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BASIC INFORMATION ON THE SURGICAL PROCEDURES

1. NC Healing Abutment 024 2244 conical diameter 4 8 mm height 3 5 mm Ti NC Healing Abutment 024 2246 conical diameter 4 8 mm height 5 mm Ti RC Healing Abutment 024 4222 conical diameter 4 5 mm height 2 mm Ti o 9 9 9 09 0 9 6 9 9 9 9 0 9 9 0 9 9 0 9 9 O0 9 0 O0 9 0 O 9 09 O9 9 0 O 0 9 0 9 9 9 9 9 0 O 9 9 0 O 9 6 0 9 9 9 9 O 0 9 9 9 9 9 9 9 0 9 9 9 9 9 RC Healing Abutment 024 4224 conical diameter 4 5 mm height 4 mm Ti RC Healing Abutment 024 4226 conical diameter 4 5 mm height 6 mm Ti RC Healing Abutment 024 4242 conical diameter 6 mm height 2 mm Ti RC Healing Abutment 024 4244 conical diameter 6 mm height 4 mm Ti RC Healing Abutment 024 4246 conical diameter 6 mm height 6 mm Ti Y s 4 mi Sterile pack of 4 cont 4 Surgical procedures 4 4 Soft tissue management 55 56 Overview of closure screws and healing abutments for Straumann Bone Level implants cont Esthetic region m Bottleshaped healing abutments preshape the soft tissue by allowing for a slight excess of mucosa during healing The insertion of the final restoration pushes the formed tissue outward supporting the creation of a naturally shaped peri implant soft tissue Make sure that there is no tension on the wound margin Otherwise mucosal necrosis can occur m he customizable Healing Abutment allows tor ind
2. 3 2 2 2 X ray templates The Xray templates are used for measurement and com parison They also assist the user in selecting the suitable implant type diameter and length The following Xray templates are available For Straumann Standard and Standard Plus implants Art No 150 215 For Straumann Tapered implants No 150 230 For Straumann Bone Level implants No 150 216 Similar to the distortions that occur in X rays the implant dimensions are shown on the individual templates with the corresponding distortion factors 1 1 to 1 721 Determining each magnification factor or scale is facilitated by showing the Xray reference sphere on the template next to the scale reference The first stage consists of comparing the size of the Xray reference sphere on the patient s with the size of the reference sphere on the template By superimposing the two pictures the correct scale can be found Then the spatial relations around the implant position are determined and the implant length and insertion depth are established 1 1 C 049 076V4 5 5 mm Example scale 1 1 1 reference sphere 5 5 3 Preoperative Planning 3 2 Planning aids 5 5 5 5 5 5 5 9 3 3 mm 4 1 mm 4 8 mm 4 8 mm 3 3 mm 93 3 4 1 4 8 4 8 mm RN RN
3. can be used repeatedly up to a maximum of ten times is recom mended The Surgery tracking sheet for Straumann cutting instruments Art No 152 755 helps to give an overview of how often the individual instruments have already been used Exception Single patient drills see page 59 2 straumann SURGERY TRACKING SHEET FOR STRAUMANN CUTTING INSTRUMENTS r 5 T BL TE Tap for Adapter Tap Adapter COEFF Note Because Straumann drills and taps are precisely manufactured and m h careful handling and cleaning techniques are essential to maintain For additional information visit www straumann com ojo o K hs H I N 9159191515159 KR 3 3 3 3 3 3 s o 8 9 424 9 ty o N N N N N N a o K 919 5 EE N I N I amp Qo 4 ei s 3 3 lt n o d 9 9 BR o c XI K K K B F c c h N N o oO Co 9 3 3 a o o o 3 3 Oo Q 3 B K3 S SJ SJ Sj AR 3 BR 3 3 4 590 Q pa w 3 3 5 o o o 55 e z
4. synOcta portfolio and the Straumann Solid Abutment The thread pitch on the Standard implants measures mm for the 2 3 3 mm implants and 1 25 mm for all other diameters 1 2 2 Straumann Standard Plus Implant The implant for flexible placement Straumann Standard Plus implants have a shorter smooth neck section of 1 8 mm that allows flexible coronoapical implant placement in combination with trans or subgingi val healing This offers the dental surgeon additional op tions that are particularly useful in the anterior tooth region of the maxilla where esthetic demands are high Similar to Straumann Standard implants this implant type uses the Straumann synOcta connection together with its corresponding prosthetic components the Straumann synOcta portfolio and the Straumann Solid Abutment The thread pitch on the Standard Plus implants measures mm for the 2 3 3 mm implants and 1 25 mm for other diameters The Straumann Standard Plus Narrow Neck implants can be used as an alternative for narrow interdental spaces They are very for indications where esthetic demands are high This one piece design implant has an external connection with a shoulder diameter of 3 5 mm an endosteal diameter of 3 3 mm and a smooth neck section of 1 8 mm Narrow neck implants use their proprietary narrow neck NN prosthetic components The implant has a thread pitch of 1 mm 6 1 The Straumann Dental Implant System 1 2
5. Do not open the blister until immediately prior to implant placement Step 2 Open the vial Turn the lid in counterclockwise direction Keep the vial upright to prevent the liquid from flowing out 1 Note the implant carrier is not firmly attached to the lid screw in the lid once again Step 3 Detach the implant carrier Detach the implant carrier from the lid by pulling it off manually LL Note Alter removing the implant from the solution the chemical activity of SLActive is ensured for 15 minutes Straumann SLA Step 1 Open the safety cap Open the satety cap of the sterile ampoule L Note For SLA implants the vial ensures the sterility of the implant unlike SLActive which utilizes a blister package for sterility Step 2 Remove the implant from the carrier Simultaneously pull down the implant carrier and litt the implant out of the implant carrier while supporting your arms 4 Surgical procedures 4 2 Opening the implant package 43 44 4 3 Placing the implant A Straumann implant can be placed either manually with the ratchet or with the aid of the handpiece A maximum speed of 15 rpm is recommended The following step by step shows how Straumann Standard Plus Implant is placed with the handpiece left column on the following pages and how a Straumann Bone Level Implant is placed with the ratchet right column 1 Note Straumann Bone Level implants must be rota
6. the drill is maximum of 0 4 mm longer than the implant insertion depth This additional length must be taken into consider ation during the planning phase Additional length of the drill tip See also the section Measurement and analysis procedure for operation planning in the DVD Straumann Dental Implant System Surgical Art No 150 541 3 Preoperative Planning 3 2 Planning aids 27 28 3 2 3 Surgical drill template A custom made drill template facilitates planning and preparation of the im plant bed and enables precise use of the cutting instruments The planning basis for tabricating this template should be the desired prosthetic result 3 2 3 1 Vacuum formed drill template A conventional surgical drill template can be produced with the vacuumformed template components The 10 mm long metal pin functions as the The drill sleeve is then secured in a drill Xray reference pin template After the pin is integrated into the template the planned implant axis and position become visible on the X ray 1 Note For veritication an Xray with the drill template may also be taken 2 2 mm pilot drill is then used for the subsequent drilling For turther information see Fabrication and use of an individual drill template No 152 290 where two fabrication methods are shown gradually in a step by step 3 Preoperative Planning 3 2 Planning aids 3 2 3 2 Ther
7. 20 3 2 3 Surgical drill template 28 3 2 3 1 Vacuumdormed drill template 28 3 2 3 2 Thermoplastic drill template 29 ABOUT THIS GUIDE Basic Information on the Surgical Procedures for the Straumann Dental Im plant System provides dental practitioners and related specialists with the es sential steps regarding surgical treatment planning and procedure The manual is divided into the following main parts For turther information regarding the Straumann Dental Implant System visit our comprehensive website at www straumann com The Straumann Dental Implant System Indications and Contraindications Preoperative Planning Surgical Procedures Healing Phase Additional Information on Instruments Appendix Index Ps N ANAN y 1 lt ye NN T A qua 4 M ln 7 r NN N A 1 THE STRAUMANN DENTAL IMPLANT SYSTEM 1 1 Overview The Straumann Dental Implant System ofters four implant is based on the tive key biological principles in implant lines with diverse body and neck designs ranging trom dentistry osseoconductivity of the implant surface control the classic soft tissue level to the bone level implant All of the microgap biomechanical implant design biological implants can be placed with one surgical kit while using distance and the locat
8. Contraindications Serious internal medical problems bone metabolism dis turbances uncontrolled bleeding disorders inadequate wound healing capacity poor oral hygiene maxillary and mandibular growth not completed poor general state of health uncooperative unmotivated patient drug or alcohol abuse psychoses prolonged therapy resistant functional disorders xerostomia weakened immune sys tem illnesses requiring periodic use of steroids titanium allergy uncontrollable endocrine disorders 2 2 1 Relative contraindications Previously irradiated bone diabetes mellitus anticoagula tion drugs hemorrhagic diatheses bruxism parafunctional habits unfavorable anatomic bone conditions tobacco abuse uncontrolled periodontitis temporomandibular joint disorders treatable pathologic diseases of the jaw and changes in the oral mucosa pregnancy inadequate oral hygiene 2 2 2 Local contraindications Inadequate bone volume and or quality local root rem nants Attention should be paid to the specific indications of the small diameter implants and the implants with a length of 6 mm as specified above 2 3 Implant specific indications Minimal Minimal ridge gap Implant type Indications and distinctive features width width SP 3 3 m Small diameter implant for narrow interdental spaces and ridges 5 5 5 5 A Caution Placement in the molar region is not recommended S 3 3 mm RN m An alternative i
9. Implant lines 1 2 3 Straumann Tapered Effect Implant The implant for immediate placement Straumann Tapered implants have a special ana tomical design which combines a cylindrical shape in its apical region and a conical shape in the coronal region making this implant particularly suitable for immediate or early implantation following extraction or loss of natural teeth With the smooth neck section of 1 8 mm healing can occur trans or subgingivally Tapered Effect implants have a Straumann synOcta connection Hence the pros thetic components of the Straumann synOcta portfolio and the Straumann Solid Abutment can be used The thread pitch of 0 8 mm provides excellent primary stability 1 2 4 Straumann Bone Level Implant Straumann expertise applied at bone level Straumann Bone level implants are suitable for bone level treatments in combination with trans or subgingival healing The implant s rough surface extends to the top of the implant and the connection is shifted inwards The Bone Level Implant uses a conicakcylindrical connection the CrossFit Connection together with its correspond ing prosthetic CrossFit components the Bone Level product porttolio A cylindrical outer contour and a thread pitch of 0 8 mm that tapers off in the coronal part of the implant provide excellent primary stability 1 3 Implant abutment connections 1 3 1 Straumann synOcta Morse taper conne
10. Similar to the Straumann synOcta connection the mechanically locking friction of the 15 conical cylindrical CrossFit Connection with four internal grooves has excellent longterm stability under all loading conditions and virtually eliminates screw loosening The CrossFit Connection is available tor Straumann Bone Level implants only Straumann Bone Level 4 1 mm and 4 8 mm implants have the same connection the regular CrossFit Connection and share the same secondary compo nents Straumann Bone level 3 3 mm implants feature the narrow CrossFit Connection The corresponding secondary components are color coded m yellow NC connection m magenta RC connection 1 The Straumann Dental Implant System 1 3 Implantabutment connections 1 4 Surfaces Straumann implants are manufactured biocompatible pure Grade 4 titanium All dental implants are provided with the SLActive or the SLA surfaces 1 4 1 Straumann SLActive Straumann SLActive surface features the scientifically proven SLA SLActive surface surface topography Additionally it exhibits fundamentally innovation m Proven SLAS sur face topography improved surface properties such as hydrophilicity and chemical activity which significantly accelerate the entire osseointegration process m Hydrophilicity for a larger acces Hydrophilicity sible surface area The hydrophilic properties of SLActive e
11. Straumann Standard 6 Straumann Standard Plus 6 Straumann Tapered Effect 6 indications 10 insertion depth 59 instrumentation 35 instruments 24 08 lingual palatinal wall 2 mesial distal point 22 minimum guidelines 15 Morse taper connection 7 osteotomes 65 8 Index 73 74 8 Index pilot drill 32 preparation implant bed 3l basic Jl fine 35 preparation depth 58 protile drilling 35 ratchet 63 reconstruction prosthetic 29 reference sphere diameter 26 risk of infection minimize 59 SCS screw driver 64 single tooth gap 17 single patient drill new generation 59 sinus floor elevation 65 SLA surface 9 57 Standard Implant 21 Straumann Dental Implant System 3 Straumann Drill Stop 59 Straumann Drill Stop Set 59 Straumann SLA 9 57 Straumann SLActive 9 57 Straumann Surgical cassette superstructure 15 surfaces 9 surgical kit 220 synOcta connection 7 tapered effect 21 tapping 30 template vacuum formed 28 transfer part 46 Twist Drill PRO do twist drill 58 wax up setup 15 Xray distortion 26 templates 26 X ray reference sphere NOTES wWwWww straumann com International Headquarters Institut Straumann AG Peter Merian Weg 12 CH 4002 Basel Switzerland Phone 41 061 965 11 11 Fax 41 0 61 965 11 Ol Straumann products are CE marked 09 07 152 754 e BOO907
12. al EDT Pes pa va ho tet the nu eA V vee mesa vm rw mtm ka 3 Preoperative Planning 3 1 Implant position 3 1 1 1 Examples for single tooth gaps For single tooth restoration the implant is placed centered within the single tooth gap The following examples show how tule 1 is implemented Straumann Standard Standard Plus and Tapered Effect implants For Straumann sott tissue level implants the gap size has to be considered for the selection of the shoulder diameter NN RN WNI In order to make use of the gap width in conjunction with rule 1 the following approximation can be used Distance between adjacent teeth at bone level The distance between adjacent teeth at bone level is approximately 1 mm 2 x 0 5 more than the gap width Hence applying rule 1 the gap width must be 2 mm wider than the implant shoulder 3 Preoperative Planning 3 1 Implant position 17 18 Shoulder diameter Gap width Distance between adja cent teeth at bone level D mm i 2 6 5 WN Rule 1 applied on both implant sides The Diagnostic T see page 23 applied in the patient s mouth or on the cast can be used to obtain an initial measurement of the gap width for the choice of the implant shoulder diameter and prosthetic reconstruction Straumann Bone Level implants For Straumann Bone level implants the distance between adjacent teeth at bone level determines the implant diam
13. are delivered non sterile in blisters and must be sterilized prior to use Subsequent loosening is made easier by applying chlor hexidine gel or sterile Vaseline to the healing cap or healing abutment before they are screwed into the implant 2 Step 2 Wound closure Adapt the soft tissue and suture it back tightly around the abutment 4 Surgical procedures 4 4 Soft tissue management 53 Overview of closure screws and healing caps for Straumann Standard Standard Plus and Tapered Effect implants Closure screw with hex socket 048 374 height 1 8 mm Ti Closure screw small Ti 048 371 048 371V4 T Closure screw large height 1 5 mm Ti 048 373 048 373 4 v Protective cap with integral occlusal screw 048 050 mm height 3 4 mm polymer Ti Healing cap with integral occlusal screw 048 043 mm height 3 4 mm Ti Closure screw large height 1 5 mm Ti 048 373 048 373 4 Healing cap height 2 Ti 048 033 Healing cap height 3 mm Ti 048 034 cw Healing cap height 4 5 mm Ti 048 037 e Healing cap height 2 mm Ti 048 038 Healing cap height 3 mm Ti 048 039 Healing cap height 4 5 mm Ti 048 053 Submucosal healing m f submucosal healing is desired use of a closure screw or shorter healing cap is recommended Transmucosal healing m By using a taller healing cap trans mucosal healing can be obtained even when the implant shoulder is in a sub gingival position Esthetic region NI
14. associated original components and instruments according to Institut Straumann AG s instructions and recommendations Use of products made by third parties in conjunction with the Straumann Dental Implant System will void any warranty or other obligation express or implied of Institut Straumann AG Instructions as to application of our products take place verbally in writing by electronic media or in hands on trainings corresponding to state of the art at the time of introduction of the product The user of Straumann products has the duty to determine whether or not any product is suitable for the particular patient and circumstances Straumann disclaims any liability express or implied and shall have no responsibility for any direct indirect punitive or other damages arising out of or in connection with any errors in professional judgment or practice in the use or installation of Straumann products The user is also obliged to study the latest developments of the Straumann Dental Implant System and their applications regularly Please note The descriptions contained in this document are not sufficient for immediate use of the Straumann Dental Implant System Knowledge of dental implantology and instruction in the handling of the Straumann Dental Implant System provided by an operator with the relevant experience are always necessary Availability Not all products listed in this brochure are available in all countries
15. relation to the anatomical structures Step 5 Widen the implant bed to 2 8 mm Continue with the implant bed preparation If necessary correct the implant position with the 2 8 mm pilot drill Use 2 2 8 depth gauge to check the preparation depth For an implant with an endosteal diameter of 3 3 mm basic preparation ends here Continue with the fine im plant bed preparation on page 35 500 rpm max 4 1 mm and 4 8 mm implants Step Widen the implant bed to 3 5 mm Continue with the 3 5 mm twist drill and check the final preparation depth with the 3 5 mm depth gauge For an implant with an endosteal diameter of 4 1 mm basic preparation ends here Continue with the fine im plant bed preparation on page 35 VOIE For 2 4 8 mm implants Step 7 Widen the implant bed to 4 2 mm Continue with the 4 2 mm Straumann Twist Drill PRO and check the final preparation depth with the 4 2 mm depth gauge Continue with the fine implant bed preparation on page 35 1 Note To facilitate introducing the instruments into the bone cavity the bony margin of the drill hole can be beveled slightly using a large round bur or with an SP profile drill corresponding to the diameter of the last twist spiral drill employed The profile drills are inserted only a fraction into the drill hole 4 Surgical procedures 4 1 Implant bed preparation 33 The following table summarizes the
16. surface the vertical reduction of the bone has to be considered 2 Step 2 Mark the implantation site Do Mark the implantation site determined during the implant position planning with the 1 4 mm round bur The implant distance indicator can be used for that purpose see pages 24 and 25 Widen and correct the position of the mark with the 2 2 3 mm or the 3 1 mm round bur it necessary 4 Surgical procedures 4 1 Implant bed preparation 31 4 Surgical procedures 4 1 Implant bed preparation Step 3 Mark the implant axis With the 2 2 mm pilot drill mark the implant axis by drilling to a depth of about 6 mm Insert the short side of the depth gauge with the distance indicator to check for correct implant axis orientation It necessary correct unsatistactory implant axis orientation in the following step 1 Note The distance indicator visualizes the shoulder diameter of 4 8 mm RN and enables checking of the probable posi tion of the implant shoulder Step 4 Prepare the implant bed to 02 2 mm Pre drill the implant bed to the final preparation depth with the 2 2 mm pilot drill Use the 2 2 mm alignment pin to check the implant axis and preparation depth AN Caution At this point take an X ray particularly with vertically re duced bone availability The alignment pin is inserted into the drilled area which allows a comparative visualization of the drill hole in
17. trom the surgical cassette with a sterile forceps and put into the handle or ratchet The forceps Art No 046 110 was developed and shaped specially to allow round instruments to be gripped securely Forceps All steps related to the maintenance of Straumann surgical instruments are part of a dental practice hygiene plan see also Care and maintenance of surgical and prosthetic instruments Art No 152 008 6 1 1 Depth marks on Straumann instruments Straumann instruments have depth marks in 2 mm inter vals that correspond to the available implant lengths The marks on twist drills are continuous between 1O mm and 12 mm The lower edge of the mark corresponds to 10 mm and the upper edge to 12 mm When inserting a Straumann Standard Plus or Tapered Effect Implant up to the implant shoulder level see Preop erative Planning on page 21 the preparation depth must be 2 mm more than the indicated implant length Example The preparation depth for a 1O mm SP implant inserted up to shoulder level must be 12 mm Due to the function and design of the drills the drill tip is O 4 mm longer than the insertion depth of the implant see also page 26 on Xray templates 6 Additional information on instruments 0 1 Surgical Instruments 12 mm mm Jj 2 D 4 2 2 1 Pilot drill 1 2 2 mm 6 Straumann Standard Plus Implant 2 Alignment pin 2 2 mm 4 1 RN length mm 3 Pilot drill 2 2 8 mm Z
18. use of instruments for the basic implant bed preparation according to the endosteal implant diameter All drills are available in a short and a long version and as multi use as well as single patient drills see also Surgical Instruments on page 58 The table lists the short multi use drills only Prepare ridge 044 004 Round bur 3 044 022 Round bur 1 4 mm implant positon 044 003 Round bur 2 3 mm 044 004 Round bur 3 1 mm 044 210 Pilot drill 1 short 2 2 mm implant axis 046 455 Depth gauge with distance indicator 2 2 2 8 mm Prepare 044 210 Pilot drill 1 implant bed short to 2 2 mm 2 2 2 mm 046 458 Alignment pin 2 2 2 mm straight Prepare 044 214 Pilot drill 2 implant bed short to 2 8 mm 2 8 mm 046 455 Depth gauge with distance indicator 022 254 Prepare 044 218 Twist drill implant bed short to 3 5 mm 3 5 mm 046 450 Depth gauge 3 5 mm Prepare 044 254 Twist drill PRO implant bed short to 4 2 mm 4 2 mm 046 451 Depth gauge O 4 8 mm 4 Surgical procedures 4 1 Implant bed preparation 4 1 2 Fine implant bed preparation The fine implant bed preparation encompasses profile drilling and subsequent tapping Instrumentation depends on the implant type the endosteal implant diameter and the bone class Profile drilling The protile drill prepares the implant bed for a specitic Straumann implant m Straumann Standa
19. 14 22 Straumann SLA 9 TE 01 2 Single patient pilot and twist drills 59 2 Indications and Contraindications 10 6 1 3 Straumann Drill Stop 59 2 1 Indications 10 6 1 4 Straumann Surgical Cassette 2 1 1 Specific indications for small diameter 6 1 5 Ratchet 63 3 3 implants 10 6 1 6 Holding key 64 21 2 Specific indications for Straumann 6 1 7 5 5 screwdrivers 64 implants with a length of 6 mm lO 6 2 Osteotomes 65 2 2 Contraindications 10 6 2 1 Instrument set for bone condensation 65 2 2 1 Relative contraindications 10 6 2 2 Instrument set for transalveolar sinus floor 2 2 2 local contraindications 10 elevation 65 2 3 Implant specific indications 1 6 2 3 Depth stops for osteotomes 65 3 Breonerative Panning 15 6 3 Cleaning and care of instruments 66 3 1 Implant position 15 7 Appendix 68 311 Mesiodistal implant position 16 71 labeling and color coding of the 3 1 1 1 Examples for single tooth gaps 17 Straumann Dental Implant System 68 3 1 1 2 Examples of multiple tooth gaps 19 72 Related documentation 2 31 2 Orofacial implant position 20 73 Important notes 2 31 3 Coronoapical implant position 21 3 2 Planning aids 29 Be inden ic 3 21 Mesiodistal and orofacial space requirements 29 3 2 1 1 Diagnostic T for Straumann Standard Standard Plus and Tapered Effect implants 23 3 2 1 2 Straumann Implant Distance Indicator 24 3 2 2 Determining the vertical bone availability 25 3 2 2 1 Xray reference sphere 23 3 2 2 2 Xray templates
20. 2 2 5 9 14 14 I 2 14 16 16 16 RN Regular Neck 4 8 mm i 5 Regular 8 mm WN Wide Neck 6 5 07 07 150 230 20807 Xray template Straumann Tapered Effect implants Art No 150 230 2 straumann 049 076V4 5 0 mm 049 076V4 6 0 mm Straumann Bone Level Implant 24 8 4 1 mm 3 3mm 48mm 24 1 mm 03 3 Straumann Bone Level Implant 0 0 21 2 6 8 10 8 12 10 14 12 AAA 14 16 Oo Straumann Bone Level Implant 4 8 mm 94 mm 93 3 mm 948mm 4 mm 3 3mm Straumann Bone Level Implant o o 2 2 4 8 10 8 12 10 14 12 16 14 16 du C 0123 Xray template Straumann Bone level implants Art No 150 216 11 06 150216 11106 To calculate the eftective bone availability the following formula should be used X ray reference sphere 5 mm x bone availability Xray bone availability Reference sphere diameter on the Xray Taking into consideration all implantrelated anatomic structures e g mandibular canal sinus maxillaris Example for a measured bone availability and reference sphere diameter on the X ray of 13 mm and 6 mm 20 distortion respectively 5 mm x 13 mm Additional length of the drill tip Note Due to the construction and function of the drills
21. 2 straumann BASIC INFORMATION ON THE SURGICAL PROCEDURES Straumann Dental Implant System COMMITTED TO SIMPLY DOING MORE FOR DENTAL PROFESSIONALS Straumann is industrial partner of ITI International Team for Implantology in the areas of research development and education CONTENTS About this guide 2 4 Surgical Procedures 30 4 1 Implant bed preparation 30 1 The Straumann Dental Implant System 3 4 1 1 Basic implant bed preparation 3 1 1 Overview 3 4 1 2 Fine implant bed preparation 35 1 2 Implant lines 41 3 Examples for fine implant bed preparation 38 1 2 1 Straumann Standard Implant 6 4 2 Opening the implant package 42 12 22 Straumann Standard Plus Implant 4 3 Placing the implant 44 1 2 3 Straumann Tapered Effect Implant 4 4 Soft tissue management 50 1 2 4 Straumann Bone level Implant 4 4 Submucosal healing 50 1 3 Implantabutment connections 7 4 4 2 Transmucosal healing 53 1 31 Straumann synOcta Morse taper connection Z 5 Healing Phase 57 1 3 2 Straumann Narrow Neck Connection 7 5 1 Healing phase duration 57 1 3 3 Straumann Bone Level CrossFit 5 2 Straumann SLActive and SLA in comparison 5 n 6 Additional Information on Instruments 58 1 4 Surfaces 7 6 l Surgical instruments 58 1 4 1 Straumann SLActive 9 6 1 1 Depth marks on Straumann instruments 58
22. Acid etched chemically active and hydrophilic SLA9 Sand blasted Large grit Acid etched This technique should be employed only by dentists who have adequate experience in the use of augmentation procedures 5 2 Straumann SLActive and SLA in comparison The bone formation process is initiated at an earlier stage with Straumann SLActive resulting in significantly earlier secondary stability and thus risk reduction during the critical healing period Total stability with SLA Total stability with SLActive Total stability Total stability Stability Primary stability Primory dip S old bone 1 SLActive stability E gt old bone S D 2 i DY 5 D SLA 5 I 9 0 1 2 3 4 5 6 7 8 0 1 2 3 4 5 6 7 8 Time weeks Time weeks 5 Healing phase 5 1 Healing phase duration 5 2 Straumann SLActive and SLA in comparison 57 58 6 ADDITIONAL INFORMATION ON INSTRUMENTS 6 1 Surgical instruments Instruments must be checked for completeness and function An adequate stock of implants and spare sterile instruments should always be available The instruments must be disassembled for sterilization Well maintained instruments prevent infections trom developing that could endanger patients as well as the practice team To avoid contamination of the operation field all of the instruments and mate rial employed must be sterile To prevent contamination of the sterile instru ments they should be removed
23. Bridge Restorations Straumann synOcta Prosthetic System Art No 152 255 m Cementretained crowns and bridges with the solid abutment system Straumann Solid Abutment Prosthetic System Art No 152 254 m Straumann Osteotomes No 150 855 and 150 857 m Straumann Bone level Implant line Basic information on the prosthetic procedures Art No 152 810 d The DVD Straumann Dental Implant System Surgical Art 150 541 features the following films m Measurement and analysis procedure for operation planning Implantation of a Standard Plus implant m implantation of a Tapered Effect implant m Surgical cassette m Osteotomes 7 Appendix 72 Related documentation Instrument care and maintenance Well maintained instruments are a basic requirement for successful treatment You will find detailed information in the brochure Care and maintenance of surgical and prosthetic instruments Art No 152 008 The Straumann guarantee As a Swiss company we attach the greatest importance to manufacturing our products in to the highest quality We are firmly convinced of the scientific and clinical basis of our Straumann Dental Implant System and draw on the fund of know how from nearly 30 years of quality production The Straumann guarantee regulates replace ment of all components of the Straumann Dental Implant System You will find detailed information in the brochure The Straumann guarante
24. N i Healing cap with integral occlusal screw 048 043 m The labial bevel facilitates exact approxi 2 mm height 3 4 mm Ti tion of the soft fi the heali RN Healing cap with labial bevel short 048 028 cap Ensure that there is no tension on the height 2 mm Ti vestibular wound margin as otherwise mucosal necrosis can occur Healing cap with labial bevel long 048 029 m o optimise the gingival contour it is ad height 3 5 mm Ti Healing cap with labial bevel 048 030 height 2 mm Ti visable after exposure of the implant 4 6 weeks after implantation to exchange the beveled healing cap for a longer healing cap without bevel selected according to mucosal thickness and temporary restoration 54 4 Surgical procedures 4 4 Soft tissue management Overview of closure screws and healing abutments for Straumann Bone Level implants Submucosal healing NC Closure Screw height mm Ti 024 2100 04 For submucosal healing a closure screw or a short healing abutment should be used Use of the H 0 5 mm closure screw is recommended for deeply placed e e e o e e e o e e 6 o e e 6 e 6 e 6 e 6 e e 6 6 6 6 6 e 6 0 9 06 0 6 9 6 e 6 9 e e 6 06 e 6 e e e o e o Closure Screw height O 5 mm Ti 024 2105 04 NC Healing Abutment 024 2222 conical diameter 3 6 mm height 2 mm Ti e B o e o o o o o e o o
25. RN WN NN RI WN a C 03 35 4 2 FI 2 1 L 4 2 4 SS I as Ei EV T 12 12 12 44 i Bn 1 M Straumann Standard implant NN Narrow Neck 3 5 WN Wide Neck 6 5 SP Straumann Standard Plus implant RN Regular Neck 4 8 en 5 5 5 5 5 5 5 5 5 3 3 mm 4 1 mm 4 8 mm 4 8 mm 3 3 mm 3 3 mm 4 1 mm 4 8 mm 4 8 mm RN RN RN WN NN RN IN RN WN _ 2 ji J 2 3 i 2 4 HB 4 L t 4 i i i j t 1 20 6 M 2 6 6 8 H 1 2 D id ro 12 WA WA 10 10 12 12 12 4 KA up 14 L WP 2 14 16 i CA 16 16 Ha 3 x Xray template Straumann Standard and Standard Plus implants Art No 150 215 E20807 07 07 150 215 Tapered Effect Implant 1 049 076V4 5 0 mm 3 3 mm 4 1 mm 4 8 mm 3 3 mm 4 1 mm 4 8 mm RN RN WN RN RN WN 0 0 2 2 2 iod d if i ya 5 a i 14 10 gt 19 tj X 3 9 fi 2 14 14 14 16 16 16 Tapered Effect Implant 3 3 mm 4 1 mm 4 8 3 3 mm 4 1 mm 4 8 mm RN RN WN RN RN WN o f o 2 2 i i i 2 4 4 i 4 4 i 8 14 i 4 Mr 1
26. Straumann Bone level Implant 4 Twist drill 3 5 mm 4 1 RC length mm 5 Twist drill PRO 4 2 Additional length of the drill tip 6 1 2 Single patient pilot and twist drills Like multi use drills single patient drills are indicated tor the preparation of the implant bed for Straumann Dental Implants They are supplied sterile and are to be used for one operation only and for one patient only Single patient drills can minimize the risk of infection for the patient They are color coded for easy identification of the diameter width Due to the function and design of the drills the drill tip is O 4 mm longer than the insertion depth of the implant New generation single patient drills are drill stop compatible They can be ordered using separate article numbers 6 1 3 Straumann Drill Stop Precise depth control The Straumann Drill Stop provides precise control over drilling depth during implant bed preparation for the placement of Straumann dental implants Delivered in sterile sets the drill stops are ready to use The Straumann Drill Stop is designed for single patient use only and must be used in conjunction with the single patient drills specifically designed for them Fach Straumann Drill Stop Set includes drill stops with the following diameters 2 2 mm blue 2 2 8 mm yellow 2 3 5 mm 4 2 mm green These diameters correspond to the diameters of the Strauman
27. Validity Upon publication of this brochure all previous versions are super seded Caution Our products must be secured against aspiration when used intraorally Do not use damaged or blunt instruments Units per package Unless stated otherwise there is one unit in each package Documentation You can obtain detailed instructions on the Straumann Dental Implant System from your Straumann representative Copyright and trademarks Straumann documents may not be reprinted or published in whole or part without the written authorization of Institut Straumann AG Straumann and or other products and logos from Straumann that are mentioned here are trademarks or registered trademarks of Straumann Holding AG and or its affiliates Definition SLActive Sand blasted Large grit Acid etched chemically active and hydrophilic Definition SLA Sand blasted Large grit Acid etched 7 Appendix 7 3 Important notes Explanation of the symbols on labels and instruction leaflets 8 number A Article number ILE Sterile by gamma irradiation Nonsterile Lower temperature limit Upper temperature limit 3 k Temperature limit Caution Federal USA law restricts this product to sale by or on the order of a dentist or physician Do not use on patients Do not reuse Refer to instructions for use Use before expiry date Protect from exposu
28. al sterilisation is not recommended Do not use dry heat sterilisation Ensure that the individual sterilisation parameters comply with the current regulations of the respective country In order to avoid damaging the surgical cassette during autoclaving it must be placed correctly in the autoclave see See also DVD Straumann Dental Implant System Surgical Art No 150 541 Surgical cassette 6 Additional information on instruments 0 1 Surgical Instruments 6 1 5 Ratchet Ratchet Service instrument The ratchet of the Straumann Dental The ratchet is supplied with a service Implant System is a two part lever instrument which is used to loosen arm instrument with a rotary knob for the headed screw changing the direction of force The ratchet is required for the follow ing Operations m manual thread tapping m manual placement of implants into their tinal position in the implant bed E Ratchet disassembled After loosening the ratchet bolt can be removed from the body of the ratchet It must be disassembled for cleaning and sterilisation 6 Additional information on instruments 6 1 Surgical Instruments 63 6 1 6 Holding key The holding key is used for stabilizing the ratchet m countering the transfer part Stabilizing the ratchet Use the pivot of the holding key to stabilize the ratchet during implant insertion or during tapping Countering the transfer pa
29. andard implants protile drilling is not required Step 2 Tapping the thread in dense bone Pretap the implant bed with the S SP tap according to the bone class and the endosteal diameter see table on page 36 Step 1 TE profile drill Shape the coronal part of the implant bed with the TE profile drill Insert the TE profile drill up to the planned implant shoulder level see page 35 Step 2 Tapping the thread dense bone Pretap the entire length of the implant bed according to the bone class and the endosteal diameter see table on page 36 with the BL TE tap 15 rpm Straumann Bone Level implants The following example shows fine implant bed preparation for 4 1 mm Bone Level Implant of 12 mm of length placed bone class or 2 making pre tapping necessary see table on page 36 These steps follow the basic implant bed preparation see pages 32 and 33 1 Step 1 Bone Level profile drill 300 rpm max Prepare the implant bed with the Straumann Bone Level protile drill Insert the protile drill up to the planned implant shoulder level see page 35 2 Step 2 Tapping the thread in dense bone Pre top the entire length of the implant bed with the BL TE tap 4 Surgical procedures 4 1 Implant bed preparation 39 The following table summarizes the use of profile drills taps for the fine implant bed preparation for all Straumann implants All profile drills are available in a
30. ant indications in the maxilla and mandible for functional and esthetic rehabilitation of edentulous and partially edentulous patients m The S SP 4 8 mm implants are especially suited for wider interdental spaces and ridges m S SP implants with a WN platform are designed for the recons SP 04 8 WN truction of teeth with a greater neck diameter Standard SP Standard Plus RN Regular Neck 4 8 mm WN Wide Neck 6 5 mm Minimal ridge width Minimal orofacial ridge width rounded off to 0 5 mm Minimal gap width Minimal mesial distal gap width for a single tooth restoration between adjacent teeth rounded off to 0 5 mm 12 2 Indications and Contraindications 2 3 Implant specific indications Minimal Minimal ridge gap Implant type Indications and distinctive features width width TE 3 3 mm RN For oral endosteal implant indications in the maxilla and mandible for functional and esthetic rehabilitation of edentulous and partially edentulous patients m Alternative in dental gaps where the roots of adjacent teeth are close together where implants with a greater endosteal diameter are contraindicated 4 1 mm RN oral endosteal implant indications in the maxilla and mandible for functional and esthetic rehabilitation of edentulous and partially edentulous patients 4 8 mm WN For oral endosteal implant indications in the maxilla and mandible 8 5 mm 8 5 mm for functional and esthe
31. cs Titanmagnetics Titanmagnetics LOCATOR LOCATOR LOCATOR 4 1 The Straumann Dental Implant System 1 1 Overview 033 2505 033 2519 23220225 033 2335 933 2545 043 2905 043 2515 049 2529 043 2535 043 2545 RN synOcta 093 0505 033 0515 039 002 053 6535 043 6505 043 0515 043 6525 JAJOI WN synOcta 2327215 93227225 2227245 033 7245 02 357225 Q49 7299 043 7245 RN synOcta 949 015 033 025 033 055 033 7645 043 615 O43 625 4 3 7099 043 645 synOcta 033 125 2327185 033 145 043 7 125 043 135 043 7145 WN synOcta NC Crossrit RC CrossFit RC CrossFit RN Solid Abutment WN Solid Abutment RN Solid Abutment RN Solid Abutment WN Solid Abutment Retentive Anchor Retentive Anchor Retentive Anchor steco steco steco Titanmagnetics LOCATOR Titanmagnetics LOCATOR Titanmagnetics LOCATOR 1 The Straumann Dental Implant System 1 1 Overview 5 1 2 Implant lines 1 2 1 Straumann Standard Implant The classic soft tissue level implant Straumann Standard implants have a smooth neck section of 2 8 mm and are especially suitable for classic single stage procedures where the implant is placed at soft tissue level and not covered with soft tissue during the healing phase The Standard Implant uses the Straumann synOcta connection together with its corresponding prosthetic components the Straumann
32. ction The Straumann synOcta Morse taper connection was introduced as a design principle for the Straumann Dental Implant System in 1986 The mechanically locking friction fit of the Straumann synOcta internal connection with an 8 cone and an octagon for the repositioning of pros thetic parts shows improved performance over traditional external connections Abutment loosening even in screw retained situations has virtually been eliminated The Straumann synOcta connection is available for Straumann Standard Standard Plus and Tapered Effect implants with the Regular Neck and Wide Neck VVN platform 1 3 2 Straumann Narrow Neck connection Straumann Standard Plus Narrow Neck implants have an external connection based on an octagon Its design is specifically optimized for strength and makes the Straumann Narrow Neck Implant one of the most stable small diameter implants on the market The Narrow Neck connection can be used only with proprietary narrow neck prosthetic components The Narrow Neck connection is available for Straumann Standard Plus Narrow Neck implants only 1 The Straumann Dental Implant System 1 3 Implantabutment connections 7 8 1 3 3 Straumann Bone Level CrossFit Connection The CrossFit Connection of Straumann Bone Level implants applies the know how and benefits from the Straumann synOcta Morse taper connection to the connection requirements at bone level
33. ds laid down in the EN ISO 9001 quality assurance system This European standard establishes in detail the criteria which a company must fulfil regarding comprehensive quality assurance during its manufacturing processes in order to be recognized Particularly high standards are rightly expected of medical products They are defined in European standards ISO 13485 which we also meet This ensures that the qual ity of our products and services meets our customers expectations and can be reproduced and traced at any time Our products comply with the essential requirements defined in the Medical Devices Directive 93 42 EEC All of our medical products therefore carry the CE mark Institut Straumann AG meets the stringent requirements of European directive MDD 93 42 EEC for medical devices and standards EN ISO 9001 and ISO 13485 Screw Carrying System Horizontal Defect Dimension Sand blasted Large grit Acid etched chemically active and hydrophilic Sand blasted Large grit Acid etched Narrow Neck 3 5 Regular Neck 4 8 Wide Neck 6 5 Narrow CrossFit Connection for BL implants Regular CrossFit Connection for BL implants Standard Standard Plus Effect Bone Level 7 Appendix 7 2 Related documentation 71 72 7 3 Important notes Disclaimer of liability The Straumann dental implant is part of an overall concept and may only be used in conjunction with the
34. e Art No 152 360 Explantation For explantation guidelines please refer to the Directions for use Explantation procedure for Straumann dental implants Art 150 854 The components required for explanation can be found in our current product cata logue References The Straumann Dental Implant System has been compre hensively clinically documented for over 25 years You can find references to the current research literature on our website Www straumann com or by contacting your local otraumann representative Courses and training Continuing education ensures long term success Please ask your Straumann representative directly for information on the Straumann Dental Implant System courses and training Further information at www straumann com Custom made products Under certain circumstances custom made products can be supplied for special indications or cases that cannot be treated with standard products A custom made product is detined according to EEC directive 93 42 EEC Article 1 section as being any product fabricated specitically tor a named patient according to specitic characteristics and prescribed in writing by an appropriately qualitied doctor who assumes the responsibility I you require a custom made product please contact your customer service Quality assurance in accordance with MDD 93 42 EEC All production stages carried out by Institut Straumann AG are subject to the Standar
35. e implant with the handpiece Move the implant into tinal position with a maximum of 15 rom turning it clockwise 1 Note When the floor of the bone cavity is reached there is a palpable increase in resistance Caution Step 4 Insert the implant with the ratchet Attach the ratchet and the pivot of the holding key which is used for stabilizing The clockwise arrow on the rotary knob signals the direction of insertion see insert Bring the implant into its final position at bone level with slow movements of the ratchet The 4 mm cylindrical part of the transfer part for Straumann Bone Level implants can be used as depth indicator e g relative to the prospective gingival margin It facilitates coronoapical implant positioning in the ante rior area Insertion torque should not exceed 35 Nem To prevent bone compression check for correct implant bed preparation when reaching 35 before the implant is in its tinal position To avoid bone damage bone necrosis or bone splitting in the event of incorrect use e g excessive tightening resistance with an inadequate drilling depth the transfer part is provided with a breaking point If the transfer part breaks during the tightening process part the transfer screw remains in the adapter and the other part in the implant The part in the implant can be easily unscrewed with the aid of a forceps For this eventuality it is advisab
36. ection of 2 8 mm are submerged in the bone as far as the margin of the SLA SLActive surface Straumann Standard Plus and Tapered Effect implants Straumann Standard Plus and Tapered implants with a smooth neck section of 1 8 mm are submerged the bone as far as the margin of the Straumann SLA SLActive surface Optionally they can be placed slightly deeper if necessary Ideally in the esthetic region the implant shoulder should be positioned about mm apical to the cemento enamel junction CEJ of the contralateral tooth or 2 mm subgingival of the prospective gingival margin see also references on page 22 Caution If a Straumann Standard Plus or a Tapered Effect implant is inserted deeper as the margin of the Straumann SLA SLActive surface the preparation depth must be increased accordingly see also page 58 3 Preoperative Planning 3 1 Implant position 21 22 Straumann Bone Level implants Straumann Bone Level implants are best set with the outer rim of the small 45 sloping edge chamfer at bone level Ideally in the esthetic region the implant shoulder should be positioned about 3 4 mm subgingival of the prospective gingival margin see also use of Bone Level transfer part on page 46 In a scalloped situation place the mesial distal point of the outer rim of the implant to bone level The lingual palatinal wall will then extend slightly over the top line of the implant The buccal wall
37. es 4 1 Implant bed preparation 35 36 Tapping Tapping prepares the implant bed for a specitic thread type It is an optional step that gives the surgeon the flexibility to adjust the surgical protocol to the bone class to help achieve optimal primary stability It is recommended in dense bone and with large diameter implants in order to keep the insertion torque in a desirable range The table below summarizes suggested tap usage S SP implants BL TE implants Bone Classes ees w qa Class hardest bone Class 4 soft bone coronal thread tapping in the coronal area of the implant bed full thread tapping over tull depth of the implant bed Tap for ratchet Tap for adapter Tap for adapter Coupling for ratchet _ _Coupling for Coupling for adapter adapter ca Label for implant type Depth mark Depth mark Cutting head 3 Cutting head A Caution S SP taps are used in the coronal area only or over the full If a tap is used it should always Straumann taps depth of the implant bed depending on implant diameter and be inserted over the full depth of the im are to be used bone class see table above plant bed preparation see table above only for the corre The S SP taps are available for adapter and for ratchet BL TE taps are available for adapter sponding implant Two lengths are offered for the ratchet version only type
38. eter Implant diameter Gap width Distance between adja cent teeth at bone level D mm b mm Rule 1 applied on both implant sides Preoperative Planning 3 1 Implant position 3 1 1 2 Examples of multiple tooth gaps The following examples show how rules 1 and 2 are implemented in multiple tooth gaps The measurement is made at bone level trom the adjacent tooth to the center of the implant and between implant centers The minimal distance of 3 mm between two adjacent implant shoulders rule 2 is important to tacilitate adaptation avoid proximity of secondary components and provide adequate space for maintenance and home care Straumann Standard Standard Plus and Tapered Effect implants Shoulder Shoulder b mm imm diameter D mm diameter D Cin Drin UTI min MM b C x e H H Implant diameter Implant diameter i D mm D mm min min min min b C BL 3 3 BL 4 3 ons l 4 i 3 Preoperative Planning 3 1 Implant position Fo eei E16 at MY od X Straumann Bone Level implants signer mw gan L 19 20 3 1 2 Orofacial implant position The facial and palatal bone layer must be at least 1 mm thick in order to ensure stable hard and soft tissue con ditions The minimal orofacial ridge
39. ion of the surface margin very similar surgical procedures With the Bone Control Design Straumann implants Straumann implants have been extensively researched help to achieve optimal preservation of crestal bone and Their optimized design called Bone Control Design soft tissue stability 5 SP TE BL 1 8 me ia 8 a 9 pee i these LI tb 1 Mama JA E fa e tt 55 75 ts tf gan t tags t giga ect SIE 4 le M 3 Jet Je we So a PC Y 2 2 Fey x Fi he al millo a wf eld i s P afi AEO Ghi O PSP O r 5 p 0 pen Uy tee ata Lidl a m Du E Jo est Bapt ne Bap u 4 n F p pass PRA peas r pua tape peer uua Straumann Straumann Straumann Straumann Standard Standard Plus Tapered Effect Bone Level Implant 5 Implant SP Implant TE Implant BL The classic soft tis The implant for The implant tor Straumann exper sue level implant flexible placement immediate place tise applied at ment bone level Straumann dental implants are available in three endosteal diameters 3 3 mm 4 1 mm and 4 8 mm A unitied color code simplities ident
40. is located somewhat below the implant edge For further information regarding surgical procedures in cases pertaining to esthetics please refer to the following scientific publications ITI Consensus Paper Buser D Martin W Belser U Optimizing esthetics for implant restora lions in the anterior maxilla anatomic and surgical consid erations Int J Oral Maxillofac Implants 2004 19 Suppl 43 61 3 Preoperative Planning 3 1 Implant position brm ii ER ITI Treatment Guide Buser D Martin WV Belser U Surgical consider ations for single tooth replacements in the esthetic zone standard procedure in sites without bone deficiencies Treatment Guide Implant Therapy in the Esthetic Zone Single Tooth Replacements 2007 Vol 1 26 37 Quintessence Publishing Co Ltd Berlin 3 2 Planning aids 3 2 1 Mesiodistal and orofacial space requirements 3 2 1 1 Diagnostic T for Straumann Standard Standard Plus and Tapered Effect implants By using the Diagnostic T in the patient s mouth or on the cast an initial impression of the spatial relations for the choice of the implant shoulder diameter and prosthetic reconstruction can be obtained The pictograms on the instruments show which arm is used for which measurement The use of additional planning methods such as the use of a drill template see page 28 is recommended X Minimum occl
41. itication of instruments and implants Endosteal implant diameter 3 3 mm 1 The Straumann Dental Implant System 1 1 Overview 3 Implant overview Neck diameter Endosteal diameter SLActive Connection Prosthetic restoration components O Al mm 053 0305 39 2305 053 0905 033 0905 Q39 19 15 093 0315 035 2315 033 6315 92227215 033 1515 093 0519 e e e 6 e e oe o o o o o o o o o o o o o o o o o oe o o o o o o e o o o o 6 9 0 6 9 099 1923 OD 2222922 093 0325 Ego a 033 1525 053 0525 2221925 093 0995 33 2939 093 0909 922227255 053 1009 053 0535 033 1345 033 0345 J33 2345 033 9545 033 1545 033 0545 193 1959 093 0355 043 0305 043 2305 043 6305 043 0505 9 0 9 oe 9 e o o o 9 0 o o 9 0 o o o o o 9 6 O43 1315 043 0315 043 2315 043 6315 042 9305 043 0515 043 1325 043 0325 O43 2329 043 0325 042 9315 043 1525 043 0525 4951995 043 0335 942 2535 043 6335 042 9325 043 1533 043 0535 043 1345 QA 0945 042 2349 042 9335 943 1545 043 0545 043 1355 043 0355 RN synOcta RN synOcta RN synOcta WN synOcta RN synOcta RN synOcta RN Solid Abutment RN Solid Abutment RN Solid Abutment WN Solid Abutment RN Solid Abutment RN Solid Abutment Retentive Anchor Retentive Anchor Retentive Anchor steco steco steco Titanmagneti
42. ividual soft tissue management LL Note Do not use customizable healing abut ments for longer than 6 months 4 Surgical procedures 4 4 Soft tissue management NC 6 9 9 0 e 0 e 06 0 0 9 9 9 6 0 9 06 0 9 0 9 9 O GO 9 9 O0 0 9 69 O 0 9 06 0 9 0 0 0 9 0 9 RC RC NC Healing Abutment bottle shape diameter 3 3 mm height 3 5 mm Ti NC Healing Abutment bottle shape diameter 3 3 mm height 5 mm Ti RC Healing Abutment bottle shape diameter 4 4 mm height 4 mm Ti RC Healing Abutment bottle shape diameter 4 7 mm height 6 mm Ti NC Healing Abutment customizable diameter 5 mm polymer RC Healing Abutment customizable diameter 7 mm polymer 024 2234 024 2236 024 4234 024 4236 024 2270 024 4270 5 HEALING PHASE 5 1 Healing phase duration SLActive At least 3 4 weeks m Good bone quality and adequate bone quantity At least 6 weeks m implants with a diameter of 4 1 mm or 4 8 mm and a Straumann SLActive SLA surface length of 28 mm m Cancellous bone quality At least 8 weeks At least 12 weeks m Implants with a diameter of 3 3 mm m implants with a Straumann SLActive SLA surface length of mm Healing phase corresponding to the situation m Straumann SLActive SIA surface is not completely in contact with the bone Bone augmentation measures are necessary SLActive Sand blasted Large grit
43. l 4 Surgical procedures 4 1 Implant bed preparation Two types of Straumann taps are available taps for ratchet and taps for adapter The taps ratchet are directly coupled to the ratchet and are for tapping with ratchet only The taps for adapter can be coupled either to a handpiece or a ratchet adapter and allow both tapping with the handpiece or with the ratchet Connect the tap adapter to the handpiece via the hand For tapping with the ratchet use the top for ratchet or connect a piece adapter Do not exceed 15 rom ratchet adapter to the tap for adapter inserting the tap into the cavity the ratchet is placed on its coupling and the thread is tapped with a slow rotating movement The holding key is used as a stabilizer to maintain the direction of tapping during the procedure 3 Holding key Handpiece Handpiece adapter for ratchet Tap for adapter Tap for adapter 4 Surgical procedures 4 1 Implant bed preparation 37 4 1 3 Examples for fine implant bed preparation Straumann Standard and Standard Plus implants 400 rpm max mma i Straumann Tapered Effect implants 300 rpm max 38 4 Surgical procedures 4 1 Implant bed preparation Step 1 Standard Plus profile drill Shape the coronal part of the implant bed with the Standard Plus profile drill Insert the Standard Plus profile drill up to the planned implant shoulder level see page 35 Note For St
44. le to keep a used sterile transfer part in stock 4 Surgical procedures 4 3 Placing the implant Step 5 Not needed for 5 5 5 SP TE implants don t need to be rotationally oriented If you are placing a Bone Level Implant with the hand piece choose the correct position as shown in Step 5 in the right column Step 5 Correct implant orientation While approaching the final implant position make sure that one of the four white marks on the blue transfer part is exactly oriented orotacially This positions the four protrusions of the internal connection for ideal prosthetic abutment orientation A quarter turn to the next white mark corresponds to vertical displacement of 0 2 mm A Caution Avoid vertical position corrections using reverse rotations counterclockwise This can cause loosening of the trans fer part and may lead to a decrease in primary stability 4 Surgical procedures 4 3 Placing the implant 47 48 Step 6 Loosen the transfer part Before removing the transfer part set the motor on the handpiece to reverse During the first few turns hold the implant with the holding key which is used for stabilizing countering the hexagon Remove the transfer part for details of the holding key see page 04 4 Surgical procedures 4 3 Placing the implant Step 6 Loosen the transfer part Change the direction of the ratchet The arrow the r
45. m a w co 833 3 3 3 3 G1 6 5 lt o NK 4 591 o B 4 575 592 o B o K o NK o N h U Cn o B 026 2310 3 3 mm 026 4310 4 1 mm 026 6310 8 4 8 mm co o N 2 P N 3 3 3 3 E 3 E E E 4 E v p 5 a v a 5 o 5 5 5 5 5 5 5 5 ade of high quality material they be used up to 10 surgical procedures However function refer to C main sur aintenance of surgical and prosthetic instruments are marked 07 07 152 755 e B00907 6 Additional information on instruments 6 3 Cleaning and care of instruments Instruments with high cutting performance are a basic requirement for successful implantation The following should therefore be remembered m Never allow instruments to land on their tips Every instrument must be used only for its particular intended purpose Dirty instruments should be placed in a bowl of Ring er s solution avoid allowing blood or tissue residue to dry on them m Residues of blood saliva tissue or bone must be removed from the instruments immediately after surgery Every piece of residue that adheres to the instruments and dries on them leads to corrosion m Multi part instruments e g ratchet internally cooled trephine drill must be disassembled for sterilisation and storage Used instrumen
46. moplastic drill template 1 Drill a hole into the previously determined implant position and in the plaster anatomic cast on its axis 2 Check the implant position by inserting the pin into the drilled hole 3 Heat the template in water until it is soft and transparent 4 Place the template on the guide pin and press onto the plaster teeth After it has cooled off and has been disinfected the thermoplastic drill tem plate determines exactly how the 2 2 mm pilot drill is to be guided Drill hole template for single tooth gap Drill hole template for free end saddle 1 Note For more detailed information please refer to the brochure The efficient aid for case planning and implant bed preparation Thermoplastic drill template Art No 152 356 3 Preoperative Planning 3 2 Planning aids 29 30 4 SURGICAL PROCEDURES 4 1 Implant bed preparation Preparing the implant bed is done using one surgical kit for all Straumann dental implants and covers two main steps Basic implant bed preparation involves ridge preparation and twist drilling For twist drilling the endosteal diameter of the implant 3 3 4 1 4 8 mm not the implant type or the bone class determines Ridge preparation the instrumentation used Fine implant bed preparation involves profile drilling and tapping For tapping the implant type S SP TE BL and bone class determine the instrumentation used Profile drilling Tapping Be
47. n drills Collar for drill stop mounting Single patient drill drill stop compatible with collar for drill stop mounting M m mm 22800 _ Ka K 22mm 028 3 5 64 2 mm Drill Stop Set one depth 6 Additional information on instruments 6 1 Surgical Instruments 59 Implant bed depth 16 mm 14 mm 12 mm 10 mm 8 mm 6mm 1 Note Straumann drill stops are not indicated for m Extraction sites where bone cavity is often wider than the diameter necessary to hold the drill stop m Use with drill templates due to the interference from or with the template For more information of the Straumann Drill Stop please refer to the brochure Straumann Drill Stop Precise depth control Art 152 053 60 6 Additional information on instruments 6 1 Surgical Instruments 6 1 4 Straumann Surgical Cassette The surgical cassette is used for the secure storage and sterilisation of the surgical instruments and auxiliary instruments of the Straumann Dental Implant System The cassette is made of a highly shock proof thermoplastic which has been proven for years in the medical area and is suitable for frequent sterilisation in the autoclave Autoclaving at a temperature of up to 134 273 F is recommended a aa aa IH In 0000 Screw co
48. n the case of a restricted ridge width 5 5 mm 7 mm 4 view of their lower mechanical strength compared to the 24 1 mm implants these implants should be used exclusively for the following indications Edentulous jaw 4 implants S SP 3 3 RN in conjunction with a bar SP 3 3 mm RN construction Partially edentulous jaw In case of fixed reconstruction combined with 4 1 mm implants and splinted with a superstructure 5 9 4 1 mm RN ti For oral endosteal implant indications in the maxilla and mm 7 mm mandible for functional and esthetic rehabilitation of edentulous and partially edentulous patients SP 4 1 mm RN E Standard SP Standard Plus cont Narrow Neck 3 5 RN Regular Neck 4 8 Minimal ridge width Minimal orofacial ridge width rounded off to 0 5 mm Minimal gap width Minimal mesial distal gap width for a single tooth restoration between adjacent teeth rounded off to 0 5 mm 2 Indications and Contraindications 2 3 Implant specific indications 11 Minimal Minimal ridge gap Implant type Indications and distinctive features width S 4 8 mm RN For oral endosteal implant indications in the maxilla and mandible for functional and esthetic rehabilitation of edentulous and partially edentulous patients m he S SP 4 8 mm implants are especially suited for wider interdental spaces and ridges SP 4 8 mm RN S 4 8 mm WN For oral endosteal impl
49. nable a larger Chemical activity accessible surface area for increased blood contact and promoting faster bone cell attachment osseointegration Chemical activity The chemical activity of SLActive provides ideal condi tions for direct protein adsorption stimulating immediate new bone formation 1 4 2 Straumann SLA The SLA surface is produced using large grit sandblasting technique that generates macro roughness on the titanium surface This is followed by acid etching that superposes a micro roughness The resulting topography otters the ideal structure for cell attachment and is also the basis for the further developed SLActive surface 1 The Straumann Dental Implant System 1 4 Surfaces 9 10 2 INDICATIONS AND CONTRAINDICATIONS 2 1 Indications Straumann dental implants are suitable for the treatment of oral endosteal implantation in the upper and lower jaw and for the functional and esthetic oral rehabilitation of edentulous and partially dentate patients unless specitic indications and limitations are present as stated below Straumann dental implants can also be used for immedi ate or early implantation tollowing extraction or loss of natural teeth Straumann implants are approved within the scope ot indications for immediate restoration single tooth gaps and in an edentulous or partially dentate jaw Good primary stability and an appropriate occlusal load are essential Two or more adjace
50. nce indicator Round bur before flap opening 1 4 mm Straumann Implant Distance Indicator for Straumann Standard Standard Plus and Tapered implants No 046 148 048 kos noas 035 9055 aldo Neck pem 0 3 Preoperative Planning 3 2 Planning aids Straumann Implant Distance Indicator for Straumann Bone level implants Art No 026 0901 m a Pa 3 2 2 Determining the vertical bone availability The vertical bone availability determines the maximal allowable length of the implant that can be placed To make it easier in determining the vertical bone availability the use of an Xray template with Xray reference spheres is recommended 3 2 2 1 X ray reference sphere The Xray reference sphere Art 049 076V4 has a diameter of 5 mm The image of the sphere on the X ray provides the reference value for the magnification scale To prepare a reference sphere carrying template the selected implant positions are marked on the study cast The Xray reference spheres are fixed at the marked points The vacuum formed template is then made with the spheres The subsequent X ray shows the vertical bone availability and mucosal thickness from which the cor responding implant length and type can be derived in consideration of the enlargement factor 3 Preoperative Planning 3 2 Planning aids 25
51. non absorbable suture material is recommended e g Polyamide or Teflon The sutures are removed after 7 10 days A postoperative Xray is recommended 4 4 1 Submucosal healing For submucosal healing healing under closed mucoperiosteal tlap the use of a closure screw shorter healing cap or healing abutment is recommended Submucosal healing is suggested in esthetic indications and for implantations with simultaneous guided bone restoration GBR or membrane technique A second surgical procedure is required for un covering the implant and insertion of the desired secondary component Step 1 Inserting the closure screw after 1st surgery Ensure that the internal configuration of the implant is clean and bloodless Pick up the closure screw with the SCS screwdriver The friction fit will secure the closure screw to the instrument during insertion and will allow safe handling Hand tighten the closure screw The design will provide a tight connection between the two components 1 Note Bone level closure screws are delivered sterile and ready to use All other Straumann closure screws are delivered non sterile and must be sterilized prior to use Subsequent loosening is made easier by applying chlorhexidine gel or sterile Vaseline to the closure screw before it is screwed into the implant 4 Surgical procedures 4 4 Soft tissue management Step 2 Wound closure Adapt the mucoperiosteal flaps carefully and sutu
52. nt implants should be prosthetically connected together if restored imme diately In the case of immediately restored edentulous indications at least 4 implants must be connected together Healing phase duration for delayed restorations is given on page 57 The prosthetic restorations used are single crowns bridges and partial or full dentures which are connected to the implants by the corresponding elements abutments On page 11 ff you find implant specific details about indications the necessary bone volume and the spacing between implants and the distance from ad jacent teeth 2 1 1 Specific indications for small diameter 3 3 mm implants As a general rule always use the largest possible implant diameter Because of their reduced mechanical stability small diameter implants are used only in cases with a low mechanical load Placement in the molar region is not recommendable For further restrictions see page 11 ff 2 1 2 Specific indications for Straumann implants with a length of 6 mm Because of the reduced surface area for anchorage in the bone these implants are to be used solely for the follow ing indications As an additional implant together with longer implants to support implant borne reconstructions As an auxiliary implant for implantborne bar constructions supporting full dentures in a seriously atrophied mandible 2 Indications and Contraindications 2 1 Indications 2 2 Contraindications 2 2
53. ntainer Color coding Green Endosteal implant diameter 4 8 mm Endosteal implant diameter 4 1 mm Yellow Endosteal implant diameter 3 3 mm m The easy to read user guide ensures a reliable working sequence through color coded arrows and silicon sleeves Clear illustrations drill length stops allow the arranged instruments screws and healing caps to be checked at a glance for correctness and completeness The instruments are positioned securely in the silicone sleeves for sterilisa tion and storage The cassette can be packed according to the working procedure using the handpiece or manually with the ratchet The surgical cassette also houses a separate screw container in which the required Straumann synOcta and Narrow Neck closure screws and healing caps are arranged thus providing ease of access to them CrossFit healing abutments for the Straumann Bone Level Implant are stored separately 6 Additional information on instruments 0 1 Surgical Instruments 61 62 Guidelines for the sterilisation of the surgical cassette Steam Sterilization Prevacuum Cycle 1923 4279 RE 20 60 min Steam Sterilization Gravity Cycle 134 C7 273 F 20 60 min No dry heat sterilization Instruments that are not thoroughly dried may corrode Before sterilisation the cassette is packed e g sealed in foil or wrapped in towels in order to keep it sterile Important Chemic
54. o o RC Closure Screw height O mm Ti 024 4100 04 implants if bone overgrowth is present kas 6 9 9 e 6 0 0 06 0 9 9 9 0 6 9 06 0 9 0 9 9 9 0 GO 0 9 O6 O 9 9 O0 9 9 0 9 6 O 9 0 9 9 9 9 9 9 06 0 RC Closure Screw height O 5 mm Ti 024 4105 04 i RC Healing Abutment 024 4222 conical diameter 4 5 mm height 2 mm Ti NC Healing Abutment 024 2222 conical diameter 3 6 mm height 2 mm Ti profiles matched to secondary components NC Healing Abutment 024 2224 allows for simple and reliable soft tissue P conicol diometer 3 mm height 3 5 mm Ti lis 5 E NC Healing Abutment 024 2226 conical diameter 3 6 mm height 5 mm Ti Transmucosal healing The set of healing abutments which have 2 NC Healing Abutment 024 2242 conical diameter 4 8 mm height 2 mm Ti oe oe 0 e e e o e e
55. oft tissue response is influenced by the position between the implant and the proposed restoration Therefore it should be based on the position of the implant abutment connection The implant position can be viewed in three dimensions m Mesiodistal m Orofacial m Coronoapical Preoperative Planning 3 1 Implant position 15 16 3 1 1 Mesiodistal implant position The mesiodistal bone availability is an important factor for choosing the implant type and diameter as well as the interimplant distances in the case of multiple implants The point of reference on the implant for measuring mesiocdistal distances is always the shoulder being the most voluminous part of the implant Note that all distances given in this chapter are rounded off to O 5 mm The following basic rules must be applied Rule 1 Distance to adjacent tooth at bone level A minimal distance of 1 5 mm from the implant shoulder to the adjacent tooth at bone level mesial and distal is required 21 5 21 5 mm 215mm Rule 2 Distance to adjacent implants at bone level A minimal distance of 3 mm between two adjacent implant shoulders mesiodistal is required gt 3 gt 3 gt 3 ve ra E F f mi Kh LE E I LI es E d SEEN Se iW T a T wma ad LLLI w mz i 1 544 MODICO fui SUDO Oe Oe Seen el Trl tty Ele
56. on 6 2 2 Instrument set for transalveolar sinus floor elevation Indicated in cases with inadequate vertical bone By tapping on the osteo tomes with a mallet the sinus floor can be fractured and elevated 1 Note The instruments with diameters of 2 2 mm 2 8 mm 3 5 mm and 4 2 mm match the implant diameters of the Straumann Dental Implant System They are available as a straight or angled model which facilitates access in the posterior region 6 2 3 Depth stops for osteotomes All osteotomes have clear laser marks for depths of 6 mm 8 mm 1O mm 12 mm and 14 mm In addition adjustable depth stops facilitate depth checking Further references regarding use the instructions for use Straumann Osteotomes Art Nos 150 855 and 150 857 See also DVD Straumann Dental Implant System Surgical Art No 150 541 Osteotomes for bone condensation Osteotomes for sinus floor elevation Depth stops for osteotomes 6 Additional information on instruments 6 2 Osteotomes 65 66 6 3 Cleaning and of instruments Caretul treatment of all instruments is of the utmost importance Even slight damage for instance to the drill tips e g when the drills are thrown into a bowl of water impairs cutting performance and thus the clinical result With correct and careful care the high quality of the material and excellent workmanship ensure that the rotating instruments drills taps etc
57. otary knob now points counterclockwise see insert Use holding key to counter the octagon and loosen the transfer part counterclockwise using the ratchet tor details of the holding key see page 64 Step 7 Remove the instruments Remove the holding key and then completely remove the transter part with the adapter the implant Step 7 Remove the instruments Remove the holding key then the ratchet while holding the adapter at the bottom Finally remove the transfer part from the implant with the adapter still mounted com pletely 4 Surgical procedures 4 3 Placing the implant 49 4 4 Soft tissue management After implantation the implant is closed hand tightened with an SCS closure screw healing cap or healing abutment to protect the implant for SCS screwdrivers see page 64 The surgeon can choose between submucosal and trans mucosal healing and has all options available for soft tissue management made possible through a set of secondary healing components The non epithelialized side of the should be approximated to the implant neck soft tissue approximation If necessary this step must be combined with a gingivectomy The wound margins are closed with atraumatic suture material and the sutures must not be tied too tightly One relieving suture is placed on either side of the closure screw or healing cap so that the wound margins are approximated without tension Use of
58. ration between adjacent teeth rounded off to 0 5 mm 14 2 Indications and Contraindications 2 3 Implant specific indications 3 PREOPERATIVE PLANNING 3 1 Implant position The implant is the focal point of the restoration It provides the basis for planning the surgical procedure Close commu nication between the patient dentist surgeon and dental technician is imperative tor achieving the desired prosthetic result To establish the topographical situation the axial orientation and the choice of implants we recommend the following m Make on the previously prepared study cast m Define the type of superstructure The waxup setup can later be used as the basis for a custom made X ray or drill template and for a temporary restoration 1 Note The implant abutments should always be loaded axially Ideally the long axis of the implant is aligned with the cusps of the opposing tooth Extreme cusp formation should be avoided It can lead to unphysiological loading The implant diameter implant type position and number of implants should be selected individually taking the anatomy and spatial circumstances e g malpositioned or inclined teeth into account The measurements given here should be regarded as minimum guidelines Only when the minimum distances are observed is it possible to design the restoration so that the necessary oral hygiene measures can be carried Out The final hard and s
59. rd Plus Tapered Effect and Bone Level implants require profile drilling with specific instruments This is independent of the bone class m Straumann Standard implants are inserted without profile drilling The profile drills are clearly marked SP TE or BL The first diameter indicated on the label corresponds to the dia meter of the guide cylinder and accordingly to the diameter of the implant bed before profile drilling All Straumann protile drills are available in a short and a long version Insertion depth on Insertion depth on Insertion depth on Insertion depth on SLActive SLA8surface implant shoulder SLActive SlA8surface implant shoulder margin level morgin level H TT Ea fs aT a a h i CUm o iu i Insert the Straumann A dent on the Bone Level Profile front of the guide Drill up to the cylinder makes planned implant the drills better shoulder level distinguishable from Tapered Effect profile drills 400 rpm max 300 rpm max 300 rpm mox L Note N Caution Due to the unflared neck portion the Straumann The profile drills are suitable only for the corresponding Standard Plus 3 3 mm and Standard Plus implant type 4 8 mm RN implants are inserted without profile Profile Drill according to the planned insertion depth of the implant Profile Drill according to the planned insertion depth of the implant drilling 4 Surgical procedur
60. re together with interrupted sutures Make sure a tight seal is formed over the implant Step 3 Reopening and removal 2nd surgery locate the implant Make a small crestal incision down to the closure screw Spread the flap slightly and remove the closure screw with the SCS screwdriver 4 Surgical procedures 4 4 Soft tissue management 51 52 4 Surgical procedures 4 4 Soft tissue management Step 4 Insertion and wound closure Rinse the exposed internal connection of the implant thor oughly with sterile saline solution Insert a suitable secondary component Adapt the soft tissue and suture it back tightly without ten sion around the secondary component 4 4 2 Transmucosal healing A versatile portfolio of healing caps and healing abutments is available for all Straumann implants enabling soft tissue sculpturing during transmucosal healing They are recommended for intermediate use After the soft tissue healing phase they are replaced with the appropriate temporary or final restoration 1 Step 1 Insertion Ensure that the internal configuration of the implant is clean and bloodless Insert the healing cap or healing abutment with the SCS screwdriver The friction fit secures the components to the instrument during insertion and ensures safe handling Hand ighten the healing cap or healing abutment The design will provide a tight connection between the two components 1 Note Healing caps and abutments
61. re to strong light or heat DRAA I M Straumann products carry the CE mark and fulfill the requirements of the Medical Devices Directive 93 42 EEC Consult operating instructions E Colored warning labels YELLOW 2 CAUTION Indicates hazards or unsafe handling which might cause minor injury or damage to property ORANGE WARNING Indicates hazards which might cause serious or fatal injury RED DANGER Indicates hazards which might cause immediate serious or fatal injury 9 N D EX axial orientation 15 biological principles 3 bone availability 23 42 augmentation class 39 condensation 65 damage 46 effective availability 27 formation process or quality 37 quantity D Bone Control Design 3 buccal wall 22 cemento enamel junction 2 colorcoded 59 contraindications 10 contralateral 21 coronal 36 coronoapical 21 CrossFit Connection 8 dental practice hygiene plan 58 depth morks 58 depth stops 65 Diagnostic T 18 23 drill template custom made 28 tree end situations 29 single tooth gaps 29 vacuum formed 28 drilling depth 59 endosteal diameters 9 full depth tapping 36 healing phase duration 74 holding key 48 64 hydrophilic properties 9 implant diameter 15 distance indicator 24 insertion depth 2 orofacial 20 position 15 92 shoulder diameter 23 specitic indications Straumann Bone level 6
62. rt Use the holding key for countering when loosening the transter part trom the implant The transfer part should be loosened only with the ratchet or handpiece counter clockwise The shape of the holding key is specially designed for ditferent oral situations Forked end when spaces are normal the torked end is attached directly to the hexagon m Closed end when the interdental space is limited the closed end must be placed on the hexagon over the transter part To do this the ratchet and adapter or handpiece must be removed 6 1 7 SCS screwdrivers 6 Additional information on instruments 6 1 Surgical Instruments Holding key Stabilizing the ratchet Forked end Closed end SCS screwdriver for manual use SCS screwdriver for mechanical use Article short long in the handpiece lengths 15 mm 21 mm 27 Article short long Material stainless steel lengths 20 mm 26 mm 32 Material stainless steel 6 2 Osteotomes 6 2 1 Instrument set for bone condensation Indicated in cases with cancellous bone bone class 3 and 4 m Reinforces bone radially to give improved primary stability to the implant 1 Note The instruments with diameters of 2 2 mm 2 8 mm 3 5 mm and 4 2 mm match the implant diameters of the Straumann Dental Implant System They are available as a straight or angled model which facilitates access in the posterior regi
63. short and a long version S SP taps are available for ratchet and for adapter The table lists the short profile drills and the taps for adapter only 044 086 044 088 044 084 044 575 044 577 044 579 044 701 044 705 044 703 026 2303 026 4303 026 6303 026 2310 026 4310 026 6310 SP Profile drill short 2 8 mm RIN SP Profile drill short 3 5 mm RIN SP Profile drill short 4 2 mm WIN S SP Tap 3 3 mm for adapter S SP Tap 4 1 mm for adapter S SP Tap 4 8 mm for adapter TE Profile drill short 2 8 mm RN TE Profile drill short 3 5 mm RIN TE Profile drill short 4 2 mm WN BL Profile drill 3 3 mm short BL Profile drill 4 1 mm short BL Profile drill 4 8 mm short BL TE Tap 2 3 3 mm for adapter Hanae BL TE 2 4 1 mm for adapter BL TE Tap 2 4 8 mm for adapter 40 4 Surgical procedures 4 1 Implant bed preparation Required step 77 Required in dense bone only gt Due to the unflared neck portion the Straumann Standard Plus 3 3 NN and Standard Plus 4 8 mm RN implants are inserted without profile drilling 4 Surgical procedures 4 1 Implant bed preparation 41 42 4 2 Opening the implant package Straumann SLActive 4 Surgical procedures 4 2 Opening the implant package Step 1 Open the blister and remove the vial 1 Note The blister ensures the sterility of the implant
64. tic rehabilitation of edentulous and partially edentulous patients m he 4 8 mm implants are especially suited for wider interdental spaces and ridges Tapered Effect RN Regular Neck 4 8 WN Wide Neck 6 5 mm Minimal ridge width Minimal orofacial ridge width between adjacent teeth rounded off to 0 5 Minimal gap width Minimal mesial distal gap width for a single tooth restoration between adjacent teeth rounded off to 0 5 mm 2 Indications and Contraindications 2 3 Implant specific indications 13 Minimal Minimal ridge gap Implant type Indications and distinctive features width width BL 3 3 mm NC m Small diameter implant for narrow interdental spaces and ridges AY Caution Placement in the molar region is not recommended BL 4 1 mm RC For oral endosteal implant indications in the maxilla and mandi ble for functional and esthetic rehabilitation of edentulous and partially edentulous patients BL 24 8 mm RC 1 m For oral endosteal implant indications the maxilla and mandible for functional and esthetic rehabilitation of edentulous and partially edentulous patients m The BL 4 8 mm implants are especially suited for wider interdental spaces and ridges BL Bone Level NC Narrow CrossFit RC Regular CrossFit Minimal ridge width Minimal orofacial ridge width rounded off to 0 5 mm Minimal gap width Minimal mesial distal gap width for a single tooth resto
65. tionally oriented for both handpiece and ratchet insertion see Step 5 on page 47 Apart trom this exception all Straumann implants are placed in the same way Placement with the handpiece Placement with the ratchet Example Straumann Standard Plus Implant Example Straumann Bone Level Implant 1 click Step 1 Attach the handpiece adapter Step 1 Attach the ratchet adapter Grasp the closed part of the implant carrier Attach the Hold the implant carrier at the closed end and push the handpiece adapter to the implant A click is heard when ratchet adapter onto the transfer part until you hear a the handpiece adapter is attached correctly click 4 Surgical procedures 4 3 Placing the implant Step 2 Remove the implant from the carrier Step 2 Remove the implant from the carrier Simultaneously pull down the implant carrier and lift the Pull the implant carrier slightly downward to remove the implant out of the implant carrier while supporting your implant from the implant carrier At the same time lift the arms implant from the carrier with a slight twisting movement prop your hands while doing this Step 3 Place the implant Step 3 Place the implant Place the implant with the handpiece into the implant Place the implant manually into the implant bed with the bed aid of the adapter 4 Surgical procedures 4 3 Placing the implant 45 46 Step 4 Insert th
66. tore starting and during the surgical procedure the following points must be considered m Check all instruments for completeness and function An adequate stock of implants and sterile spare instruments should always be available Do not use cutting instruments more than 10 times The table Surgery Tracking Sheet for Straumann Cutting Instruments Art No 152 755 facilitates tracking m Ensure ample cooling of drills with pre cooled 5 C 41 F physiological sterile saline solution NaCl or Ringer s solution Do not exceed the indicated speed for drills see graphics and tables page 31 tt Use drills in ascending order of their diameter Use only light pressure and an intermittent drilling technique 4 Surgical procedures 4 1 Implant bed preparation 4 1 1 Basic implant bed preparation After opening the gingiva the basic implant bed preparation begins with preparing the alveolar ridge Step 1 and marking the implantation site with a round bur Step 2 Atter that the implant bed preparation with pilot and twist drills follows Step 3 7 according to the endosteal implant diameter chosen in the preoperative planning see Chapter 3 page 15 1 Step 1 Prepare the alveolar ridge Caretully reduce and smooth a narrow tapering ridge with a large round bur This will provide a flat bone surface and a sufficiently wide area of bone L Note When choosing the implant length SLActive SLA
67. ts must always be placed in a suitable medium for disintection prior to cleaning Dirty instruments must be placed only on the intended surface cassette lid or appropriate dish m Never disinfect clean including ultrasonically or sterilise instruments made of different materials together m Damaged instruments must be sorted disinfected cleaned separately and discarded m Never store instruments damp or wet for prolonged periods You will find detailed information in the brochure Care and maintenance of surgical and prosthetic instruments Art No 152 008 Ultrasonic Cleaning Cassette The Ultrasonic Cleaning Cassette ensures optimal storage during instrument disintection and cleaning in the ultra sonic bath The pimpled silicone mat prevents the cutting edges of the instruments from coming in contact which would have a negative effect on their cutting performance 6 Additional information on instruments 6 3 Cleaning and care of instruments 67 68 7 APPENDIX 7 1 Labeling and color coding of the Straumann Dental Implant System Naming and labeling explanations yellow Endosteal implant diameter 3 3 mm Implant types Standard Implant SP Standard Plus Implant TE Tapered Implant BL Bone Level Implant Narrow Neck 3 5 mm RN Regular Neck 2 4 8 mm WN Wide Neck 6 5 mm NC Narrow CrossFit 2 3 3 mm RC Regular CrossFit 4 1 and 4 8 mm 7 Appendi
68. usal space requirement Determining the implant shoulder diameter in a for the lowest prosthetic restoration option single tooth gap Y Interproximal distance width Z Implant center to adjacent tooth the gap width Implant shoulders NIN Narrow Neck 3 5 RN Regular Neck 4 8 WN Wide Neck 6 5 Determining the minimal distance between im plant axis and adjacent teeth Minimum vertical space requirement for access with surgical instruments 1 Note Currently a Diagnostic T for Straumann Bone Level implants is not available 3 Preoperative Planning 3 2 Planning aids 23 24 3 2 1 2 Straumann Implant Distance Indicator Two types of distance indicators are available m For Straumann Standard Standard Plus and Tapered Effect implants Art No 046 148 m For Straumann Bone Level implants Art No 026 0901 The four discs of the implant distance indicators display the shoulder diameters of Straumann implants The implant distance indicators can be used to check the available space before the start of treatment or intraoperatively to mark the desired implant site Alter opening and precise positioning of the discs at the planned implantation site it is possible to drill through the perforation in the disc s with the round bur 1 4 mm No 044 022 in order to mark the centre of the implant bed Intraoperative use of the dista
69. widths for individual implant types are given in the indication tables on page 11 ff Within this limitation a restoration driven orofacial implant position and axis should be chosen such that screw retained restorations are possible Bone layer at least mm in thickness LE 247 Choose the orofacial implant position and axis so that the screw channel of the screw retained restoration is located behind the incisial edge 3 Preoperative Planning 3 1 Implant position Caution An augmentation procedure is indicated where the oro facial bone wall is less than 1 mm or a layer of bone is missing on one or more sides This technique should be employed only by dentists who have adequate experi ence in the use of augmentation procedures 3 1 3 Coronoapical implant position Straumann dental implants allow for flexible coronoapical implant position ing depending on individual anatomy implant site the type of restoration planned and preference In the anterior area a deeper coronoapical implant position is better for esthetic reasons In this situation the use of Straumann Standard Plus Tapered Effect or Bone level implants is recommended The following illustration shows the coronoapical implant position for these implants B UNUS Standard Standard Plus Tapered Effect Bone Level Straumann Standard implants Straumann Standard implants with a smooth neck s
70. x 7 1 labeling and color coding of the Straumann Dental Implant System Example of label on implant packaging Connection type Implant type Length of the SLA9 SLActive surface Article number 128 Barcode il Institut Straumann AG CH 4002 Basel Switzerland Use before expiration date Single use only Please read and follow instruction leaflet Straumann products are CE marked and fulfill the requirements of the European Medical Devices Directive 93 42 EEC Straumann Straumann Standard Plus Implant Standard Plus Implant Endosteal diameter 3 3 mm Endosteal diameter 4 1 mm Narrow Neck Regular Neck 8 mm SLAS 1O mm SLActive Endosteal diameter Surface type OT number 9 A C Rxonly The Green Dot 5 Manufacturer Caution Federal law US restricts this product to sale by or on the order of a dentist or physician Sterilized with gamma radiation Straumann Straumann Tapered Effect Implant Bone Level Implant Endosteal diameter 4 8 mm Endosteal diameter 4 1 mm Wide Neck Regular CrossFit 12 mm SLActive 12 mm SLActive 7 Appendix 7 1 Labeling and color coding of the Straumann Dental Implant System 69 70 7 2 Related documentation 1 Note Our detailed documentation will help you in caretully planning and performing your implantbased restorations m Straumann Narrow Neck Art No 152 305 m Crown and

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