or
registered trademarks of Straumann Holding AG and/or its affiliates.

56

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 Notes

57

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 1 Bernhard N et al. (2009): The Binary TiZr Alloy – A newly developed Ti Alloy for use in dental implants; Forum Implantologicum 5(30) 2 Medvedev et al. (2016):
Microstructure and mechanical properties of Ti-15Zr alloy used as dental implant material; J. Mech. Behav. Biomed. Mater. 2016 Sep; 62:384-98. doi: 10.1016/j.
jmbbm.2016.05.008. epub 2016 May 11 3 Gottlow J et al. (2012): Evaluation of a new Titanium-Zirconium dental implant: a biomechanical and histological
comparative study in the mini pig; Clin. Implant Dent. Relat. Res. 14 Suppl. 1:e204-e212 4 Thoma et al. (2011): Tissue integration of a new Titanium-Zirconium
dental implant: a comparative histologic and radiographic study in the canine; J. Periodontol. 2011 Oct; 82(10):1453-61. doi 10.1902/jop.2010.100737 5 Wen
et al. (2014): The osseointegration behavior of Titanium-Zirconium implants in ovariectomized rabbits; Clin. Oral Implants Res. 2014 Jul; 25(7):819-25. doi:
10.1111/clr.12141. epub 2013 Feb 21 6 Nelson K (2016): Rehabilitation of irradiated patients with chemically modified and conventional SLA implants: a clinical
clarification; J Oral Rehabil; 43: 871–872. doi:10.1111/joor.12434 7 Heberer S et al. (2011): Rehabilitation of irradiated patients with modified and conventional
sandblasted, acid-etched implants: preliminary results of a split-mouth study; Clin. Oral Impl. Res. 22, 2011; 546-551 8 Cabrera-Domínguez JJ et al. Clinical
performance of titanium-zirconium implants with a hydrophilic surface in patients with controlled type 2 diabetes mellitus: 2-year results from a prospective
case-control clinical study Clin Oral Investig 2020 Jul;24(7):2477-2486 9 Alsahhap A et al. Survival of Titanium-Zirconium and Titanium Dental Implants in
Cigarette-smokers and Never-smokers: A 5-Year Follow-upChin J Dent Res. 2019;22(4):265-272 10 Lang, N. P., G. E. Salvi, G. Huynh-Ba, S. Ivanovski, N. Donos and
D. D. Bosshardt (2011). "Early osseointegration to hydrophilic and hydrophobic implant surfaces in humans." Clin Oral Implants Res 22(4): 349-356. 11 Oates,
T. W., P. Valderrama, M. Bischof, R. Nedir, A. Jones, J. Simpson, H. Toutenburg and D. L. Cochran (2007). "Enhanced implant stability with a chemically modified
SLA surface: a randomized pilot study." Int J Oral Maxillofac Implants 22(5): 755-760. 12 Nicolau, P., F. Guerra, R. Reis, T. Krafft, K. Benz and J. Jackowski (2019).
"10-year outcomes with immediate and early loaded implants with a chemically modified SLA surface." Quintessence Int 50(2): 114-124. 13 Reis, R., P. Nicolau,
N. Calha, A. Messias and F. Guerra (2019). "Immediate versus early loading protocols of titanium-zirconium narrow-diameter implants for mandibular overden-
tures in edentulous patients: 1-year results from a randomized controlled trial." Clin Oral Implants Res 30(10): 953-961. 14 Eckert, S. E., G. Hueler, N. Sandler, R.
Elkattah and D. C. McNeil (2019). "Immediately Loaded Fixed Full-Arch Implant-Retained Prosthesis: Clinical Analysis When Using a Moderate Insertion Torque."
Int J Oral Maxillofac Implants 34(3): 737–744. 15 Kuchler U, Chappuis V, Bornstein MM, Siewczyk M, Gruber R, Maestre L, Buser D. Development of Implant
Stability Quotient values of implants placed with simultaneous sinus floor elevation – results of a prospective study with 109 implants. Clin. Oral Impl. Res.
28, 2017, 109–115. 16 El Chaar E, Zhang L, Zhou Y, et al. Osseointegration of Superhydrophilic Implants Placed in Defect Grafted Bones. International Journal
of Oral & Maxillofacial Implants . Mar/Apr2019, Vol. 34 Issue 2, p443-450 17 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): 78–86

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