Professional Documents
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Spi Vario Spi Retain Prosthetic Procedure en
Spi Vario Spi Retain Prosthetic Procedure en
Spi Vario Spi Retain Prosthetic Procedure en
Prosthetic procedure
Notes
EXPLANATION OF SYMBOLS Batch code Use by date Date of manufacture Sterilized using irradiation Upper limit of temperature Do not re-use Non-sterile
RESPONSIBILITY/LIABILITY As part of an overall scheme, Thommen implants may be used only with the ori ginal components and instruments in accordance with the manufacturers instructions. The use of unapproved components from other systems can cause malfunctioning of the implants and abutments and lead to implant failure. The use of the product is the responsibility of the user and, as such, beyond the control of Thommen Medical AG. We refuse to accept any responsibility or liability for any damage due to incorrect utilization of the product. Products labeled For Single-Use Only may not be refurbished and/or reused. The refurbishment and/or reuse of these products can affect its function (tting and/or cutting properties) as well as its safe use (risk of infection, fading of the laser or color marks, corrosion). Detailed information about the possible consequences, which may result from negligence to follow this information, is avail able from your dealer. GUarantee oF Sterility oF sterile proDUCts Products of the Thommen
Caution Catalogue number Consult instructions for use Do not resterilize Do not use if package is d amaged Atmospheric pressure limitation Manufacturer
Implant System supplied in sterile packaging must not be resterilized. If the sterile packaging is damaged during transport or storage, the product must not be used. Products that have been opened and have not been immediately used for the intended operation must not be used thereafter. After resterilization, the safety, function and efcacy of the product cannot be guaranteed by the man ufacturer. STORAGE Plastic parts must be stored at room temperature and protected from exposure to strong light or high heat. INSTRUCTIONS FOR USE The following information is not intended as comprehensive for the Thommen Implant System. New customers are advised to undergo training by a specialist experienced in the use of this system. VALIDITY This product catalogue replaces all previous editions.
COLOR CODE Each implant platform diameter has a color code, which can be found on all implant packs (with the exception of SPI DIRECT), on the impression items and on most diameter-specific instruments. Yellow = platform B 3.5 mm
ProDUCt DoCUMentation You can nd detailed information on the handling of Thommen implants in our brochures. Ask our national representatives for product brochures and instructions for use. AVAILABILITY NOTE Not all products shown in this brochure are available in all countries. For further information please contact our subsidiary or distributor in your country. CopyrigHt/RegistereD SPI, INICELL and APLIQUIQ are registered
trademarks of Thommen Medical AG. Publication or reproduction is permitted only with the written consent of Thommen Medical AG. COLORED WARNING STICKER
= platform B 5.0 mm
Violet = platform B 6.0 mm New design the application has not been changed.
Contents
Thommen prosthetics Impression at implant level Impression SPI DIRECT SPI SELECTION for case planning SPI TEMPORARY for temporary restorations SPI VARIO for occlusal screw-retained restorations SPI VARIO T for transversal screw-retained single crowns SPI RETAIN for hybrid dentures Abutment screws SPI MONO torque ratchet Care, maintenance, sterilization Product overview General instruments Torque values
4 6 10
12
15
18
24
28 35 37 40 42 46 47
Other prosthetic systems, including SPIVARIOmulti, SPIEASY, SPIART and ZEST LOCATOR, are covered in separate brochures that are available upon request.
Thommen Medical
Thommen prosthetics
The comprehensive range of Thommen prosthetics affords maximum exibility and ease in the fabrication of cemented and screw-retained restorations, and hybrid dentures. This manual describes prosthetic procedures for SPIVARIO, SPIVARIO T, and SPIRETAIN.
Thommen implants
The minimal height allows for versatile use in restricted spaces. The plastic cylinder is easy to shorten to the desired height which guarantees precise, simple, and rapid pattern fabrication. Custom-made abutments for cemented restorations can be fabricated as well. VARIO gold abutments are available with a hexagon connection for single crowns and a cone connection forbridges.
SPIDIRECT
DIRECT implants have an integrated abutment for a one-stage surgical approach. These implants are designed exclusively for bar constructions intended for immediate loading. Thanks to the one-stage procedure and immediate loading being possible, treatment time and stress experienced by the patient are minimized.
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The transversal lingual screw allows a conditionally remov able solution, even in the region of the anterior teeth, with no esthetic compromise. The prefabricated gold blank for direct ceramic application ensures precision at the margins and saves time since no metal has to be cast.
The RETAIN product range provides the ideal solution for the edentulous jaw from reasonably priced retentive anchors and bar constructions to individually milled abutments.
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Select the appropriate retentive impression coping: The conical impression copings closely mimic the emergence prole of the EASY abutments, while the cylindrical impression copings are suitable for cases with minimal mesial-distal space. Retentive impression copings are available in 10mm and 16mm lengths. Place the retentive impression coping in the internal connection of the implant. Where occlusal space is limited, the retentive impression coping can be shortened accordingly. At least 1 retention ring must be maintained. In particular where the space is limited by the adjacent teeth, the following instruments may simplify the insertion of the impression coping in the internal connection of the implant: Art. no. 3.03.522, positioning handle Art. no. 3.03.550, crown holder Art. no. 3.03.527, tweezers
Secure the impression coping using the appropriate impression screw (see table page 42). If the impression coping was shortened, the suitable length of impression screw is determined by the impression tray height and/or the available occlusal space. Caution Any rough or sharp edges produced by shortening the impression coping must be removed with a suitable grinding/polishing tool.
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Modify an impression tray (rigid or custom) to allow access to the impression screw. Make the impression using an elastomer impression material (polyvinylsiloxane or polyether rubber). Hydrocolloid and alginate are not suitable for this procedure.
Once the impression material is completely set, remove the impression screw from the implant and take out the impression. The impression coping remains in the impression material. Include the impression screw when sending the impression assembly to the dental technician for fabrication of the master cast in the laboratory.
Master cast fabrication Determine the platform diameter as indicated by the color coding. Place an implant level analog on the impression coping. Hold the analog rmly in position to prevent the impression coping from turning while tightening the impression screw.
Fabricate the master cast. Type 4 (improved dental stone) is recommended for master cast fabrication.
Note A gingival mask may simplify pattern fabrication and improve emergence prole. Impression copings made of titanium are designed for multiple use. However, they need to be replaced if: damage or signs of wear are evident in or on the connection geometry the color of the impression coping is no longer easily identiable due to repeated maintenance cycles
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Select the short or long repositionable impression coping according to available occlusal space and soft tissue height. The conical impression copings closely mimic the emergence prole of the EASY abutments. Place the repositionable impression coping in the internal connection of the implant. In particular where the space is limited by the adjacent teeth, the following instruments may simplify the insertion of the impression coping in the internal connection of the implant: Art. no. 3.03.522, positioning handle Art. no. 3.03.550, crown holder Art. no. 3.03.527, tweezers
Secure the impression coping using the appropriate impression screw (see table page 42). The protruding screw head prevents the impression material from owing into the screw channel of the impression coping.
A custom-made tray is recommended for use with the repositionable impression coping. Make the impression using an elastomer impression material (polyvinylsiloxane or polyether rubber). Hydrocolloid and alginate are not suitable for this procedure.
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Master cast fabrication Carefully remove the impression from the impression copings which will remain on the implants. Thereafter remove the impression screws and copings from the implants. The repositionable impression coping must be submitted to the dental technician for fabrication of the master cast in the laboratory.
Replace the impression screw with the corresponding abutment screw (art. no. 4.03.500 for PF B3.5mm and art. no. 4.03.501 for PFB4.06.0mm) and secure the analog to the repositionable impression coping.
Position this unit in the impression again, taking care to align the impression coping correctly. Fabricate the master cast. Type 4 (improved dental stone) is recommended for master cast fabrication.
The short height of the abutment screw eliminates any possible interference that could occur with the taller impression screw. This technique ensures accurate repositioning of the impression coping in the impression.
Note A gingival mask may simplify pattern fabrication and improve emergence prole.
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The DIRECT removal screw or closure screw must be removed from the implant before taking an impression. Thoroughly clean and dry the internal conguration.
Place the impression coping for bar directly on the cone of the DIRECT implant using the 4-lobe screwdriver. Apply some occlusal pressure to the impression coping to keep the integrated holding pin in place.
Make the impression using an elastomer impression material (polyvinylsiloxane or polyether rubber). Hydrocolloid and alginate are not suitable for this procedure. The impression coping will remain in the impression throughout the procedure.
Carefully position the DIRECT analog into the impression coping with a gentle twist. Check to ensure complete seating and stability of the analog and fabricate the master cast.
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Carefully pour the impression in type 4 (improved dental stone). Use caution not to dislodge the analogs during the procedure.
Note Fabricate the bar on the DIRECT analogs in accordance with the case plan and instructions regarding RETAIN bar abutments (see page 28 and subsequent pages).
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SPI SELECTION
for case planning
The SELECTION abutments from the Thommen Implant System are a convenient tool for case planning and abutment selection in the clinical and laboratory setting. A series of SELECTION abutments may be placed on the implants or analogs to choose the optimal gingiva collar and cone height from the available abutment range, and to observe other spatial aspects. The SELECTION abutments have an integrated retention pin that secures the SELECTION abutment on the implant or analog without requiring the use of a screw.
Advantages at a glance
Fast and accurate verification of the appropriate abutment
type and size for each case
Snap-in retention for quick placement and removal Suitable for both intraoral and laboratory use Color coded for quick and easy identification
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Simple identication All SELECTION abutments have an S before the article number, which stands for SELECTION. The article number after the S corresponds to the article number of the actual abutment which simplies the ordering of the abutment needed.
Example Bar Selection abutment Bar abutment Art. no. S.4.03.388 Art. no. 4.03.388
The VARIO Selection abutments are available only in the cone connection version for bridges. They can be used equally well for the design of bridges and single crowns. The lower edge of the circular undercut on the VARIO Selection abutment indicates both the junction between gold abutment and plastic cylinder and the minimal construction height. The VARIO Selection abutments indicate both the article number of the VARIO abutment for bridges and the article number of the VARIO abutment for crowns.
The VARIO T Selection crown is a replica of the assembly consisting of a VARIOT gold blank and a VARIO T abutment. The lower edge of the circular undercut on the VARIO T Selection abutment indicates the minimal construction height. The S article number given refers to the VARIO T gold blank only. The VARIO T abutment must be ordered separately. VARIO T gold blank PF B 3.5 mm PF B 4.5/5.0/6.0 mm Suitable VARIO T abutment VARIO T abutment for single tooth, art. no. 4.03.370 VARIO T abutment for single tooth, art. no. 4.03.371
Note The SELECTION abutments can be handled and placed using one of the following instruments: Art. no. 3.03.522, positioning handle Art. no. 3.03.550, crown holder Art. no. 3.03.527, tweezers
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Information regarding the use of SPISeleCtion abutments SELECTION abutments must not be waxed-up, because the dimensional tolerances of these components differ from those of actual abutments. SELECTION abutments are intended for case planning purposes only. They may be used in the mouth of the patient only after wound healing is completed and only momentarily.
Cleaning of SELECTION abutments: SELECTION abutments must be cleaned thoroughly immediately after intraoral use. It is particularly important to clean the abutment channel. The SELECTION abutments must be disinfected with disinfection agent and ster ilized in an autoclave. If the abutment channel appears heavily contami nated, the retention pin should be removed to allow proper cleaning and replaced with a new one.
All SELECTION abutments are pretted with retention pins made of the plas tic material, PPSU, which can be subjected to sterilization. This design ensures xation of the SELECTION abutments on the implant or the analog with out a retaining screw. The retention pin has the 4-lobe design. This makes it possible to pick up and insert the SELECTION abutment using the corresponding screwdrivers.
Retention pins are available as spare parts for PF B3.5mm (art.no. 2.03.800Q4) and for PF B4.06.0mm (art.no. 2.03.801Q4).
A
The convenient organizer box (art.no. 8.03.021) can be used for storage of all SELECTION abutments in a clearly arranged fashion.
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SPITEMPORARY
for temporary restorations
TEMPORARY abutments may be used for provisional restorations until the nal restorations are ready for placement. These can also be used as the basis for customized soft-tissue conditioning.
Advantages at a glance
Temporary restorations can be fabricated intraorally,
or in the laboratory
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Indications Abutments for temporary crowns (with hexagon connection) are for use with single teeth only. They cannot compensate for axial divergences. Abutments for temporary bridges (with cone connection) are for use with bridges or splinted constructions only. Axial divergences of up to 30 can be bridged.
Processing instructions for manufacture of the superstructure In-mouth fabrication Secure the selected temporary abutment on the implant using an abutment screw. If the height of the abutment prevents maximal intercuspidation, reduce the cylindrical part, i.e. the screw channel. The opposing tooth must be kept from being in occlusal contact with the abutment. The temporary abutment may be fabricated using the impression, a vacuumformed matrix or a prefabricated crown form. Seal the occlusal screw channel opening with wax to prevent liquid plastic material from owing into the screw channel. Alternatively, and if occlusal space permits, the abutment screw may be replaced with the fabrication screw (lightly coated with Vaseline) before the liquid veneer material is applied and cured. This method will also keep the screw channel open. Remove the temporary abutment from the mouth after polymerization is complete. Fill any remaining voids, rene contours, smooth and polish.
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Laboratory fabrication Secure the temporary abutment on the analog using an abutment screw. If the height of the abutment prevents maximal intercuspidation, reduce the cylindrical part, i.e. the screw channel. The opposing tooth must be kept from being in occlusal contact with the abutment. For esthetic reasons, it is preferable to fabricate the temporary restoration using prefabricated plastic denture teeth. A matrix should be fabricated using plaster or silicone. Replace the abutment screw (art. no. 4.03.500 for PF B 3.5 mm, art. no. 4.03.501 for PF B4.06.0mm) with the supplied fabrication screw. The screw must only be tightened lightly by hand using a maximum tightening torque of 5 Ncm. The screw serves as temporary ll-in while the plastic veneering material is being processed and ensures that the screw channel remains open. Lightly coat this screw with Vaseline before polymerization.
The fabrication screw supplied is made of black anodized aluminum and designed exclusively for single use as a modeling aid. It must not be used for permanent insertion of the temporary restoration in the mouth of the patient. The abutment screw used in the laboratory must not be used for denitive insertion of the temporary restoration in the mouth. The serviceable life of the temporary abutment in the mouth of the patient is one year due to its limited mechanical long-term stability. In order to reduce the forces acting on the abutment, the nished temporary restoration must be out of occlusion. Only new abutment screws (art. no. 4.03.500 for PF B 3.5 mm, art.no. 4.03.501 for PF B 4.06.0 mm) may be used for nal placement of the temporary restoration. Use a torque value of 15 Ncm (PF B 3.5 mm) or 25 Ncm (PF B 4.06.0mm) to tighten the abutment screw.
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SPI VARIO
for occlusal screw-retained restorations
VARIO gold abutments are used to fabricate occlusal screw-retained olutions. Restorative options include single crowns, custom abutments s and multiunit bridge restorations. They consist of a nonoxidizing cast-on alloy base and a plastic cylinder that forms the screw channel. The plastic cylinder will be incorporated into the pattern and leave no residues after burn-out.
Advantages at a glance
Minimal height creates restorative options even if the available occlusal space is limited
Easy shortening of the plastic cylinder to the desired height Option of fabricating custom-made abutments Prefabricated connection geometry and screw seat made
of (nonoxidizing) high gold content alloy
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Indications VARIO gold abutments for crowns (with hexagon connection) are for use with single tooth reconstructions and custom abutments. They are not suitable for bridges because axial divergences cannot be compensated. VARIO gold abutments for bridges (with cone connection) are for use with bridges and splinted constructions. Axial divergences of up to 30 can be bridged.
Processing instructions for fabrication of the superstructure Place the VARIO gold abutments on the analogs and secure them using the matching abutment screws.
Shorten the height of the plastic cylinder such that maximum intercuspidation is possible. Avoid any occlusal contact between the plastic cylinder and the opposing tooth.
The minimum construction height of VARIO gold abutments for bridges and for crowns is 2.5 mm.
2.5 mm
Material specication VARIO gold abutments Nonoxidizing precious metal cast-on alloy Melting interval 14001460C WAK 25600C 12.8 m/mk Gold Platinum Palladium Iridium 60% 24% 15% 1%
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Initiate pattern fabrication with wax modeling. If ceramic veneer is to be pplied to the framework, a minimum thickness of 0.3 mm of casting alloy a must remain over the VARIO gold abutment after framework nishing. It is advisable to allow additional wax thickness for casting and nishing. Please refer to the information provided by the alloy manufacturer for additional technical information. Since the VARIO gold abutment does not form an adhesive oxide layer, the ceramic veneer must not come in contact with the VARIO gold coping. Porcelain that directly contacts the VARIO gold coping will result in bonding problems. In order to prevent casting errors and casting ash, the 0.5 mm collar of the VARIO gold coping must not be covered in wax. The 0.5 mm collar and all machined surfaces of the gold abutment must be scrupulously clean before investing.
The nished pattern should be sprued in preparation for investing. onventional and indirect spruing techniques that place the pattern above C the thermal zone will facilitate proper mold ll and alloy solidication. Do not use any wax surfactant.
A phosphate bonded investment material is recommended. Please refer to the instructions of the manufacturer of the investment material.
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After casting, allow the casting ring to cool slowly to room temperature. Carefully devest the framework using suitable means, e.g. ultrasound, a water jet, pickling solution or a glass ber brush. Connection geometry and screw channel must not be sandblasted under any circumstances. Modication of the precision connection will jeopardize the long-term success of both the prosthetic solution and the implants.
The screw seat must not be reworked under any circumstances. The seat of the abutment screw would thus be shifted deeper into the internal con guration and the mechanical stability of the abutment would no longer be guaranteed.
If minor casting ash is detected on the machined mating surface of the base, this surface can be smoothed-off using the corresponding VARIO reamers for base, preferably under a microscope. If any casting errors or other forms of damage are detected, in particular related to the screw seat or connection geometry, the work must be redone. Special care must be taken when polishing the VARIO collar. In order to reduce the risk of damaging the collar, an analog should be secured to protect the connection geometry.
The minimal wall thickness of the cast-on fuse-on alloy must be no less than 0.3 mm after the nishing of the cast superstructure. Exposed sites of the VARIO gold abutment may lead to ssures in the ceramic veneer. New abutment screws must be used for permanent insertion of the restoration in the mouth. Always follow the recommended torque values of 15 Ncm in the case of Thommen implants PF B 3.5 mm and 25 Ncm in the case of PF B 4.06.0 mm.
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Clinical case The VARIO gold abutment for crowns can also be used for fabricating a custom- made abutment as base for cemented restorations.
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Case images used with kind permission of Cesare Ferri, dental technician, Rome, Italy.
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SPI VARIO T
for transversal screw-retained single crowns
Ceramic-veneered single crowns can be made with VARIO T in a time- saving and highly accurate fashion. VARIO T consists of an abutment with a hexagon connection and a gold alloy blank that accepts direct ceramic application. The prefabricated components ensure a precise t at the margin and no esthetic compromises.
Advantages at a glance
Removable restoration (conditionally)
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Processing instructions for fabrication of the superstructure For a VARIO T restoration, the implant hexagon is placed such that the transversal screw access hole is directed towards lingual/palatinal.
VARIO T
Secure the VARIO T abutment on the analog using the abutment screw. Secure the VARIO T gold blank on the abutment using the transversal screw.
It is recommended to indicate the location of the VARIO T transversal screw access hole on the master cast.
In order to protect the connection geometry during the grinding of the ARIO T gold blank, the gold blank must be secured to the VARIO T abutV ment on the analog. The gingival edge of the VARIO T gold blank must not be shortened. A ne gold margin of at least 0.3 mm should remain. The horizontal laser mark (A) on the gold blank indicates the minimum occlusal height. The vertical mark (B) on the transversal screw channel is ush with the screw head. Do not grind this area beyond the depth of the laser mark. The site where the transversal screw contacts the inner surface of the gold blank is indicated by the labial ring (C) and must not be subjected to grinding. Proper framework design will ensure a strong veneer layer.
A C
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Contour the VARIO T gold blank (by grinding) to the proper dimensions for proper porcelain support. Check the processed VARIOT gold blank by means of silicone matrix formed by a full contour wax-up. Maintain adequate thickness of the blank paying careful attention to the critical areas indicated by the laser markings. Overreduction (preparation) will need to be corrected by soldering.
Veneer the VARIO T gold blank in accordance with the instructions of the manufacturer of the ceramic material. For application of the ceramic material, it is recommended to secure the VARIO T gold blank to the VARIO T abutment. This is made easier by the VARIO T lab pin (D) since the transversal screw does not need to be tightened and removed repeatedly. In addition, the thread is thus protected from unnecessary wear and tear. To prevent contamination of the applied ceramic material, it is recommended to transport the crown to the ring tray using the VARIO T crown holder.
Any oxide and ceramic residues remaining on the base or the outer margin of the connection geometry after ring can be removed using the platform-specic VARIO T reamer.
Special care is required during the polishing of the outer edge. To reduce the risk of damaging the edges, an analog should be secured in order to protect the precision of the connection geometry.
Material specication VARIO T gold blank Fuse-on alloy with a high gold content Melting interval 11001210C WAK 25500C 14.3 m/mk
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Permanent insertion of the restoration Remove the abutment from the master cast, clean thoroughly and place them on the implant in the correct orientation. A new abutment screw must be used for permanent insertion of the VARIOT abutment and tightened using a tightening torque of 15 Ncm for Thommen implants of PF B 3.5 mm and 25 Ncm for PF B 4.56.0 mm. A new VARIO T transversal screw must be used for permanent insertion of the crown. The tightening torque for the VARIO T transversal screws is 10 Ncm.
Case images used with kind permission of Dr. Markus Jungo, private practice, Rheinfelden, Switzerland, and Dental-Labor Fischler AG, Mhlin,Switzerland.
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SPIRETAIN
for hybrid dentures
Offering options for retentive anchors, bar constructions and milling abutments, the RETAIN product range offers ideal solutions for the edentulous jaw.
Advantages at a glance
Retentive anchor abutments available in two heights
Bar abutments with a choice of titanium and gold copings
The ZEST LOCATOR System is also suitable for hybrid denture restorations and is documented in a separate brochure (Fo_02d111).
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Retentive anchor
The purpose of the retentive anchor abutment is to stabilize and retain the denture in the mouth of the patient using as few anchoring elements as possible. Optimization of the denture seating depends mainly on the quality and quantity of the hard and soft tissue at the alveolar ridges. Retentive anchor abutments are available in two heights (short: 1.8 mm; and long: 3.0 mm) and have a spherical diameter of 2.25 mm. They are compat ible with all matrices having the same geometry (e.g. DallaBona, Supra snap, Tima, Ecco etc.; please comply with the processing instructions of the matrix manufacturers). Matrices with a lamellar geometry are preferable to those using annular springs, since the male parts are subject to signicantly less wear.
Indications The edentulous lower jaw (interforaminal) requires two retentive anchor abutments The edentulous upper jaw requires two or more retentive anchor abutments Mandibular arches forming an acute angle
Contraindications Combined reconstructions on teeth/implants Combination with construction elements with different degrees of freedom Implants that have not been placed perpendicular to the occlusal plane and are not parallel Implants that are unfavorably distributed over the mandibular arch and prevent a tangential rotation axis Unilateral dentures without transversal support Unfavorable alveolar ridge status (e.g. bone decits, jaw defects, etc.)
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Processing instructions for fabrication of the superstructure In a case of an edentulous lower jaw, insert retentive anchor abutments on two implants that were placed interforaminally. The implants should be parallel and perpendicular to the plane of occlusion for long-term trouble-free function of the retentive anchors. There must be a tangential rotation axis. Secure the retentive anchors in the implants at a tightening torque of 25Ncm using the MONO torque ratchet and MONO insertion device (art. no. 3.03.169). Use a custom-made tray without impression coping to take the impression.
Place the analog for retentive anchor in the spherical prole of the impression and pour-up the master cast.
The matrices for the retentive anchors are t into the existing prosthesis in accordance with normal guidelines. Cast metal reinforcements are recommended in fabrication of hybrid dentures.
Note The hybrid denture must be relined at regular intervals in order to ensure req uisite soft-tissue support and prevent excessive load acting on the implants.
Case images used with kind permission of Dr. Guglielmo Santoro, Rome, Italy, and Cesare Ferri, dental technician, Rome, Italy.
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Both DIRECT implants with their integrated bar abutments and all other Thommen implants in combination with bar abutments are suitable for use with bar-supported denture fabrications. Assuming all other clinical requirements are met, immediate loading is possible when using a bar construction because it acts as a splint to stabilize the implants.
Indications The edentulous lower jaw with four Thommen implants The edentulous upper jaw with six Thommen implants
Processing instructions for fabrication of the superstructure If Thommen implants other than DIRECT are used, secure the correspond ing bar abutments to the analogs using the abutment screw.
Secure the gold copings or titanium copings using the occlusal screw for bar.
Fit the individual bar segments in the gaps using a paralleling instrument. To achieve good joining results in the soldering step, the gap between bar segment and bar coping should be as narrow as possible. Maintain a distance of at least 2.0 mm between bar and gingiva. Minimal construction height of bar solutions is shown in the image to the right.
DIRECT Bar abutment 8.8 mm 7.3 mm
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Soldering The bar can be soldered or laser welded. Soldering pins for bar can be used to improve the xation and anchoring of the gold copings in the soldering block. Occlusal screws that are exposed to heat must not be used for permanent insertion of the bar. The bar abutments must not be exposed to heat.
Fabricate dentures and process existing dentures in accordance with the structural, esthetic and phonetic requirements. It is recommended to construct hybrid dentures with a cast metal reinforcement processed into the plastic material.
Permanent insertion of the bar Loosen and remove the occlusal screws and bar from the master cast. Remove the bar abutments from the analog/master cast (exception: DIRECT), clean thoroughly, and then position them on the clean implant. The correct seating of the bar must be checked for t prior to the nal tightening of the screws (Shefeld test). In the permanent insertion of the superstructure in the mouth, use new abutment screws to secure the bar abutments and tighten these screws using a tightening torque of 15 Ncm for Thommen implants PF B 3.5 mm and 25Ncm for PF B 4.05.0 mm. Then permanently x the bar using new occlusal screws for bar, complying with the recommended using a tightening torque of 15 Ncm.
905955C
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Milling abutment
The milling abutment is made of titanium, can be custom-modied, and affords the dental technician optimal exibility in abutment design.
Indications Cone and telescopic constructions Custom-milled abutment for cemented solutions
Processing instructions for fabrication of the superstructure Following the fabrication of the master cast, secure the selected milling abutments to the analog using the abutment screw. A separate cast is recommended for the milling process. The connection geometry of the milling abutment must not be damaged. In the case of a conical or telescopic crown restoration, the milling abutment should be prepared so that the crown margins will be supragingival in order to prevent irritation of the mucosa. When using the milling abutment as a custom abutment for a cemented restoration, it should be prepared such that the cement margin for the crown is subgingival to achieve proper esthetics. In all cases, the grinding limit for the milling abutment is 0.5mm from the bottom edge.
If applicable, the milling abutment can be shortened to the minimal height of 2.3 mm (PFB4.06.0 mm) or 1.9 mm (PF B 3.5 mm). Manufacture the denture in accordance with the structural, aesthetic and phonetic requirements of the individual case. Cast metal reinforcements are recommended in fabrication of hybrid dentures.
1.9 mm 2.3 mm
Permanent insertion of the superstructure An index made from self-curing resin is recommended for abutment transfer. This ensures accurate transfer from the working cast to the patient. Remove the milling abutments from the master cast, clean thoroughly and place them in the transfer index. If an index is not available, be sure to maintain the same orientation during transfer. For permanent insertion of the superstructure in the mouth, use new abutment screws and tighten these screws using a tightening torque of 15 Ncm for Thommen implants PF B 3.5 mm and 25 Ncm for PF B 4.06.0 mm.
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Clinical case The milling abutment can also be used for the manufacture of a custommade abutment as base for cemented restorations.
Case images used with kind permission of Cesare Ferri, dental technician, Rome, Italy.
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Abutment screws
All screws of the Thommen Implant System have a unique 4-lobe screw head geometry for easy pick-up and transport of the screws. A single screwdriver can be used for placing and removing all components. The screwdriver is available in three different lengths. 4-lobe screwdrivers are available with a connection for the MONO torque ratchet and with a latch type connection for the handpiece. The long abutment screw is recommended in situations where the vertical height of the restoration is adequate. If the space inside the mouth (above the restoration) is limited, being able to select a shorter screwdriver simplies the securing of the abutment screw. In addition, the longer abutment screw may make closing-off the screw channel easier. The regular (short) abutment screw must be used with the following abutments: Bar abutment VARIO T abutment EASY abutment having a short cone and shoulder height Angled EASY abutments, short Always use new abutment screws for permanent insertion of an abutment or restoration. Tighten them using the dened tightening torque (see page 47). Superstructures must be checked at regular intervals in order to identify any damage or loosening of the screws. Do not reuse screws that have come loose. Retightening may overstrain the material and lead to fracture of the screw.
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PF 3.5 mm
PF 4.0 mm
PF 4.5 mm
PF 5.0 mm
PF 6.0 mm
Abutment screws, 4-lobe, titanium alloy Length 5.8 mm 7.2 mm 10.2 mm 4.03.500 4.03.501 4.03.502
MONO screwdriver, 4-lobe, stainless steel/PEEK extra short Length B 8.5 mm Shaft length 14.5 mm 5.1 mm 3.03.165 short 22.2 mm 10.3 mm 3.03.166 long 28.2 mm 16.3 mm 3.03.167
Screwdriver for handpiece, 4-lobe, stainless steel extra short Length Shaft length 17.0 mm 3.5 mm 3.03.500 short 22.0 mm 8.0 mm 3.03.501 long 28.0 mm 14.5 mm 3.03.502
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The MONO torque ratchet is designed for both surgical and prosthetic use. It is manufactured from a solid billet of high-strength, corrosion-resistant titanium alloy. The one-piece construction dramatically simplies regular maintenance as there are no parts to disassemble for cleaning and no lubrication is required. The new one-piece accessory instruments are similarly easy to clean. Together with the MONO torque ratchet, they form an exceptionally convenient and highly ergonomic instrument system.
Advantages at a glance
Suitable for both surgery and prosthetics
Manufactured in one piece1
Highly ergonomic design Torque range from 10 to 35 Ncm (5 Ncm increments) High-strength, corrosion-resistant titanium alloy
Patent pending
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Finger plate
The MONO torque ratchet is labeled IN on one side and OUT on the other. For tightening, place the MONO torque ratchet on the accessory instrument such that the side labeled IN faces upwards. For unscrewing, turn the MONO torque ratchet over and place it on the ccessory instrument such that the side labeled OUT faces upwards. a
Finger plate
The arrows (2) on either side indicate the direction of rotation to be used. The guide key (art. no. 3.03.203) can also be used to apply apical pressure to the screwdriver when vertical space is limited. Always apply apical pressure to ensure that the driver is fully seated in the screw.
For tightening Thommen prosthetic components, place the MONO torque ratchet on the accessory instrument in the direction of the arrow until it stops. Do not force the MONO torque ratchet over the accessory instrument ratch et body. They should slide together easily. If this is not possible, check that the accessory instrument is compatible. Only accessory instruments specically designed for use with the MONO torque ratchet may be used. Do not attempt to insert any other instruments into the MONO torque ratchet as damage and/or improper function may result.
Reading the torque values: The prescribed torque is applied through the bending rod of the MONO torque ratchet. Upon actuation of the bending rod, the indicator shows the torque that is being applied on a scale. The pointer must indicate 0 when no force is being applied to the torque handle. If the pointer indicates either more or less than 0, then the torque handle may have been damaged and correct torque measurement may not be possible. Do not use the instrument in this condition.
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Indications/Intended use The bone contouring instrument is designed for use where bone prevents complete seating of the healing cap, impression coping, gingiva former or abutment.
Application The bone contouring instrument can be used either with a contra-angle handpiece or manually using the MONO insertion device, short.
Gently position the guide pin of the bone contouring instrument into the implant. Ensure that the axis of the instrument is aligned to the axis of the implant.
Rotate the instrument clockwise to remove excess bone and shape the emergence cone. Stop rotation as soon as the bone contouring instrument touches against the platform of the implant as this indicates all of the interfering bone is removed. The internal conguration of the implant must be cleaned thoroughly and dried prior to taking the impression and before placing any prosthetic components.
Note Please comply with the following instructions when using the handpiece: Maximum rotational speed is 200 rpm. Irrigation with cooled (approx. 5 C) sterile physiological saline solution is recommended. A surgical handpiece must be used as the drive unit; turbines are not suitable as torque is insufcient. For detailed instructions for care, maintenance, and reprocessing of instruments, please refer to pages 40 and 41.
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The products of the Thommen Implant System are fabricated from highquality materials and with the highest precision. Well cared-for instruments not only protect the patient and the practice team from infections, but are also a prerequisite for the success of the treatment. Insufcient or improper care can quickly lead to damage. Please comply with the following notes and working instructions. The package label shows whether a product is packaged in sterile or nonsterile condition. Instruments that are supplied in non-sterile condition and are intended for intraoral use must be cleaned, disinfected, and where applicable sterilized prior to use. For cleaning, disinfection, and sterilization, the instruments and components must be grouped according to their materials. Suitable cleaning and disinfection agents for the various materials are commercially available. Please comply fully with the instructions of the manufacturer with regard to the suitability of materials, dosage, concentration, exposure time, and temperature. The following substances are not suitable for the cleaning of instruments made of stainless steel (risk of corrosion): Cleaning and disinfection solutions with a high chlorine or oxalic acid content The following substances are not suitable for the cleaning of instruments made of titanium (risk of discoloration): All oxidizing acids (nitric acid, sulfuric acid, oxalic acid) and H2O2 (hydrogen peroxide) The following substances are not suitable for use with anodized aluminum (surface damage): Alkaline cleaning agents (bases) with a pH > 9. Agents with a pH of 5to9 are suitable. Used instruments must rst be disinfected and then cleaned. Make sure that no blood and/or secretions dry and then adhere to the instruments. For this purpose, the instruments should be rinsed with running cold water and cleaned with a clean cloth as quickly as possible after their use. Strongly contaminated instruments should be cleaned by means of ultrasound. Clean each instrument using a machine or nylon brush and commercially available cleaning solutions (do not use wire brushes, hard or abrading cleaning aids or steel wool). If a washing machine is used, make sure that the instruments do not contact each other as this may lead to damage. The instruments must not be kept or stored for any period of time in a wet state.
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Cutting instruments intended for multiple use Cutting instruments intended for multiple use must be replaced after a max imum of 20 maintenance cycles, or immediately should they show signs of damage or wear.
Notes for cleaning of the MONO torque ratchet and MONO accessory instruments We recommend brushing the gaps of the MONO torque ratchet using an interdental brush (max. bristle B of 0.7 mm). This ensures proper cleaning. The nger rest (made of PEEK) of the MONO insertion instruments and screwdrivers must be removed prior to cleaning if strong contamination is evident. All instruments and components must be checked after cleaning for wear, damage, and proper function. Replace if necessary. Abutments made of titanium can be steam-sterilized at 134C (see table below). Hot air sterilization is not permissible.
Sterilization Package each instrument/component/abutment in its separate protective pouch. Place the lled protective pouches in a perforated container in the autoclave. Place the instruments in the dedicated compartments and holders of the surgical cassette. Then place the surgical cassette in a sterilization package that is suitable for steam sterilization and place both in the autoclave.
Sterilization parameters: Steam sterilization using Prevacuum Vacuum Temperature Sterilization time 18 minutes 40 minutes Drying time
134C 134C
Store instruments and other items in the protective pouches until use. The user is responsible for assessing the suitability and application options of the product for the intended purpose prior to its use. Any application of the products is part of the responsibility of the user and beyond the control of Thommen Medical AG. We decline any and all responsibility and liability for any damage that may be caused during the application
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Product overview
SPIELEMENT, SPICONTACT, SPIONETIME
PF 3.5 PF 4.5 PF 4.0
Retentive
Impression copings for single use cylindrical H 10.0
extra short L 12.5 3.03.5 72 short L 16.5 3.03.5 73 long L 21.5 3.03.5 74 extra long L 27.5 3.03.5 80
extra short L 13.2 3.03.5 75 75 75 75 short L 17.2 3.03.5 76 76 76 76 long L 22.2 3.03.5 77 77 77 77 extra long L 28.2 3.03.5 81 81 81 81
3.03.0 60
3.03.0 61 65 62 63
Temporary restoration
Abutment for crown 4.03.0 80 Abutment for bridge 4.03.0 84 Abutment screws 4.03.5 00 4.03.5 01 01 01 01 4.03.0 89 85 86 87 4.03.0 88 81 82 83
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4.03.5 02 02 02 02
PF 6.0
PF 5.0
SPIDIRECT
PF 6.0 PF 5.0
Repositionable
short H 8.0
long H 12.0
3.03.0 90
3.03.0 95 91 92 93
3.03.0 60
3.03.0 61 65 62 63
Example
4.03.0 80 4.03.0 88 81 82 83 4.03.0 84 89 85 86 87 Art. no. 4.03.084 Art. no. 4.03.089 Art. no. 4.03.085 4.03.0 84 4.03.0 89 85 86 87 Art. no. 4.03.086 Art. no. 4.03.087
4.03.5 00
4.03.5 01
01
01
01
The table is based on the color-coded prosthetic components and the article numbers thereof.
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4.03.5 02 02 02 02
PF 3.5
PF 3.5
PF 4.5
PF 4.5
PF 4.0
PF 6.0
PF 4.0
SPIVARIO
Abutment/screws Crown
SPIVARIO T
2.03.4 10 Bridge
14
11
12
13
4.03.3 70
71
71
71
2.03.4 00 04 01 02 03
4.03.5 00
4.03.5
01
01
01
2.03.2 10
11
12
13
4.03.5 03
4.03.5 00
4.03.5
04 04 04
4.03.5
01
01
01
01
02 02 02 02
S.2.03.2 10
11
12
13
Analogs
Reamer/guide pin
Base
Base
3.03.4 20 20 21
21
21 Outer margin
3.03.4 09
09 09 09
3.03.4 22 25 23 23 23
3.03.4 00
04 05 06
08 08 08
3.03.5 48
49 49 49
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PF 6.0
PF 5.0
PF 5.0
PF 3.5
PF 3.5
PF 3.5
PF 4.5
PF 4.5
PF 4.5
PF 4.0
PF 4.0
PF 6.0
PF 4.0
PF 6.0
SPIRETAIN
Milling abutment
PF 5.0
PF 5.0
4.03.5 00
4.03.5 00
4.03.0
49 41 43
4.03.5
01
01
01
01 Gold coping
4.03.5
01
01
01
4.03.5
02 02 02 02
35
70
06
S.4.03.3 80 88 81 82
3.03.1
00
3.03.1
05
3.03.0
33
Solder pin
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PF 6.0
PF 5.0
45
General instruments
3.03.1
60
3.03.1
62
3.03.1
63
3.03.1
65
3.03.1
66
3.03.1
67
3.03.5
00
3.03.5
01
3.03.5
02
Guide key
3.03.2
03
Positioning handle
3.03.5
22
3.03.2
50
3.03.5
50
Tweezers
3.03.5
27
1.03.0
22
8.03.0
19
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Torque values
All 4-lobe screwdrivers have a predetermined breakage point. If the applied torque is too high and the screwdriver breaks, the fragments thus formed are easy to remove.
PF B 3.5 mm
PF B 4.0 mm
PF B 4.5 mm
PF B 5.0 mm
PF B 6.0 mm
10 Ncm
VARIOmulti abutment
15 Ncm
Occlusal screw, VARIOmulti Abutment screw in combination with ceramic restorations (except PF B 3.5 mm)
Abutment screw (except PF B 3.5 mm)
20 Ncm
25 Ncm
30 Ncm
* Customizable gingiva former immediately after implantation # 10 Ncm This overview can be ordered in the form of a laminated single sheet under article no. Fo_22d123.02 (available in English only).
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Headquarters Thommen Medical AG Hauptstrasse 26d 4437 Waldenburg | Switzerland Phone +41 (0)61 965 90 20 Fax +41 (0)61 965 90 21 info@thommenmedical.com
Italy Dental Trey S.r.l. Via Partisani, 3 47016 Fiumana | Predappio (FC) | Italy Phone +39 0543 929111 Fax +39 0543 940659 implantologia@dentaltrey.it www.dentaltrey.it Japan/Asia Thommen Medical Japan Inc. Representative Office Asia 3-20-14, Senriyama-Nishi | Suita Osaka 565-0851 | Japan Phone +81-(0)6-6385-4255 Fax +81-(0)6-6385-4256 info@thommenmedical.jp Japan J. Morita Corporation 23-28, 1-chome, Esaka-cho Suita City | Osaka 564-0063 | Japan Phone +81-(0)6-6384-6921 Fax +81-(0)6-6384-6746 http://spi.dental-plaza.com Middle East Star Science International GmbH Jupiterstrasse 57 3015 Bern | Switzerland Phone +41 (0)31 941 07 31 Fax +41 (0)31 941 07 33 star.science@bluewin.ch New Zealand Gunz Dental Pty Ltd. PO Box 99176 Newmarket Auckland 1149 | New Zealand Phone +64 9 366 0249 Fax +64 9 522 2910 www.gunz.co.nz Poland C. Witt i Spka Sp. z.o.o. 87-100 Toru, ul. w. Katarzyny 4/4 | Poland Phone +48 56 652 16 95 Fax +48 56 655 01 26 www.cwittdental.pl biuro@cwittdental.pl Singapore FONDACO Pte Ltd 7 Kaki Bukit Road 1, #03-06, Eunos Techno Link Singapore 415937 | Singapore Phone +65 6392 2806 Fax +65 6392 1296 fondaco@fondaco.sg South Korea Dami Medical Co., Ltd. 6F, 426-1, Hapjeong-dong, Mapo-gu Seoul 121-886 | South Korea Phone +82-(0)2-3141-2875 Fax +82-(0)2-3141-2877 www.damimedical.com Spain/Portugal ISP Implante Suizo de Precisin C/ Los quintos n 1 03350 Cox (Alicante) | Spain Phone +34 (0)96 536 1020 Fax +34 (0)96 675 1347 isp@dentacare.es
Switzerland Thommen Medical (Schweiz) AG Postfach 1160 | Neckarsulmstrasse 28 2540 Grenchen | Switzerland Phone +41 (0)32 644 30 20 Fax +41 (0)32 644 30 25 info@thommenmedical.ch Taiwan Ting Sing Trading Co., Ltd. No. 30 | Sec. 2 | Chang-An East Road Taipei | Taiwan | R.O.C. Phone +886-2-25420968 Fax +886-2-25420969 www.tingsing.com.tw USA Thommen Medical USA L.L.C. Idea Center | 1375, Euclid Avenue Cleveland OH 44115 | USA Toll-free phone number: +1-866-319-9800 Fax +1-216-583-9801 info.usa@thommenmedical.com
Subsidiaries/National Distributors Australia Gunz Dental Pty Ltd. City South Business Park Units 3-4, 26-34 Dunning Ave Rosebery NSW 2018 | Australia Phone +61 2 9935 6677 Fax +61 2 9935 6666 APryce@gunz.com.au www.gunz.com.au Austria Thommen Medical Austria GmbH Technologiezentrum Neusiedl Ludwig Boltzmann Strae 2 7100 Neusiedl am See | Austria Phone +43 (0)5 9010 29230 Fax +43 (0)5 9010 29231 info@thommenmedical.at Benelux Thommen Medical Benelux B.V. Edisonweg 17B 3404 LB IJsselstein Postbus 430 3400 AK IJsselstein | Netherlands Phone +31 (0)30 68 68 468 Fax +31 (0)30 68 68 469 info.benelux@thommenmedical.com Canada Thommen Medical Canada Inc. 1100 Burloak Dr. | Suite 300 Burlington, ON L7L 6B2 | Canada Phone +1 (905) 336-8966 +1-877-242-6012 (North America) Fax +1 (905) 332-3007 +1-877-242-6013 (North America) info@thommenmedical.ca China Shanghai Yujing Trading Co., Ltd. Room G | Floor 15 | Jia Fa Bldg. No. 129-1 Da Tian Rd. Shanghai 200041 | China Phone +86-21-62723077 Fax +86-21-62175264 France Thommen Medical France 10, avenue Piern 77680 Roissy-en-Brie | France Phone +33 (0) 1 83 64 06 35 Fax +33 (0)3 89 33 52 53 commande@thommenmedical.fr Germany Thommen Medical Deutschland GmbH Am Rathaus 2 79576 Weil am Rhein | Germany Phone +49 (0)7621-4 22 58 30 Fax +49 (0)7621-4 22 58 41 info@thommenmedical.de
Fo_22d010.07 11/10
AHA, Basel