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Implant Restorative Study Club March Follow-up
- 1. IRSC Follow-up Mr. Fred Senne, the guest speaker (Dentsply), kindly allowed us to give you his slides for reference. Please contact us if you have practice questions or would like to see certain topics presented at IRSC. We look forward to seeing you at the next IRSC meeting on May 9th. The topic is: The Fixed Hybrid Denture Solution with 4-6 Implants Using the Straumann Dental Implant System presented by Brad Cates of Straumann. Chris Bishop and Savi Abey Implant Restorative Study Club (IRSC) Prosthodonticsin.com
- 2. Dentsply Contacts Implant Restorative  Mr. Fred Senne (Regional Manager, West – Study Club Laboratory Channel) 800-531-3481 x66285 fred.senne@dentsply.com  Clark Beal (Clinical Sales Rep) 440-7830 clark.beal@astratech.com  Alex Schaeffer (District Manager, Laboratory Sales) 773-469-4979 alex.schaeffer@dentsply.com
- 3. THE NEW POWERHOUSE IN IMPLANT DENTISTRY
- 4. The freedom of unlimited possibilities – patient-specific CAD/CAM abutments for all major implant systems
- 5. Atlantis BioDesign Matrix™ Atlantis VAD™ (Virtual Abutment Design) Designed from the final tooth shape Natural Shape™ Shape and emergence profile are based on the individual patient anatomy Soft-tissue Adapt™ Optimal support soft tissue sculpturing and adaptation to the finished crown Custom Connect™ Strong and stable fit –customized connection for all major implant systems
- 6. Atlantis VAD™ (Virtual Abutment Design) – designed from the final tooth shape Utilizing the unique Atlantis VAD™ software, Atlantis™ Abutments are individually designed from the final tooth shape. The result is an optimized abutment solution that offers the best possible function and esthetics.
- 7. Atlantis VAD™ (Virtual Abutment Design) • Proprietary software system designs abutments entirely in a virtual environment • Utilizes optimized 3D scanning of casts • Integrates technician’s specifications into design • Automatically detects multiple features/design parameters • Engineered designs ensure highest level of precision
- 8. Designed from final tooth shape The scanned model is When the desired tooth shapes The final design is checked for transformed into a 3D image, are decided, the abutments are fit and occlusal clearance before making it possible to create the designed the abutments are produced final tooth shape.
- 9. Atlantis VAD™ is beyond CAD • CAD abutment design is humans doing design aided by computers • Atlantis VAD™ is computers doing design aided by humans • Part of an integrated, highly optimized process • Specialized to abutment design – Creates an optimal design to begin with based on • Anatomy • Engineering • Manufacturability – Never permits an invalid design
- 10. Value of Atlantis VAD™ • Esthetics – based on the natural tooth shape • Function – retention, anti-rotation, crown function/failure • Mechanics – undercuts, fit, low-fracture • Compensates for misalignments of the implant – angulations, offset • Open for cooperation and partnerships, such as 3Shape, Dental Wings and 3M
- 11. Original design Design based on ideal values: Feature Original values Shoulder 0.5 mm Taper 2.5° Path of insertion even Original Optimal goal Result - Thin distal core
- 12. Manual correction: Option 1 Feature Original values New values Shoulder 0.5 mm 0.5 mm Taper 2.5° 1.5° Path of insertion even even Original Optimal goal Result - Reduced taper allows for tighter fit - Optimal goal still not achieved
- 13. Manual correction: Option 2 Feature Original values New values Shoulder 0.5 mm 0.5 mm Taper 2.5° 2.5° Path of insertion even 3° change Original Optimal goal Result - Increase mesial porcelain offset - Possible conflict with path of insertion - Optimal goal still not achieved
- 14. Manual correction: Option 3 Feature Original values New values Shoulder 0.5 mm 0.3 mm Taper 2.5° 2.5° Path of insertion even even Original Optimal goal Result - Only 1.0 mm for porcelain
- 15. The optimized solution: Atlantis VAD™ Feature Original values New values Shoulder 0.5 mm 0.31 mm Taper 2.5° 2.12° Path of insertion even change of 0.7° Original Optimal goal Result - Optimal retention and fit - 1.3 mm available for porcelain - Optimal goal achieved
- 16. What Atlantis VAD™ considers Cusp and fossa positions Core angle limits Occlusal surface existence Margin width relative to implant Cusp angles Core keep out zone Porcelain thickness Core completion Sulcus shape Tissue blanching Papilla positions Occlusal undercut Screw exposure Papilla widths Base emergence angle smoothness Base undercut Core wall thickness Crown emergence angle smoothness Margin depth from soft tissue Bevel heights adjustment Ideal shoulders Emergence angle limit Core shank interference Margin follows soft tissue Path of insertion Cingulum undercut Taper angle Cervical margin visibility Ideal base shape per tooth Occlusal reduction Core height Interproximal reduction Margin smoothness Blank limit Margin height from implant Papilla undercut Core retention …and more Papilla smoothness Margin to counterbore distance
- 17. Natural Shape™ – shape and emergence profile are based on the individual patient anatomy The unique anatomical shape and emergence profile of the abutment nourish long-term soft tissue management and provide optimal support and retention for the final restoration.
- 18. Teeth are not round Atlantis™ Abutments are designed from the final tooth shape Reference: Wheeler´s Dental Anatomy, Physiology and Occlusion, Major M. Ash, Stanley Nelson
- 19. Atlantis™ Abutments - closest to natural prepared teeth Atlantis™ patient-specific Stock abutments CAD/CAM abutments
- 20. Stock vs. Abutments Atlantis™Atlantis™ abutment - optimized function and esthetics Atlantis™ patient-specific abutment Stock abutment
- 21. Soft-tissue Adapt™ – optimal support soft tissue sculpturing and adaptation to the finished crown The design of each Atlantis™ Abutment takes biology, anatomy and engineering principles into consideration, providing the right conditions for soft tissue to heal and adapt to the finished crown.
- 22. Design options Full anatomical Contour soft tissue Support soft tissue No tissue displacement dimensions
- 23. Narrow healing situation Full anatomical dimentions Contour Support soft tissue No tissue displacement
- 24. Wide healing situation Fulltissue displacement Contour soft No anatomical dimentions Support soft tissue
- 25. Soft-tissue Adapt™ Courtesy of Dr. Julian Osorio, Dr. Keith Phillips and Dr. Harold van der Burg
- 26. Custom Connect™ – strong and stable fit – customized connection for all major implant systems Atlantis™ Abutment connections and abutment screws are specifically engineered and tested for each implant interface for optimal fit, stability and a successful result.
- 27. Atlantis™ patient-specific abutments for all major implant systems • Astra Tech • BioHorizons • Biomet 3i • Dentsply Friadent • Keystone Dental • Nobel Biocare • Straumann • Sybron Implant Solutions • Zimmer Dental All trademarks are the property of their respective owners.
- 28. Atlantis™ interface design philosophy All interfaces are designed within the constraints of the particular implant and include: • Insertion feature for simplified handling • Seating surface necessary to maintain tight seal and stability • Anti-rotation features that also allow the abutment to be accurately indexed to the implant • Each abutment screw is designed to work optimally with the specific connection and to correspond to the manufacturer’s torque driver
- 29. Implant interface connection types Seal A Seal B C Seal Insertion Insertion Anti-rotation Insertion Anti-rotation Anti-rotation A) Deep conical seal B) Planar or shallow cone C) Planar seating surface with indexing feature with internal connection with external connection E.g. Astra Tech, NobelActive, Straumann E.g. Zimmer TSV, 3iCertain, E.g. Nobel Branemark, Straumann BoneLevel NobelReplace, Keystone Prima Narrow Neck All trademarks are the property of their respective owners.
- 30. Atlantis™ quality • Atlantis™ abutments are required to pass the same testing protocol for regulatory authority clearance as implant OEM products • Atlantis products are subjected to extensive mechanical testing including extreme geometries (maximum angle, maximum length) in both static and fatigue loading conditions
- 31. Engineering analysis on Atlantis™ interface designs • Finite Element Analysis (FEA) performed for every interface design to optimize strength of critical regions • Validated by mechanical testing • Various configurations tested • Component designs optimized via FEA & testing (wall thickness, radii, etc.)
- 32. Atlantis™ interface design • All dimensional features of an implant are first characterized in great detail • Detailed dimensional data are analyzed using statistical methods • Interface design variables are analyzed and designed to match or exceed functionality of the OEM connection for: – Ease of insertion – Anti-rotation – Precision seal/seating surface
- 33. Atlantis™ Abutments • Consistent quality of fit, independent of implant system (higher precision of fit for some interface designs) • Reliability of functionality equivalent to or better than OEM • Confidence of FDA cleared product that’s backed by extensive design analysis and mechanical testing
- 34. Atlantis BioDesign Matrix™ Atlantis VAD™ (Virtual Abutment Design) Designed from the final tooth shape Natural Shape™ Shape and emergence profile are based on the individual patient anatomy Soft-tissue Adapt™ Optimal support soft tissue sculpturing and adaptation to the finished crown Custom Connect™ Strong and stable fit –customized connection for all major implant systems
- 35. THE NEW POWERHOUSE IN IMPLANT DENTISTRY
Hinweis der Redaktion
- Atlantis is comprised of a unique combination of four key features, which together, make the Atlantis BioDesign Matrix. These features work together to support soft tissue management for ideal functional and estheitc result. This is the true value of Atlantis for dental laboratories, clinicians and implant patients.
- Atlantis VAD ™ (Virtual Abutment Design) is an expert system software that designs abutments entirely in a virtual environment. It ’s smart software that can take all of the information input and transform it into an initial abutment design. Atlantis VAD utilizes optimized 3D scanning of casts to create a virtual copy of your case. It then integrates your specifications into the initial engineered design. Engineered designs ensure highest level of precision no matter what the interface or material.
- Atlantis VAD™ designs each abutment from the final tooth shape. It starts with the end in mind and then makes the abutment work for the restoration. With stock abutment restorations, the crown is adapted to suit the abutment – with Atlantis VAD – the abutment is adapted to fit the crown! This gives you the ability to follow traditional crown manufacturing techniques and creates a more esthetic and functional restorations.
- When designing an abutment, there are some basic ideal values that one would look to achieve. In this example, what you see is an abutment that is designed to follow the parameters of these ideal values where there is a 0.5 mm shoulder width, a taper of 2.5 degrees, and the path of insertion is even in distance to the neighboring teeth on either side. However, the distal core (on the left) is thin and what we would like to achieve instead for this particular case, is an optimal goal (CLICK MOUSE TO BRING UP) of increasing the distal height of the abutment.
- When working manually to redesign the abutment to reach the ideal goal, one option would be to leave the shoulder height value the same and adjust the degree of taper. When the degree of the taper is reduced the fit of the coping to the abutment may become too tight. In this example, you can also see how when decreasing the taper by one degree, you also decrease the space between the abutment and neighboring teeth and while this also increases the distal height of the abutment closer to the optimal goal, it still does not reach the desired goal.
- In this second design change option, the original shoulder and taper values are left the same, while the path of insertion is offset by three degrees distally (left). While this change does bring us closer to the optimal goal, it is still not fully achieved. In addition, changing the path of insertion can sometime cause other conflicts with such things as parallelism needed. And in this particular case, the mesial (right) porcelain offset is increased too much as a result of the change.
- Yet another possibility, is to adjust the distal (left) shoulder width. Here you see an example where the distal shoulder width is reduced by 0.2 mm in order to produce the optimal goal for the abutment design. Unfortunately, this change also creates a situation where there is only 1.0 mm of space on the distal side for the porcelain.
- Here you see an abutment design that utilizes Atlantis VAD optimization. Atlantis VAD is a sophisticated technology that has all abutment design expertise, design considerations and parameters and manufacturing constraints and requirements built in. This allows Atlantis VAD to make small changes to all the parameters to achieve an optimal trade-off to create an optimal balance of all design considerations and constraint to develop a unique and optimized abutment design – consistently, every time and for every case. It allows for results that can be achieved by a human only if they had infinite time and computer-like patience.
- One of the challenges to getting great implant restorative results stems from the fact that implants are round but teeth are not. You have to transition somehow, from round implant to tooth-shaped crown. If you use a round stock abutment as the foundation for your tooth-shaped crown, you cannot transition from round to tooth shape until you reach the restorative margin of the abutment. If you place the margin near the tissue to allow for easy cement removal, you get “potato-on-a-stick” restorations or “lollipop” restorations that don’t resemble real teeth – they look like implant crowns.
- Another option is to set the margin very far sub-gingival in order to give the crown more room to make the transition. This results in a more natural looking restoration but can create a difficult situation for cement removal. As you know, cement left behind is one of the key reasons for implant failure post integration and can also cause fistulas and infections.
- With patient-specific abutments, the anatomical abutment design allows for a natural looking restoration and cement removal is made easier because the abutment margin can be designed to be where you want it.
- You have a lot of control in how your Atlantis Abutments are designed. The “Emergence Width” choice you make has the single largest impact on how the abutment is designed. Depending on what you select, the abutment can come back looking very different so it’s important to understand these choices and how they influence design. We’ll walk through each one in detail.
- Full anatomical dimensions Largest diameter abutment provided with best emergence profile possible. A surgical incision for placement may be required. 2. Contour soft tissue Medium diameter anatomically shaped abutment up to 1.0 mm larger than sulcus of model of soft tissue provided. 3. Support soft tissue Anatomically shaped abutment will be up to 0.2 mm larger than sulcus of silicone model of soft tissue provided with desired emergence profile. “Easy” insertion. 4 . No tissue displacement Smallest diameter, non-anatomically shaped abutment with no soft issue support. The abutment will not touch the soft tissue.
- Full anatomical dimensions Largest diameter abutment provided with best emergence profile possible. A surgical incision for placement may be required. 2. Contour soft tissue Medium diameter anatomically shaped abutment up to 1.0 mm larger than sulcus of model of soft tissue provided. 3. Support soft tissue Anatomically shaped abutment will be up to 0.2 mm larger than sulcus of silicone model of soft tissue provided with desired emergence profile. “Easy” insertion. 4 . No tissue displacement Smallest diameter, nonanatomically shaped abutment with no soft issue support. The abutment will not touch the soft tissue.
- The result, is optimized and predictable adaptation of the soft-tissue.
- When we created Atlantis™, our vision was to provide dental implant restorations as individual as every patient, every time and for every major implant system – unique originals for unique individuals.
- In the development of all interfaces for Atlantis Abutments, the key functional aspects that impact product handling and performance are carefully evaluated, including ease of insertion, the presence of a tight abutment-to-implant seal, anti-rotation and an abutment screw designed to correspond to the implant manufacturer ’s torque driver and guidelines.
- There are three basic categories or types by which abutment-to-implant connections can be described, as shown in this diagram. The connection type influences how the three key functional aspects of insertion, anti-rotation and seal is addressed.
- For NA the regulatory authority is FDA.
- An example of one way Atlantis™ Abutment interface designs are analyzed and optimized is through the use of a finite element analysis, which is a computer-based form of stress analysis that is performed to evaluate stress distribution as a result of load to ensure that all Atlantis Abutment interfaces are optimized for strength and reliability.
- A consistent process is also followed in the development of Atlantis™ Abutment interfaces, which include (read bullets) .
- The consistency of design and extensive quality testing and control processes allows us to provide our customers with (read bullets).
- Only the unique combination of the four key features of the Atlantis BioDesign Matrix working together can ensure optimal soft tissue management for ideal functional and esthetic results. This is what differentiates Atlantis from your traditional stock components as well as other so-called “CAD/CAM” solutions.