Prosthodontic Procedure

Transcription

1 Prosthodontic Procedure TSH BNT Regeneration Implant Systems CAD-CAM Digital Solutions Services

2 Important: before using Phibo The innovative and patented design of the Phibo implant systems incorporates advanced technological features developed only for professionals who understand technology as an advantage, and design as a benefit. Phibo complies with all the European guidelines and legal requirements regarding the manufacture and distribution of medical and health products. The Phibo implant system is certified and authorised for marketing by European Notified Body Phibo Dental Solutions S. L. complies with the strictest international standards on the quality of medical devices, guaranteeing perfect product quality, with the sole objective of constantly increasing client satisfaction. The use of other components or products not manufactured by Phibo Dental Solutions, S. L., which come into contact with Phibo implant system originals manufactured by Phibo Dental Solutions, S. L. in accordance with the original design specifications, may cause serious health problems for the patient as they are not intended for use with elements that are referenced in the documentation supplied by the manufacturer. Any use of non-original components or instruments mentioned in this procedure, that come into contact with referenced components, will automatically cancel any type of warranty covering products manufactured by Phibo Dental Solutions, S. L. Because the use and application of the Phibo dental implant system are beyond the control of the manufacturer, the user is responsible for any damage that may result from the use of the product. Phibo Dental Solutions, S. L. declines all responsibility for damage derived from its incorrect manipulation or use. Reusing single-use products may cause deterioration, with a risk of tissue infection, surgical or prosthodontic failure and/or deterioration of patient health. The documentation of the Phibo implant system is periodically updated according to the state of scientific and technological knowledge. Users of the Phibo system should request product information on a regular basis and attend the training courses on the product and technique that are held regularly. The use and placement of Phibo implants in inappropriate sectors, and the use of surgical instruments or prosthetic components not contemplated in this procedure may cause serious patient health problems as well as total loss of the product warranty. The Phibo implant system has been designed for single and multiple dental restorations according to the traditional clinical processes reflected in this documentation. The warranty excludes cases involving insufficient bone for implant placement, clinical risk cases such as sinus lifts, bone fillings, advanced surgical techniques, cases of severe or unsuitable disparallelism between implants, and other cases. The Phibo implant system is internationally distributed in various countries with different technical and healthcare regulations and laws; accordingly, there may be differences from one country to another in terms of the contents of the procedure. Consult the exclusive Phibo distributor in your country and request the documentation for the products and their availability. Phibo Dental Solutions S. L. reserves the right to modify and develop the products reflected in this procedure, without prior warning. All rights reserved. Reprinting or processing the contents of this publication in any format requires prior written permission from Phibo and Phibo Dental Solutions, S.L. L. PHIBO Implants, Tissue Care TM, TSA, TSA ADVANCE, TSH, Avantblast, ProUnic, ProUnic Plus TM, Duplit TM, Softissue, International Phibo Group TM, Ific, VK, BNT, Genoral, Esthetic Tissue, Phibo Esthetics, Phibo Surgical, Phibo Prostodontics, Phibo Scientific, are commercial and/or registered trademarks of Phibo Dental Solutions, S. L. Phibo implants are protected by international patent. Other products and accessories are protected by patents or are patent pending. 1

3 Technical Information The information given below is not sufficient to use Phibo dental implants, because the person handling them also needs to have sufficient training and information in dental implant techniques to know how to use Phibo dental implants. Please read the detailed information in the implant leaflet carefully before use. The instructions for using and maintaining Phibo products are given in the documents and procedures manuals for the Phibo implant system. Phibo prosthodontic components and instruments are not supplied sterile. They must be cleaned, disinfected and sterilised before and after use. The cleaning, disinfection and sterilisation protocol can be consulted in the document PROSPLDEEN_rev001. 2

4 CONTENTS INTRODUCTION FEATURES OF THE DIFFERENT PROSTHESETIC ACCESSORIES IMPRESSION TAKING CEMENTED FINAL RESTORATIONS DRILLABLE ABUTMENTS SCREWED FINAL RESTORATIONS DIRECT CASTING TO IMPLANT FINAL RESTORATIONS WITH OVERDENTURES BALL ABUTMENTS NON-HEXED CASTING CYLINDER 3

5 INTRODUCTION The purpose of this Prosthodontic Procedure is to provide an overview of all accessories, establishing the procedure for the different prosthodontic restorations that can be performed performed over BNT & TSH implants in the Phibo system, for both clinical and laboratory use. From single and multiple cases, fixed prostheses and complete restorations to the different connection methods: cemented or screwed. With the Phibo BNT & TSH system, you can apply many of the existing options in current implantology. The Phibo BNT & TSH implant system offers a range of accessories that enable prosthodontic restorations over implants easily and provide solutions so that the aesthetic and functional components guarantee successful treatment for your patient. There are two impression taking options. Direct with closed cuvette or indirect with open cuvette. Both available using different accessories. The Phibo BNT & TSH system has direct Casting to implant, Non-Hexed Casting or Hexed Casting for use in both multiple and single screwed prosthetic restorations. The Phibo BNT & TSH system also offers a range of drillable abutments, with different heights and angulations for use in restorations with cemented prostheses. PROCEDURES BY IMPLANT AND PROSTHODONTIC RESTORATION TYPE. EARLY LOADING Provisional or final restoration with occlusal contact, at six weeks in the mandible and eight weeks in the maxilla, after insertion of the implant. The prosthetic process is performed in the laboratory. DELAYED LOADING Provisional or final restoration with occlusal contact, at three months in the mandible and six months in the maxilla, after insertion of the implant. The prosthetic process is performed in the laboratory. 4

6 FEATURES OF THE DIFFERENT PROSTHESETIC ACCESSORIES HEXED DRILLABLE ABUTMENTS The drillable abutment family is machined in titanium. It includes the following types of abutments:. Drillable abutments with 2 mm and 4 mm shoulder for all the BNT & TSH implants in series 2, 3, 4 and 5. The abutment retention screw is supplied separately.. Angulated 15 and 25 drillable abutments for BNT & TSH 3 and 4 implant series. They are supplied without transgingival height and with 1 mm transgingival height. They are supplied together with the retention screw. As their names indicates, drillable abutments are indicated to be drilled and modified as needed by the user in cemented restorations. The fixation torque for the retention screw is 35 N cm. INDICATIONS. In general for single and multiple cemented restorations over the abutment.. To level the crown emergence height in relation to the adjacent natural teeth and the thickness of the soft tissue:. If the occlusal height from the implant exceeds 6 mm.. If it is necessary to adjust the height of the antagonist and parallelise the prosthesis insertion axis.. In fixed restorations with disparellelism between implants.. In single or multiple restorations where, due to the position of the implant, the retention screw entry hole in a screwed prosthesis compromises the aesthetic outcome of the restoration. ADVANTAGES. Greater control of the aesthetic outcome of the prosthesis. PRECAUTIONS. Possibility of prolonged tissue reaction due to the cement used.. Retention of the prosthesis due to excess cement.. Less control of crown or bridge seating during the cementing process. CONTRAINDICATIONS. If the occlusal height from the implant platform is less than 4 mm. DIRECT UCLA CASTING TO IMPLANT The implant direct Casting cylinder family is machined in plastic. They are indicated for screwed single or multiple restorations or bar overdentures for the Phibo BNT & TSH system. The implant direct Ucla Casting cylinder family is comprised of: - Hexed Ucla casting cylinder: Indicated for single, screwed fixed crowns. -Non-hexed Ucla casting cylinder: Indicated for multiple fixed restorations or overdentures. The different types of casting cylinders in the Phibo BNT & TSH system are supplied apart from the retention screw, which is set at a 35 N cm torque. ADVANTAGES Easy prosthesis removal to make maintenance and hygiene easier during periodic check-ups. CONTRAINDICATIONS In cases in which the entry hole for the retention screw affects the aesthetics of the restoration. 5

7 BALL ABUTMENTS A ball abutment is a base abutment for performing restorations with implant-gingival-supported overdenture. The ball abutment is machined in titanium. Available for series 3 and 4 in the following sizes.. BNT & TSH series 3 implants: Abutments with 2 mm and 4 mm transgingival zone.. BNT & TSH series 4 implants: Abutments with 2 mm and 4 mm transgingival zone. The final implant insertion torque is 35 N cm. Maximum permitted angulation: 30º between implants. INDICATIONS. Ball abutment for performing restorations with implant-gingival-supported overdenture in the mandibular sector.. In cases with a significant mandibular elastic bone mass loss, where placement of implants for other types of restoration represents a high risk of bone fracture. ADVANTAGES. Allows you to perform restorations with overdenture.. The retention system is simple and reliable. RELATIVE CONTRAINDICATIONS. In the maxillary bone. As it is necessary to place a greater number of implants due to low bone density, adjusting the rebasing and the overdenture to the abutment is more complex.. In all cases where another type of restoration is indicated.. In restorations with more than two implants with severe disparallelism (as insertion of the prosthesis would be difficult). COMPLEMENTARY SUPERSTRUCTURES. Machined titanium sleeve with O-ring: Accessory that integrates with the lower part of the overdenture and holds it to the implant by connection to the ball abutment. The element that provides the sleeve-abutment retention function is a rubber O-ring seal seated inside the sleeve. IMPRESSION TAKING METAL TRANSFERS CHARACTERISTICS Accessories machined in titanium.. Available for open cuvette technique: metal transfer with long screw.. Available for closed cuvette technique: metal transfer with short screw.. The blister contains: impression transfer, long screw for open cuvette and short screw for closed cuvette. INDICATIONS Implant Direct Impression. In cases of severe disparallelism between implants or between implants and teeth, the impressions are taken using an open cuvette and long retention screw using the impression transfer for open cuvette. In cases of parallelism between implants or between implants and teeth, the impressions are taken using a closed cuvette and short retention screw using the impression transfer for closed cuvette. 6

8 ADVANTAGES In cases of pronounced disparallelism, taking the impression with an open cuvette allows you to perform a precise transfer of the implants to the working model. RECOMMENDATIONS You must follow the indicated procedure for the seating and fixation of the impression transfer in the implant. In the case of significant soft tissue thickness, we recommend taking a control X-ray of the seating of the transfer to the implant shoulder. ACCESSORIES AND CLINICAL MATERIAL Metal impression transfer for open cuvette or impression transfer for closed cuvette for BNT & TSH systems, according to the chosen technique. Phibo system 1.25 mm screwdriver. *Individual cuvette. *Impression material. *Impression material adhesive. LABORATORY BNT & TSH implant analogue Phibo 1.25 mm screwdriver *MATERIAL NOT SUPPPLIED BY Phibo INSTRUCTIONS FOR USE PROCEDURE IN THE CLINIC Remove the healing abutment. Select the technique for impression taking (open or closed cuvette) and, therefore, the corresponding impression transfer. Fit the 1.25 mm screwdriver into the retention screw, pass it through the transfer until it protrudes through the lower end. Fasten the transfer and screw unit to the implant head. To do this, place the unit on the implant, screwing it until you see that the base of the metal transfer has made contact with the implant head. Immediately after, loosen the retention screw and slightly turn the body of the impression taking clockwise or anti-clockwise. If the body does not turn, it is adjusted by the implant hexagon, if it turns you should combine gentle pressure in the occlusive-gingival direction with a turn until you see that the unit is seated between the hexagons. Finish screwing the retention screw and manually tighten (we recommend checking the fixation using a perioapical X-ray). Air-dry the transfer. Apply the impression material around the transfer. Insert the cuvette in the mouth with the rest of the impression material and wait until it sets. Open cuvette technique: Remove the fixation screw and drag the cuvette with the body of the transfer. Closed cuvette technique: Remove the cuvette directly once the impression material has set and remove the implant impression transfer. Replace the healing abutment. Send the following to the laboratory:. Impression cuvette.. Impression transfer with the corresponding screw.. Implant analogue.. Bite registration.. Antagonist model. 7

9 PROCEDURE IN THE LABORATORY Open cuvette technique: Position the implant analogue over the body of the open cuvette retained in the impression material and secure it with the retention screw. Closed cuvette technique: Secure the implant analogue to the closed cuvette with the screw. Insert the unit into the cuvette lining up the flat faces; apply light pressure until it clicks into place. Cast the zone corresponding to the soft tissue with soft resin and wait for it to set. Prepare the rest of the cuvette with plaster to obtain the final working model. Open cuvette technique: Once the plaster has hardened, remove the retention screw and separate the model. Closed cuvette technique: Once the plaster has hardened, separate the model from the cuvette and remove the metal impression transfer by loosening the retention screw. Prepare and mount the model in the semi-adjustable articulator. Use the registrations taken before surgery. Perform a study of: o Position of the implant (angulation and parallelism). o Spaces and dimensions available. o Height of the soft tissue for creation of the emergence profile. o Antagonist type. With the information obtained, choose the optimum abutments and necessary accessories for creating the prosthesis in the laboratory. CEMENTED FINAL RESTORATIONS DRILLABLE ABUTMENTS CHARACTERISTICS. Abutment machined with a smooth transition zone on the shoulder. The abutment fixation torque for the implant is 35 N cm.. Fixed prostheses cemented to drillable abutments are created using casting in metal of the base structure, modelled based on the titanium abutment itself. INDICATIONS. In general for single and multiple cemented restorations over the abutment.. To level the crown emergence height in relation to the adjacent natural teeth and the thickness of the soft tissue.. When it is necessary to adjust the height of the antagonist and parallelise the prosthesis insertion axis.. In single or multiple restorations where, due to the position of the implant, the retention screw entry hole in a screwed prosthesis compromises the aesthetic outcome of the restoration. CONTRAINDICATIONS. When the occlusal height from the implant is less than 4 mm. ADVANTAGES. Greater control of the aesthetic outcome of the prosthesis.. Resolves poor fit of the final crown to the abutment. DISADVANTAGES. Difficult to remove the excess cement. 8

10 ACCESSORIES AND CLINICAL MATERIAL. Phibo 1.25 mm screwdriver. Phibo dynamometric wrench.. *Impression registration over implant:. *Impression material.. *Individual cuvette *MATERIAL NOT SUPPPLIED BY Phibo LABORATORY. BNT & TSH implant analogue.. BNT & TSH Drillable Abutments.. BNT & TSH final clinical screw.. Phibo 1.25 mm screwdriver. INSTRUCTIONS FOR USE IMPRESSION TAKING AND CASTING (Refer to impression taking procedure) PROCEDURE IN THE LABORATORY SELECTION AND PLACEMENT OF DRILLABLE ABUTMENT Choose the type of drillable abutment corresponding to: o Height of the soft tissue from the implant shoulder to the free gingival margin. o Disparallelism of the implant. o Emergence profile of the prosthesis. Insert the selected abutment into the implant analogue, adjusting the hexagons using small turns and manually screwing the retention screw until the drillable abutment is fixed over the BNT & TSH implant analogue. Check the height of the drillable abutment in relation to the antagonist arch and parallelism with the adjacent teeth and/or abutments. Model the abutment by drilling if necessary. MAKING THE PROSTHESIS Fill in the drillable abutment retention screw entry hole with wax and prepare the abutment with a spacer. Perform waxing directly over the abutment after it is modelled using the corresponding drill (if indicated) before applying the suitable separator. Model the structure for casting in wax or resin. Perform the casting in metal. Extract the structure cast in the cylinder. Check and adjust the shoulder. Ceramise without glazing, if applicable. Create a guide key for the position of the drillable abutment in the mouth on the model. Remove the drillable abutment from the model. PROCEDURE IN THE CLINIC: STRUCTURE TEST Remove the healing abutment from the implant. Place the abutment(s) in the acrylic resin guide key created in the laboratory. Secure the abutment to the implant using the acrylic resin positioning guide and thread the retention screw until the abutment is seated, gently tightening it by hand. Mount the prosthesis structure in the mouth over the abutment. Check the fit of the structure. Implant-abutment shoulder fastening. o Passivity. o Relation to the gum. o Contact points. o Occlusion. Remove the structure from the mouth and re-mount it in the working model. Replace the healing abutment. 9

11 PROCEDURE IN LABORATORY: STRUCTURE FINISHING Complete ceramization and glazing. PROCEDURE IN THE CLINIC PLACEMENT OF ABUTMENTS AND THE FINAL PROSTHESIS. Remove the healing abutment from the implant. Place the abutment(s) in the acrylic resin guide key created in the laboratory. Secure the abutment to the implant using the acrylic resin positioning guide and thread the retention screw until the abutment is seated, gently tightening it by hand. Tighten the retention screw using the 1.25 mm screwdriver tip and the dynamometric wrench to a torque of 35 N cm. Mount the prosthesis structure in the mouth over the abutment. Check the fit of the structure. o Implant-abutment shoulder fastening. o Passivity. o Relation to the gum. o Contact points. o Occlusion. 10

12 SCREWED FINAL RESTORATIONS DIRECT CASTING TO IMPLANT The implant direct Casting cylinder family is machined in plastic. They are indicated for screwed single or multiple restorations or bar overdentures for the Phibo BNT & TSH system. The implant direct Ucla Casting cylinder family is comprised of: - Hexed Ucla casting cylinder: Indicated for single screwed fixed restorations. -Non-hexed Ucla casting cylinder: Indicated for multiple fixed restorations or bar overdentures. The different types of casting cylinders in the Phibo BNT & TSH system are supplied apart from the retention screw, which is set at a 35 N cm torque. ADVANTAGES Easy prosthesis removal to make maintenance and hygiene easier during periodic check-ups. CONTRAINDICATIONS In cases in which the entry hole for the retention screw affects the aesthetics of the restoration. ACCESSORIES AND CLINICAL MATERIAL. Phibo 1.25 mm screwdriver.. Phibo dynamometric wrench.. *Impression registration over implant:. *Impression material.. *Individual cuvette. *MATERIAL NOT SUPPPLIED BY Phibo LABORATORY. BNT & TSH implant analogue.. BNT & TSH casting cylinder.. BNT & TSH final clinical screw.. BNT & TSH laboratory screw.. Phibo 1.25 mm screwdriver. *MATERIAL NOT SUPPPLIED BY Phibo 11

13 INSTRUCTIONS FOR USE PROCEDURE IN THE CLINIC IMPRESSION TAKING AND CASTING (Refer to impression taking procedure) PROCEDURE IN THE LABORATORY SELECTION AND PLACEMENT OF THE UCLA CASTING CYLINDER Choose the type of casting cylinder to make the prosthesis and check o Height of the soft tissue from the implant platform to the free gingival margin. o Emergence profile of the prosthesis. Insert the chosen casting cylinder into the implant analogue. Check the height with relation to the antagonist arch and parallelism with the adjacent teeth and/or abutments. Model the structure in wax or resin for casting one the casting cylinder. Cast the modelled structure using the normal procedure. Go over and polish the structure if necessary. PROCEDURE IN THE CLINIC: STRUCTURE TEST Remove the healing abutment from the implant. Secure the structure test to the implant with the retention screw. Check the fit of the structure. o Implant-abutment shoulder fastening. o Passivity. o Relation to the gum. o Contact points. o Occlusion. Remove the structure from the mouth and re-mount it in the working model. Replace the healing abutment. PROCEDURE IN LABORATORY: STRUCTURE FINISHING Complete ceramization and glazing. PROCEDURE IN THE CLINIC PLACEMENT OF THE FINAL PROSTHESIS. Remove the healing abutment from the implant. Secure the structure test to the implant with the retention screw. Tighten the retention screw using the 1.25 mm screwdriver tip and the dynamometric wrench to a torque of 35 N cm. Check the fit of the structure. o Implant-abutment shoulder fastening. o Passivity. o Relation to the gum. o Contact points. o Occlusion. 12

14 FINAL RESTORATIONS WITH OVERDENTURES BALL ABUTMENT CHARACTERISTICS A ball abutment is a base abutment for performing restorations with implant-gingival-supported overdenture. The ball abutment is machined in titanium. The following ball abutment sizes are available for the BNT & TSH implant series 3 and 4. Abutments with 2 mm and 4 mm transgingival zone. The final fixation torque for the implant is 35 Ncm. COMPLEMENTARY SUPERSTRUCTURES Sleeve machined in titanium with O-ring seal. Accessory that integrates with the lower part of the overdenture and holds it to the implant by connection to the ball abutment. The element that provides the sleeve-abutment retention function is a rubber O-ring seal seated inside the sleeve. INDICATIONS Ball abutment for performing restorations with implant-gingival-supported overdenture in the mandibular sector. In cases with a significant deficit of mandibular elastic bone mass, where placement of implants for other types of restoration represents a high risk of bone fracture. RELATIVE CONTRAINDICATIONS In the maxillary bone. As it is necessary to place a greater number of implants due to low bone density, adjusting the rebasing and the overdenture to the abutment is more complex. In all cases where another type of restoration is indicated. ADVANTAGES. Simpler treatment Allows you to perform restorations with overdenture. The retention system is simple and reliable.. Less working time.. Improves quality of life for elderly patients with significant bone reabsorption.. The retention system with O-ring facilitates reconstruction by allowing an angulation of +/- 30º between the different sleeves that support the overdenture. RECOMMENDATIONS. Periodically replace the O-ring retention seal.. Periodically check the patient until a perfect fit is achieved between the soft tissue and the prosthesis. ABUTMENT OPTIONS. BNT & TSH series 3 implants: Abutments with 2 mm and 4 mm transgingival zone.. BNT & TSH series 4 implant: Abutments with 2 mm and 4 mm transgingival zone. APPLICABLE PROCEDURES. Standard. 13

15 ACCESSORIES AND MATERIAL CLINIC. Phibo 1.25 mm screwdriver.. Phibo dynamometric wrench.. *Impression registration over implants.. *Impression material.. *Individual cuvette. *MATERIAL NOT SUPPPLIED BY Phibo LABORATORY. BNT & TSH implant analogue.. BNT & TSH ball abutment.. Metal sleeve with an O-ring seal for the BNT & TSH ball abutment.. Phibo 1.25 mm mechanical or manual screwdriver. 14

16 INSTRUCTIONS FOR USE PROCEDURE IN THE CLINIC IMPRESSION TAKING AND CASTING (Refer to impression taking procedure) PROCEDURE IN THE LABORATORY SELECTION AND PLACEMENT OF BALL ABUTMENTS Choose the transgingival zone height of the ball abutment that is most suitable for the reconstruction. Place the selected abutment on the BNT & TSH implant analogue. Check the height of the abutment in relation to the antagonist arch and the space for creation of the overdenture. PROCEDURE IN THE LABORATORY: MAKING THE PROSTHESIS Model the overdenture structure. Secure the metal sleeve with the O-ring seal to the overdenture using temporary material. PROCEDURE IN THE CLINIC: STRUCTURE TEST Remove the healing abutments. Mount the structure over the abutments. Check. o Implant-abutment shoulder fastening. o Passivity. o Relation to the gum. o Occlusion. Remove the structure and the abutments from the mouth. Replace the healing abutments. PROCEDURE IN THE LABORATORY: STRUCTURE FINISHING Modify the shape of the structure if necessary. Extract the sleeves and the temporary cement. Secure the sleeves permanently with acrylic resin. PROCEDURE IN THE CLINIC PLACEMENT OF ABUTMENTS AND THE FINAL PROSTHESIS.. Remove the healing abutment.. Secure the ball abutment to the implant using the 1.25 mm screwdriver tip and the dynamometric wrench to a torque of 35 N cm.. Mount the overdenture over the abutments in the mouth.. Check o Implant-abutment shoulder fastening. o Passivity. o Relation to the gum. o Occlusion. Teach the patient how to insert and extract the overdenture, and how to maintain oral hygiene. Normal wear and tear requires periodically replacing the O-ring rubber seal, removing the previous one with a probe and replacing it with a new one. 15

17 NON-HEXED CASTING CYLINDER. ACCESSORIES AND CLINICAL MATERIAL. Phibo 1.25 mm mechanical or manual screwdriver. BNT & TSH impression transfer. BNT & TSH healing abutment. *Impression registration. *Impression material. Phibo dynamometric wrench. BNT & TSH clinical screw. *Individual cuvette *MATERIAL NOT SUPPPLIED BY Phibo LABORATORY. BNT & TSH implant analogue. Non-hexed casting cylinder for BNT & TSH. BNT & TSH laboratory screw. Phibo 1.25 mm manual screwdriver INSTRUCTIONS FOR USE IN THE CLINIC IMPRESSION TAKING AND CASTING (Refer to impression taking procedure) PROCEDURE IN THE LABORATORY SELECTION AND PLACEMENT OF THE UCLA CASTING CYLINDER Choose the type of Casting Cylinder to make the prosthesis and check: o Height of the soft tissue from the implant platform to the free gingival margin. o Emergence profile of the prosthesis. Insert the chosen casting cylinder into the implant analogue. Check the height with relation to the antagonist arch and parallelism with the adjacent teeth and/or abutments. Model the structure in wax or resin for casting on the casting cylinder. Model the bar in wax or secure pre-fabricated plastic bars to the casting cylinder models. Cast the modelled structure using the normal procedure. Go over and polish the structure if necessary. Create the structure of the overdenture over the bar and its fixation. PROCEDURE IN THE CLINIC: STRUCTURE TEST Remove the healing abutment from the implant. Secure the structure test to the implant with the retention screw. Check the fit of the structure. o Implant-abutment shoulder fastening. o Passivity. o Relation to the gum. o Occlusion. Remove the structure from the mouth and re-mount it in the working model. Replace the healing abutments. 16

18 PROCEDURE IN THE LABORATORY FINISHING OF THE STRUCTURE Modify the overdenture or the bar suitably. PROCEDURE IN THE CLINIC PLACEMENT OF THE FINAL PROSTHESIS. Remove the healing abutments from the implants. Secure the bar to the implants with the retention screws. Tighten the retention screw using the 1.25 mm screwdriver tip and the dynamometric wrench to a torque of 35 N cm. Secure the overdenture over the bar in the mouth. Check the fit of the structure. o Implant-abutment shoulder fastening. o Passivity. o Relation to the gum. o Occlusion. Teach the patient how to insert and extract the overdenture, and how to maintain oral hygiene. This document was reviewed and approved on 2013/05/24 PROCEPROSBNTTSHEN_rev002 Headquarters: Phibo Dental Solutions S.L. Polígono Industrial Mas d'en Cisa, Gato Pérez, Sentmenat Barcelona Spanien 17

19 Prosthodontic Procedure TSH BNT Phibo Headquarters Pol. Ind. Mas d en Cisa Gato Pérez, Sentmenat Barcelona Spain Tel Fax