cemented bridge using cpk abutments step-by-step

Step-by-Step

Cemented Bridge

4.

Using Abutments

Internal Hex. Implant System

6.

®

Step-by-Step

Cemented BridgeUsing CPK Abutments

Internal Hex. Implant System

© MIS Corporation. All rights reserved.

MIS reserves the right to modify the products described in this manual as well as to revise this publication at any time and without informing any person of such revision or change. All rights reserved. No part of this publication may be reproduced, transcribed, stored in an electronic retrieval system translated to any language or computer language, or be transmitted in any form whatsoever without the written consent of the publisher.

Note: This guide is specified for educational use only.

®

Committed to your success, MIS provides comprehensive

product information, manuals and training courses. The following step-by-step guide aims to guide you through the fabrication of fixed multiple unit restorations for internal hexagon implants using MIS’ Complete Prosthetic Kit.

Contact us at: [email protected] or visit: www.mis-implants.com.

1.

2.

A Cemented Bridge on Multiple Implants

Advantages

Weaknesses

Use of prefabricated abutments ■ Optimal esthetic occlusal surface ■ Reduction of cost and simple laboratory procedures ■ Passive fit is achieved between the bridge and abutments

Not suitable for limited interocclusal conditions ■ Cement excess must be totally removed ■ Difficult to remove after cementation ■ Implants must be parallel ■ Prefabricated abutments are not suitable for all clinical conditions. Custom-made abutments are required occasionally

The fabrication of an implant-retained cemented bridge is a staged process. The secure placement of a bridge may be obtained either by using screws or by cementation. This guide relates to cemented bridges, specifying each and every stage using a closed tray impression technique. The suggested impression technique and choice of materials should be considered as recommendations only.

General Information

Since the procedure is prosthetic oriented, an initial planning involving all relevant professionals is critical. The dentist performing the prosthetic stage should be an active participant, together with the surgeon, in the decisions affecting the choice of implants, the type of prosthesis (cemented or screw retained) and of the three dimensional positioning of the implants.

Parallel insertion and accurate spacing between implants is essential for proper and easy bridge reconstruction.

The cemented bridge method is characterized by both advantages and weaknesses:

MD-P1530MD-P2530

MD-MAC10MD-WMAC1

MD-MACF1MD-A0010MD-P0030

MD-CPK41MD-CPK42MD-CPK43MD-CPK44MD-CPK61MD-CPK62


MD-A1510MD-A2510

MD-CTP10 MD-CR010 MD-AN151MD-AN251

MD-GPC10MD-GP010

Restorative Components - Recommended Indications Table

Location

Abutment description

Esthetic angulated abutment

15° or 25°

Up to 4mm buccal Up to 6mm palatal

Standard post abutment

Adjustable, based on abutment preparation

Friction fit post platform switching


Esthetic abutment

Up to 2mm buccal Up to 6mm lingual/palatal

Anatomic transgingival abutment

According to gingival height available in heights of 1,2,3,4mm


15° or 25°

Up to 2mm buccal Up to 4mm palatal

Crown/ Implant

Inclination Ratio

Gingival Height

Anterior Maxilla

Conical post abutment


Anterior Mandible

Zircon - Zro2 esthetic abutment

Up to 3.5° Up to 2.5°

Up to 2mm buccal Up to 4mm lingual/palatal

Angulated abutment

Up to 2mm buccalUp to 4mm lingual

Canine, Premolars and MolarsPremolars and Molars

Catalog Number

Screw-retained gold-plastic abutments

Up to 2mm

Up to 3.5° Up to 4° 15° or 25°

MIS’ CPK system is designed for the restoration of a single implant or multiple parallel implants. Comprising ready-made components for the entire cemented restoration procedure, the Complete Prosthetic Kit simplifies impression and transfer

methods. The kit contains all the required restorative components: Abutment, plastic healing cap, two burnout sleeves and an analog. CPK Kits are available in two abutment heights and in a variety

of gingival heights.

The CPK System (Complete Prosthetic Kit)

CPK components (cutaway view)

MD-CPK61

MD-RSM60

MD-IC800MM-CHC60

MD-IC040

MD-ICH40

Anatomic cementing transgingival abutment

Abutment analog Burnout plastic cap

Burnout anti-rotation plastic cap

Impression coping plastic cap

Plastic healing cap

MN-RSM40 MN-CHC40 MN-ICH40 MN-IC040

MK-NPK42

MN-CPK42 MN-IC600


MK-NPK41

MN-CPK41 MN-IC600

MN -RSM60 MN-CHC60 MN-ICH40 MN-IC040

MK-NPK61

MN-CPK61 MN-IC600


MK-NPK62

MN-CPK62 MN-IC600

1.

2.

3.

4.

Kit options table

NARROWPLATFORM

Option

Option

Option

Option

MN-RSM40 MN-CHC40 MN-ICH40 MN-IC040MN-CPK44

MK-NPK44

MN-IC600 7.


MK-NPK43

MN-IC600 5.


MK-NPK63

MN-IC600 6.

8.MN-RSM60 MN-CHC60 MN-ICH40 MN-IC040MN-CPK64

MK-NPK64

MN-IC600

2.10

Ø4mm

4º

H - gingival height

Anatomic transgingival abutment dimensions:

Option

Option

Option

Option

L= 4,6mm

L - crown height

H=1,2,3,4mm

MD-RSM40 MD-CHC40 MD-ICH40 MD-IC040

MK-CPK41

MD-CPK41


MK-CPK81

MD-CPK81


MK-CPK62

MD-CPK62


MK-CPK61

MD-CPK61


MK-CPK42

MD-CPK42


MK-CPK82

MD-CPK82

MD-IC800

MD-IC800

MD-IC800

MD-IC800

MD-IC800

MD-IC800

5.

6.

2.

3.

4.

1.

Kit options table

STANDARDPLATFORM

Option

Option

Option

Option

Option

Option


2.45

L=4,6,8mm

Ø4.8mm

4.8º

MD-CPK43

MD-RSM80 MD-CHC80 MD-ICH40 MD-IC040MD-CPK83





MK-CPK43

MK-CPK83

MK-CPK64

MK-CPK63

MK-CPK44

MK-CPK84

MD-CPK84

MD-IC800

MD-IC800

MD-IC800

MD-IC800

MD-IC800

MD-IC800

8.

9.

10.

11.

12.

7.Option

Option

Option

Option

Option

Option


L - crown heightH - gingival height

H=1,2,3,4mm

MW-RSM40 MW-CHC40 MW-ICH40 MW-IC040

MK-WPK41

MW-CPK41


MK-WPK81

MW-CPK81


MK-WPK62

MW-CPK62


MK-WPK61

MW-CPK61


MK-WPK42

MW-CPK42


MK-WPK82

MW-CPK82

MW-IC800

MW-IC800

MW-IC800

MW-IC800

MW-IC800

MW-IC800

5.

6.

2.

3.

4.

1.

Kit options table

WIDEPLATFORM

Option

Option

Option

Option

Option

Option


MK-WPK43

MW-CPK43


MK-WPK83

MW-CPK83


MK-WPK64

MW-CPK64


MK-WPK63

MW-CPK63


MK-WPK44

MW-CPK44


MK-WPK84

MW-CPK84

MW-IC800

MW-IC800

MW-IC800

MW-IC800

MW-IC800

MW-IC800

8.

9.

10.

11.

12.

7.

2.45

Ø5.5mm

4.8º

Option

Option

Option

Option

Option

Option


L - crown heightH - gingival height

L=4,6,8mm

H=1,2,3,4mm

B.A.

MF7-11375

MT-RI050

MT-HDL30

MD-CPK61

MD-S0220

Components:

Implant

Torque wrench

Long hex. driver 0.05’’


Based on the loading protocol, remove healing caps to expose the implants.

Exposed implants

Implant exposure

Place anatomic cementing transgingival abutments on the implants according to tissue depth. Abutments are available in four transgingival heights of 1, 2, 3 and 4mm.

The anatomic cementing transgingivalabutment is attached by screwing-on prosthetic screw using a long hex. driver and a torque wrench to tighten the abutment to 30 Ncm afterwards.

Placement of anatomic cementing transgingival abutments

Abutment placementStep 1.

Prosthetic screw

www.mis-implants.com

Ste

p 1

B.A.

MF7-11375

MD-CPK61

MD-IC800



For closed tray impression technique, adapt the impression coping plastic caps (MD-IC800) to the anatomic cementing transgingival abutments (MD-CPK61).

To ensure correct placement, the impression copings should be placed so that the groove on top of the plastic sleeve faces the flat surface of the abutment. Correct location is indicated by stable seating of the plastic (snap engagement).

Indication of the correct location of the impression coping plastic cap on the abutment. The plastic caps should snap into position.

Impression coping plastic caps (transfer coping) for closed tray technique

Taking the impression

For best results, copings must be completely covered by impression material and the tray fully seated. It is recommended to inject low-viscosity impression material into the retention grooves and around the plastic sleeves prior to seating of the tray with a heavier impression material.

Closed tray impression

Implant

Step 2.

Components:


Ste

p 2

A.

MF7-11375

MM-CHC60

MH-03375

MD-CPK61

Healing cap

MT-HHR13

Long hand screwdriver for 0.05’’ hex.


Plastic healing cap

Implant

Components:

Plastic healing caps(Option A)

Plastic healing caps in place

After impression taking, three options are available: 1) delivery of a temporary restoration; 2) covering the abutments with plastic healing caps; 3) removing the abutments and replacing them with titanium healing caps. Temporary plastic healing caps (MM-CHC60) can be temporarily cemented to protect the abutments, prevent creeping of the gingiva on top of the abutment margins and, to prevent inconvenience to the patient. This procedure avoids re-seating and re-tightening of the abutments, as required when using the titanium healing caps.

In order to connect titanium healing caps, it is necessary to remove the anatomic cementing transgingival abutments from the implants. Healing caps are made of titanium alloy and are available in several heights*. Standard and anatomic caps, Ø4mm for standard caps and Ø5.5mm for anatomic caps (SP). The titanium healing caps should extend at least 1mm above the gingiva.

Connecting standard or anatomic healing caps

Standard or anatomic healing caps can also be used

B. (Option B)

Step 3.

MH-53375Anatomic Healing cap

Note:* Narrow Platform: 2,3,4,5,6, 8mm (Anatomic 2,3,4,5,6mm)Standard Platform: 3,4,5, 6mm (Anatomic 3,4,5,6mm)Wide Platform: 3, 4, 5mm (Anatomic 3, 4, 5mm)

Ste

p 3


B.A.

MD-IC800

MD-RSM60


Abutment analog

Components:

Impression plastic caps

The impression plastic caps are clearly visible in the impression.

It is important to confirm proper seating of the impression copings in the impression material. If the copings are not completely stable in the impression, it is recommended that a new impression be taken.

Impression evaluation Abutment analogs

Abutment analogs (MD-RSM60) should be attached to the impression plastic caps.

Proper insertion and alignment of the analog in the copings is critical. No gaps or misalignment should be evident (snap engagement).

Abutment analogs attached to the impression caps

Please align the flat surface of each abutment analog to the corresponding surface in the impression caps prior to seating of the analog into place.

Note:

Step 4.

C.

Use of gingival simulation material

Use gingival simulation material around the neck of the analogs. The material facilitates access to the analogs for laboratory work.

Simulation of gingiva

It is recommended to isolate the impression material from the simulated gingiva with a special isolation material, in order to avoid bonding between the two materials.

Note:

Ste

p 4


A.

MD-RSM60

Stone model with abutment analogs and simulated gingiva

Stone model with abutment analogs

The final working model is ready for the next step.

Components:

Abutment analog

Step 5.

Ste

p 5


A.

MD-RSM60

B.

Diagnostic wax-up

Prepare an indicative silicone key to be used as a negative replica of the missing teeth.

Silicone index

Silicone index

A diagnostic wax up is built directly on the analogs.

The diagnostic bridge

Abutment analog

Components:

Step 6.

Ste

p 6


B.A.

MD-RSM60

MD-IC040

MD-ICH40

Placement of burnout plastic caps on analogs

Place the burnout plastic caps tightly onto analogs.

Burnout plastic caps

The CPK system includes an anti-rotation burnout plastic cap for single unit cemented restorations.

Optional

Burnout anti-rotation plastic cap

Components:

Abutment analog

Burnout plastic capAdjustment of burnout plastic caps

Adjust burnout plastic sleeve by simply cutting excess height with a hot surgical blade.

Occlusal adjustment of burnout plastic caps Step 7.

C. D.

Burnout wax on plastic caps.

Block adjusted burnout plastic cap window with burnout wax or burnout resin. Use the silicone index to verify correct

height of the burnout plastic caps.

Block burnout plastic cap Verifying spacing

Verifying proper space between burnout plastic caps and silicone index.

Ste

p 7

B.

MD-RSM60

MD-IC040

A.

Wax carving

Use wax or burnout resin to carve desired framwork.

Use silicone index to verify that the space left is adequate for porcelain.

Silicone index with wax-up

Wax carving Silicone index with wax-up

Components:

Abutment analog

Burnout plastic cap

Step 8.

Ste

p 8


B.A.

MT-CS450

MT-GP450

Shoulder reamer

Follow manufacturer instructions and fabricate metal framework based on conventional metal casting techniques.

Pre-casting

The “snap” rim ring

The plastic copings for CPK abutment are fitted utilizing a “snap mechanism”. The “snap mechanism” is a ring that fits onto an undercut groove on the abutment. This allows the abutment to be perfectly positioned and fixed on the analog.

To ensure accurate seating of the cast framework on the prosthetic abutments, it is essential to grind and remove the metal “snap mechanism”. For best results, use MIS shoulder reamer (MT-CS450).

Removal of “snap” rim ringSnap mechanismStep 9.

Guide Pin

Components:

C.

1

3

2

D.

Shoulder reamer

Use the shoulder reamer as the last step, after making standard framework adjustments, to remove “snap mechanism”.

The shoulder reamer is composed of three elements: the guide pin(1), the shoulder reamer itself(2) and the prosthetic holder MT-MSD20(3).

Careful use of shoulder reamer

The shoulder reamer (MT-CS450) assembly

Grinding with the shoulder reamer

Ste

p 9

MT-MDS20 is also available within MK-0001 Abutment holding system kit.

Note:

F.E.

Metal framework try-in in patient’s mouth

Metal framework try-in in the mouth

It is critical that the metal framework fits the abutments passively. “Passive fit” means that the framework can be seated all the way with no pressure on the abutments. Standard metal framework evaluation and adjustments procedures should be used to verify correct seating of the framework.

Try-in and adapt metal framework following conventional laboratory techniques. The technician must verify passive fit of the framework.

Metal framework try-in on model

Metal framework try-in on a stone model

B.A.

MD-RSM60

MF7-11375

MD-CPK61

MK-0022

Porcelain try-in on model

Once the appropriate shade is selected, porcelain is baked following standard procedures and adjustments.

Porcelain build-up Porcelain try-in

Prior to placing the bridge, remove the temporary plastic healing caps from the patient’s mouth.

Proximal and occlusal contacts should be adjusted before cementation. “Crown Set” (MIS cement) is recommended for cementation of PFM bridges and crowns.Ensure removal of excess material.

Porcelain try-in in the mouth

Abutment analog

Implant


Crown set

Components:

Step 10.

Ste

p 10


MN-IC600

MN-CP013

MN-CPH13

M4Ø 3.30mm

SEVENØ 3.30mm

MH-N2330MH-N3330MH-N4330MH-N5330MH-N6330

MH-52330MH-53330MH-54330MH-55330MH-56330

H-3,4,5,6Ø4mm

H-2,3,4,5,6Ø5.5mm

MN-I0330 MN-RSM10 MN-CPK41MN-CPK42MN-CPK43MN-CPK44

MN-CPK61MN-CPK62MN-CPK63MN-CPK64

MN-MAC10 MN-AN020

MN-ICH40 (Anti-rotation)

MN-IC040

MN-IT100

MN-PF330

MN-IT300

MN-S0160 MN-S0160

Restorative procedure

NARROW PLATFORM

Plastic cylinders

Prosthetic options

Healing caps

Standard AnatomicImpression copings Analog

Anatomic transgingival abutments

Cementing posts

Angulated abutments

Screw Screw

M4Ø 3.75mmØ 4.20mm

SEVENØ 3.75mmØ 4.20mm

MD-ICH40 (Anti-rotation)

MD-IC040

MH-03375MH-04375MH-05375MH-06375

MH-53375MH-54375MH-55375MH-56375

MD-I0375

MD-IT300

MD-RSM10

MD-S0200MD-S0220MD-S0222MD-S0224

MD-S0200MD-S0220MD-S0222MD-S0224

MD-G0220 MD-G0220

H-3,4,5,6Ø4mm

H-3,4,5,6Ø5.5mm

MD-IT100



MD-CPH13

MD-CPH50

MD-CP013

MD-CP050

MD-GP010

MD-GPC10

MD-PF375

MD-A1510MD-A2510

MD-P1530MD-P2530

MD-AN151

MD-S0200MD-S0220

MD-CTP10MD-MAC10MD-WMAC1

MD-MACF1

MD-A0010MD-P0030

MD-CR010 MD-AN251

MD-IC800

Healing capsImpression copings Analog


Plastic cylinders

Goldplastic cylindersStandard Anatomic

Angulated abutments

Esthetic angulated abutments

Cementing posts

Esthetic abutments

Prosthetic options

STANDARD PLATFORM

Screw Screw Screw

Restorative procedure

MW-ICH40 (Anti-rotation)

MW-IC040

MD-S0200MD-S0220MD-S0222MD-S0224

MD-G0220

MW-AN151 MW-P1510MH-W3500MH-W4500MH-W5500

H-3,4,5Ø5mm

MH-W3630MH-W4630MH-W5630

H-3,4,5Ø6.30mm

MW-I0470 MW-RSM10

M4Ø 5mmØ6mm

SEVENØ 5mmØ6mm

MW-IT300

MW-IT100

MW-CPH13

MW-CPH60

MW-CP013

MW-CP060

MW-GPC10

MW-GP010

MW-CPK41MW-CPK42MW-CPK43MW-CPK44MW-CPK61MW-CPK62

MW-CPK63MW-CPK64MW-CPK81MW-CPK82MW-CPK83MW-CPK84

MD-S0200MD-S0220MD-S0222MD-S0224

MD-G0220

MD-S0200MD-S0220

MW-CTP10MW-MAC10

MW-P0010

MW-IC800

MW-PF550

MW-WMAC1

WIDE PLATFORM Restorative procedure

Plastic cylinders

Goldplastic cylinders

Healing capsImpression copings AnalogStandard Anatomic


Angulated abutment


Cementing posts

Esthetic abutment

ScrewScrew Screw

Prosthetic options

All rights reserved. No part of this publication may be reproduced, transcribed, stored in an electronic retrieval system, translated into any language or computer language, or be transmitted in any form whatsoever, without the prior written consent of the publisher. Warning: MIS’ products referred to in this publication should be used by licensed dentists only.


© MIS Corporation. All right reserved

®

MC-PMU06 Rev.4

MIS’ Quality System complies with international quality standards: ISO 13485:2003 - Quality Management System for Medical Devices, ISO 9001: 2008 – Quality Management System and CE Directive for Medical Devices 93/42/EEC. MIS’ products are cleared for marketing in the USA and are CE approved.

cemented bridge using cpk abutments step-by-step

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