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User`s guide Natea+ 2014

1. teknika GROUP u Hexagon Taper 11 Surgical PROCEDURE Emergence switching The assembled implant abutment is not linear in profile but has a concavity coronal to the fixture head as the abutment is narrower than the external diameter of the implant This allows for the development of a ring of connective tissue that brings gt Mechanical stability of soft tissue Protection of the biological seal by reducing the risk of trauma to the soft tissue gt The concavity formed by the prosthetic junction isolates any inflammatory tissue The 3mm of biological space needed to isolate amp protect the crestal bone from the external environment is achieved by the greater length A of the prosthetic junction concavity rather than just the height B The concavity formed by the implant abutment prosthetic junction isolates any inflammatory tissue from the bone crest see Fig 2 Richard J Lazzara Stephan S Porter PDR volume 26 n 1 2006 euroteknika exclusive microthread Mechanical anchorage to enhance the implant stability in critical sites made up of the endo bone neck that suffers most of masticatory forces A thicker microthread for a higher resistance to tear constraints Synchronicity with the main thread in order not to wrest bone when following it gt A unique design with 6 entries to guarantee the microthread anchorage in a precise calibrated similar and undamaged track gt
2. Garantee In case of non osseointegration you must inform your commercial representative so that we can examine the causes for the failure and bring the necessary corrective actions An exchange may take place when the defect of the product is established if the failure results from an incorrect clinical analysis a surgical protocol not adapted to the case from the use of blunt drills or for any other reason independant from the product quality the guarantee will not be taken into consideration Parts PACKAGING Sterility and rule of asepsis not to compromise the conventional hygiene conditions associated with the implant practice The non sterile instruments and items delivered used for the implantology treatment must be decontaminated and according to a tested process sterilized at the gt Most of our parts are delivered sterile and can therefore be used straightaway A reference indicator shows the components effective sterility on the packaging The sterility is guaranteed for 5 years from packaging date A standard expiry date is indicated on the label gt Only an undamaged packaging can guarantee the products imperviousness sterility Do not use implants with packaging which has been damaged or Implants prematurely opened Cover screw Our products have been designed so as to enable Supplied with implant handling without affecting their sterility It is therefore Drills importa
3. Resonance frequency analysis insertion torque and BIC of 4 implants com parison and correlation study in sheep University Saint Joseph Libanon Comparison of two types of decalcified freeze dried bone allograft in treatment of dehiscence defects around Natea implants in dogs Univer sity of Iran 2011 Comparison of the insertion and desinsertion torque of a cylindrical and a tapered implant in 3 different materials University of Catalonia Spain 2008 UNIVERSIDAD COMPLUTENSE MADRID A global solution FOR IMPLANTOLOGY S euroteknika groupe 726 rue du G n ral De Gaulle 74700 SALLANCHES France w T l 0 4 50 91 49 20 Fax 33 0 4 50 91 98 66 Les implants dentaires euroteknika sont des dispositifs m dicaux de Classe Ilb Ils sont conformes aux normes en vigueur notamment EN1642 IS014801 1505832 2 IS05832 3 and ne sont pas rembours s par l assurance maladie lls b n ficient du marquage CE0499 d livr par SNCH M U NATS G B 1 3 01 est necessaire de bien prendre connaissance de la notice d instructions and du manuel d utilisation relatifs aux systemes implantaires euroteknik i www euroteknika com euro r teknika
4. 4 Remove the impression and connect the abutment analog into the impression coping inside the impression The snap fit guarantees the correct position of the analog Picture 2 5 Fit the protection cap on the solid abutment Picture 3 LABORATORY STEPS 6 Make the plaster cast model 7 Seat the burn out sleeve on the analog and wax up the framework Picture 4 8 Cast the wax up 9 Make the ceramic part of the prosthesis 10 The crown is cemented on the abutment in the mouth after the removal of the protection cap PICTURE 1 IMPRESSION ON UNMODIFIED SOLID ABUTMENT 4 Impression coping L Click lt q Abutment Tighten at 35N cm with the external hexagonal key and the torque wrench lt mplant PICTURE 2 USE OF ANALOG Click Impression coping a Analog PICTURE 3 PROTECTION CAP Click Protection cap a Abutment Implant PICTURE 4 ON PLASTER CAST Burn out sleeve Friction fit not snap fit eu teknika GROUP 1121414 Prosthetic PROCEDURE Protocol ON MODIFIED SOLID ABUTMENTS Adjustments on solid abutments do not allow to fully enjoy the advantages of a standard impression system We recommend applying the following technique only on single crowns for which the prosthetic adaptation is less sensitive to inaccuracy of Impression copings Photo credit Dr J BOUCHET France PICT
5. lt Double asymmetrical thread References Length L o 5 6 0051 045 006 MRENE 2 ne 2 i 6 mm NIDP 41 42 060 NIDP 48 49 060 NIDP 60 62 060 The implant is supplied with ACONTECEN 8mm 36 37 080 41 42 080 48 49 080 NIDP 60 62 080 10 mm NIDP 36 37 100 NIDP 41 42 100 NIDP 48 49 100 NIDP 60 62 100 12 mm NIDP 36 37 120 NIDP 41 42 120 NIDP 48 49 120 NIDP 60 62 120 14 mm NIDP 36 37 140 NIDP 41 42 140 NIDP 48 49 140 Direct implant driver gt Time saving during surgery gt The insertion level and the connection orientation are easier to see gt Informs about gingival height Astra 8 Naturactis Naturall compatibility Even though it has its own prosthetic range the Natea implant with its hexagonal internal connection morse taper benefits from an Astra Ocean compatible prosthetic range common with the Naturactis Naturall implants Airtightness amp stability The internal conical connection Morse Taper guarantees the airtightness and the stability of the abutment fixture connection S Dibart M Washington M Fan Su Z Skobe The connection has an internal hexagon which allows the abutment to be orientated at the right angle The depth of the connection 2 8mm and the quality of the joint between the parts guarantee a great stability while putting the pieces together and prevent the prosthetic from unscrewing euro
6. 5 Making the prosthesis using the burn out sleeves clearing the sockets of screws access see picture 4 lt External hexagonal key 6 Fitting of the infrastructure in the mouth The insertion must be passive Checking and adjustment of occlusion 7 Final adjustment of the prosthesis Protection cap 10 N cm lt Abutment 8 Tightening of the prosthesis on the Tetra abutments in the mouth with the torque wrench Ref CCC 35 at 20 N cm Seal the screw heads and access holes lt Implant PICTURE 4 Burn out sleeve 20 N cm ZN Use a new screw for the final tightening For your fittings use other screws especially reserved lt Plaster cast for that purpose For laboratory manipulations use guide screws eu teknika GROUP u OVERDENTURE ON O RING ABUTMENTS euro teknika Prosthetic PROCEDURE For removable prosthesis WITH BALL ABUTMENTS 1 Screw manually or with the external hexagonal key the impression copings into the implants for taking the impressions 2 Unscrew the impression coping to remove the impression 3 Connect the analogs to the impression coping see picture 2 4 Send the impression to the laboratory which fabricates the plaster cast model 5 Screw the O Ring abutments into the implant analogs on the model Use the internal hexagonal O Ring key Ref CCL HI 25 26 see picture 3 6 The O Ring attachments are snapped onto the
7. Surgery amp Prosthesis aiigele feiileJa euroteknika is the result of 20 years of clinical applications and 24 years of research and development confirmed by valuable help of international research laboratories The design of our implants is based on the skills of our teams which are both reactive and experienced in implantology Technical and biomechanical skills of our engineers enabling to guarantee the resistance of the component and their adaptation to the oral environment thanks to modern means of simulation Biological and physiological skills of the associated laboratories enabling to validate the capacity of osseointegration of our systems gt Clinical and practical skills of our dentists advisers ensuring the ergonomics of our products the confirmation of our protocols and the ranges adapted to the various clinical cases natea implants are relied on the most new advanced scientific knowledge regarding implant treatment which provides this implant an optimal capacity of anchoring with a strong osseointegration in particular in the cortical bone area To enable you to take the best advantage of the natea implant we created this manual with a professional care We invite you to read it with your best attention Each detail even the least important has its importance and underlines even more the difference between the beginner and the specialist euro ek Warning General information Pre implant study
8. Implant PICTURE 5 IN THE MOUTH lt Prosthesis screw 20 N cm gold palladium abutments 4 Implant PICTURE 2 CONNECTING THE ANALOG Screw 10 N cm lt Impression lt Analog PICTURE 4 ON THE PLASTER CAST MODEL Laboratory guide screw 77 7 20 N cm gold palladium abutment or burn out sleeve euro teknika GROUP L PIE TT Prosthetic PROCEDURE Screwed prosthesis ON PLURAL ABUTMENTS For multi unit prosthesis on parallel or divergent implants 1 Remove the healing abutment and screw the Plural abutments into the implants in the mouth with the external hexagonal key ref CCL HE 12 22 Tighten the abutment with the torque wrench Ref CCC 35 at 25 N cm 2 Using the same key or manually screw the pick up impression copings into the abutments 3 Take the Impression with an open tray 4 Unscrew the impression copings and connect the analogs into the impression copings the analog replicates the implant topped by a Plural abutment see picture 2 5 At this stage a protection cap can be used as a temporary cover for the implants A temporary prosthesis can be fabricated on the protection cap or directly onto the temporary abutments screwed onto the plural abutments Screwing of temporary abutments at 20 N cm 6 Send the impression to the laboratory 7 The plaster cast model is made at laboratory 8 The burn out sleeves are fixed on t
9. Prosthetic PROCEDURE Zirconia prosthesis give an excellent aesthetic result to implant restorations A biocompatible titanium coating on the abutment which connects with the implant ensures an excellent seal and reduces stress as the contact 16 titanium to titanium Discreet Thin titanium interface gt Thin collar and low profile gt Invisible in the final restoration Even more discreet gt TIN biocompatible coating yellow titanium nitride coating gt Softer colour at the gingival margin 4 70 mm Reliability Titanium on titanium contact gt The interface avoids a zirconia contact on titanium implant connection Same hardness as the implant there is no alteration of the connection and it maintains a good seal esth ti Applications Single crowns The thin titanium interface allows abutments or collars to be made in zirconia or pressed ceramic ALFONSI Laboratory France Coping Abutment v i _E 25 N cm 2 22 25 N cm Frameworks 4227 O Laboratory ALFONSI Paris France Protocol 1 PRODUCTION OF THE RESTORATION 1 Production of the restoration in pressed ceramic coping use the usual technique of lost wax in manufactured zirconia abutment the model of the manufactured element will be delivered either on traditional physical model or in digital format scanner or CAD ALFONSI Laboratory Paris France 2 Sandblasting o
10. Continuity with the microthreads the protrusions and macrothreads for a better load distribution along the implant Assembly type Platform switching Spread surface B crown bone distance A mucous attachment surface E A gt B Inflammatory zone Healthy gingival against the bone The active insertion of the microthread in the cortical zone First bone pit made by the min thread A tapered neck for a better primary stability with a cortical support gt Stabilization of the implant notwithstanding a poor apical bone density gt A controlled implant insertion for a guaranteed primary stability Double threads gt Fast screwing of the implant gt Reduced bone heating when screwing the implant A central protrusion between threads gt Increases surface contact with bone to enhance osseointegration Cellular reconstruction is activated by this change of geometry An asymmetric thread gt The thread directly influences effective surface of the implant B 1 C gt Allows a better occlusal load distribution Non traumatic and active apex gt A groove closer to the apex to enhance the self tapping effect of the threads gt The threads start from the apex for a high self tapping ability of the implant and a better apical anchorage gt A safe use in risky sites sinus dental nerve teknika GROUP CET TT s SURGICAL KITS The stake for the rea
11. S implant W Wide D 6 hexagonal key zeug Titanium abutment with Laser ER Supra Prosthetic abutments ao Gingival C OA a corresponding identification crestal height B een profile Mn emergence profile code NPSPOS606 ECT 1 28 Wu aa ama ps Poseoe mor 1 28 _ mem ROSSI 2 as O nespo sose 4 ss _ m ma 3 es m s N O N nja I m teknika GROUP TT ss IMPRESSION TECHNIQUES euro teknika Impression TECHNIQUES Depending on the clinical case you can choose to make dental impressions using 3 different techniques Technique WITH PICK UP IMPRESSION COPING Material required External hexagonal keys short CCL HE 1218 20 mm um medium 12mm om CCL HE 12 22 MM av BA u long CCL HE 12 30 na External hexagonal mandrels short 22 mm i 26 mm long TT e CMA HE 12 22 ee Technique WITH POP IN IMPRESSION COPING Material required External hexagonal keys A short CCL HE 12 18 20 mm medium Y CCL HE 12 22 long CCL 12 30 External hexagonal mandrels 22mm 26mm lt u w r short 12 22 Technique WITH POP UP IMPRESSION COPING Material required External hexagonal keys A short CCL HE 12 18 20 mm TRIER medium 12 mm fa mm Y CCL HE 12 22 o no long W H
12. clinical or esthetic level For all the euroteknika implants the preparation of the implant site is carried out in 3 steps 1 Initial preparation of the implant site marking of the bone and first drilling 2 Calibration of the implant site bores drillings and or tapping 3 Implant placement picking up screwing stabilization and suture Precautions for use For all the surgical procedure the following instructions must be observed and respected gt Make sure you have a sufficient number of implants and sterile instruments gt All the instruments must be sterile complete checked and functional especially the measurement instruments calibrated according to the manufacturer s recommendation and the cutting instruments should not be used more than 10 times gt All the reusable products must be disinfected cleaned and sterilized gt All the disposable components delivered non sterile must be disinfected cleaned and sterilized before intra oral use Using a thermo disinfector and a Class B autoclave is possible for the components out of their package in a specific bag according to the manufacturer s recommendations gt In case of plastic or ceramic components always disinfect and cold sterilize with CHLORHEXIDINE gt Any product delivered sterile by gamma radiation must not be re sterilized gt Respect the sterile parts of the package when opening it and place its content on a sterile field V Respec
13. constant irrigation After their use place the drills in a stainless steel container filled with a saline solution If you wish to work without the stops you can use the marks on the drill ca Ex A stop marked lg 12 means that it will enable to make an implant depth of 12 mm after the stop is placed on the drill When mounted on the drill the stop measures 4 mm as our drills are 16 mm in length 1 Set the stop 7 stoP 2 Stop in correct position Implant L 12 teknika GROUP 1121414 Surgical PROCEDURE Protocol STEP BY STEP 0 4 mm NP rmina DRILLING Soft bone D4 To enhance primary stability the implant socket is 0 8 mm undersized compared with the implant diameter The whole thread is compressed in the bone Better stability Implant socket Thread tops 0 3 mm Normal bone D2 D3 The implant socket is 0 6 mm undersized compared with the implant diameter The thread is compressed in the bone until its basis to ensure a good primary stability Implant socket Thread tops Hard bone D1 The implant socket is 0 3 mm undersized compared with the implant diameter The thread is partially compressed in the bone to ensure a good primary stability Minimum heating Implant socket mr Thread tops N To avoid problems with osseo integration due to over heating of bone drills for hard bone are calibrated to prepare the implant s
14. fabricated on the top of the protection caps see picture 3 6 The plaster cast model is made at laboratory 7 Use a burn out sleeve or a gold palladium abutment onto the analog on the model with a lab guide screw see picture 4 8 Fabricate the prosthesis and thoroughly clear the access screw 9 Try in the mouth check and adjust occlusion 10 Finish the prosthesis 11 Final fitting of the complete prosthesis The insertion should be passive 12 Tighten the prosthesis on con hex abutment to 20N cm with the torque wrench Ref CCC 35 Seal the screw heads and access holes see picture 5 HOW TO USE GOLD PALLADIUM ABUTMENTS SOLID TO LIQUID Characteristics of the gold and base chemical composition Gold Au 58 25 11 190 Platinum 21 90 1 Palladium Pd 19 41 1 Irridium Ir 0 44 95 VJ 00 Hardness HV gt 160 Solidus Liquidus 1400 1490 C Density 17 5 g cm3 Thermal Expansion 12 4 um m K N Do not use the final abutment screw in the lab or for trying of the prosthesis this would damage the physical properties For try ins and laboratory work use lab guide screw ref NPV VG 14 105 For finalfixing in the mouth use a new abutment screw 1 SCREWING THE IMPRESSION COPING lt Impression coping lt ConHex abutment 25 N cm lt Implant PICTURE 3 PROTECTION CAP ka Plastic cap m or titanium cap Screvved ConHex abutment 4
15. in the mouth with the abutment screw provided in the pack Use a dynamometric key to apply the proper tightening torque see picture 4 If the abutment was fitted some time before tighten to the correct torque level once again before fitting the prosthesis 9 Take an x ray to check the fit of the abutment in the implant 10 Final adjustment of the finished prosthesis 11 Cement prosthesis onto the abutment Do not use the final abutment screw in the lab or for trying of the prosthesis this would alter its physical properties For try ins and laboratory work use lab guide screws ref NPS VG 16 200 NPS VG 16 250 For final fixing in the mouth use a new abutment screw N Use the torque wrench for the precise tightening of the prosthetic parts at 25 N cm 1 SCREWING THE 2 CONNECTING THE IMPRESSION COPING IMPLANT ANALOG E Neq mE ES PAS E Rein lt Screw 10 4 Impression y lt Analog lt Pick up Impression coping T Implant 3 ON THE PLASTER CAST MODEL 4 IN THE MOUTH Screw Laboratory screw 25 N cm I lt Straight abutment Definitive tightening with the torque wrench at 25 N cm Implant euro _teknika GROUP sm mm CEMENTED PROSTHESIS ON SOLID ABUTMENT euro teknika L Prosthetic PROCEDURE SOLID ABUTMENT USE A standard protocol using snap fit Impression copings ensures an accurate Impression which gives
16. mandrels short and long External hexagonal mandrel Mandrel extension Depth gauge Paralleling pins Point drill 1 5 2 2 Initial drill 2 2 Cortical drills Final drills Drill stops Surgical SEQUENCER Ref CSC 7 20 empty delivered This allows you to set out the implants and instruments in the order necessary for a specific surgical procedure 3 Picking up the implants 2 Opening the implant packaging 4 Picking up the healing abutments 1 First sequence of drills Second sequence of drills euro teknika GROUP BT LII PROTOCOL BY BONE DENSITY AND IMPLANT DIAMETER IMPLANTS 3 6 IMPLANTS 4 1 pm tengihs8 10 12 14mm Ig 6 Lengths 8 10 12 14 mm 7 Sole meee D4 D2 D3 MD D2 D3 ED CDD GENE ri drill ha Ns Ns 2 777 2 8 2 3 3 3 3 5 E GE gr pe G po 4 e gt xu TA sacd I 800 rpm 800 rpm 3 3 6 313 6 3 5 4 1 3 5 4 1 3 5 41 0835 41 3 5 4 1 I I ac Q lt E SM A ENT _ _ gt JJ 5 Mm Tyv XP UI O 400 rpm 400 rpm c x or E D 4 1 lt j a 233 LLI a 2 e 6 x Es I O mi E v 25 rpm 1 n 800 rpm 25 rpm S option option from 15 to 25 rpm 3 6 mm Example of insertion for a 10 mm long implant the same a
17. must be ideally slightly smaller than the prosthetic crown to insure the widening of the soft tissues and the prosthesis emergence The ratio crown height implant height must always be below 1 gt molar replacement must be done with either 2 implants of small diameters or with an implant of large diameter so the support cusps are located in the implant s axis better distribution of the forces on the bone euro teknika GROUP sam 4 I Natea implant 3 6 Natea implant 4 1 Natea implant Q 4 8 Natea implant Q 6 Caption Pre implant STUDY Use of the SURGICAL TRANSPARENCIES In order to guide the choice of the implant in terms of length and diameter euroteknika has developed surgical transparencies that show the dimensions of its different implants Thereby the implants are represented with 1 1 1 3 1 and 1 7 1 magnifications magnifications correspond to the usual magnifications of the different types of medical imaging systems retroalveolar X ray X ray dental panoramic and tomography analysis SCANORA CBCT Cone Beam When the practitioner accurately knows the magnification of the pre surgical X ray and if this magnification 16 1 1 1 3 1 or 1 7 1 by a simple superposition of the corresponding template 1 1 template for a 1 1 magnification 1 3 1 template for a 1 3 1 magnification and 1 7 1 template for a 1 7 1 magnification it is possible to determine which type o
18. of the implant rts B 2 di The tap is used either with contra angle at a speed of 15 to 20 rpm or manually with a tap wrench teknika GROUP 1 feel Surgical PROCEDURE Protocol STEP BY STEP Lines to measure mplant INSERTION gingival heights from 3 The implant can be inserted manually or with the the crestal ridge Y handpiece This procedure must be done with the greatest care so that the implant does not come in contact with any non sterile element before insertionin Le the bone socket To do so use the screwing mandrel Torque Mark indicating that the driver or manual key After opening the tube connect the transmission is inserted This mark should appropriate implant driver directly to the implant without area 7 disappear when properly taking it out of its casing before inserted in the implant Retention area in the extremities of the 6 sides 12 a The implant should be taken out of its casing as follow Step 1 Seat the hexagon of the mandrel or key into the implant hexagon Step 2 To seize the implant slightly rotate the mandrel or key in the implant in clockwise direction until the implant stops turning in its casing a device in the casing allows to limit the implant rotation while grasping it Step 3 Insert the mandrel into the implant by applying light pressure so that it is retentive on the implant 5N 5000 a The positioning
19. of the attached vestibular gingiva is not enough Parking OF THE BONE Set the motor speed at 1000 to 1200 RPM according to the bone quality and start irrigation Visually pinpoint the implant areas The bone marking is made with a pointing drill of 1 5 mm diameter more effective than a round bur The pilot drill has a point which can easily go through the cortical layer Its upper part with a 2 2 mm diameter is used as a guide for the following drill After being used place the drill in a steel container with a saline solution In case of multiple implants in the same area proceed with the marking of sockets following the spacing rules described above Depth drilling O 1 5 angle of cut 90 The following illustrations represent the drilling sequences for Natea 4 7 in a medium and dense bone density For the other implant diameters please see protocol on page 26 27 BE CAREFUL Maintain a minimum space around the implants according to the common rules in implantology gt In the labio lingual or palatal direction save 1 5 mm to 2 mm of bone In the mesio distal plan save 2 mm between a natural tooth amp the implant thread or 3 mm between 2 implants threads gt The width of the implant neck must be taken into account for the implant placement Our gauges show the neck width to help place the implants with precision To anticipate the necessary space between the necks of implant
20. spaces to insert the 3 specific drivers and 2 mandrels for Aesthetica or Uneva implants placement Contents External hexagonal keys long medium amp short Implant direct keys short medium amp long Click wrench Square key for taps Implant direct mandrels short amp long External hexagonal mandrels short amp long Mandrel extension Paralleling pins Paralleling implant gauges Depth gauge Point drills Initial cylindrical drills 2 2 Ig 8 10 12 14 mm Intermediate cylindrical drills Cortical drills for each implant diameter Very hard bone drills Stops for drills Drill stop tool Gingiva gauges Mini SURGICAL KIT Ref NIDK P 36 a NIDK P 36 4X CONTENTS Medium external hexagon key Medium key for direct handling Click wrench Short mandrel for direct handling Short external hexagonal mandrel Depth gauges for drills 2 2 Point drill Q1 5 Q 2 2 Initial drills 2 2 length 8 10 12 14 mm Cylindrical drills Cortical drills Final drills Paralleling implant gauges In option Short external hexagon key Long external hexagonal mandrel Short key for direct handling Long mandrel for direct handling Tap wrench Extension mandrel Paralleling pins Taps euro teknika GROUP e m m Short implants SURGICAL KIT Ref NIDK P 48 6 CONTENTS Click wrench Implant direct keys short medium and long External hexagon key Implant direct
21. the product Check the proper assembling of parts in order not to cause the prosthesis to fail and to guarantee its mechanical functions and the final esthetic result A unique common connection The implants Naturactis Naturall Natea have a unique common connection for all the diameters compatible with Astra s Ocean connection CEMENTED PROSTHESIS 4 PLATFORMS 2 2 Prosthetic PROCEDURE Cemented prosthesis ON TRANS SCREWED ABUTMENT PROTOCOL 1 After removing the healing abutment take the impression with the impression coping into the implants 2 Unscrew the impression coping gt tf a pop in impression coping has been used the impression may be withdrawn directly Impression coping is then unscrewed connected to analog and then placed back in the impression If a pick up impression coping has been used the impression coping must be unscrewed to be removed The analog is then connected to the pick up impression coping inside the arch of the impression see picture 2 3 Send the impression to the laboratory 4 The plaster cast model is made at laboratory 5 The laboratory chooses the abutment straight or angulated 7 15 or 20 see the prosthetic panorama The abutments can be customised if necessary They are placed on model with a laboratory screw see picture 3 6 Make the wax up on the abutment 7 Cast the wax up and finalize the crown 8 Seat the abutment
22. CCL HE 12 30 External hexagonal mandrels short 22 26 long gt impression copings Pick up 13 5 mm CMA HE 12 26 short long NPE T35 NPE 135 L Pop in impression coping Q 3 7 mm NPI 37 CMA HE 12 26 Pop up impression coping O 4 1 mm CMA HE 12 26 Implant analog 3 5 mm 1 1 NLA H35 Implant analog 3 5 mm NLA H35 Implant analog 3 5 mm H35 with PICK UP IMPRESSION COPING PROTOCOL gt After having unscrewed the healing abutment manually screw the pick up transfer into the implant lt Screw using the hexagonal key Do not exceed the 10 N cm TO Mer maximum tightening torque 24 You can choose between 2 heights of impression coping according to your case e Short height 10 mm e Long height 13 5 mm After making sure the transfer is positioned correctly make the Impression using an open tray and clear the head of the screw i Pick up impression a coping lt Implant gt Once the impression has been made unscrew the pick up transfer using the external hexagonal key gt Remove the impression gt Screw the analog onto the transfer gt Be careful to always hold the analog and not the tray Important Information Advantages Disadvantages gt Precision gt Long unscrewing time with the tray in place in the Better accommodates divergent axe
23. O Ring abutments 7 Process the overdenture in resin on a wax up as for a normal full denture 8 Attach the O Ring attachments into the acrylic base of the overdenture 9 Reline the overdenture and adjust the occlusion 10 Final fixing Screw the O Ring abutments into the implant with the torque wrench Ref CCC 35 at 35 N cm The overdenture can now snap onto the balls Re check the mucosal support A It is also possible to take the impression on the ball abutment so the impression coping Is not necessary In this case use ball abutment analog ref OPS HOBI PICTURE 1 SCREWING IMPRESSION COPING Impression coping Implant PICTURE 2 CONNECTING THE ANALOG RE 2 CONNECTING THE ANALOG lt Screw 70 N cm lt Impression 1 mplant analog PICTURE 3 ON PLASTER CAST lt O Ring y Clic O Ring abutment L 35 N cm Paster cast euro teknika GROUP BT LII Download the full studies Studies amp PUBLICATIONS e Placement of implants in the mandible reconstructed with free vascularized fibula flap comparison of 2 cases with Aesthetica implants University of Cukurova Turkey 2008 Slim implants for complete denture wearers clinical aspects and pers Nancy Universit pectives with OBI implants University of Auvergne Cler
24. Surgical procedure FOREWORD Impression techniques WITH PICK UP IMPRESSION COPING Prosthetic procedure FOREWORD ZIRCONIA PROSTHESIS on titanium abutmenNt SCREWED PROSTHESIS on ConHex abutment For more information on euroteknika p 6 p 7to 9 p 11 to 14 p 15 to 39 Fi 16 Pi 16 pu Pi 28 zi 40 p 43 to 47 P 45 46 P 47 p 49 to 72 PR DO po 52 P 66 m GS nd d implants please visit our complete internet website www euroteknika implants com E teknika GROUP The placement of euroteknika implants must be done by a practioner who has been previously trained for the dental implantology techniques and in aseptic conditions specific to this type of treatment The following instructions will guide you throughout the different stages of your implantology treatments They contain advice as precise as possible but cannot be used as recipes every clinical situation must be evaluated for each patient A great number of factors acts independently to obtain success in an implantology treatment It is up to the practioner to recognize the key factors and to use his clinical experience Among other aspects the coordination between the prosthesis laboratory dental technician and the practioner must be perfect so as to give the global treatment plan more consisting Only the practioner remains responsible for his different choices and decisions as to the treatment s feasib
25. TURE 1 SCREWING THE IMPRESSION COPINGS PICTURE 2 CONNECTING THE ANALOGS Impression copings Screws Plural abutments 25 N cm Implants PICTURE 3 PROTECTION CAPS PICTURE 4 ON THE PLASTER CAST MODEL Caps 10 N cm Screwed Plural abutments 4 Laboratory Screws 20 N cm Implants PICTURE 5 IN THE MOUTH y an Ma Screw Plaster cast 25 N cm I N lt Burn out sleeves Plural abutments 35 N cm Implants Screwed restorations ON TETRA ABUTMENTS 4 Juli x External hexagonal key Abutment and abutment holder 1 Remove the cover screws or the healing abutments 25 N cm and set up the Tetra abutments on implants in the mouth Implant 2 Screw the angulated abutments with the external hexagon key at 25 N cm and the straight abutments with the internal hexagonal key ref HI2024 at 35 N cm see picture 1 E Screw 10 N cm 3 Make the impression with the pick up technique described in picture 2 or pop in impression coping 4 Screw the protection caps at 10 N cm or the temporary abutments on Tetra abutments at 20 N cm with the torque wrench Ref CCC 35 A temporary prosthesis may be realised on temporary abutments or protection caps see picture 3 a Abutment za Implant PICTURE 3 LABORATORY STEP
26. URE 1 IMPRESSION ON MODIFIED ABUTMENT 1 Choose the abutment height 4 5 5 7 mm 2 Adjust the solid abutment respecting the shaping E T lt Impression limit t coping Click 3 Place and tighten the abutment at 35 N cm Nm 4 Take the impression with the white open impression gt s Sold abutment coping snapped onto the abutment Gentle pressure allows the impression coping to fit onto the abutment Thenie tado dall external hexagonal key and en the impression material is injected inside and a the toraue wrench around the impression coping until it covers completely plant the plastic part see picture 1 Tighten at 35N cm with the 5 Protection cap setting onto the abutment during the prosthesis manufacturing time PICTURE 2 PROTECTION CAP LABORATORY STEPS 6 Make the model with the impression Use epoxy resin instead of plaster 7 Seat the burn out sleeve on the model and wax up lt Protection cap of the framework 8 Cast the wax up see picture 3 9 Make the ceramic part of the prosthesis lt Implant 10 The crown is cemented after removal of the protection cap PICTURE 3 ON PLASTER CAST za Burn out sleeve a Plaster cast Multi unit prosthesis A very precise adaptation of the prosthesis is necessary to avoid any tension fracture That is why we recommend the use of uncut solid abutments with an adapted height the shortest p
27. a reliably accurate model of the abutment The impression coping snaps onto a small prominence located above the abutment shoulder see the red area on the picture below The burn out sleeves are not snapped on the abutments in order to allow the technician to remove them more easily and to avoid reshaping which may compromise the prosthetic joint Impression coping Easy to fit over the solid abutment without clearing the sulcus Snapping area Impression coping sua Make sure to align the flat plane of the abutment with the interior flat plane of the impression coping Implant Two types of impression copings are available When restoring unshortened solid abutments use the colored snap on impression coping over the abutment in a closed tray When the abutment has been modified use the white open impression coping over the abutment see page 58 Protocol ON UNMODIFIED SOLID ABUTMENTS 1 Choose the abutment height 4 5 5 7 2 Screw the abutment with the torque wrench ref CCC 35 at 35 N cm 3 Snap on the coping onto the abutment Make sure to align the rib of the coping with the flat side of the abutment Then the impression material is spread all around the impression coping covering it completely This technique gives an accurate impression of the implant shoulder information is given by the coping part and not the impression material Picture 1
28. bove the bone 3 available gingival heights divergent implants prosthetic part gt For multi unit prosthesis on parallel or gt Small size of 3 8 mm for reduced spaces and taper height of 1 8mm of the Secondary components different for the straight and angulated versions gt Tapered support of the bar gt Unsuitable for single crowns Tetra gt For multi unit prosthesis on parallel or divergent implants gt Common secondary parts for the straight and angulated versions with a wide choice Easy grip and positioning with a rigid handle Wide diameter of 4 8 mm for a good support laid flat on the neck gt Unsuitable for single crowns Screwed restoration ON CONHEX ABUTMENT For single prosthesis 1 The healing abutment is removed and the ConHex abutment is screwed onto the implant in the mouth with the internal hexagon key ref CCL HI 25 26 and the torque wrench Ref CCC 35 at 25 N cm 2 Screw the impression coping onto the ConHex abutment with the hexagonal key ref CCL HE 12 22 see picture 1 3 Take the impression 4 Unscrew the impression coping and remove the impression Screw the analog onto the impression coping You can also use a pop in impression coping with the closed tray technique see picture 2 5 While the prosthesis is being fabricated the implant can be covered with one of the two protection caps plastic or titanium a temporary prosthesis can be
29. e bone cylinder obtained Implant removal 16 facilitated by using an implant holder screwed on the implant The socket can possibly be re implanted If the patient is ready to receive a new implant with an implant of wider diameter in the case that the placement of this Implant occurs at the same time To put another implant with a smaller diameter it is better to wait for the complete healing of the socket It is important that the reasons of the failure are analyzed before placing a new implant The doctor decides whether it is necessary to use bone material to fill in the socket and rebase the denture with a soft resin If the patient must carry a prosthesis in the anterior area it should be rebased with a soft resin gt Either with a healing abutment if only one surgical stage is planned Select the most relevant part to get an aesthetic and natural shape of the soft tissues around the implant Screw manually the abutment with the external hexagonal key at 10 N cm or with the torque wrench ref CCC35 for a better precision However the dentist must be able to analyze if the conditions of the clinical case are appropriate to an immediate loading Studies and scientific datas indicate that immediate loading has proven to be successful at the mandibular when the prosthesis 16 built on 4 implants or more linked together Immediate loading is not recommended on a single implant EXTRACTION KIT Su
30. e cases gt The divergence between the implants should be lower than 20 gt Not recommended for multi unit cases Ei Pecnnique with POP UP IMPRESSION COPING 3 4 Clippable transfer cap PROTOCOL y gt After having unscrewed the healing abutment manually screw the pop up transfer into the implant using the external Screw hexagonal key Do not exceed the 10 N cm maximum JD N com tightening torque gt gt gt After making sure the transfer is positioned correctly Install the clippable transfer cap e Orient the pink cap rib towards the transfer s flat plane e Clip hear the insertion click y lt Pop in impression gt Make the impression with a closed tray gt Once the impression has been made remove the tray ideally on the transfer axis coping gt Unscrew the pop up transfer using the external hexagonal key gt Screw the analog onto the transfer then orient and Implant reposition the transfer into the impression clipping it into the transfer cap Rib flat plane alignment Make sure the transfer is inserted and oriented correctly into the impression It is possible to use the pop in version using the screw ref NPS VTB 16 156 Align the flat plane of the transfer with the interior flat plane of the plastic cap in the impression material Important Information Advantages Disadvantages Precision Possible repositioning errors Restrict
31. e drills corresponding to the diameter of the chosen implant and to adapt the implant socket to the bone quality of the area see pages 24 and 25 This information has been transferred on a plasticized sheet included to facilitate the procedure During It avoids a transplant graft and will not even require to be stabilized if the bone defect has several walls Be careful this bone must be preserved of any contamination and treated under the same conditions of asepsis as the implant the drillings verify that the bone bleeds Should the opposite occur scratch a little the bone to make it bleed In the absence of vascularization it s better to close and to wait for a revascularization Drilling speed should be between 600 and 800 RPM STOPS The stops can be picked up directly on the drill with a contra angle Check the alignment of the stop extremity with the graduation on the drill Verify the stop 18 properly fixed on the drill After a large number of uses it is possible that the stops do not clip in place as easily on the drill In this case change the stop The stops have groove to help the insertion of the key To remove a stop insert the proper key in the stop groove and push the stop towards the drill extremity In a bone D2 D3 the drills are being used at a speed between 800 and 1200 rpm depending on their diameter In a D1 bone we can use slower speeds between 300 and 800 rpm The drills must work under
32. e right time If the drill is blocked it can be removed by using the motor reverse mode BE CAREFUL The rounded end of the implant doesn t fit until the P TRITT pi E STOP very bottom of the socket prepared with the drill The socket will be slightly deeper than the implant length This avoids any risk of apical compression and L 10 warranties the crestal anchorage in cortical area Apical reserve Ma S from 0 5 to 0 9 mm Surgical PROCEDURE Protocol STEP BY STEP amp 525 OF DEPTH option Check the depth of the socket using the graduated depth gauge diameter 2 2 in option sold separately This The apical part of the angled gauge also allows to check the state of the implant socket fenestration NaturActis Natea Naturall CE depth gauge can also allow to control an ww hemorrhagic flow of the SOCKETS AXIS Insert the thinner side 1 5 2 2 of the parallelism gauge s in the implant s socket s to evaluate the axis of emergence of the implant s The gauge so positioned can also control a hemorrhagic flow COLLECT We advise you to collect the bone fragments resulting from each drilling in order to be able to correct any bone defect or to improve margins of an irregular crest The volume of the collected bone is in most cases enough to correct some moderate defects DRILLINGS Use the diagrams p 30 and 31 to determine the succession of th
33. ed oral opening Divergence between implants should be lower than Unscrewing after having removed the tray 20 more comfortable for the patient gt Ideal for single cases euro teknikas GROUP _ adle BUNNEN PROSTHETIC PROCEDURE Prosthetic PROCEDURE Foreword Warning The tightening torques indicated in this manual should be respected to avoid risks of damaging breaking or dysfunction of the items gt Check the proper assembling of parts in order not to cause the prosthesis to fail and to guarantee its mechanical functions Secure the instruments and prosthetic components handling from the risk of fall in the mouth or out of sterile field because of their small sizes Make sure they are properly gripped on the instruments Certain prosthetic components are delivered sterile to be used during the surgery ATTENTION not to re use them All the disposable components delivered non sterile must be disinfected cleaned and sterilized before intra oral use Respect the decontamination and or sterilization rules plastic or ceramic components cannot be sterilized in an autoclave In case of plastic or ceramic components always disinfect and cold sterilize with CHLORHEXIDINE Any product delivered sterile by gamma radiation must not be re sterilized Respect the sterile parts of the package when opening it and place the content on a sterile field Respect the expiry date of
34. f implant can be placed in the available bone volume When the practitioner does not know the magnification of the X ray or to avoid any mistakes he may place a reference object with known dimensions in the mouth of the patient when performing the X ray examination in order to determine the associated magnification _ dimensions of the reference object measured on the radiograph Magnification n o_ A n nN s gt 01 real dimensions of the reference object The real dimensions of the reference object shall be known to a minimum accuracy of 15um The reference object shall be held in position using wax for example or by embedding the object in a partial impression Care should be taken for the patient not to swallow the reference object Use a safety thread if the geometry of the reference object allows it Then if the calculated magnification is 1 1 1 3 1 or 1 7 1 you may use the transparencies In all cases if the magnification is not 1 1 1 3 1 or 1 7 1 t is not possible to use the transparencies provided by the euroteknika but the bone volume may be determined thanks to proportionality calculation using the X ray and the measured magnification In this pre implantation phase the practitioner must also design the coming prosthetic construction since implantology must be considered as a prostheticaly driven project Indeed pre prosthetic planning and surgical planning are closely linked and any change to one will have con
35. f the interface First protect the connection and the gingival area then sandblast the surface that will be in contact with the bonding composite with a medium grain size lt 50 microns under a pressure of 2 bars 3 Clean the interface with ethanol 4 Bonding Use a self curing universal self adhesive composite Apply the composite on the titanium interface and the zirconia abutment or sleeve then assemble the two parts For a complete polymerization of the material follow the instructions of the product manufacturer GARCZAREK Laboratory Sallanches France 3 CLEAN THE INTERFACE WITH ETHANOL 5 Screw tightening Tighten at 25 N cm according to the diameter of the screw Please order lab guide screws separately do not use the same screw for lab work and final fixing in the mouth Short 8 mm ref CCL HE 12 18 Medium 12 mm ref CCL HE 12 22 Long 20 mm ref CCL HE 12 30 GARCZAREK Laboratory Sallanches France euro teknika GROUP CONS BS S 0S SCREWED PROSTHESIS ON PLURAL ABUTMENTS For th heti f di O N C O N H EX a a nu T iu poma ABU ITMENT Coated screw design to avoid unscrewing ON TETRA ABUTMENTS euro teknik GROUP ES EH Prosthetic PROCEDURE 3 abutments types FOR THE SCREWED PROSTHESIS ConHex Plural gt For single unit crowns gt Total abutment height of 2 7 mm with indexation system gt The prosthetic margin is 1 mm a
36. he analogs see picture 4 9 Fabricate the prosthesis and thoroughly clear the access screw 10 Try in the mouth check and adjust occlusion 11 Finish the prosthesis 12 Final adjustment of the prosthesis 13 Passive insertion and tighten on the Plural abutments in the mouth with the torque wrench Ref CCC 35 at 25 N cm Seal the screw heads and access holes see picture 5 N Do not use the final abutment screw in the lab or for trying of the prosthesis this would damage the physical properties For try ins and laboratory work use lab guide screw ref NPV VG 18 105 For final fixing in the mouth use a new abutment screw Screwed prosthesis ON STRAIGHT ABUTMENTS PICTURE 1 SCREWING THE IMPRESSION COPING p Screws 10 N cm copings Plural abutments 35 N cm Implants PICTURE 3 PROTECTION CAP Caps a 10 N cm a Screwed Plural abutments Implants PICTURE 5 IN THE MOUTH lt Screws ez lt 25 N cm i i Burn out sleeves lt Plural abutments 35 N cm Implants PICTURE 2 CONNECTING THE ANALOG Screws 70 N cm Impression Abutment analogs PICTURE 4 ON THE PLASTER CAST MODEL lt Laboratory screws 20 N cm lt Burn out sleeves euro teknika GROUP rums ug ss zs Prosthetic PROCEDURE Screwed prosthesis ON ANGULATED ABUTMENTS PIC
37. he implant is achieved with the implant A Do not apply excessive pressure during implant placement Excessive overtightening may damage internal holder key i I mea connection and over compress the surrounding bone It is finalized with the click wrench or with the torque ee sirong resistance is wrench It is recommended to check the primary encountered during tightening lightly unscrew the implant stability of the implant at the end of the screwing by then insert back the implant If there is still strong trying to move it resistance remove the implant and place it back into its titanium casing and widen the implant site according to the drilling protocol If the implant can move its primary stability is inadequate and the osseointegration may fail then it is better to remove it and to use an implant with a bigger diameter if the bone volume is sufficient 12 d Final implant placement For optimized aesthetic results place the implant at bone level Use the depth sign on the key or the mandrel The angled gauge in option sold separately and the paralleling pins can also allow to measure gingival height NaturActis Natea Naturall CE h A When placing the implant align one of the hex sides on the implant manual driver or mandrel parallel to the buccal wall which ensures that one of the flat side of the hexagon is parallel to the buccal side ensuring preferred pro
38. ient angle to have embrasures for the passage of tooth brush It must also achieve a specified distance between contact points of crowns and the summit of the interdental bone crest Prof Tarnow this distance must be lower than or equal to 5 m The angle defined by the conicity must exert a light pressure on the papilla to stimulate the healing without risk of necrosis 1 Final prosthetic project to be achieved Localization of the prosthetic joint at least 1 5 mm below the gingiva for an l na aesthetic result gt Enables to determine the height of the B abutment gt Healing abutments have a higher diameter 0 4 mm than the final abutment to avoid gingiva stick and improve patient s comfort to make the intervention faster for easier and less painful insertion of impression copings and definitive abutments avoid anesthesia Healing abutment Titanium abutment Preparation of the prosthetic profile Table for the selection of the tissue level parts emergence Use a healing abutment which Laser code on the top of the abutment has a bigger emergence profile E i mergen diameter 0 4 mm than the Rage Platform letter titanium abutment which will be mae placed later E Extra narrow 3 6 Tighten the healing abutment Supracrestal gingival height N Narrow 4 6 at 10 N cm with the external indication for a crestal C R Regular Q 5 2 or sub crestal
39. ifferent lengths patient s throat It is important to be able to change an implant s choice gt t is strongly advised to prepare the receiving socket during a procedure to replace an implant which has been with euroteknika instruments shown in this manual contaminated for any reason to insert an extra implant in certain cases to insure the long term treatment success PRE IMPLANT STUDY euro teknika It is necessary to evaluate the possibility of an implantology treatment and to Pre implant STUDY determine the treatment plan IMPLANT treatment feasibility This study takes different elements into consideration gt patient s questionnaire to reveal potential health medications problems which could have a bearing on the treatment success alcohol use of tobacco or drugs general dental hygiene gt An oral examination which will give details about the mouth opening the ligne of the patient s smile if is it a gingival smile the coronary height and the volume of bone available the type of occlusion Guide for the IMPLANTS CHOICE Available bone volume In the mesio distal plan gt Leave 2 mm between the implant s thread and natural teeth gt Leave 3 mm between the thread of two implants In the labio lingual palatal direction Leave if possible 1 5 to 2 mm of bone thickness around the labial palatal amp lingual surfaces O implani 88 0 41 eoas 906 gt Biological test
40. ility implants prosthetic parts materials used and settings The technical specifications and clinical advice in this manual are given solely as a guideline and cannot give rise to any claims All the essential information is indicated in the instruction for use supplied with products We have taken great care in the design and production of our products However we reserve the right to bring modifications or improvements arising from new technical developments in our implantology system We will advise of any modifications having an implication in the operation mode According to the importance of the modifications a new manual will be issued Indeed a mark on the back page indicates the date of issue of your surgery manual and enables us to check if you have the latest update version You will also be able to access our web site to check the latest version of this manual The reproduction and distribution of all or part of this manual need previous agreement from euroteknika GENERAL INFORMATION euro teknika General INFORMATION natea implant GENERAL INDICATIONS The euroteknika dental implants are suitable for oral bone implantation at the mandible and maxilla and for oral aesthetic restoration of fully or partially edentulous patients except in the presence of specific indications and contra indications hereinafter mentioned euroteknika dental implants can be used for differed immediate or early loading after a tooth extrac
41. ite to a slightly larger diameter than normal Tapping This procedure is optional it depends on the bone quality and on the wanted level of compression on the bone To eliminate any overheating usually caused by this procedure euroteknika supplies taps that only feature an active part limited to a reduced number of threads The shape of the tap allows for just a few of the thread cutters to touch the bone in a forward rotation Once to depth the tapping cutters only minimally touch the bone again during the reverse rotation coming out of the bone site preparation In most of the cases it is advised to only thread the GAUGES Dimensioned to the final diameter 3 3 5 4 2 they enable a last check of the depth of the socket They are graduated like the drills i e every 2 mm from 6 mm to 16 mm AN Once the depth gauge is placed in the bone you should not see the graduation which must not appear above the bone ED DRILL Use the cortical drill after the cylindrical drill according to the protocol of bone density p 26 27 at a speed between 300 and 400 rom maximum gt Use the cortical drill with the same color code as the implant diameter This stage is required in all cases whatever the hardness of the bone is to ensure cortical compression onto the implant neck euro cortical part of the bone socket to facilitate the insertion of the implant while optimizing the primary stability
42. lization of the implant socket is on BE CAREFUL two levels di A calibration of the socket to obtain a good It Is necessary to choose the prosthetic parts before the primary stability of the implant main condition for the implant placement in order to insert the implant at the osseointegration right place Minimum overheating to avoid all irreversible bone necrosis The socket preparation will be made under constant external irrigation with sodium chloride at 0 9 The critical temperature threshold is 47 C for 1mn At 50 C the necrosis is irreversible WARNING The minimum heating will be achieved with irrigation and with a proper selection of drills with a good cutting Obtaining a calibrated socket assuring a good power It is therefore necessary to check the number airtightness of use of the drills involved in the implant socket gt The instruments are sorted by their stage of use as preparation Use the cursors in the surgical kit and change your shown by arrows on the kit Numbers notify the main drills after 10 15 uses steps of each stage Readability of the sequences 3 IMPLANT 2836 IMPLANT 841 Dani Cortical Dr s A TY euro teknikas GROUP _ adle BUNNEN Surgical PROCEDURE Surgical KIT This surgical kit offers all the instruments necessary to achieve the surgical protocol and to manage all the bone densities for natea implants Y 3 6 Y 4 1 Q 4 8 Y 6 Free additional
43. marking s not visible any more the mandrel is correctly seated b The positioning marking s visible the mandrel is not oriented nor inserted properly In that case go back to step 1 The positioning marking on the mandrel is visible the mandrel is not oriented nor inserted properly In that case go back to step 2 Step 4 The mandrel is properly seated in the implant apply light pressure counter clockwise Step 5 Take the implant to its receiving site Note Be careful with the risk of fall on the floor or in the mouth when taking the implant 12 b For a good positioning with the handpiece we recommend a speed of 15 to 25 r mn to control the insertion of the implant The positioning with the handpiece enables to measure the insertion torque of the implant and to evaluate its primary stability We recommend to set the implant at 30 N cm minimum for a delayed loading and higher than 40 N cm for early or immediate loading Never exceed an insertion torque of 70 N cm Bone D1 D2 For D1 D2 bone it is recommended during the screwing of an implant with a contra angle to finalize the screwing with the torque wrench in order to ensure the good insertion of the implant 9 Screw with the handpiece Finish screwing with the torque wrench GROUP 11214143 eu teknika Surgical PROCEDURE Protocol STEP BY STEP 12 c In the case of manual placement the first screwing of t
44. mont Ferrand ort France 2013 Placement of Naturactis implants in post extraction sites University of Madrid Spain 2013 e Contribution of a hybrid synthetic and innovating product in the bone surgery and its filling Matri BONE with Natea and Naturall implants Uni versity Henry Poincarre Nancy France 2012 Implant supported prosthetic solution in case of small inter alveolar dis Universite tance on Aesthetica implants Polyclinic Kiev Ukraine 2009 d Auvergne Histology and histomorphometry Comparative study with the Universal Branemark implants Angers Histological Laboratory France 1993 Multicentric study on the evolution of 3000 euroteknika and Nobel care implants from 1984 to 1997 comparison of the results Faculty of UNIVERSIT Medicine of Angers France 1997 BORDEAUX Quantitative study on the rough surfaces of titanium dental implants and SEGALEN their microstructures University Henry Poincarre Nancy France 2011 Analysis of the surface treatment of euroteknika and competitor implants nserm University of Barcelona Spain 2006 Evaluation of the euroteknika implant microfiltration University of Cata Universit Saint Joseph lonia Spain 2008 Beyrouth Liban em gt Comparison between the digital planning and the final position of the implants with the teknika3D system University of Bordeaux France 2013
45. nt to follow a precise handling technique so as Labels QR code for rapid and simple access to the user manual E Our implants are delivered with 2 principal labels and one removable label clearly Manufacturing Store in a dark place p gt Be careful see detailed description showing the mark the Store in a dry place reference and the batch Ama zima osos w number for a total of 3 labels RN 39 Date of manufacturing rs MN TAttad NN Complying with European requirements directives i 95 0 x 12 Pi regarding medical plan 93 42 CEE gt 2 labels for the patient s file MP M E z of the practioner who placed le Use until the implant and or of the BULU LAGA di Don t use if the packing is damaged mx m PL kb 5 1 correspondent ET uni 2 i P Zn s f See the instruction manual STERILE R gt 1 label for the patient i uo du Gorda Da Cait Sanitation method using radiation ammen CE REF m Product reference number Q Don t reuse seuen O O F T ZLI Don t sterilize twi sterilize twice Zi fi Serial number qe Storage OF THE PRODUCTS The implants must be stored in a clean dry and cool place Precautionary MEASURES It is strongly advised to keep in stock implants which We recommend to use a safety thread on the cover the most frequently used diameters as well as the instruments to avoid any accidental fall of tools in the d
46. orage surface of these implants 16 limited they should be used only for the following indications as complementary implants to longer implants in a multi unit or full restoration to support full prosthesis in case of a very atrophied mandible gt on implant sites of a bone quality higher to D4 according to the Misch classification Contra indications to the use OF THE IMPLANTS REMINDER Absolute contra indications patients with little motivation or cooperation gt age of the patient young patient during growth gt severe medical diseases gt poor hygiene of the patient bone metabolism disorders uncontrolled hemorrhagic disorders healing disorders y V Relative contra indications V gt major psychological disorders gt use of anticoagulants hemorrhagic diathesis gt functional disorders gt insufficient volume and or an osseous quality gt risky cardiopathy gt a poor oral hygiene gt Incomplete maxillary and mandible growth temporomandibular joint disorder gt uncontrolled systemic pathology endocrine gt an insufficient restorative space diseases xerostomy allergy to titanium gt if a sinus lifting is needed with the implant gt infectious hematological and immune pathology gt a patient presenting risks patient exposed to immune disorder atomic radiation bruxism uncontrolled parodontitis gt alcoholism medication or drug addiction regular addiction to smoking steroid use
47. ossible to tolerate the axial divergences of implants If no abutments are suitable it is better to work with trans screwed abutments and to make the impression on implants Temporary RESTORATIONS A provisional restoration can be fabricated on the protection cap of the solid abutment rm The protection cap will be then sealed onto the solid abutment 1 Choose the protection cap adapted to the abutment used 2 Make some grooves on the cap to improve the retention of the temporary tooth 3 Put a small quantity of provisional cement inside the cap and on the solid abutment 4 Seat the cap on the solid abutment until you feel the snap on the basis of the abutment 5 Check the correct placement of the cap and remove excess cement 6 Make the provisional restoration on the cap Solid abutment KITS These kits include all parts necessary for a cemented restoration on the selected height of solid abutment This avoids any error when purchasing the parts which will have to be used together easy to identify the parts and no risk of forgetting one of the parts The kit includes An impression coping for A protection cap impressions on non modified solid abutments A burn out sleeve for single An opened impression or multi unit prosthesis coping for impression on modified abutment An analog euro teknika GROUP m ZIRCONIA PROSTHESIS ON TITANIUM ABUTMENT euro teknika L
48. rgical PROCEDURE HEALING PROCESS In case the implant has been placed without being immediately loaded THE SOCKET IS RE OPENED 3 TO G MONTHS LATER gt Use a probe to locate the cover screw gt Open the site with a gingival punch if there is sufficient attached gingiva on both sides of the crest If necessary repel the bone that has been growing on the cover screws with small enamel chisel or a small bone trepan Unscrew the cover screw with an hexagonal key or mandrel reverse mode at low speed Choice of THE HEALING ABUTMENT gt Clean the top of the implant surface and rinse with physiological serum gt Measure the depth of gingival sleeve by introducing a probe through the gingival tissue to the base of the smooth cone which is loaded on top of the implant Choose a healing abutment according to the prosthetic plan The healing abutment allows to give its shape to the future emergence prosthetic profile while waiting for the stabilization of the gingival height In order to select the most appropriate healing abutment the burying depth of the prosthetic joint and the desired emergence profile have to be defined first A amp B enable to determine the most appropriate abutment The table below shows you the healing abutment corresponding The neck depends on the aesthetic emergence profile that you want to achieve the prosthetic abutment should have the same conicity This must be a suffic
49. s implant 36 dat gt The 3 9 or 4 8 shoulder of paralleling pins enable to preview spacing between the implants and thus to place the adjacent implants by leaving enough space between them Axis of point drill 2 2 contro OF THE SOCKET AXIS After the point drill using check the axis of the first sockets by looking at the orientation of the drill mandrel or by inserting in the socket the thinnest side Q 1 5 2 2 of the paralleling pin a rst DRILL 2 2 drill of the length of Choice of the length of the Remember to make the axial the implant to be placed 2 2 mm drill correction at this stage if it is necessary Thanks to the point The preparatory drill allows to determine the axis drill previously used the drill and the depth of the implant socket diameter 2 2 will be perfectly centered and guided at the i t f th ket The natea 0 2 2 drills are drills with a stop There cn are 5 lengths 6 8 10 12 14 mm Achieve the drilling under constant external irrigation of sodium chloride and at a speed between 1000 and 1200 rpm according to the bone quality The drill progression must be done without strain If it is not the case it indicates that bone residue are clogging the drill An easy backward and forward motion very controlled so as to not ovalize the area will enable more fluid progression of the drill This does not require a reversing of the motor if it is done at th
50. s glycemy A complete X Ray file showing the available bone s volumes gt Complete tests studies with the two dental arches in occlusion gt An implant treatment cannot be started without a thorough cleaning of all the patient s infectious seats Bone quality It is recommended to use larger implants in low density bones to compensate the reduced bone implant surface contact Recommended length Bone quality The classification of osseous structures 1 very high density of compact bone 2 thick layer of cortical bone around a dense core of spongious tissue 3 thin layer of cortical bone around a big core of spongious tissue 4 thin layer of cortical bone around a big core of low density of spongious tissue A important quality of remaining alveolar bone B limited resorption of the alveolar bone crest C important resorption of the alveolar bone crest D beginning of the basal resorption bone E important resorption of the basal bone Misch 1998 Lekholm and Zarb 1985 Classification of partially edentulous arches for implant dentistry Maxillar O o o 660 e lt lt Implants e o Mesio distal e pr rm length of the maxillar teeth 8 8 5 5 55 5 75 8 9 5 5 55 4 3 5 Mesio distal A Jum m i lt length of the mandibular teeth e lt Implants Mandible Dimensions of the crown and occlusal loads gt The implant table
51. s for the other lengths A The protocol for a 6 mm long implant of implants is different IMPLANTS 4 8 IMPLANTS 6 Ig 6 1 Lengths 8 10 12 14 mm mi Ig 6 IF Lengths 8 10 12 mm NA Go GUMB ODD GLB 5 mn om GD CE v v 4 8 x x v v vw D 4 Q 4 2 Q 5 2 5 4 NA A NE 5 a EE y y y E 600 rpm 600 rpm 600 rpm 600 rpm 4 2 4 8 042 48 4 2 4 8 4 2 4 8 4 2 4 8 5 4 6 5 4 6 5 4 6 O 5 4 6 5 4 6 400 rpm 400 rpm or Q E Oy S O 600 rpm 600 rpm 25 rpm option 600 rpm from 15 to 25 rpm curdi teknika co Surgical PROCEDURE Protocol STEP BY STEP EYP reparation of the implant site Prepare the access to implant site via a crestal incision through the attached gingival tissue and raise a partial thickness flap The flap should extend to allow for proper visualization of the site and adjacent tooth root when required A partial thickness flap is made at the proposed implant site The reflection on the flap is made large enough to visualize the adjacent roots and not into the papilla areas in an effort to preserve this tissue In the edentulous area the incision is made at the crest of the ridge and reflected for access If minimally attached gingiva Is an Issue avoid over reflection of the tissues into the sulcus to preserve the attachment The crestal incision is often made towards palate for aesthetic reasons or when the quantity
52. s mouth uncomfortable for patients with problems Repositioning errors are impossible except analog swallowing and vomiting Ideal for multiple and single cases Lengthier Implementation with the removal of the splint heads and of the impression material Restricted oral aperture contra indicated on implantation sites in the posterior sections euro teknika GROUP m m Impression TECHNIQUES ecnnique with POP IN IMPRESSION COPING PROTOCOL gt After having unscrewed the healing abutment manually screw the pop in transfer into the implant using the external hexagonal key Do not exceed the 10 N cm maximum tightening torque D e lt Screw 10 N cm After making sure the transfer is positioned correctly make the impression with a closed tray Remove then the impression ideally in the transfer axis Pop in impression coping Unscrew the pop in transfer using the external hexagonal key Screw the analog onto the transfer manually orient and re position the transfer into the impression Implant Make sure the transfer is inserted and oriented correctly into the impression Important Information Advantages Disadvantages gt Restricted oral opening Precision varies depending on the quality of Unscrewing after having taken out the tray impression materials more comfortable for the patient gt Possible repositioning errors gt Ideal for singl
53. sequence on the other It is during this phase that we may determine the number of implants their diameters their lengths their locations and their orientations in order that we may proceed with the planned prosthetic construction SURGICAL PROCEDURE Surgical PROCEDURE Foreword Warnings Treatment planning and placement of dental implants require specific considerations Practitioners are recommended to take practical training in order to learn proper techniques including biomechanical requirements and radiographic evaluation Improper techniques in either implant placement or restoration can result in implant failure and significant loss of surrounding bone Drilling sequences to place implants refer to a specific depth measurement and to unique reference points for each system The clinician should refer to the corresponding manual to see the description of the measurement system specific to the selected product before applying it to the patient Every implant system has specific measurement characteristics As a consequence the surgeon must be familiar with the measurement system being utilized in order to be able to provide safety margins adjacent to any anatomical structure Failure to respect these measures can result in permanent injury Each system has specific design characteristics Combining non compatible components can lead to mechanical failure of components damage to tissue or unsatisfactory results on the
54. sthetic abutment orientation 1 2 e Removal of the driver To remove the driver slightly rotate it counter clockwise before lifting it up Vestibular flat side ED Protection OF THE CONNECTION It is ensured Either with a cover screw if the treatment includes a second surgical stage It is supplied in the cap of the implant tube and can be taken with the hexagonal key The best way to pick it up is to turn the cap around the key rather than actioning the key In this case the suture is made over the cover screw It is recommended not to pull too much on the soft tissues to avoid any exposition of the screw Interrupted suture can be made every 2 mm they should be socket tightened If the patient has a provisional prosthesis it is recommended to groove the intrados The conventional osseointegration Is 3 months at the mandibular 6 months at the maxillary due to a different bone quality The dentist should define this period by taking into account the bone quality the implant primary stability and the prosthetic plan In certain cases the dentist can decide to connect the prosthetic parts without waiting for the osseointegration Osseointegration period to obtain a good AN In case of failure Try to unscrew the implant with the implant key the direct implant driver or an implant extractor In case you fail to do so use a trephine with a greater diameter than the placed implant and remove th
55. t the expiry date of the product gt For stainless steel the use of sodium hypochlorite is prohibited high risk of corrosion gt Respect the different combinations of materials when cleaning and decontaminating them in order not to damage the components gt Detergent and disinfectant solutions must have a neutral pH or a low alkaline level gt Any preparation of the implant site with cutting instruments on contra angle requires profuse Irrigation with a sterile saline solution NaCl gt Respect the sequence of the recommended instruments with a permanent control of the implant axis and depth according to the planned prosthetic restoration gt Make sure to minimize the thermic and surgical traumatism and to eliminate any contaminant and any infection source which may cause a failed osseointegration or poor esthetic result Secure the instrument and implant components handling and from the risk of fall in mouth or out of the sterile field because of their small sizes Make sure they are properly gripped on the instruments Surgical PROCEDURE NATEA IMPLANT Applications Features Natea is a polyvalent implant intended to be placed at a bone level position Its cylindrical shape make it i 3 7 4 2 49 6 2 0 4 suitable for hard densities Smooth y X bone level e E Ze o oa Se le O RACA YH 3 6 4 1 4 8 6 Sandblasted amp etched length Real screw thread 1 60 mm
56. tion or loss euroteknika implants are suitable in the framework of their indications for immediate restoration of fully or partially edentulous jaws A good primary stability and a suitable occlusal load are paramount The healing duration for differed restorations is indicated at the corresponding chapter Commonly used prosthetic restorations are single crowns bridges and full or partial prosthesis connected into the implants by prosthetic components specific to the implant being used You will find at the following pages for each implant detailed information about the necessary bone volume the space between two implants and the distance to respect with the adjacent tooth gt Lack of retention of a prosthesis Inadequate localization and number of remaining gt Instability of a prosthesis abutments Functional discomfort with the prosthesis Lack of dental abutment to perform a fixed prosthesis Psychological refusal of the wearing of a prosthesis gt Edentulous area with healthy adjacent teeth Parafunctional practices which compromise the gt Dental agenesis stability of a prosthesis gt Request for a preservation treatment refusal of alteration of healthy teeth gt They are supra crestal implants designed to be placed in two steps surgery with a Morse tapered connection The immediate connection of an healing abutment will enable to work in one step surgery Specific indications for 6 MM LONG IMPLANTS As the anch

User`s guide Natea+ 2014

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