/30/05 8:48 AM Page 2 Table of Contents
Overview
1
General Guidelines
2
Abutment Flowchart
6
Impression-Taking Techniques
9
Closed-Tray Impression Technique
10
Open-Tray Impression Technique
11
Temporary Abutments
14
Fixed Abutments (Cement-Retained Restorations)
16
Preangled Fixed Abutments (Cement-Retained Restorations)
18
PureForm Ceramics (Cement-Retained Restorations)
20
Shouldered Abutments
(Screw-Retained Restorations, Non-Engaging)
24
Direct Gold Copings, Engaging
26
Direct Gold or Plastic Copings, Non-Engaging
28
O-Ring Attachments
30
Yellow
Blue
Green
Black
3.25mm
Color-Coding
Zimmer Dentals color-coding system is located on the Surgical Kit tray, certain
Spline prosthetics and the product packaging. It provides simplicity at a glance
by indicating the diameter compatibility of the product based on the stripe found
on the package or the surgical kit.
The chart below indicates which color corresponds to each product interface
diameter.
COLOR
PRODUCT DIAMETER COMPATIBILITY
3.75mm & 4.0mm
5.0mm
Common products that are compatible with more
than one diameter (i.e. 3.25mm & 4.0mm).
Table of Contents
Spline Prosthetic Manual 4789.qxp 9/30/05 8:48 AM Page 3 The Prosthetic Products Manual (PPM) is designed to provide a basic overview
of the prosthetic procedures applicable to the Spline Dental Implant System.
Refer to Zimmer Dentals Instructions For Use (Part. No. 4718) for additional
information.
Team Approach
Successful implant treatment requires the coordinated efforts of several dental
professionals the restorative dentist, the surgeon (periodontist, oral surgeon,
general dentist), the laboratory technician, and the dental hygienist. By holding
a presurgical conference, these individuals are able to develop an appropriate
treatment strategy. This provides a balance between esthetic, functional and
surgical goals. In addition, the coordinated approach ensures that treatment is
complete, guarding against omission of important technical considerations
of biomechanics.
Patient Evaluation & Selection
Take a general medical history
Undertake a psycho-social evaluation
Explore indications and contraindications
Determine feasible vertical dimensions
Consider biomechanical considerations
Discuss treatment objectives and patients expectations
Perform various radiographic evaluations
General Considerations
Control of biomechanical stresses is the key factor to long-term success of the
prosthesis. Even after implant integration, imbalances in occlusal forces can lead
to implant failure. This is especially true for molar and cuspid implants. The large
surface area of these teeth attest to the great forces in these regions, and clinicians
should design their case plans accordingly. It is recommended that a one-to-one
implant to natural tooth root ratio be used whenever possible. To begin restoration
procedures, remove the Temporary Gingival Cuff.
1
Overview
Spline Prosthetic Manual 4789.qxp 9/30/05 8:48 AM Page 4 All Systems
Sterilization
The Spline Dental Implant System abutments, attachments, and laboratory
components are provided non-sterile and should be sterilized prior to use,
according to the table on page 5. All parts must be removed from their packaging
before sterilization.
Note: Two-piece components should be disassembled prior to
re-sterilization to ensure maximum efficacy.
Prosthetic Torque Wrench
To ensure that consistent torque is applied to abutments and coping screws,
the prosthetic torque wrench may be used.
Seating Tools
For complete prosthetic seating instructions, see Instructions for Use, Part. No. 4718.
The prosthetic abutments are seated with the 1.25mmD (0.050") Hex Tool, the
Shouldered Abutment Seating Tool, or the O-Ring Seating Tool. To ensure firm
and complete seating, apply maximum torque with the thumb and forefinger to
the seating tool, or utilize the prosthetic torque system. When using the 1.25mmD
(0.050") Latchlock Hex Tool, operate at 25 rpm or less at a maximum torque of
30 Ncm.
Prosthetic Design and Biomechanical Considerations
General Considerations
In considering prosthetic design, the clinician should be aware that control of
biomechanical stresses is the key factor in long-term success of the prosthesis. Even
after implant biointegration, imbalances in occlusal forces can lead to implant failure
due to tissue damage. This is especially true for molar and cuspid implants. The large
surface areas of these teeth attest to the great forces in these regions, and clinicians
should design their plans accordingly.
General guidelines to minimize excessive compressive and/or
transverse forces include:
Reduce occlusal tables by one-third (bicuspidize) to reduce off-axis loads.
Create shallow incline planes to redirect unfavorable forces.
Do not include cantilevering as part of a treatment plan due to the force
amplification of the resultant moment arm.
Group function occlusal scheme is recommended.
Ensure light occlusal centric contact.
Use of night guards is highly recommended for patients who are bruxers, clenchers
or heavy biters.
Note: Eight-millimeter implants require additional implants or natural teeth to distribute occlusal loads; they
should generally not remain free-standing.
Components
Prosthetic Torque Wrench
Second-Stage Surgical/Prosthetic Kit
Shouldered Abutment Seating Tool
O-Ring Attachment Seating Tool
Hex Tool Kit, 1.25mmD (0.050")
Long and Short
Shouldered Abutment Inserts,
Long and Short
Hex Inserts, 1.25mmD (0.050")
Long and Short
2
General Prosthetic Guidelines
Spline Prosthetic Manual 4789.qxp 9/30/05 8:48 AM Page 5 Maintenance
The successful dental implant should have an unbroken perimucosal seal between
the soft tissue and the abutment surface. To maintain the integrity of the seal,
the patient must engage in a disciplined and thorough form of oral hygiene specific
to dental implants. This requires that the patient be thoroughly committed to the
importance of these maintenance methods for the continued health and success
of the implant. Clinicians, dental hygienists, and patients must understand and
appreciate the need for a comprehensive implant maintenance program, including
regularly scheduled recall visits.
Long-term health of an implant can be directly related to the quality of oral hygiene.
Potential implant candidates should establish an adequate oral hygiene regimen
prior to implant therapy. Following implant placement, the clinician should instruct
the patient on proper tools and techniques used to ensure long-term maintenance
of the implant(s). The patient should also be instructed to periodically visit their
dental clinician for professional cleanings and evaluation.
Visits should be scheduled at least every three months the first two years. After
this period, patients should be scheduled according to their oral hygiene and
prophylaxis needs.
Prosthetic Applications
Terminal abutment/pier abutment; single-tooth restoration
(for molars, 2 implants should be used, if space is available)
Implant-supported bridge; tissue-supported overdenture* with
implant retention
Implant-supported bridge; hybrid overdenture* (hybrid overdenture
incorporates a bar with attachments or clips set in a single axis of
rotation. Support design should distribute posterior load to soft
tissue without producing excessive force on the implants.)
Implant-supported bridge; bar-supported overdenture; screw-
retained, full-arch reconstructions.
Number of Implants
1 implant
2 implants
3-4 implants
5 or more implants
*Overdentures using fewer than 5 implants should be supported by tissue or a combination of tissue and
implant-supported bar with clips or attachments (hybrid).
3
Types of Restoration
Spline Prosthetic Manual 4789.qxp 9/30/05 8:48 AM Page 6 Periapical X-Rays
To verify proper seating of prosthetic components, a periapical x-ray should be
taken to evaluate the abutment-implant interface. Any noticeable gap is indicative
of improper seating and the abutment should be removed. Entrapped tissue or
debris must be removed if present, and the abutment connection repeated and
confirmed with a new radiograph.
Impressions
Use a medium or heavy bodied impression material for all impressions.
Suitable materials include polyvinyl siloxane or polyether.
Prosthetics
Nonprecious alloys are NOT recommended for use with implants. When casting
the plastic waxing sleeves or gold copings, it is recommended to use a mid-to
high-content gold alloy to prevent excessive wear of the lapping shafts.
DO NOT
cast to fixed or angled titanium abutments. Use the appropriate style and
diameter of prosthetic component according to the implant system.
Replacement of Abutments
The prosthetic abutments are designed and tested to meet or exceed normal
functional loading requirements. In the event of excessive loading (e.g., traumatic
occlusion, parafunctional habits, extensive cantilevers, etc.) or misuse, the
abutments threaded shaft or its retaining screw may break in the area of the thread
relief. Should this occur, a thread fragment may remain in the implant body. Use
a small bur in a handpiece to cut a slot or groove in the thread fragment. A regular
straight blade screwdriver, narrow enough to fit into the implant, can be used to
engage the slot to unscrew the remainder of the thread.
Caution: When modifying
titanium intraorally, copious amounts of irrigation should be used to prevent the
implant from overheating.
4
Types of Restoration
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