/NobelReplace Ø4.3mm. /NobelReplace Ø3.5mm

Transcription

1 Neoss Matrix Manual

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3 Neoss Matrix System Introduction The Neoss Matrix System has been designed to facilitate the fabrication of custom designed gold, titanium, other alloys and ceramic abutments or frameworks, each having a precision machined fit. The Neoss Matrix System can be utilized in the production of cement or screw retained implant prosthesis and is compatible with a range of dental implant systems offered by other manufacturers and suppliers. Some of the compatible dental implant systems are listed below. Nobel Biocare, Brånemark System RP, 3i & generic Ø3.75mm and 4.0mm external hex implants Nobel Biocare, Brånemark System NP 3.5mm Nobel Biocare, Replace /NobelReplace Ø4.3mm Nobel Biocare, Replace /NobelReplace Ø3.5mm Straumann Ø4.8 mm Matrix abutments are available in gold and titanium. Neoss Matrix System offers an efficient high accuracy prosthetic solution, while ensuring optimum quality control and offering an economical solution with numerous technical benefits. The Matrix Aesthetic Abutments Titanium range, with its 0.3mm low collar height, offers a unique opportunity to use a wide range of CAD/CAM equipment for dental implant prosthetics in addition to conventional crown and bridge restorations. Replace and Brånemark System are registered trademarks of Nobel Biocare AB. Nobel Biocare and NobelReplace are trademarks of Nobel Biocare AB. Straumann is a registered trademark of Straumann Holding AG. 3i is a registered trademark of Biomet 3i LLC Ltd. 3

4 Restorative Assistants The principles for restoring dental implants are very similar to conventional crown and bridge techniques. Many restorative dentists and assistants find the restorative aspects of implant dentistry easier and therefore more rewarding. The terminology used in implant dentistry differs from conventional dentistry but the treatment options are similar: Conventional Dentistry Tooth root Crown preparation Removable dentures Crown Bridge Implant Dentistry Implant Abutment Overdentures Crown An implant crown may be cemented onto the abutment, or screw retained to the abutment, or screw retained directly to the implant Bridge A bridge may be cemented onto the abutments, or screw retained to the abutments, or screw retained directly to the implants Generally the patient will present to the restorative clinician with a healing abutment in place. In the majority of cases the impression will be taken at implant level, however some abutments allow for their preparation intraorally similar to that of a natural tooth in these cases a conventional crown and bridge impression protocol would be followed. Note: Please refer to the information in this manual for procedures and information in relation to Neoss Matrix Abutments single unit and multiple unit construction which includes Matrix Abutment Gold, art no , , , , and Matrix Aesthetic Abutment Titanium, art no

5 Neoss Matrix Abutments Abutments and frameworks may be produced in Zirconia or other options such as gold, titanium, chrome cobalt or they may be CAD/CAM produced while maintaining the accuracy and tolerances obtained from machined components. This is possible due to the NeoLink, which is a precision machined component made of gold or c.p. titanium providing the interface between implant and abutment framework. The preformed plastic anatomical copings provide a complete range of abutments designs for various teeth, emergence profiles, heights and angulations. The Matrix Aesthetic Abutments Titanium, art no are delivered with abutment and laboratory screws, while the Matrix Abutments Gold currently are delivered without screws. Please refer to section below concerning screw availability and compatibility. Neoss Matrix System abutments are available for restoration of a single crown (Mono) or bridgework (Multi): The Neoss NeoLinks are compatible with a range of dental implant systems offered by other manufacturers and suppliers. Some of the compatible dental implant systems are listed below. Nobel Biocare, Brånemark System RP, 3i & generic Ø3.75mm and 4.0mm external hex implants Nobel Biocare, Brånemark System NP 3.5mm Nobel Biocare, Replace /NobelReplace Ø4.3mm Nobel Biocare, Replace /NobelReplace Ø3.5mm Straumann Ø4.8 mm Neoss Matrix Aesthetic Abutments Titanium are supplied as kits comprising: 1 x NeoLink titanium with a low 0.3mm height collar. Set of preformed plastic copings 1 x Abutment Screw 1 x Laboratory Screw Neoss Matrix Abutments Gold are supplied as kits comprising: 1 x NeoLink gold with a 0.7mm height collar Set of preformed plastic copings Replace and Brånemark System are registered trademarks of Nobel Biocare AB. Nobel Biocare and NobelReplace are trademarks of Nobel Biocare AB. Straumann is a registered trademark of Straumann Holding AG. 3i is a registered trademark of Biomet 3i LLC Ltd. 5

6 Neoss Matrix Aesthetic Abutments Titanium Compatible with Nobel Biocare, Brånemark System RP, 3i & generic Ø3.75/4.0mm external hex implants Nobel Biocare, Brånemark System NP Nobel Biocare, Replace / NobelReplace Ø4.3mm Nobel Biocare, Replace / NobelReplace Ø3.5mm Straumann Ø4.8 Matrix Aesthetic Abutment Titanium including screws Hex RP Mono Ti #31171 Hex NP Mono Ti #31173 Replace RP Mono Ti #31175 Replace NP Mono Ti #31177 Straumann Mono Ti #31179 Hex RP Multi Ti #31172 Hex NP Multi Ti #31174 Replace RP Multi Ti #31176 Replace NP Multi Ti #31178 Straumann Multi Ti #31180 Screws Abutment screw Hex RP Gold, 1 pc #31190 Laboratory screw Hex RP, 5 pcs #31195 Abutment screw Hex NP Ti, 1 pc #31189 Laboratory screw Hex NP, 5 pcs #31194 Abutment screw Replace RP Gold, 1 pc #31188 Laboratory screw Replace RP, 5 pcs #31193 Abutment screw Replace NP Ti, 1 pc #31187 Laboratory screw Replace NP, 5 pcs #31192 Abutment screw Straumann ø4,8 Ti, 1 pc #31191 Laboratory screw Straumann ø4,8, 5 pcs # Screws art no are only compatible with Neoss screwdrivers. The Matrix Aesthetic Abutments Titanium, art no are co-packaged with abutment and lab screw (both required to be used with the Neoss screwdriver). The original manufacture s screws can be used with all Matrix Aesthetic Abutments Titanium, art no All Matrix Aesthetic Abutments Titanium can be used with abutment and lab screw art no Replace and Brånemark System are registered trademarks of Nobel Biocare AB. Nobel Biocare and NobelReplace are trademarks of Nobel Biocare AB. Straumann is a registered trademark of Straumann Holding AG. 3i is a registered trademark of Biomet 3i LLC Ltd. 6

7 Neoss Matrix Abutments Gold Compatible with Nobel Biocare, Brånemark System RP, 3i & generic Ø3.75/4.0mm external hex implants Nobel Biocare, Brånemark System NP Nobel Biocare, Replace / NobelReplace Ø4.3mm Nobel Biocare, Replace / NobelReplace Ø3.5mm Matrix Abutment Gold not including screws Hex RP Mono Gold #31106 Hex NP Mono Gold #31126 Replace RP Mono Gold #31110 Replace NP Mono Gold #31118 Hex RP Multi Gold #31107 Hex NP Multi Gold #31127 Replace RP Multi Gold #31111 Replace NP Multi Gold #31119 Screws Abutment screw Hex RP Gold, 1 pc #31190 Laboratory screw Hex RP, 5 pcs #31195 or Original manufacturer s screw Original manufacturer s screw (required) Abutment screw Replace RP Gold, 1 pc #31188 Laboratory screw Replace RP, 5 pcs #31193 or Original manufacturer s screw Abutment screw Replace NP Ti, 1 pc #31187 Laboratory screw Replace NP, 5 pcs #31192 or Original manufacturer s screw Straumann Ø4.8 Straumann Mono Gold #31130 Straumann Multi Gold #31131 Neoss Gold Abutment Screw #31150 (required) Note: Identification of Neoss Abutment screw vs Laboratory screw. Abutment Screw Laboratory Screw (with larger tap) Replace and Brånemark System are registered trademarks of Nobel Biocare AB. Nobel Biocare and NobelReplace are trademarks of Nobel Biocare AB. Straumann is a registered trademark of Straumann Holding AG. 3i is a registered trademark of Biomet 3i LLC Ltd. 7

8 Neoss Matrix Abutments Once the appropriate system implant replica/s have been identified on the master model the corresponding crown (Mono) or bridgework (Multi) NeoLink is selected in either gold or titanium. A custom abutment or framework is produced by combining the most appropriate design of plastic anatomical coping with the desired NeoLink. There are a number of options: 1. CAD/CAM abutments/frameworks cemented or bonded to the NeoLink/s Titanium. Note: Bonding of CAD/CAM designed copings or frameworks may be done prior to or after application of the porcelain/restorative material. This depends on the materials and techniques utilized. 2. Invest and cast directly onto the Gold NeoLink with a suitable alloy. 3. Remove the NeoLink from the waxed coping/framework and cast the anatomical coping/ framework (in a desired alloy) without the NeoLink. After proper finishing of the cast coping/framework bond to the NeoLink/s. Note: The margin on the Matrix Aesthetic abutments is too thin to be used in conjunction with welding a cast coping/framework to the NeoLink. Two types of restorations can be produced; a restoration cemented on to custom abutments or a framework retained directly to the head of the implant fixture by abutment screws. Because the cast abutment or framework can be bonded to the preci sion machined NeoLink a true passive fit can be achieved. Inaccuracies caused in casting or porcelain firing can therefore be eliminated. Generally connection by cementation or bonding is carried out in the laboratory after the application of the restorative material. All metals, alloys and ceramics can be bonded to NeoLinks, including cobalt chromium for example. Note: It is possible to cast gold abutments or framework in the same manner as titanium in that it may be cast separate to the NeoLink. Therefore the possibility exists to have a prosthesis completed in a gold alloy with conventional PFM techniques, then bonded or cemented to a titanium NeoLink this results in a titanium precision machined interface between the implant and the abutment. 8

9 Impression Techniques Generally to construct an accurate prosthesis using the Neoss Matrix Abutments an implant level impression is required. The purpose of an implant level impression is to accurately transfer the position of the implant in relation to natural teeth or other implants as well as the soft tissue contours directly to a labo ratory model. An implant level impression may be made at different stages during treatment and is dependant on operator preferences At time of initial surgery for one stage techniques, or to enable the delivery of a provisional crown at second stage surgery At second stage surgery Following soft tissue healing after a second stage surgical procedure When using Neoss Matrix Abutments please use the specific manufacturer s components and follow their published recommended guidelines for implant level impression techniques. 9

10 Single Unit Construction Individual crowns may be constructed in one of two ways. The selected option will depend on clinical preferences, angulation of the implant and aesthetic demands: As an integral screw retained crown/abutment attached directly to the implant (use NeoLink Mono). As a two part restoration with a custom screw retained abutment and a cement retained or lingually screw retained crown (use NeoLink Mono). Note: When the single unit crown is to be constructed from a ceramic or Zirconia material either CAD/CAM or pressed then it is recommended that the Neoss Matrix Aesthetic Abutment Ti, Mono is used. This NeoLink has a collar height of only 0.3mm. Clinical procedure visit 1 1. An implant level impression is recorded and sent to the laboratory. When taking an impression please use the specific manufacturer s prescribed impression copings and replicas and follow their recommended guidelines for implant level impressions. Laboratory procedure A. Ensure that the implant replica is correctly seated on to the impression coping and pour the model in the usual manner. Once set, remove the impression tray from the working model. 10

11 Single Unit Construction Tip: Soft tissue material may be applied around the impression coping before the model is poured. Another option is to construct the soft tissue model on the master model by injecting soft tissue material into a prepared putty key which has been reseated onto the prepared model. B. Attach the NeoLink to the implant replica on the working model with a laboratory screw. C. Assessing the location, proximity of adjacent teeth and occlusion, select the most appropriate preformed anatomical coping. The coping is pushed firmly onto the NeoLink until it is properly seated (no gap) and rotated to the most desir able position. D. The plastic coping can be modified to provide the optimal emergence profile, contour and occlusal form. This is carried out by selective grinding with a bur (tungsten carbide or diamond), or by addition using an appropriate dental wax or self polymerizing pattern resin. Wax design for a separate screw retained abutment with a cement or lingual screw retained crown. 11

12 Single Unit Construction Wax design for screw retained crown direct to implant. E. The waxed abutment is then scanned and milled, or invested and cast in accordance; CAD/CAM scanning and milling described on page 18. Direct investing casting described on page 20. Indirect investing bonding described on page 21. F. After milling or casting the abutment is trimmed and polished in the usual manner and final construction of the crown is completed. G. The finished crown is returned to the dentist for insertion. 12

13 Single Unit Construction Tip: The clinical insertion of abutments can be simplified by the fabrication of a simple transfer jig from self curing acrylic or pattern resin. This is designed to fit over the abutment and span the adjacent teeth to provide correct orientation. The NeoLink is of very high precision margins should be finished and polished with extreme care. An implant analog/protection analog should be screwed on the abutment to protect the margins. Clinical procedure visit 2: 1. The abutment is screwed into the implant using the appropriate abutment screw as described on page Once the fit has been verified it is tightened to the manufacturers recommended torque, which for the Neoss RP screws is 32 Ncm and for the Neoss NP screws 20 Ncm. 3. If the crown was constructed as a separate unit it is then cemented onto the abutment in the desired manner. Note: When cementing or lingually screw retaining a crown/bridge onto an abutment the screw access hole should be blocked out with an appropriate material (e.g. gutta percha) prior to cementing of the crown. When screw retaining a crown direct to the implant the screw access hole should be filled with a small amount of removable material then overfilled with a permanent material (e.g. composite resin). 4. The occlusion and retention are then checked and verified. 13

14 Multiple Unit Construction Multiple Unit implant supported bridges may be constructed in one of two ways. The selected option will depend on clinical preferences, angulation of the implant/s and aesthetic demands: As an integral screw retained one piece bridge attached directly to the implants (use NeoLink Multi). As a cement retained or lingually screw retained bridge over individual custom abutments which have been screwed directly to the implants (use NeoLink Mono). Note: When the bridge framework is to be constructed from a ceramic or Zirconia material it is recommended that the Neoss Matrix Aesthetic Abutment Ti be used. This NeoLink has a collar height of 0.3mm. When constructing an integral one-piece bridge attached directly to the implants, use Neoss Matrix Aesthetic Abutment Multi Ti. Tip: Spare plastic abutments can be utilized for the pontic area. IMPORTANT NOTE: The NeoLink Multi is used when either the bridge or bridge framework will be connected directly to the implants. Neoss Matrix Abutments the divergence or convergence is dependent on the tolerances of the individual implant system. The laboratory procedure for Neoss System abutments and Neoss Matrix abutments are the same. Clinical procedure visit 1: 1. An implant level impression is recorded and sent to the laboratory. When taking an impression please use the specific manufacturer s prescribed impression copings and replicas and follow their recommended guidelines for implant level impressions. 14

15 Multiple Unit Construction Laboratory Procedure A. Ensure the implant replicas are correctly seated on to the impression copings and pour the model in the usual manner. Once set remove the impression tray from the working model. Tip: Soft tissue material may be applied around the impression coping before the model is poured. Another option is to construct the soft tissue model on the master model by injecting soft tissue material into a prepared putty key which has been reseated onto the prepared model. B. Attach the NeoLinks to the implant replicas on the working model with labora tory screws. C. Select the most appropriate preformed anatomical coping. The copings are pushed firmly onto the NeoLinks until they are properly seated (no gap) and rotated to the most desirable position. D. The plastic copings can be modified to provide the optimal emergence profile, contour and occlusal form. This is accomplished by selective grinding with a bur (tungsten carbide or diamond) or by addition using an appropriate dental wax or self polymerizing pattern resin. Wax design for a separate screw retained abutment with a cement or lingual screw retained bridge. 15

16 Multiple Unit Construction Wax design for screw retained bridge direct to implant. E. The waxed abutment is then scanned and milled or waxed and cast following either; CAD/CAM scanning described on page 18. Direct investing casting described on page 20. Indirect investing bonding described on page 21. F. After milling or casting the framework is trimmed and polished in the usual manner and final construction of the bridge is completed. Note: If the design of the prosthesis is for a multiple unit framework then it may be returned to the dentist prior to completion for a metal try-in if desired. 16

17 Multiple Unit Construction Tip: The clinical insertion of abutments can be simplified by the fabrication of a simple transfer jig made from self curing acrylic or pattern resin. The jig should be designed to fit over the abutments and/or span the adjacent teeth to provide correct positioning. A jig is not required when the abutments are cast into a multiple unit framework. The NeoLink is of very high precision margins should be finished and polished with extreme care. An implant analog should be screwed on the abutment to protect the margins. Clinical Procedure visit 2: 1. The abutments or framework are screwed into the patient s mouth using the appropriate abutment screws as described on pages Once the fit has been verified it is tightened to the manufacturer s recommended torque. For Neoss RP screws 32 Ncm and for the Neoss NP screws 20 Ncm. 3. If the bridge is constructed as a separate unit it is then cemented or linguallly screwed onto the abutments/framework in the desired manner Note: When cementing or lingually screw retaining a bridge onto an abutment the screw access hole should be blocked out with appropriate material (e.g. gutta percha) prior to cementation of the bridge. When screw retaining a bridge directly to the implant the screw access hole should be filled with a small amount of removable material then overfilled with a permanent material (e.g. composite resin). 4. The occlusion and retention are checked and verified 17

18 CAD/CAM Solutions For CAD/CAM abutments/framework: scan the abutment/framework according to the specific CAD/CAM system requirements. It is possible to produce abutments/framework with all major CAD/CAM systems. For further information contact your local Neoss representative. For CAD/CAM systems providing double scan features we recommend the following procedure to ensure that the screw access hole is correctly read and scanned by the scanner, and to ensure that it is pre-prepared into the abutment/framework: 1. After final waxing/preparation of the abutment/framework on the model, insert an extension from the NeoLink to the outer surface of the screw access hole in the pre-formed plastic coping. Round plastic tube/rod of 2.5 mm diameter may be used (alternatively use the impression coping screw) This extension tube is trimmed level to (or minimally above)the screw access hole in the preformed plastic coping. Spray with scanning powder/paint if recommended by the CAD/CAM provider. Remove waxed abutment from the NeoLink being careful to leave the extension tube in correct position. Spray exposed extension tube and NeoLink with scanning powder/paint if recommended. Note: For increased rotational stability in single tooth case, it is possible to adjust the NeoLink by creating a flat side of the NeoLink cylinder prior to scanning. 6. Scan the NeoLink with the extension tube as the FIRST scan in the scanner. 7. Place the waxed abutment onto the NeoLink and do the SECOND scan - following the specific CAD/CAM manufacturer s manual for Double scanning techniques. This process will create a thin shell of material (ceramic, metal) over the screw access hole, which is easily removed prior to sintering, or after sintering by careful grinding for a ceramic restoration. 18

19 CAD/CAM Solutions 8. When a milled and sintered coping has been created it is then cemented on the NeoLink by: A. B. Sandblasting the NeoLink with Aluminum Oxide of microns do not sandblast fitting surface of NeoLink, use replica to protect the fitting surface. Apply a metal primer to the NeoLink. C. Bonding the milled coping onto the NeoLink with a preferred cement according to the cement manufacturer s recommendations. An opaque cement is optimal. Please refer to the cement recommended by the CAD/CAM-provider. 19

20 Direct Investing Casting The prepared coping attached to the NeoLink is removed intact from the model by first removing the laboratory screw. The NeoLink remains in situ. Note: Gold NeoLinks are fabricated from a non-oxidizing gold alloy suitable for direct casting. The abutment/framework is then invested using an appro priate investment material and cast. Tip: As the gold NeoLink is made of non-oxidizing alloy, ensure the design allows for 0.2mm of new alloy at the interface to avoid porcelain cracks. Hint: During investing do not use solvent based wetting agents that can damage the surface of the plastic copings. It is also recommended that wetting agents are not applied to the Gold NeoLink. The specific manufacturer s guidelines in relation to investing, burnout times, temperatures, melting, and casting should be adhered too. Following casting and cooling the investment is gently removed with an ultrasonic cleaner, water jet or acid pickling NOT sandblasting. 20

21 Indirect Investing Framework Bonding It is necessary to bond directly to the titanium NeoLink, as it is not possible to cast a number of alloys and metals, including c.p. titanium The completed custom abutment or framework is removed from the model with the NeoLinks in situ. The NeoLinks are carefully removed from the prepared framework. It is then invested in the appropriate investment and cast in conventional dental laboratory techniques for casting titanium or other conventional non-precious alloys. Tip: During investing do not use solvent based wetting agents that can damage the surface of the plastic copings. The specific manufacturer s guidelines in relation to investing, burnout times, temperatures, melting and casting should be adhered to. When the abutment or framework has been cast the NeoLinks are relocated in the framework and reseated on the master model. Please refer to note below for details. There are a number of cements and bonding materials suitable for this technique. The manufacturer s recommendations should be adhered to. Note: In order for the NeoLink to be easily reseated into the cast abutment/framework some adjustments may be required, the following options are recommended: BONDING to maintain maximum surface area it is recommended that careful/selective grinding be done inside the cast abutment/framework. BEFORE cementing or bonding, the NeoLink must be blasted with micron particles in order for the cast abutment/framework to achieve appropriate retention to the NeoLink. IT IS IMPORTANT TO protect the margins and the seating surface of the NeoLink by attaching an implant analog to the abutment BEFORE BLASTING. Note: Laser welding of the Matrix Aesthetic abutments are not recommended since the low collar height, 0.3 mm, might impare the welding result. Tip: To reduce the possibility of the framework discoloring. do not steam clean the framework for at least 20 mins after polishing. The NeoLink is of very high precision margins should be finished and polished with extreme care. An implant analog should be screwed on the abutment to protect the margins. 21

22 Technical Data Technical data Gold All NeoLinks for cast gold abutment or frameworks are fabricated from a non-oxidizing highfusing gold alloy, therefore porcelain cannot be bonded directly to it. When casting onto the NeoLink/s ensure that the casting or bonding alloy is compatible. High gold content ISO 9693 (metal ceramic) NIOM Type A and ISO 1562 (dental gold casting alloy), Type 4 are suitable. The melting range of the casting alloy must not distort or melt the NeoLink less than 1250 C is recommended. Casting alloys should exhibit a proof stress of Rp0.2>500N/mm 2 according to ISO Composition Au 60%, Pt 24%, Pd 15%, Ir 1% Colour Melting Range White C ( F) Hardness HV5 200±20 CTE 500 C 12.5 μm/m.k 600 C 12.6 μm/m.k 22

23 Technical Data Technical Data Titanium All Titanium NeoLinks are made from Commercially Pure Titanium Grade 4 5 (alloy). Physical Data Typical 4 Typical 5 Melting Range C+/-15 C ( F) 1668 (3034) 1668 (3034) Thermal Exp. Coeff. ( C) K x x 10 6 Beta Transus C+/-15 C( F) 960 (1760) 980 (1796) 23

24 Australia Neoss Australia Pty. Ltd PO Box 404 NEW FARM QLD 4005 T F E info.au@neoss.com Austria Neoss GmbH E info@neossimplant.de T F Germany Neoss GmbH Im MediaPark 8 D Köln T F E info@neossimplant.de Italy Neoss Italia S.r.l. Via Marco Antonio Colonna, 42 I Milano T (centralino) F E italia@neoss.info New Zealand Neoss Australia Pty. Ltd PO Box 404 NEW FARM QLD 4005 T F E info.au@neoss.com Sweden Neoss AB Mölnlycke Fabriker 3 S Mölnlycke T F E info@neoss.se United Kingdom Neoss Ltd. Windsor House Cornwall road Harrogate, HG1 2PW T F E info@neoss.com United States Neoss Inc Burbank Blvd., Ste. 220 Woodland Hills, CA toll free T F E contact.usa@neoss.com Replace and Brånemark System are registered trademarks of Nobel Biocare AB. Nobel Biocare and NobelReplace are trademarks of Nobel Biocare AB. Straumann is a registered trademark of Straumann Holding AG. 3i is a registered trademark of Biomet 3i LLC Ltd UK Printed in the UK Neoss Limited, Copyrights, design rights and trademarks in this document are Neoss documents, software and designs, if it is not stated to the contrary. These may not be reprinted, copied, or published in whole or in part, without the written authorisation of Neoss Limited.