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-CPK63MD-CPK64MD-CPK81MD-CPK82MD-CPK83MD-CPK84
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
Adjustable, based on abutment preparation
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
Esthetic angulated abutment
15° or 25°
Up to 2mm buccal Up to 4mm palatal
Crown/ Implant
Inclination Ratio
Gingival Height
Anterior Maxilla
Conical post abutment
Adjustable, based on abutment preparation
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
MN-RSM40 MN-CHC40 MN-ICH40 MN-IC040
MK-NPK41
MN-CPK41 MN-IC600
MN -RSM60 MN-CHC60 MN-ICH40 MN-IC040
MK-NPK61
MN-CPK61 MN-IC600
MN-RSM60 MN-CHC60 MN-ICH40 MN-IC040
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.
MN-RSM40 MN-CHC40 MN-ICH40 MN-IC040MN-CPK43
MK-NPK43
MN-IC600 5.
MN-RSM60 MN-CHC60 MN-ICH40 MN-IC040MN-CPK63
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
MD-RSM80 MD-CHC80 MD-ICH40 MD-IC040
MK-CPK81
MD-CPK81
MD-RSM60 MD-CHC60 MD-ICH40 MD-IC040
MK-CPK62
MD-CPK62
MD-RSM60 MD-CHC60 MD-ICH40 MD-IC040
MK-CPK61
MD-CPK61
MD-RSM40 MD-CHC40 MD-ICH40 MD-IC040
MK-CPK42
MD-CPK42
MD-RSM80 MD-CHC80 MD-ICH40 MD-IC040
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
MD-RSM40 MD-CHC40 MD-ICH40 MD-IC040
2.45
L=4,6,8mm
Ø4.8mm
4.8º
MD-CPK43
MD-RSM80 MD-CHC80 MD-ICH40 MD-IC040MD-CPK83
MD-RSM60 MD-CHC60 MD-ICH40 MD-IC040MD-CPK64
MD-RSM60 MD-CHC60 MD-ICH40 MD-IC040MD-CPK63
MD-RSM40 MD-CHC40 MD-ICH40 MD-IC040MD-CPK44
MD-RSM80 MD-CHC80 MD-ICH40 MD-IC040
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
Anatomic transgingival abutment dimensions:
L - crown heightH - gingival height
H=1,2,3,4mm
MW-RSM40 MW-CHC40 MW-ICH40 MW-IC040
MK-WPK41
MW-CPK41
MW-RSM80 MW-CHC80 MW-ICH40 MW-IC040
MK-WPK81
MW-CPK81
MW-RSM60 MW-CHC60 MW-ICH40 MW-IC040
MK-WPK62
MW-CPK62
MW-RSM60 MW-CHC60 MW-ICH40 MW-IC040
MK-WPK61
MW-CPK61
MW-RSM40 MW-CHC40 MW-ICH40 MW-IC040
MK-WPK42
MW-CPK42
MW-RSM80 MW-CHC80 MW-ICH40 MW-IC040
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
MW-RSM40 MW-CHC40 MW-ICH40 MW-IC040
MK-WPK43
MW-CPK43
MW-RSM80 MW-CHC80 MW-ICH40 MW-IC040
MK-WPK83
MW-CPK83
MW-RSM60 MW-CHC60 MW-ICH40 MW-IC040
MK-WPK64
MW-CPK64
MW-RSM60 MW-CHC60 MW-ICH40 MW-IC040
MK-WPK63
MW-CPK63
MW-RSM40 MW-CHC40 MW-ICH40 MW-IC040
MK-WPK44
MW-CPK44
MW-RSM80 MW-CHC80 MW-ICH40 MW-IC040
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
Anatomic transgingival abutment dimensions:
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’’
Anatomic cementing transgingival abutment
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
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p 1
B.A.
MF7-11375
MD-CPK61
MD-IC800
Anatomic cementing transgingival abutment
Impression coping plastic cap
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:
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A.
MF7-11375
MM-CHC60
MH-03375
MD-CPK61
Healing cap
MT-HHR13
Long hand screwdriver for 0.05’’ hex.
Anatomic cementing transgingival abutment
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)
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p 3
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B.A.
MD-IC800
MD-RSM60
Impression coping plastic cap
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:
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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.
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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
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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
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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
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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
Anatomic cementing transgingival abutment
Crown set
Components:
Step 10.
Ste
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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-CPK41MD-CPK42MD-CPK43MD-CPK44MD-CPK61MD-CPK62
MD-CPK63MD-CPK64MD-CPK81MD-CPK82MD-CPK83MD-CPK84
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
Anatomic transgingival abutments
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
Anatomic transgingival abutments
Angulated abutment
Esthetic 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.
www.mis-implants.com
© 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.