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Ivoclar Vivadent
Implant Esthetics

Implant Esthetics

Product catalog summary

Introduction to Dental Implantology
Dental implantology involves using alloplastic materials to replace missing teeth, functioning as artificial roots implanted into the jawbone. The manual provides an overview of implantology, focusing on planning and executing prosthetic treatments, with step-by-step instructions for fabricating implant superstructures.

Structural Elements
The manual classifies structural elements into primary (implant), secondary (abutment), and tertiary (superstructure) components. The implant acts as the artificial tooth root, the abutment connects the implant to the superstructure, which is the visible prosthetic restoration.

Planning of Implant-Retained Prosthetic Restorations
Successful implant-retained restorations require precise planning and execution. The manual emphasizes a prosthetics-oriented implantation plan, including clinical and laboratory procedures such as impression taking, bite registration, and model fabrication. Backward planning is recommended, starting with the desired prosthetic outcome to determine implant placement.

Factors of Successful Osseo-Integration
Key factors include patient selection, bone quality and quantity, implant material and surface, and careful implantation planning. Pre-operative planning tools such as radiographic examinations and diagnostic casts are essential.

Fabrication of Superstructures
The manual details the fabrication process for both metal-supported and all-ceramic implant-retained restorations, including single-tooth and bridge restorations. It covers abutment selection and processing, framework construction, and veneering techniques.

Clinical and Laboratory Procedures
The manual outlines a comprehensive procedure for fabricating implant superstructures, involving both clinical and laboratory steps, including planning, impression taking, temporary restorations, and final incorporation of the superstructure.

Diagnostic Wax-Up and Jaw Records
A diagnostic wax-up is essential before any prosthetic restoration to plan the optimal functional and aesthetic tooth position. It helps identify atrophied jaw bones and determine augmentative measures for implant-retained prosthetic restoration.

Radiographic Template
Radiographs provide crucial information about bone structure and anatomical landmarks for implantation. A planning template with radiopaque markers is used to determine implant positions, number, diameters, and lengths, considering the enlargement factor.

Planning Template
A planning template is fabricated post-diagnostic wax-up using a silicone matrix. It can be extended to a radiographic and drill template, aiding in determining the planned implant position.

Drill Template
Drill templates assist in implant placement during surgery, ensuring the planned location and axial position are transferred to the bone. Stability and fixation in the dental or gingival area are crucial.

Impression Taking Methods
Impression taking aims to accurately reproduce the oral situation, including implant position. Methods include closed-tray and open-tray impressions, each suitable for different implant scenarios. Precise insertion or screwing of impression caps and posts is vital.

Model Fabrication
Accurate model fabrication is crucial for prosthetic restoration. It requires precise processing of materials and coordinated clinic-laboratory cooperation to achieve the zero position of implants.

Bite Registration
Bite registration determines the maxillo-mandibular relationship, using auxiliaries provided by implant manufacturers. It is performed with standard materials and articulated in an adjustable articulator.

Gingival Mask
A removable gingival mask is fabricated for implant-retained restorations, offering advantages like unimpeded view and precise gingiva reproduction. It can be fabricated directly or indirectly.

Gingiva Former
Gingiva formers aid in controlled healing of the peri-implant mucous membrane, improving the aesthetic starting position. They can be prefabricated or custom-made.

Temporary Restorations
During the healing phase, temporary restorations are crucial. They can be fabricated in the clinic or laboratory and are used for planning the final restoration. Temporaries should not transmit occlusal force to the healing implant.

Implant-Retained Prosthetic Superstructures
The function and aesthetics of restorations are influenced by implant position and diameter. Superstructures should consider functional, aesthetic, and hygiene aspects. Abutment selection is crucial and should be done in the laboratory based on the intended superstructure.

Specifications and Procedures
The document outlines the importance of maintaining a correct length relation between the superstructure and the implant, emphasizing that the superstructure should be smaller. If longer, interlocking is necessary. The implant type and manufacturer guidelines must be observed. The cement border should not exceed 2.0 mm subgingival for hygiene reasons.

Abutment Types and Customization
Prefabricated abutments are available in titanium or zirconium oxide, with options for customization. Titanium abutments come in various gingiva heights and angles, while zirconium oxide abutments are CAD/CAM-fabricated. Custom-fabricated abutments can be made from precious metal alloys and resin.

Superstructure Attachment Methods
Superstructures can be screw-retained or cemented. Screw-retained options allow for removability and repair access but may have aesthetic and accessibility drawbacks. Cemented superstructures offer better aesthetics and ease of handling but pose challenges in excess cement removal.

Abutment Preparation
Abutments should be prepared like natural tooth cores, with customization possible. The preparation involves checking vertical dimensions, circumference, and preparation angles. Titanium abutments require careful grinding to prevent overheating.

Fabrication of Implant-Retained Restorations
Examples include single-tooth restorations and bridges using various materials and techniques, such as metal-ceramic veneers and CAD/CAM-fabricated zirconium oxide frameworks.

Important Considerations
Manufacturer instructions must be strictly followed during fabrication. The document highlights the importance of maintaining a clean and precise casting process to ensure the accuracy and fit of the superstructures.

Frameworks for Cemented Superstructures
The document outlines the process of fabricating frameworks for cemented superstructures using IPS d.SIGN® 98 alloy. The screw cavity is blocked with wax or resin, and the framework is shaped using a silicone key. The framework design must adhere to metal-ceramic restoration guidelines, with a minimum thickness of 0.3 mm for single-tooth frameworks. After examination under a stereo microscope, the framework is invested, cast, and finished using tungsten carbide metal burs, maintaining a circular metal margin.

Metal-Ceramic Veneer
Using IPS InLine® leucite metal-ceramic, frameworks are cleaned with aluminum oxide and prepared for oxidation. Opaquer application begins once an even oxidized surface is achieved. The veneering material layers should be between 0.8 mm and 2.0 mm, with specific thicknesses for different ceramic areas. The final product is checked for fit, occlusion, shade, and hygiene capability.

Transfer Aids
Transfer aids are used to ensure the correct positioning of secondary elements from the model to the patient. Prefabricated or custom-fabricated aids are used depending on the implant manufacturer, ensuring the occlusal screw cavity remains unobstructed.

All-Ceramics
Zirconium oxide abutments offer a metal-free option for implant-retained restorations. Techniques include press, CAD/CAM, and layering. Customized zirconium oxide mesostructures are designed and milled using CAD/CAM technology. The document emphasizes careful adherence to processing instructions to avoid damage.

Implant-Retained Bridges
For metal-supported bridge restorations, precision is crucial to ensure a tension-free fit. The document highlights the importance of using materials with adequate strength and ensuring a precise fit to avoid biological and technical failures.

Superstructures
Using Callisto® Implant 78 alloy, the document describes the process of fabricating titanium abutments and alloy frameworks. It emphasizes the importance of checking parallelism and maintaining a minimum framework thickness of 0.3 mm. The document also provides tips for handling framework copings and ensuring a precise fit.

Press and Layering Technique
The document details the press and layering technique using IPS InLine® PoM and leucite glass-ceramic ingots. It describes the process of fabricating a fully anatomical wax on the opaquerized framework, checking margins, and investing the superstructure. The importance of coordinating CTE values of the alloy and ceramic ingot is highlighted.

Specifications and Procedures
The document outlines the procedures for creating metal-ceramic and all-ceramic dental superstructures. Key steps include blasting crown margins, separating superstructures with a diamond wheel, and checking the accuracy of fit. The stain and glaze firing process is crucial for achieving the desired aesthetic and functional results.

Materials and Techniques
Metal-ceramic veneers can be applied using press or layering techniques. The document emphasizes the importance of using appropriate materials like IPS InLine and IPS e.max systems for different types of superstructures. The use of zirconium oxide frameworks and CAD/CAM procedures is highlighted for all-ceramic superstructures.

Recommendations and Best Practices
It is recommended to ensure the implant is longer than the superstructure and to follow the manufacturer's instructions carefully. Cantilever units should be attached to interconnected superstructures and have a reduced shape.

Standards and Compliance
The document stresses the importance of adhering to the manufacturer's processing instructions, particularly those from Ivoclar Vivadent, to ensure compatibility and optimal results.

Product Overview
A comprehensive list of Ivoclar Vivadent products and alloys is provided, detailing their applications and compatibility with various dental procedures. The document also includes contact information for Ivoclar Vivadent offices worldwide.

Conclusion
The document serves as a detailed guide for dental professionals on the fabrication and application of dental superstructures, emphasizing precision, material compatibility, and adherence to procedural guidelines.

Catalog excerpts

ManualImplant Superstructures for Crown and Bridge Restorations passion vision innovation

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Cultural historical finds indicate that humans tried to replace missing teeth by homeo- or alloplastic materials (human or animal teeth, carved bones, ivory or mother of pearl items) from very early on. What is known as dental implant today was first inserted towards the end of the nineteenth century. Today's customary implant shape was inspired by that of the natural root of the tooth and used for the first time in 1939. Since that time, implantology has been continuously further developed and has become an important element of dental restorative treatment. Dental implantology requires well-founded...

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NavigationImplantology - Introduction to dental implantology - Factors of successful osseo-integration - Clinical and laboratory procedures - Impression taking methods - Bite registration - Model fabrication - Gingival mask - Gingiva former - Temporary restorations - Abutment selection - Abutment processing - Individual mesostructures (abutment/secondary element) - Framework for the cemented superstructure - Metal-ceramic veneers - Transfer auxiliaries All-ceramic - Zirconium oxide abutment / all-ceramics Overview of Ivoclar Vivadent products

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Navigation The fabrication of a functional and aesthetic implant-retained restoration involves interwoven clinical and technical procedures for which various dental products are used. This Manual describes the different procedures for the fabrication of implant-retained prosthetic restorations. The navigation shows the sequence of procedures for an implant-retained restoration in six main working steps. Each step is again divided to provide a more detailed overview of the individual processes. The red ticks within the working steps indicate the processes explained in this Manual. The colour code...

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Implantology Introduction to dental implantology Implantology is the science of implanting foreign (alloplastic) materials to replace endogenous (lost) organ functions with the objective of tissue-friendly setting (biointegration). Dental implants may also be called artificial roots which are implanted into the jaw bone in the place of missing teeth. In dentistry, dental implants are alloplastic materials, which are incorporated in the area of the mucous membrane-periosteum epithelium and/or the jaw bone in order to retain dental restorations. We are working with open implants in dentistry, which...

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Patient selection - healthy oral and overall situation of the patient - correct information of the patient about the treatment procedure and the intended treatment result Bone quantity - the available bone structure of the maxilla and mandible determines the indication and the selection of the implant system - in case of an atrophied alveolar process, reconstruction of bones by means of augmentation techniques Bone quality - the suitability is determined by two different bone structures (compacta, spongiosa) and is sub-divided into four categories I-IV Implant material - the requirements, such...

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Surgical procedures in the implant technique are divided into: - soft tissue intervention (gingiva, mucosa) - hard tissue intervention (bone) The planned implant position of the diagnostic model is transferred to the intra-oral situation with the help of a drill template or a navigation system. Superstructures Fixed or partly removable: Individually fabricated crowns and bridges - purely implant-retained - one or several implants connected with natural abutment teeth (hybrid bridge) Removable or partly removable: - implant-retained over dentures - implant-retained hybrid dentures Occlusion -...

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Structural elements CLASSIFICATION STRUCTURAL ELEMENTS Transocclusal screw Superstructure (crowns/bridges) Horizontal screw Tertiary elements (exostructure) Secondary elements (mesostructure) Implant abutment screw Abutment (prefabricated or customized) Anti-rotation lock Implant head Implant shoulder Implant neck Primary elements (endostructure) Implant Gingiva Alveolar bone Implant body Implant apex

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Implant The term implant describes the part of an implant system that is anchored in the jaw bone. The implant can also be called 'artificial tooth root'. Primary element / endostructure = "Implant" Implant apex – The implant apex is the lower (apical) part of the implant body, through which the vertical force exerted on the implant is transmitted to the jaw bone. Screw implants transmit the vertical force via the thread into the bone. Implant body – The part of a root replacement that is positioned in the bone (intra-ossal) is called the implant body. The coated, perforated implant bodies are...

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Superstructures A superstructure comprises everything that is retained by the implant and protrudes into the oral cavity, i.e. secondary and tertiary elements. Secondary element / mesostructure = «Abutment» Abutment – The abutment is the part of a one- or twophase implant system which is connected to the implant or fixed to it. It is the build-up that protrudes into the oral cavity, which is either directly included into the superstructure or which serves as a connection element between the implant and the superstructure. Implant abutment screw – The implant screw, also called abutment screw,...

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Planning of implant-retained prosthetic restorations The main objective of implant-retained prosthetic reconstructions is the restoration of the function. By means of augmentative procedures and membrane techniques, implants may be inserted wherever they are useful in connection with interdisciplinary treatment planning and permit good aesthetic results. Aesthetic aspects have become increasingly important in implant prosthetics. The possible treatment plan and prosthetic restoration should be defined in advance by the entire team consisting of jaw surgeon, dentist, and dental technician. A carefully...

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Clinical and laboratory procedures for the fabrication of implant-retained superstructures The clinical and laboratory procedure for the fabrication of implant superstructures shown below represents one option and is related to the superstructures presented in this Manual. Practice, Clinic – – – – Dental Laboratory Planning / analysis / patient selection Impression of the maxilla and mandible Centric registration to determine the TMJ relations Facebow registration – – – – Fabricating the preoperative models Articulating by means of the facebow registration Model analysis Anatomical wax-up / set-up...

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Implant Esthetics

Implant Esthetics

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