Astra Tech Implant System SmartFix Concept

Astra Tech Implant System SmartFix conceptManual and product catalogAstra Tech Implant System EV

The Astra Tech Implant System EV is designed for easeof use and versatility in providing treatment solutionsfor your implant patients.The foundation of this evolutionary system remainsthe unique Astra Tech Implant System BioManagementComplex, which has been proven to predictablyprovide long-term marginal bone maintenance andesthetic results.Animation showing:SmartFix concept for Astra Tech Implant System EVStep-by-step procedure

Astra Tech Implant System CONTENTSIntroduction – SmartFix conceptIntroduction4Treatment planningPre-operative considerationsImplant assortment for SmartFix conceptAbutment assortment for SmartFix concept566Step-by-step ��–Implant placementAbutment connectionImmediate temporizationProsthetic and laboratory procedures781012OsseoSpeed Profile EV15Simplant computer-guided implant treatment16Atlantis patient-specific suprastructures17AppendixBone Reamer EVSmartFix GuideStep-by-step procedure – Verification jig181920Product catalog22Torque guideExplanation of the symbols on labels and instructions for useIndex282829This manual is designed for use by clinicians who have undergone appropriateeducation and training in surgical and prosthetic implant treatment. Staying currenton the latest trends and treatment techniques in implant dentistry through continuededucation is the responsibility of the clinician.This manual only addresses the additional information needed to work with theSmartFix concept. For all other instructions and/or a full description of implantplacement and restorative procedures for the Astra Tech Implant System EV as wellas all the instruments and components needed, please refer to the Surgical ManualAstra Tech Implant System EV, OsseoSpeed Profile EV, Screw-retained restorationmanual, Guided surgery manual and the Astra Tech Implant System EV Product Catalog.AstraTechClinical&AstraTech EVImplantSystem Product catalAstraogTech ImplantSystem EVAll products may not be regulatory cleared/released/licensed in all markets.Please contact the local Dentsply Sirona sales office for current product assortmentand availability.To improve readability, Dentsply Sirona does not use or in body copy.However, Dentsply Sirona does not waive any right to the trademark andnothing herein shall be interpreted to the contrary.ImplantSystem laboratoryScrew-retaine manuald restorationsSystemAstraTech ImplantAstraTechImplantSystem SurgicalmaAstra Tec nualh Implant System EVAstraTechImplantSystem Manualand proOsseoSpeed duct catalogProfileEVProduct illustrations are not to scale.3

IntroductionIntroduction – SmartFix conceptWith the SmartFix treatment concept patients canbenefit from an immediate implant-supportedrestoration, as a provisional prosthesis is screwed ontothe implants on the day of surgery. Final solutions forthe SmartFix treatment concept include both fixedprostheses and removable solutions e.g. Atlantispatient-specific suprastructures.By placing two posterior implants at an angle, longerimplants can be used adjacent to areas of otherwiseanatomically compromised bone volume such asclose to the mental foramen or the maxillary antrum,increasing bone-to-implant contact and reducing theneed for vertical bone augmentation. The tilted posteriorimplants reduce cantilevers and improve prostheticsupport by increasing the anterior/posterior spread.Biomechanical measurements show that tilted implants,when part of prosthetic support, do not have a negativeeffect on the load distribution. The tilting of implants hasbeen used in clinical practice for over a decade and hasshown good results.The ease of using the SmartFix concept4 Reduces treatment time for the patient Involves all team members in the treatment plan toensure a quality outcome Uses a prosthetically driven protocol to improve theesthetic result Allows the patient to leave the clinic, with implantretained teeth, on the day of surgery Provides one uniform interface to reduce restorativecomplexity Provides a simplified restorative concept to reducechair time Increases patient acceptance by minimizing costs

Treatment planningPre-operative considerationsThe SmartFix concept is an implant-prosthetic procedurefor the immediate restoration of edentulous patients withscrew-retained bridges or bar dentures on a minimumof four implants. The posterior implants placed at anangle are restored with 17 or 30 angled Multibase EVabutments to obtain a common path of insertion. Bone quality and quantity, primary implant stability,design of restoration and loading conditions shouldalways be carefully examined and assessed by theclinician when deciding the appropriate time to loadthe implants in the individual case.Both parts of the Multibase EV abutment need tobe tightened to 25 Ncm to secure a stable screwjoint and pre-load. Thus implants need to be stableenough to withstand this tightening torque if youconsider immediate temporization. If in doubt, healingabutments or even a two stage surgical approach canbe an alternative. Possible extraction sites should be debridedthoroughly. It is advisable to place implants betweenextraction sockets. It is recommended that a new denture, to be convertedinto a temporary fixed restoration on the day ofsurgery, is fabricated in advance. If possible, the posterior implants should be placedusing maximum diameter and length within thelimitations of available bone. Extensions should be limited to one tooth bilaterallyfor an immediate acrylic bridge with a maximum of12 teeth. Fabrication of an immediate acrylic bridge can bemade from a well-adapted existing denture in goodcondition. For best esthetics and function, the final bridge shouldhave 12 teeth and a supporting metal framework.For tilted posterior implants, plan for the emergence ofthe screw access hole to be located within the occlusalsurfaces of the posterior teeth.Low cone and gingival height– more free interocclusal space.Cone taper 21 – allows for flexible bridgeinsertion by non-parallel abutments.One uniform prosthetic interface forabutments, lowering the inventory needs.The narrow abutment design reducesthe need for bone reaming, therebysimplifying the abutment connection.The angled abutment is designed withtwo pieces, which provides for full wallstrength and full thread support forbridge screw.Available as straight, 17 and 30 , indexed andindex-free, in different gingival heights to handlechallenging clinical situations.Multibase EV abutments aredelivered with a pre-mounted,flexible plastic holder for easyhandling during installation.Fitting 3.6, 4.2 and 4.8 OsseoSpeed EV andOsseoSpeed Profile EV implant diameters.5

Treatment planningImplant assortment for SmartFix conceptOsseoSpeed EV implants are available in a versatilerange of shapes, diameters and lengths for all indications,including situations with limited space and/or bonequantity.OsseoSpeed EVSpecific colors have been assigned to the differentimplant-abutment connection sizes, which areconsistently used throughout the system and identifiedby symbols and markings.Note: OsseoSpeed Profile EV implants and componentsare also marked with a “P”.The following implants can be used when using theSmartFix concept with the Astra Tech Implant System EV:OsseoSpeed EVØ 3.6Ø 4.2Ø 4.8PurpleYellowBlueOsseoSpeed Profile EV OsseoSpeed EV straight implantsDiameters: 3.6 S, 4.2 S and 4.8 SLengths: 6 mm–17 mm OsseoSpeed EV conical implantsDiameters: 4.2 C and 4.8 CLengths: 8 mm–17 mmOsseoSpeed Profile EV OsseoSpeed Profile EV straight implantsDiameters: 4.2 PS and 4.8 PSLengths: 8 mm–17 mmOsseoSpeed Profile EV conical implantsDiameters: 4.2 PC and 4.8 PCLengths: 8 mm–17 mmØ 4.2Ø 4.8YellowBlueAbutment assortment for SmartFix conceptMultibase Abutment EV for OsseoSpeed EVVersion:straight, 17 and 30 Diameter:Height:1.5, 2.5, 3.5Indexing options:Indexed abutments will seat in six availablepositionsIndex-free abutments will be seated any rotational positioninMultibase Abutment EV for OsseoSpeed Profile EVVersion:straight, 17 and 30 Diameter:Height:1.5, 2.5, 3.5Indexing option:Index-free abutments will be seated any rotational positioninNote: Some restorative components are marked with a groove or laser marking todifferentiate from other similar components of the Astra Tech Implant System EV.6

Step-by-step procedure – Implant placementStep-by-step procedure – Implant placementBelow is a step-by-step procedure for implant placementin the maxilla using OsseoSpeed EV 4.2 S implants.Implant placement1a1b1c2a2b2c1SmartFix Guide (Optional) After raising a flap, prepare an osteotomyfor the SmartFix Guide Drill in the midline using 1-Twist Drill EV 1.9to a depth of 1 1 mm (1a). The guide can be pre-shaped outside theoral cavity. Place the guide in the osteotomy – thelines on the guide help aligning the axis ofthe implant (2a).34ABImplant placement Choose a starting point and an anglewhich results in an osteotomy that doesnot interfere with the maxillary sinus (1b). Prepare the implant site. Drill toappropriate depth and check for correctangulation, by using the installation guide. Follow the drilling protocol forOsseoSpeed EV 4.2 S implant. Install the implant so that the top of theimplant is at bone level on the mesialside (2b). This could result in a subcrestalposition at the distal.Note: Regarding minimum torquerequirement for immediate temporization,see section Pre-operative considerations.Note: See surgical manual for detailedsurgical drilling protocol and options.All drilling should be performed ata maximum speed of 1500 rpm withprofuse irrigation.Bone Reamer EV (Optional) A reamer can be used when boneinterferes with a correct abutment seating. Manually connect the appropriate BoneReamer Guide EV to the implant using ahex driver (1c). Use the appropriate bone reamertogether with a driver handle. Place the bone reamer over the guideand remove bone by rotating the reamerunder irrigation (2c). You can also usethe reamer in a contra angle at low speedunder irrigation (max. 100 rpm). Remove the guide using a hex driver.Note: The depthmarkings on thebone reamer aremeasured from theimplant and up tothe indication line.5 mm4 mm3 mm2 mmThe guide isprovided with adepth stop.7

Step-by-step procedure – Abutment connectionStep-by-step procedure– Abutment connectionAbutmentheadHolderBelow is a step-by-step procedure for abutmentconnection in maxilla using Multibase EV abutments.Multibase Abutment EV30 and 17 AbutmentbodyDelivered assembledin a sterile blister packAbutmentscrewAbutment connection – Multibase Abutment 30 1a2a1b3aAbutment body 8Select the appropriate abutment angleand height. Connect the abutment body to theimplant and rotate the abutment tothe desired position (1a). The flexible holder can be bent tofacilitate placement. Perform initial tightening of the abutmentscrew with a manual hex driver (2a). Unscrew the holder from theabutment body (3a).2b1c3bAbutment body/head Use the restorative driver handletogether with the hex driver and theTorque Wrench EV to tighten theabutment screw to the recommendedtorque (25 Ncm) (1b). Flip the holder over 180 degrees to theside that holds the abutment head (2b). Screw the abutment head into theabutment body with the holder (3b).2c3cAbutment head Snap off the handle (1c). Perform initial tightening with the manualMultibase Driver EV to initially tighten theabutment head (2c). Use the restorative driver handle togetherwith the Multibase Driver EV and thetorque wrench to tighten the abutmenthead to the recommended torque(25 Ncm) (3c).