Straumann® high temperature furnaces provide a variety of features combining easy operation and performance consistency. Space-saving designs with fully-automated, pre-programmed and customizable sintering programs make them ideal for the dental laboratory. Straumann® Therm for zirconia restorations Optimally coordinated, fully automated sintering programmes for different restoration sizes Three stackable sintering bowls to maximize utilization Four sintering programmes available Straumann® Argotherm for Sintron® CoCr restorations Sinter programme optimized for Sintron® CoCr restorations Easy-to-use: Sintering at the press of a button Sintering under shielding gas Minimal consumption of argon gas, actively cools after sintering OUR OFFERING FOR DENTAL LABS FOR DENTISTS FOR DENTAL LABS The Straumann® CARES® offering for dental labs connects carefully selected, best-in-class dental equipment (scanners, CARES® Visual software, milling machines, high-temperature furnaces) with the latest digital technology and premium materials to provide a seamless, fully validated workflow for the state-of-the-art dental lab. You can be sure that our solution will 1. enable you to offer a broader range of prosthetic solutions and services, 2. increase your lab’s productivity and efficiency and 3. let you enjoy the benefits of future-proof hardware and software! FOR DENTISTS Replace traditional dental impressions with highly accurate digital data! Based on our novel 3D capture technique called Multi-scan Imaging™, the extremely compact Straumann® CARES® Intraoral Scanner allows dentists and clinicians to quickly and easily create digital impressions. The remarkably small handpiece, one of the smallest on the market today, is particularly patient-friendly. Based on the open STL data format, digital impressions can be sent directly to your lab partner via Straumann® CARES® Connect. THE BROCHURES OUR “DIGITAL PERFORMANCE” ROADSHOW 2016/17 STAY TUNED! The post Straumann® CARES® high temperature furnaces Therm and Argotherm: meet the increased demand for zirconia and Cobalt-chrome restorations appeared first on STARGET COM.
On the occasion of the recent publication of his latest research in the International Journal of Oral and Maxillofacial Implants*, Professor J. Robert Kelly, a renowned material scientist from the University of Connectitut, was kind enough to grant us an interview. The cited study and the conclusions drawn from it once more show that not all implant abutments are equal and that the use of original prosthetic components is highly recommended for the reliability and success of the restoration. Professor Kelly, in your latest research, you have tested the fatigue behaviour of zirconia abutments from four major manufacturers. Can you tell us more about it? This project examined commercially available custom CAD/CAM abutments for failure behaviour and failure origins to gain insights into the role of abutment design and manufacturing on their lifetimes. The goal was to perform clinically relevant mechanical testing to provide practitioners with evidence for choosing the designs and materials to protect and benefit their patients and potentially to provide manufacturers with feedback regarding processing and design issues. “The bottom line of our research is Straumann wins for the all-zirconia abutments, clearly underlining that the manufacturer matters!” What was the methodology for testing these products? One implant type was used throughout the entire project: the Straumann® Bone Level Implant (D4.1 mm, H10 mm). Initially, the project was planned for studying four all-zirconia abutments but only two manufacturers still offered such abutments for the chosen implant (Straumann and DENTSPLY ATLANTIS), whereas Nobel Biocare and Glidewell discontinued their all-zirconia abutments. We therefore studied two groups of abutments: two all-zirconia abutments – Straumann CARES® and Dentsply Antlantis – and two titanium-zirconia (Ti-base) hybrids, i.e. Nobel Biocare and Glidewell. All abutments were tested in a dynamic fatigue test set-up (adapted ISO 14801 protocol) aiming at eliminating implant fracture and maximizing stresses in the abutment and implant/abutment connections. The abutment lifetime extrapolation was then calculated from the fatigue test data which allowed us link mechanical tests with clinical relevance. What have you found out about differences between manufacturers and their origins? Differences in durability were dramatic and quite unexpected. Contrary to expectations, there was no inherently “best” design between the two groups, all-zirconia or Ti-based. Not so subtle manufacturing differences clearly separated Straumann as being far superior to DENTSPLY ATLANTIS. For the Ti-based systems the Nobel Biocare results were also way better than Glidewell. Our estimate of the time required for 10% of the Straumann abutments to fail was approximately 20 years – clearly well-designed and manufactured. Two distinctly different failure modes were found within each type of abutment (pure zirconia and Ti-base) and both occurred in parts from each manufacturer. For all-zirconia abutments failure occurred either from within the implant, likely prior to screw failure or from the screw seat. For Ti-base abutments failures were due to either titanium tube tearing (at the base of the tube) not involving zirconia fracture or by a combination of de-bonding and zirconia fracture. The bottom line of our research is: Straumann wins for the all-zirconia abutments and Nobel Biocare for the 2-piece abutments – clearly underlining that the manufacturer matters! Why do the two abutments groups have different results and why can’t they be compared? All-zirconia abutments are used in situations requiring highest esthetic needs, in the anterior region. Especially in situations with thin gingiva they have a clear esthetic advantage over 2-piece abutments. The excellent clinical success rate of Straumann CARES® ZrO2 abutments is underlined in a series of clinical studies. 2-piece abutments, on the other hand, are typically used in the posterior and premolar regions and therefore are exposed to much higher clinical loads compared to the anterior region. It is therefore obvious that 2-piece abutments need to exhibit higher mechanical stability compared to 1-piece abutments. There are design differences between them worth dwelling on. While the 2-piece abutments do have a continuous column of titanium in the joint, the zirconia is still directly loaded by the crown and it is thinner than in the 1-piece systems. There is also the addition of a bonded interface (zirconia-titanium) that appears to be their weak link with many unknown variables such as bonding technique, materials and cement thickness. Titanium tube tearing may be influenced by tube height, radius of curvature at the tube base joint and the metallurgy of this part. To my knowledge, none of these potential variables have been studied. “The excellent clinical success rate of Straumann® CARES® ZrO2 abutments is underlined in a series of clinical studies.” Is it clinically relevant to extrapolate cycles to sextillion cycles? As already mentioned, the prediction of 10% failure at 20 years is remarkably good for any prosthetic system. Extending this to well, well beyond patient lifetimes seems unnecessary. Focusing on the full zirconia abutments group, what clinical conclusions can be drawn from the differences between Straumann and DENTSPLY ATLANTIS? From our study it is clear that Straumann has much better results than DENTSPLY ATLANTIS. Coincidentally, Prof. Marco Ferrari from the University of Siena completed a 3-year clinical study including the DENTSPLY ATLANTIS abutment that we tested. They reported 17% failures during this period, in remarkably good agreement with our laboratory data. Small adjustments in our main extrapolation assumptions, 70 N clinical load and 1.5 million chewing cycles per year, validate our model with his clinical findings. “From our study it is clear that Straumann has much better results than DENTSPLY ATLANTIS.” Are you surprised by the fact that what are claimed to be three compatible abutments have much worse rotational play than the original Straumann abutment? How important is it for you to use original components? Rotational play turned out not to predict fatigue performance in this study, but does clearly reinforce our main finding that seemingly “similar” parts from different manufacturers can have serious performance differences. We clearly identified durability differences, even if the specific cause of poor durability was not identified. As for original components in general, I advise against using lower cost third-party abutments. My experience shows that the quality of their materials is definitely inferior. There is way too much to lose and it is certainly not worth it for a savings of 100 dollars. * Kelly J.R, Rungruanganunt P. Fatigue Behavior of Computer-Aided Design/Computer-Assisted Manufacture Ceramic Abutments as a Function of Design and Ceramics Processing. International Journal of Oral and Maxillofacial Implants 2016;31(3): 601–609. Prof. J. Robert Kelly DDS, MS, DMedSc University of Connecticut, Farmington Department of Reconstructive Sciences, Center for Biomaterials, University of Connecticut Health Center, Farmington. Currently Director at the Center for Advanced Technology Integration, UConn Health Center. Founder of Oral Fluid Dynamics, LLC (2015). The post Original components: “Seemingly ‘similar’ parts from different manufacturers can have serious performance differences“ appeared first on STARGET COM.
Wet, wet/dry and dry-milling: the Straumann® CARES® M Series milling and grinding system enables dental laboratories to produce an extensive range of restorations for every type of indication. Its compact design fits in any laboratory and it can handle a wide range of materials, allowing your lab to produce a broad range of prosthetics – from inlays, onlays, veneers, and single crowns, to bridges and screw-retained restorations. Prosthetics can be milled, or ground, in wet or dry modes from materials, including glass ceramic, zirconia, PMMA, cobalt-chromium – sinter metal, wax, lithium disilicate ceramics and resin nanoceramic. The M Series is a single system that can handle the majority of your casework. With multiple workflow options, you can enjoy the full flexibility of using one system regardless of what case appears from your customer. Changing from dry to wet mode is a very easy process in only 6 steps. For work peaks, or complex cases, our centralized milling facility operates as an extension of your lab. The Straumannn CARES® Visual CAM Module includes an elaborated collision control and evasion to ensure a high degree of process reliability: quick nesting, easy positioning, and alignment of design in the blank, as well as nesting for different blank and block shapes and sinter support block for long-span zirconia restorations. The Straumannn CARES® Visual CAM Module provides effective nesting of objects and fast milling path calculation. Sinter supoort structures and individual nesting pins available (click on picture to enlarge). OUR OFFERING FOR DENTAL LABS FOR DENTISTS FOR DENTAL LABS The Straumann® CARES® offering for dental labs connects carefully selected, best-in-class dental equipment (scanners, CARES® Visual software, milling machines, high-temperature furnaces) with the latest digital technology and premium materials to provide a seamless, fully validated workflow for the state-of-the-art dental lab. You can be sure that our solution will 1. enable you to offer a broader range of prosthetic solutions and services, 2. increase your lab’s productivity and efficiency and 3. let you enjoy the benefits of future-proof hardware and software! FOR DENTISTS Replace traditional dental impressions with highly accurate digital data! Based on our novel 3D capture technique called Multi-scan Imaging™, the extremely compact Straumann® CARES® Intraoral Scanner allows dentists and clinicians to quickly and easily create digital impressions. The remarkably small handpiece, one of the smallest on the market today, is particularly patient-friendly. Based on the open STL data format, digital impressions can be sent directly to your lab partner via Straumann® CARES® Connect. THE BROCHURES OUR “DIGITAL PERFORMANCE” ROADSHOW 2016/17 STAY TUNED! The post Straumann® CARES® M Series: more options for in-lab milling and grinding appeared first on STARGET COM.
The selection of the implant abutment for each individual patient case is an important part of the implant-prosthetic treatment phase. Long-term clinical studies on fixed implant-supported reconstructions show low technical complication rates regarding the abutment itself . In this article, Julia-Gabriela Wittneben discusses different implant abutment types, the various abutment materials, and their clinical indications. A clinical case presenting step-by-step the treatment of a single edentulous gap with an all-ceramic screw-retained implant crown is shown here. 1. Implant abutment types Implant abutments can be either standard or customized (Fig. 2). The use of a standard abutment is indicated if the implant is placed in an almost ideal prosthetic position. The advantages of standard abutments are time efficiency in the overall treatment and therefore shortening of the technical manufacturing time. Divergences between implants supporting multi-unit prostheses can be corrected with angled standard abutments. In the esthetic zone, it is important that the collar height of a prefabricated abutment is not a uniform 360 degrees, as the interproximal position of the crown margin would be placed too far submucosally. Therefore, the ideal design of a standard abutment should be similar to a tooth preparation, following the contour of the gingival margin2 (Fig. 1). Clinical limitations exist regarding the position of the implant in a vertical dimension. If the implant is placed too apically, standard abutments are not indicated, especially for screw-retained reconstructions, as they do not provide enough support for the veneering ceramic. Customizing an abutment gives the clinician the freedom to individualize its position and angulation. In the case of a bone level implant, it is also possible to individualize the emergence profile and future crown margin position of the final restoration. It allows abutments to be designed to provide optimal support for the veneering ceramic material, especially for screw-retained reconstructions. Individualization may be achieved using CAD/CAM technology, gold abutments produced with traditional lost-wax casting methods, or titanium base abutments (Fig. 2). Customized abutments manufactured via CAD/CAM can be made of titanium or zirconium dioxide for bone- and tissue-level implants. They can be used for cement- or screw-retained single crowns or cement-retained bridges. The benefits of the CAD/CAM abutment include the possibility of using a high-performance ceramic material, which again offers many advantages, especially in esthetic sites. In patients with a thin tissue biotype, no grayish shining-through will be visible with a white-colored abutment. However, it is also possible to choose titanium as a material. Another advantage is individualization regarding the angulation and design of the abutment to support the veneering ceramic. Traditional cast gold abutments can be used for screw- and cement-retained single crowns and bridges, and are available for implants placed at soft tissue or bone level. Their advantages consist in the facilitation of the screw retention with bridges. Disadvantages, however, are that gold abutments are technique-sensitive, require more time, and generate higher manufacturing costs. An in vivo histological study in dogs has demonstrated that gold alloys also have disadvantages in terms of soft tissue integration. Histologically, an apical shift of the barrier epithelium and the marginal bone around gold alloy abutments has been shown3. The third group of customized abutments on implants are the titanium base abutments. They are two-piece abutments with a titanium base. Clinicians are sometimes concerned about the handling of complications with a full ceramic abutment regarding the retrieval of broken-off ceramic fragments in the implant, which can be difficult. The main advantage of this abutment type is that there is no ceramic material inside the titanium implant connection. However, the disadvantage lies in the lack of evidence in published clinical data to date. In particular, the soft-tissue reaction regarding the bonding gap, especially in bone-level implant cases in the esthetic zone, remains unknown. In consequence, this type of abutment should be used with this current limitation in mind 4. However, use with soft tissue-level implants with a microgap above bone level might be less of a concern. An example of a soft tissue-level implant case is presented step-by-step on the following pages (Figs. 3-15). 2. Implant abutment material Different biomaterials are available for implant abutments. PMMA (polymethyl methacrylate), titanium, and PEEK (polyether ether ketone) are indicated for abutments supporting provisionals – especially for bone-level-type implants – to customize the emergence profile and individualize the peri-implant mucosa with soft tissue conditioning5. The materials of choice for abutments for final restorations are titanium, gold, zirconium dioxide, and aluminum oxide-based ceramic. Titanium and zirconium dioxide will be discussed in this article regarding clinical and histological performance. Titanium is the biomaterial of choice regarding long-lasting and well documented behavior under functional loading for both soft and hard tissues. It has excellent biocompatibility, mechanical strength, and is resistant to corrosion. Therefore, it is the abutment material of choice for posterior sites. However, the expectations of patients in the anterior zone are increasing. In esthetic sites, mucosal thickness plays an important role. An animal study comparing different dental materials under different mucosal thicknesses showed that titanium induced the most prominent color change. Zirconium dioxide did not induce visible color changes in 2 and 3 mm thick mucosa.6 With the background of the available clinical evidence and systematic reviews, no differences were found between zirconium dioxide and metal abutments in clinical performance based upon esthetic, technical, or biological outcomes7,8,9,10. In vitro studies have shown statistically significant greater wear of zirconium dioxide than of titanium abutments inside the titanium implant11. However, the clinical relevance remains unclear. In our clinic, we have been using Straumann® CARES® CAD/CAM fabricated zirconium dioxide abutments since 2009 on a daily basis in esthetic cases with bone level implants, and have had no issues with abutment fractures so far. The correct CAD/CAM design of a zirconium dioxide abutment and the quality and precision of the connecting part into the implant play a crucial role in long-term success. Focusing on the outcome of histological studies, an in vivo study shows that there were no visible differences in soft tissue health in peri-implant mucosa adjacent to zirconium dioxide and titanium abutment surfaces12. Another study found that soft tissue around zirconium dioxide heals faster than when in contact with titanium13. A systematic review14 evaluating the existing literature on zirconium dioxide abutments concludes based on evidence from animal and human histological studies that zirconium dioxide is as suitable a material for dental implant abutments as titanium. Regarding plaque accumulation, zirconium dioxide appears to have a lower tendency for surface-bound bacterial plaque in early stages, which is advantageous. 3. Conclusion and clinical recommendation Abutment selection in esthetic sites. Implant abutments are located in a transition zone where they are in contact with the implant and the surrounding peri-implant tissues. Therefore, the choice of abutment is of major importance, especially in a sensitive region like the esthetic zone. For single-unit reconstructions, zirconium dioxide abutments are indicated, which can be either standard or customized depending on the prosthetic position of the implant. For multi-unit reconstructions, zirconium dioxide abutments are recommended for cement-retained bridges, and gold titanium abutments for screw retained bridges. Abutment selection in posterior sites. Clinical indication of each implant abutment type depends primarily on the prosthetic position of the implant and whether single or multiple units need to be replaced. Standard and Straumann® Variobase abutments are the abutment of choice in posterior sites if the prosthetic position of the implant is ideal. Angled standard abutments, individualized CAD/CAM abutments made of titanium, or cast abutments in gold are indicated in cases where the implant is not placed in an ideal prosthetic position. In multi-unit reconstructions, standard titanium or individualized gold abutments are recommended. Clinical case report Restoration of a single edentulous gap with an all-ceramic screw-retained implant crown in a posterior site using the Straumann® Variobase Abutment. This case was treated in a multidisciplinary approach: Prof. Dr. med. dent. Daniel Buser (Surgical), Dr. med. dent. Julia-Gabriela Wittneben, (Prosthetics), Thomas Furter, CDT (Lab). Fig. 3 wittneben03 Fig. 4 wittneben04 Fig. 5 wittneben05 Fig. 6 wittneben06 Fig. 7 wittneben07 Fig. 8 wittneben08 Fig. 9 wittneben10 Fig. 10 wittneben11 Fig. 11 wittneben12 Fig. 12 wittneben13 Fig. 13 wittneben14 Fig. 14 wittneben15 Fig. 15 wittneben16 Patient: non-smoking, healthy female, 43 years. Situation: a single edentulous tooth gap, region 46 (FDI). A Straumann® Soft Tissue Level Regular Neck Implant with Straumann® SLActive® surface was placed in a correct three-dimensional position (Fig. 3). Open-tray impression and bite registration followed eight weeks later. Peri-apical radiograph for evaluation of the impression coping position (Fig. 4). Fabrication and articulation of the master casts. Insertion of the scanbody. The cast was centralized in the scanning machine (Fig. 5). Bite registration with the scanbody in place (Fig. 6). Verification of digital image and manual modification, matching occlusion of the opposing dentition (Figs. 7, 8). A Straumann® Variobase Abutment was used (Fig. 9). An IPS e.max CAD crown made of lithium disilicate glass ceramic was ordered and delivered to the dental laboratory in a bluish color (Fig. 10). The crown was cut back with a diamond bur and crystallized in a furnace. Characterization and finalization of the crown followed by the manual addition of veneering ceramic (IPS e.max. Ceram) and the use of stain and glaze paste (IPS e.max Ceram Essences and FLUO). Different firing cycles. Cementation of the crown on the Straumann® Variobase Abutment with adhesive cement (Multilink Hybrid Abutment Cement). The excess cement was removed and polished (Figs. 11, 12). The final crown was tried intraorally and inserted with 35 Ncm inside the implant (Figs. 13, 14). Evaluation of the crown position (Fig. 15). The occlusion was adjusted and oral hygiene instructions given to the patient. IPS e.max CAD, IPS e.max. Ceram, Essences and FLUO are registered trademarks of Ivoclar Vivadent, Schaan/ Liechtenstein. REFERENCES 1 Wittneben JG, Buser D, Salvi GE, Bürgin W, Hicklin S, Brägger U. Complication and failure rates with implant-supported fixed dental prostheses and single crowns: a 10-year retrospective study. Clin Implant Dent Relat Res. 2014 Jun;16(3):356-64. 2 Giglio GD. Abutment selection in implant-supported fixed prosthodontics. Int J Periodontics Restorative Dent 1999;19(3):233-241. 3 Welander M, Abrahamsson I, Berglundh T. The mucosal barrier at implant abutments of different materials. Clin Oral Implants Res. 2008 Jul;19(7):635-41. 4 Zembic A, Kim S, Zwahlen M, Kelly JR. Systematic review of the survival rate and incidence of biological, technical, and esthetic complications of single implant abutments supporting fixed prostheses. Int J Oral Maxillofac Implants(Suppl) 2014:99-116. 5 Wittneben JG, Buser D, Belser UC, Brägger U. Peri-implant soft tissue conditioning with provisional restorations in the esthetic zone: the dynamic compression technique. Int J Periodontics Restorative Dent. 2013 Jul-Aug;33(4):447-55. 6 Jung RE, Sailer I, Hämmerle CH, Attin T, Schmidlin P. In vitro color changes of soft tissues caused by restorative materials. Int J Periodontics Restorative Dent. 2007 Jun;27(3):251-7. 7 Kapos T, Ashy LM, Gallucci GO, Weber HP, Wismeijer D. Computer-aided design and computer-assisted manufacturing in prosthetic implant dentistry. Int J Oral Maxillofac Implants. 2009;24 Suppl:110-7. 8 Sailer I, Philipp A, Zembic A, Pjetursson BE, Hämmerle CH, Zwahlen M. A systematic review of the performance of ceramic and metal implant abutments supporting fixed implant reconstructions. Clin Oral Implants Res. 2009 Sep;20 Suppl 4:4-31. 9 Zembic A, Bösch A, Jung RE, Hämmerle CH, Sailer I. Five-year results of a randomized controlled clinical trial comparing zirconia and titanium abutments supporting single-implant crowns in canine and posterior regions.Clin Oral Implants Res. 2013 Apr;24(4):384-90. 10 Wismeijer D, Brägger U, Evans C, Kapos T, Kelly JR, Millen C, Wittneben JG, Zembic A, Taylor TD. 11 Consensus statements and recommended clinical procedures regarding restorative materials and techniques for implant dentistry. Int J Oral Maxillofac Implants. 2014;29 Suppl:137-40. 12 Klotz MW, Taylor TD, Goldberg AJ. Wear at the titanium-zirconia implant-abutment interface: a pilot study. Int J Oral Maxillofac Implants. 2011 Sep-Oct;26(5):970-5. 13 van Brakel R, Meijer GJ, Verhoeven JW, Jansen J, de Putter C, Cune MS. Soft tissue response to zirconia and titanium implant abutments: an in vivo within-subject comparison. J Clin Periodontol. 2012 Oct;39(10):995-1001. 14 Degidi M, Artese L, Scarano A, Perrotti V, Gehrke P, Piattelli A. Inflammatory infiltrate, microvessel density, nitric oxide synthase expression, vascular endothelial growth factor expression, and proliferative activity in peri-implant soft tissues around titanium and zirconium oxide healing caps. J Periodontol. 2006 Jan;77(1):73-80. 15 Nakamura K, Kanno T, Milleding P, Ortengren U. Zirconia as a dental implant abutment material: a systematic review. Int J Prosthodont. 2010 Jul-Aug;23(4):299-309. Julia-Gabriela Wittneben, Switzerland Dr. med. dent., MMSC Senior Lecturer at the Department for Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland. Lecturer at the Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, USA. The post Julia-Gabriela Wittneben: Abutment selection and long-term success appeared first on STARGET COM.