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SKY fast & fixed Manual - bredent medical GmbH & Co.KG

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<strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> <strong>Manual</strong><br />

12<br />

9 3<br />

Extraction - Implantation - Immediate <strong>fixed</strong> bridge<br />

2. Edition


Dear practice team / dear laboratory team,<br />

Welcome to the world of <strong>bredent</strong>!<br />

The Swabian family-owned company <strong>bredent</strong> group with its two companies<br />

„<strong>bredent</strong>“ - which focuses on dental techniques - and „<strong>bredent</strong> <strong>medical</strong>“ -<br />

which focuses on implant dentistry, has extensive know-how and experience<br />

in their respective business fields. Over more than 35 years the company has<br />

concentrated on the development and production of innovative products and<br />

systems and has gained an excellent reputation worldwide. Today the <strong>bredent</strong><br />

group is widely known for their quality-oriented therapeutic concepts for<br />

dentists and dental technicians for the benefit of the patient.<br />

The main idea of the philosophy of the <strong>bredent</strong> group is to combine the products<br />

of oral implantology with dental techniques to create a perfect symbiosis.<br />

A symbiosis which enables users to optimize work and procedures to reduce<br />

treatment time and costs correspondingly. In order to meet the most demanding<br />

requirements and expectations, the <strong>bredent</strong> group cooperates very closely with<br />

leading dentists and dental technicians. As a result, clinical know-how is always<br />

reflected in the therapeutic concepts.<br />

The use of <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong>, the comprehensive system for immediate implant<br />

placement in the edentulous jaw, allows to make the dream of numerous<br />

patients to have <strong>fixed</strong> teeth come true.<br />

The happy patient leaves the practice with <strong>fixed</strong>, implant-supported bridges after<br />

a few hours - with a simple, reliable and favorably priced restoration.<br />

We will be glad to inform you about the advantages and possibilities of <strong>SKY</strong><br />

<strong>fast</strong> & <strong>fixed</strong> and its benefits in a personal conversation. This manual includes<br />

a detailed description of the surgical procedure and the prosthetic solutions.<br />

You can contact us at any time if you have further questions.<br />

Yours truly<br />

Peter Brehm


<strong>fast</strong> & <strong>fixed</strong><br />

Patient-oriented treatment<br />

This concept addresses mainly patients who are facing<br />

edentulousness. On the one hand this patient group, in particular,<br />

is afraid of edentulousness and of receiving a full denture,<br />

and, on the other hand, also wants to avoid extensive surgical<br />

procedures but still wishes to have a <strong>fixed</strong> restoration at a <strong>fixed</strong><br />

price.<br />

Developed by practitioners<br />

The clinical experience of Dr. Frank Kistler, Dr. Steffen Kistler and<br />

Dr. Georg Bayer and the dental-technical know-how of Stefan<br />

Adler (DT) were integrated in the development of this innovative<br />

concept. <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> allows extraction, implant placement<br />

and fabrication of an immediate dental restoration in just a<br />

single day. Extensive augmentation procedures are not required.<br />

<br />

Predictable result<br />

Standardization of processes, which is supported by this system,<br />

allows to offer high-quality restorations at an affordable price.<br />

As a result, the profitability of the practice and the laboratory<br />

will increase since more patients can be treated in less time.<br />

Use the comprehensive course program for the dentist/dental<br />

technician team to enter into the exciting and promising subject<br />

of <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong>.<br />

<br />

<strong>bredent</strong> <strong>medical</strong> would like to thank Dr. Frank Kistler,<br />

Dr. Steffen Kistler and Dr. Georg Bayer und Stephan Adler (DT),<br />

Landsberg for providing the photo material.<br />

The procedures described in this manual may only be carried out using components<br />

and instruments of <strong>bredent</strong> <strong>medical</strong>.<br />

Please observe the General Terms of Business and the information on ordering of<br />

<strong>bredent</strong> <strong>medical</strong>.<br />

Subject to changes.<br />

3


Therapeutic concept<br />

Treatment options based on the example of the edentulous<br />

<strong>Co</strong>mplex surgical<br />

and prosthetic<br />

treatment<br />

20,000 €<br />

or more<br />

Removable restoration Fixed restoration<br />

UVE - visio.lign bridge<br />

Locator<br />

8,000 - 15,000 €<br />

up to 5,000 €<br />

<strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong><br />

immediate restoration<br />

mini<br />

When discussing possible implant restorations for edentulous jaws, the<br />

treatment team can also respond to the individual needs of the patient<br />

to cover a wide range including the mucosa-borne, implant-retained<br />

hybrid denture to the <strong>fixed</strong> bridge. In addition to the finanical aspect,<br />

the period of treatment and the fear of edentulousness are also criteria<br />

for decision-making for numerous patients.<br />

4<br />

Tel. (+49) 0 73 09 / 8 72-4 40 | Fax (+49) 0 73 09 / 8 72-4 44 | www.<strong>bredent</strong>-<strong>medical</strong>.com | e-mail info-<strong>medical</strong>@<strong>bredent</strong>.com


<strong>fast</strong> & <strong>fixed</strong><br />

Problem<br />

Severely atrophied jaw<br />

• Patient‘s residual teeth are not worth preserving<br />

• Patient is afraid of being edentulous<br />

• Patient is not willing to receive a conventional<br />

denture<br />

Previous solutions<br />

1. Augmentations<br />

• increased risk of complications<br />

• immediate loading is not possible, i.e. patient<br />

will be edentulous for at least 6 months<br />

• normally, repeated surgical treatment is required<br />

2. Implant-retained dentures<br />

• no posterior support<br />

• immediate restoration in the LJ only possible<br />

for rigid connection - Ledermann type<br />

• does not fulfill the patient‘s wish<br />

5


Therapeutic concept<br />

Solution<br />

The Ledermann concept of immediate splinting of<br />

four implants in the lower jaw and the fabrication<br />

of an immedate restoration comprising a bar and a<br />

cover denture produced excellent long-term results.<br />

Dr. Malo, Lisbon, developed this concept further by<br />

angular placement of the posterior implants and<br />

shifting the position of these implants „backwards“<br />

to achieve enhanced biomechanical support and<br />

enable immediate treatment and loading with a<br />

<strong>fixed</strong> bridge.<br />

This proven concept ensures that<br />

• the local bone is used in a perfect manner<br />

• critical anatomical areas are protected<br />

• the fabrication of an immediate <strong>fixed</strong> bridge is<br />

enabled<br />

Ledermann<br />

<strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong><br />

Frequently, insufficient bone height in the upper jaw in the<br />

region of the maxillary sinus makes implant placement<br />

impossible. Thanks to the blue <strong>SKY</strong> implants that are inserted<br />

at a specific angle along the maxillary sinus, the terminal<br />

abutment is distalized in the region of the first molar so that a<br />

perfectly supported bridge restoration can be fabricated.<br />

Especially in patients who have lost their teeth quite some<br />

time ago, the residual bone height in the lower jaw above<br />

the mandibular canals is mostly insufficient for implants with<br />

adequate lengths to ensure the necessary stability. Accordingly,<br />

the possible implant positions are limited to the region between<br />

the foramina mentalis.<br />

Torsion of the mandibular plate is outside the <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong><br />

implant area. The rigid, primary splinted structure is not affected<br />

by torsion during mastication.<br />

6<br />

Tel. (+49) 0 73 09 / 8 72-4 40 | Fax (+49) 0 73 09 / 8 72-4 44 | www.<strong>bredent</strong>-<strong>medical</strong>.com | e-mail info-<strong>medical</strong>@<strong>bredent</strong>.com


<strong>fast</strong> & <strong>fixed</strong><br />

Patient-oriented treatment<br />

The patient wishes to have <strong>fixed</strong> teeth for better quality of life and health through healthy nutrition. He puts his trust in<br />

the decision of the dentist with regard to the number of implants and the extent of surgery that are required. A look in the<br />

mirror and a healthy bite in an apple confirm successful treatment for the patient.<br />

Patient‘s wishes:<br />

• Few practice visits<br />

• Short treatment time<br />

• No complex surgical procedures<br />

• Avoiding bone replacement materials<br />

• No removable temporaries<br />

• Predictable costs – <strong>fixed</strong> price<br />

<strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> bridge restoration in the upper jaw<br />

• Six implants<br />

Palate-free restoration<br />

• Avoiding sinus lifting<br />

• Reduction of treatment time<br />

• Reduction of costs<br />

<strong>fast</strong> & <strong>fixed</strong> bridge restoration in the lower jaw<br />

• No debonding or loosening of the distal abutments<br />

since the implant site is outside the distortion area of<br />

the mandibular plate<br />

• Four implants<br />

No nerve lateralization<br />

• Fixed bridge restoration<br />

• Reduction of costs<br />

<strong>bredent</strong> literature list<br />

on <strong>fast</strong> & <strong>fixed</strong><br />

REF 000327EX or<br />

PDF for download:<br />

www.<strong>bredent</strong>-<strong>medical</strong>.com<br />

<br />

<br />

&<br />

<br />

<br />

Literature:<br />

Apracio C, Perales P, Rangert B. Tilted to maxillary sinus grafting: A clinical, radiologic and Periotest study. Clin Implant Dent Relat Res 2001; 3:39-49<br />

Malo‘P et al. “All on four“ immediat function concept with Branemark system implants for completely edentulous manandibles: A 1 year<br />

retrospective clinical study. Clin Implant dental Res 2005; 7(1):88-94<br />

Fischer K, Sternberg T. Early loadingof ITI implants supporting a maxillary full-arch prosthesis: one Year data of a prospective, randomised study.<br />

Int J Oral Maxillofac Implants 2004; 19:374-381<br />

TarnowDP, Pet al: Immediat loading of treaded implant at stage-1 surgery in edentulous arches: Ten<br />

<strong>Co</strong>nscutive case reports with 1-to 5-years data. Int J Oral Maxillofac Implants 1997; 12:319-324<br />

Dr. Frank Kistler und Dr. Steffen Kistler, all-on-four, neu Philosophie bei der implantologischen Versorgung im zahnlosen Kiefer. BZB/BLZK & KZVB, April 2005<br />

Dr. Frank Kistler et al., Imlantation im atrophierten Kiefer ohne Anwendung von augmentativen Verfahren.<br />

Oral implant, Dezember 2007<br />

Stephan Adler, Spannungsfreie Sofortversorgung im Pick-up-Verfahren. Quintessenz Zahntechnik, Juli 2008<br />

7


Therapeutic concept<br />

Frequently asked questions<br />

What is the target of the <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> concept?<br />

The target of the <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> concept is to provide patients with immediate temporary restorations which require only<br />

minimal surgical effort and take masticatory functional requirements into consideration. <strong>Co</strong>nsequently, augmentation<br />

techniques are avoided in surgery and angulated placement of the posterior implants allows to support the denture in the<br />

area of teeth no. 5 and 6.<br />

For which users is <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> suited?<br />

The <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> concept requires perfect coordination and cooperation between surgeons and dental technicians. To<br />

ensure successful treatment of the patient, the dental technician‘s office/laboratory should be close to the surgeon‘s practice<br />

and the dental technician should be involved in the process of bite taking. The concept can only be integrated into the<br />

practice through teamwork.<br />

Indication range<br />

The <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> system is a prosthetic concept for immediate restorations of edentulous patients. To achieve enhanced<br />

support of the temporary restoration, distal placement of the posterior implants at an angle of 35° is possible. This<br />

angulation is compensated by the special abutments.<br />

For which patients is <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> particularly suited?<br />

Patients with residual teeth not worth preserving are particularly afraid of being edentulous and wish to receive a <strong>fixed</strong><br />

denture/restoration as soon as possible. <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> allows to offer these patients a reliable treatment concept with<br />

limited and predictable effort.<br />

<strong>Co</strong>ntraindications<br />

The <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> system is not suitable for standard contraindications in implant dentistry such as patients with<br />

cardiovascular problems, bruxism, osteoporosis, heavy smokers, alcohol abuse, diabetes, etc.<br />

What is the clinical experience gained with the <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> concept?<br />

The original concept was developed by Dr. Mallo from Lisbon. He used this method and treated several thousand patients<br />

with tremendous success. The <strong>SKY</strong> system was developed further by Dr. Bayer and Dr. Kistler in Landsberg (dental practice)<br />

with the objective to considerably simplify the handling of the entire procedure. A <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> literature list is available<br />

from <strong>bredent</strong> <strong>medical</strong> (REF 000327EX).<br />

What is the long-term behavior of the angulated implants?<br />

Immediate placement of the suitable abutment onto the implant under sterile conditions is essential for long-term bone<br />

preservation. This will reduce the microgap problem and ensure long-term success. The abutment should not be removed<br />

when integrating the definitive restoration. No increased level of bone resorption could be observed among patients treated<br />

so far.<br />

8<br />

Tel. (+49) 0 73 09 / 8 72-4 40 | Fax (+49) 0 73 09 / 8 72-4 44 | www.<strong>bredent</strong>-<strong>medical</strong>.com | e-mail info-<strong>medical</strong>@<strong>bredent</strong>.com


<strong>fast</strong> & <strong>fixed</strong><br />

Team concept<br />

<strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> is a highly attractive product for our<br />

practice since it allows to standardize the work processes<br />

and facilitates after-treatment considerably<br />

because the <strong>fixed</strong> bridge avoids the formation of pressure<br />

spots which may cause non-scheduled patient visits.<br />

Moreover we have found out that patients take<br />

more time to receive the definitive restoration but also<br />

prefer restorations with a higher quality.<br />

A sensitive approach under continuous control is required<br />

when placing angled implants.<br />

Dr. Steffen Kistler and Dr. Frank Kistler, Dr. Georg<br />

The fabrication of a <strong>fixed</strong> bridge within a short time is a<br />

challenge for all dental technicians which can<br />

be met by standardization and the use of modern<br />

materials and techniques. A standard routine can be<br />

obtained after a limited number of restorations, which<br />

also provides room for details.<br />

Preconditions<br />

for the successful use in the practice are:<br />

an experienced implantologist with good<br />

knowledge about surgery<br />

a flexible dental technician who can quickly<br />

adapt to the respective situation. Ideally, the dental<br />

laboratory should be close to the dentist practice.<br />

Stephan Adler (DT)<br />

9


Therapeutic concept<br />

Fundamentals<br />

Working levels<br />

With <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> restorations the working level<br />

(abutment interface) is raised from the implant shoulder<br />

to the level of <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> abutments. The following<br />

components that are used are no longer designated as<br />

abutments but as copings, e.g. impression coping or<br />

prosthetic coping.<br />

• Abutment level<br />

When using <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> abutments, the<br />

impression and and the restoration is completed with<br />

the copings on the abutment level without protection<br />

against rotation, which is not required for splinted<br />

restorations.<br />

• Implant level<br />

With <strong>SKY</strong> classic and blue<strong>SKY</strong> the impression and<br />

insertion of the abutments are completed on the implant<br />

level. The abutments are <strong>fixed</strong> in six positions<br />

thanks to the Torx® with a length of 3.5 mm.<br />

Divergence compensation through outer cone<br />

The 17.5° outer cone of the <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> abutments<br />

allows to compensate divergent implants. Maximum<br />

compensation is 35°; for biomechanical reasons, however,<br />

we recommend not to exceeed the following angles:<br />

• 0° 0° - 10°<br />

• 17.5° 5° - 30°<br />

• 35° 25° - 45°<br />

Abutment level<br />

Implant level<br />

35° 17.5° 0°<br />

45° 30° 25° 10° 5° -10°<br />

17.5°<br />

Height of abutments<br />

The values of height of the <strong>fast</strong> & <strong>fixed</strong> abutments refer<br />

to the long leg of the abutments. The actual gingiva<br />

heights are as follows:<br />

Shoulder height<br />

4 mm<br />

Gingiva height<br />

0.9 mm<br />

5 mm<br />

1.7 mm<br />

3 mm 2 mm<br />

5 mm<br />

3.6 mm<br />

Prosthetic monoplatform of <strong>SKY</strong><br />

A single diameter of all prosthetic parts for all implant<br />

diameters facilitates the fabrication of an immediate<br />

restoration considerably. If a different diameter is<br />

required during the insertion of the implant, this will not<br />

affect the prepared prosthetic parts.<br />

Torx®<br />

Prosthetic key<br />

Only a single screwdriver is required for all prosthetic<br />

parts of the <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> system!<br />

Mounter for<br />

ratchet<br />

Mounter for<br />

contra-angle<br />

10<br />

Tel. (+49) 0 73 09 / 8 72-4 40 | Fax (+49) 0 73 09 / 8 72-4 44 | www.<strong>bredent</strong>-<strong>medical</strong>.com | e-mail info-<strong>medical</strong>@<strong>bredent</strong>.com


<strong>fast</strong> & <strong>fixed</strong><br />

System components<br />

The <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> system components with 0°, 17.5° and 35° angled abutments are especially intended for primary<br />

splinted structures. 35° angled abutments offer more space to use local bone and hence contribute essentially to achieving<br />

long-term success of the implant.<br />

These advantages allow <strong>fast</strong> fabrication of occlusal screw-retained temporaries for immediate treatment of patients. In<br />

combination with the new, state-of-the art crestally structured blue<strong>SKY</strong> titanium implant with sandblasted and etched<br />

surface successful implant placement of the system is guaranteed.<br />

<strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> Impression and model fabrication<br />

<strong>SKY</strong> f & f<br />

impression coping<br />

with integrated screw<br />

<strong>SKY</strong> f & f gingiva former<br />

<strong>SKY</strong> f & f<br />

laboratory analog<br />

<strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> Temporary restoration<br />

<strong>SKY</strong> f & f<br />

abutment 35°<br />

DH 4 mm<br />

<strong>SKY</strong> f & f<br />

prosthetic coping<br />

Titan<br />

35° 17.5° 0°<br />

<strong>SKY</strong> f & f<br />

abutment 35°<br />

DH 5 mm<br />

<strong>SKY</strong> f & f<br />

abutment 17.5°<br />

DH 3 mm<br />

<strong>SKY</strong> f & f<br />

abutment 17.5°<br />

DH 5 mm<br />

<strong>SKY</strong> f & f<br />

abutment 0°<br />

DH 2 mm<br />

blue<strong>SKY</strong><br />

blue<strong>SKY</strong><br />

blue<strong>SKY</strong><br />

<strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> accessories for definitive restorations<br />

<strong>SKY</strong> f & f Impression coping<br />

open tray<br />

<strong>SKY</strong> f & f Prosthetic coping<br />

Resin burn-out<br />

<strong>SKY</strong> f & f Prosthetic coping<br />

HSL cast-on<br />

11


Therapeutic concept<br />

Overview - surgical procedure for free-hand implant placement<br />

The surgical procedure required for<br />

<strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> can be almost entirely<br />

standardized.<br />

Surgical planning is carried out based on<br />

the precise analysis of the anatomical<br />

conditions.<br />

After the extraction of residual teeth<br />

not worth being preserved, inflammatory<br />

tissue is carefully removed and the bone<br />

is leveled. The nerve is exposed in the<br />

lower jaw.<br />

The central implants are placed starting<br />

from the middle of the ridge. The<br />

parallelizing pins are used for orientation<br />

purposes when placing the angled,<br />

posterior implants. Then the 0° and 35°<br />

abutments are screwed on.<br />

The suture is closed after screwing on the<br />

aburments.<br />

A monophase impression is taken on the<br />

level of the abutment using a closed tray.<br />

The gingiva formers prevent the swelling<br />

soft tissue from covering the abutments.<br />

A mushbite is prepared to determine the<br />

jaw relation.<br />

The patient can recover in the relaxation<br />

room until his <strong>fixed</strong> bridge is integrated.<br />

12<br />

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<strong>fast</strong> & <strong>fixed</strong><br />

Overview - fabrication of a temporary bridge<br />

A key aspect of <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> is the<br />

simple and reliable fabrication of the<br />

<strong>fixed</strong> temporary resin bridge.<br />

In combination with <strong>bredent</strong> visio.lign<br />

veneers, dental technicians are enabled<br />

to fabricate appealing temporary<br />

restorations in less than 2 hours whilst<br />

avoiding time-consuming and complex<br />

preparatory work.<br />

After model fabrication and mounting<br />

in the articulator, the wax setup is done<br />

using the visio.lign veneers.<br />

Thanks to the design of the veneers,<br />

very little manual reworking is required.<br />

The setup is transferred to a matrix.<br />

The bridge body is completed after<br />

conditioning the veneers.<br />

When fabricating the bridge, spacers<br />

ensure that only one prosthetic coping<br />

is integrated while the other are<br />

polymerized (stress-free) in situ. Then<br />

the bridge is polished in the laboratory.<br />

The patient is enabled to leave the<br />

practice on the day of surgery with a<br />

<strong>fixed</strong> appealing bridge. He can participate<br />

in social life again without any<br />

limitations.<br />

13


<strong>Co</strong>ntents<br />

Treatment procedure - surgery - step by step<br />

Template-guided implant placement<br />

page 16<br />

Free-hand implant placement UJ<br />

page 18<br />

Free-hand implant placement LJ<br />

page 32<br />

Initial situation<br />

Temporary <strong>fixed</strong> bridge - long-term therapeutic<br />

treatment<br />

Prepared bridge using template-guided planning.<br />

page 17<br />

• Fabrication of a new temporary visio.lign bridge.<br />

Perfectly matched materials and visio.lign veneers<br />

enable efficient working.<br />

page 24<br />

Fixed bridge on the day of surgery<br />

14<br />

Tel. (+49) 0 73 09 / 8 72-4 40 | Fax (+49) 0 73 09 / 8 72-4 44 | www.<strong>bredent</strong>-<strong>medical</strong>.com | e-mail info-<strong>medical</strong>@<strong>bredent</strong>.com


<strong>fast</strong> & <strong>fixed</strong><br />

Definitive restoration<br />

Metal-reinforced resin bridge based on<br />

<strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> abutments<br />

• Economic solution<br />

• Occlusal screw-retained<br />

page 36<br />

Definitive restoration<br />

in combination with <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> abutments<br />

page 38<br />

Impression<br />

in combination of implant level and abutment<br />

level<br />

page 38<br />

„Landsberger Brücke“<br />

• Partially removable bridge<br />

• Zirconium or metal substructure<br />

• Ceramic veneering in the anterior region<br />

• visio.lign veneers in the posterior region<br />

page 40<br />

Bar restorations<br />

• with <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> abutments<br />

• with <strong>SKY</strong> bar system<br />

page 46<br />

<br />

The Implant Prosthetics catalog provides<br />

an overview of the implant-specific range<br />

of products of the <strong>bredent</strong> group.<br />

REF 000 348 GB<br />

<br />

15


Template-guided implant placement<br />

Preparing and planning<br />

Documentation of template-guided implant<br />

placement, scan template and surgical<br />

templates supported by mini 1 <strong>SKY</strong> FRP,<br />

planned with <strong>SKY</strong>planX.<br />

Initial situation<br />

Patient with edentulous upper jaw and<br />

insufficient bone quantity<br />

Fixed reference points (FRP)<br />

3 mini<strong>SKY</strong>-FRP implants are inserted in the<br />

upper jaw for fixation of the scan and drilling<br />

templates. These implants also contribute to<br />

stabilizing the temporary denture.<br />

mini 1 <strong>SKY</strong><br />

Fabrication of the scan template<br />

Based on the prosthetic set-up, the scan<br />

template is produced using radiopaque X-resin<br />

CT DVT so that the prosthetic requirements<br />

can be taken into consideration for implant<br />

planning.<br />

Precision in situ and on the model is ensured<br />

by the mini<strong>SKY</strong>-FRP implants.<br />

3D-resin<br />

X-resin<br />

3D planning<br />

Based on the necessary inforamtion about the<br />

bone and the desired prosthetic restoration,<br />

the implant position can be planned using<br />

the 3D planning software <strong>SKY</strong>planX.<br />

mini 1 <strong>SKY</strong><br />

planning matrix<br />

Planning in the<br />

panoramic radiograph<br />

16<br />

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<strong>fast</strong> & <strong>fixed</strong><br />

Surgery and temporary bridge<br />

Fabrication of the drilling template<br />

The data from the 3D planning software are<br />

exactly transferred with the <strong>SKY</strong>5X transfer<br />

table. The mini<strong>SKY</strong>-FRP implants ensure<br />

accurate transfer from the model to the mouth.<br />

Guidance of drills<br />

The <strong>SKY</strong>planX sleeve system with drill stops<br />

ensures reliable guidance of the drills.<br />

click<br />

Inserting the temporary bridge<br />

3D planning allows reliable and stress-free<br />

polymerization of the prepared temporary<br />

bridge with little effort.<br />

We would like to thank the dental and laboratory team<br />

Dr. Margit & Dr. Michael Weiss and MDT Guido Gäßler<br />

The detailed desciption of this case is available from <strong>bredent</strong><br />

REF 000 336 0D<br />

Documentation on 3D planning:<br />

3D implant plannin REF 000 269 GB<br />

Drilling Sleeves and Surgical Drills REF 000 292 GB<br />

mini<strong>SKY</strong> FRP REF 000 298 GB<br />

17


Free-hand implant placement UJ - step by step<br />

Initial situation<br />

Upper jaw with residual teeth not worth being preserved.<br />

Three-dimensional planning was carried out based on<br />

a DVT scan. Free-hand surgery was performed.<br />

Situation after extraction and healing prior to surgery.<br />

Exposure of the ridge<br />

The standard tools/instruments of the <strong>SKY</strong> OP Tray<br />

(REF <strong>SKY</strong>-X0T21) are used for <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong>.<br />

18<br />

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<strong>fast</strong> & <strong>fixed</strong><br />

Preparation of the implant cavity<br />

Determination of the mid-line and the position<br />

of the first implant with the pilot drill.<br />

Pilot drill<br />

For straight positions, the Twistdrill (Ø 2 mm)<br />

with depth markings can be used with or<br />

without drill stop. The parallel indicators are<br />

placed after each drilling process for enhanced<br />

orientation.<br />

Twist-Drill<br />

Orientation on the Sinus maxillaris<br />

• Predrilling based on preplanning and<br />

measurement picture<br />

• Puncturing and probing<br />

The six parallel indicators show the ideal<br />

positions and the angulation of the distal<br />

implants. The blue<strong>SKY</strong> implants (distal<br />

angulation) have a length of 14 or 16 mm.<br />

Parallel indicators<br />

b<br />

a ~ b<br />

a<br />

Tips from users:<br />

A control radiograph after drilling with a measuring device is recommended.<br />

19


Free-hand implant placement UJ<br />

Preparation of the implant cavity<br />

The preparation of the implant cavity is carried<br />

out in accordance with the bone quality and based<br />

on the surgical protocol of the <strong>SKY</strong> implant system.<br />

REF 000 281 GB or<br />

www.<strong>bredent</strong>-<strong>medical</strong>.com / download catalogs<br />

<br />

<br />

Preparation of the implant site<br />

The anatomical structures need to be considered<br />

when drilling the implant cavity. A drill stop is<br />

not used for implants at an angled position.<br />

Final drill<br />

Final drill<br />

Crestall drill<br />

Removal of the implants from the packaging<br />

<strong>SKY</strong> TK insertion instrument<br />

The implant is removed with the placement<br />

instrument for the contra-angle or the ratchet<br />

and safely held thanks to the conical Torx®.<br />

At least 30 Ncm<br />

For immediate loading, the torque should be at<br />

least 30 Ncm when screwing in the implants.<br />

20<br />

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<strong>fast</strong> & <strong>fixed</strong><br />

Alignment of the angled implant<br />

To ensure enhanced orientation, a <strong>SKY</strong><br />

impression abutment can be screwed on.<br />

The position of the Torx® in the implant is<br />

essential for alignment of the screw canal of<br />

the 35° abutment, i.e. it must be observed when<br />

inserting the implant. The position of the<br />

Torx® can be clearly recognized at the insertion<br />

instrument. If an edge is aligned to the<br />

vestibular direction, the screw canal is in a<br />

vertical position.<br />

<strong>SKY</strong> TK insertion instrument<br />

Vestibular<br />

21


Free-hand implant placement UJ<br />

Insertion of the abutments<br />

<strong>Co</strong>mpensation of angulation<br />

The <strong>SKY</strong> impression abutments were screwed<br />

on to clearly indicate the implant axes.<br />

Owing to anatomical conditions, labial protrusion<br />

of the screw openings through the straight <strong>SKY</strong><br />

<strong>fast</strong> & <strong>fixed</strong> abutments may occur in the upper<br />

anterior region.<br />

To avoid this, the screw canal can be shifted<br />

to the oral direction by using 17.5° or 35°<br />

abutments.<br />

Insertion of the <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> abutments<br />

Divergences are compensated after screwing<br />

on the straight and angled abutments. The<br />

abutments are <strong>fast</strong>ened using a torque of at<br />

least 25 Ncm. 17.5° abutments were screwed<br />

in the anterior region.<br />

<strong>SKY</strong> f & f<br />

abutment 0°<br />

<strong>SKY</strong> f & f<br />

abutment 17.5°<br />

<strong>SKY</strong> f & f<br />

abutment 35°<br />

25 Ncm<br />

The straight abutments with integrated screw are<br />

put on the screwdrives and can be safely inserted.<br />

The abutments are not protected against rotation.<br />

Tips from users:<br />

Do not reach with pliers or tweezers into the occlusal thread to avoid damage to the thread.<br />

Diamond-coated tweezers have proved to be suitable tools.<br />

22<br />

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<strong>fast</strong> & <strong>fixed</strong><br />

Impression and bite taking<br />

Screwing on the impression copings<br />

Prior to closing the wound with a suture, the<br />

impression copings with integrated screw are<br />

screwed on manually for the closed impression.<br />

<strong>SKY</strong> f & f impression coping<br />

with integrated screw<br />

10 Ncm<br />

The closed impression with breciform D<br />

disposable impression trays is recommended for<br />

the immediate restoration. For technicians it is<br />

essential that the palate and the tuber area are<br />

included in the impression.<br />

Bite taking<br />

Bite taking is carried out in a way to include the<br />

impression copings. Before surgery, a mushbite<br />

is useful for control purposes after mounting<br />

the models in the articulator.<br />

<strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> gingiva formers offer good<br />

comfort for the patient until the temporary<br />

bridge is inserted and prevent the swelling<br />

gingiva from covering the abutment.<br />

Tips from users:<br />

The dental techician should be present during the impression and bite registration processes to get an idea of the<br />

clinical situation which he needs to bear in mind when preparing and designing the temporary restoration.<br />

23


Immediate restoration - Fabrication in the laboratory<br />

Fabrication of a new temporary visio.lign bridge<br />

Immediately after surgery the temporary restoration is fabricated in the laboratory.<br />

Disinfecting<br />

The Dentaclean impression and denture<br />

disinfectant has a contact time of one minute!<br />

Dentaclean<br />

Repositioning of the impression abutments<br />

After cleaning, the impression abutments are<br />

screwed on the laboratory analogs and repositioned<br />

in the impression. The impression copings<br />

can be repositioned in the impression more<br />

easily if they are wetted with vaseline.<br />

Gingiva mask<br />

The analogs are coated with Multisil-Mask<br />

soft to avoid chipping of plaster around the<br />

abutments and hence the loss of essential<br />

parameters of the gingival situation.<br />

Multisil-Mask soft<br />

Thixo-Rock, a quick-setting and dimensionally<br />

stable class IV super-hard stone, is recommended<br />

for the fabrication of the plaster model.<br />

Thixo-Rock<br />

24<br />

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<strong>fast</strong> & <strong>fixed</strong><br />

Mounting in the articulator<br />

The models are mounted in the articulator<br />

based on a mushbite. A second mushbite which<br />

includes the palate and the tuber area and<br />

was taken before implant placement is used to<br />

control the articulation.<br />

Adapting the prosthetic copings<br />

The impression copings are screwed off and<br />

replaced by the prosthetic copings. The height<br />

is checked in the articulator and, if necessary,<br />

reduced using a separating disc.<br />

<strong>SKY</strong> f & f prosthetic coping<br />

Titanium<br />

Set-up<br />

visi.lign veneers are used for the set-up.<br />

Generally, temporary bridges for immediate loading do not have extensions. To achieve good patient acceptance,<br />

a bridge from tooth 5 to tooth 5 is recommended. An extension that may be required needs to be discussed in the<br />

individual case.<br />

25


Immediate restoration - Fabrication in the laboratory<br />

Fabrication of a new temporary visio.lign bridge<br />

Set-up<br />

The small thickness of the veneers of 1 mm<br />

allows to set up teeth quickly and offers<br />

sufficient space for a stable bridge structure.<br />

Key<br />

Haptosil D is used to prepare a key of the setup.<br />

If a soft silicone (brecision implant light)<br />

is previously directly applied to the teeth, the<br />

interproximal areas are adequately filled and<br />

perfect retention of the teeth in the key is<br />

achieved without any adhesive.<br />

Haptosil D<br />

Spacers<br />

To ensure passive fit of the resin bridge, only<br />

one prosthetic coping is integrated on the<br />

model. The remaining three copings are <strong>fixed</strong><br />

in situ similar to ...<br />

...bonding (luting) used in electroplating. Silicone<br />

tubes are slid on the prosthetic copings as<br />

spacers. They are included in the packaging of<br />

the prosthetic copings.<br />

Sealing the screw canal<br />

The screw canal of the prosthetic coping, which<br />

was integrated, is sealed. The restoration is<br />

ready for finishing.<br />

In this case the screw canal was sealed using a<br />

long screw.<br />

26<br />

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<strong>fast</strong> & <strong>fixed</strong><br />

<strong>Co</strong>nditioning of the visio.lign.veneers<br />

After cleaning, the visio.lign veneers are<br />

sandblasted (110 my) at 2.5 bar and abrasive<br />

dust is removed using oil-free compressed air.<br />

Steam blasting results in moisture and affects<br />

bonding!<br />

The bond strength is increased by the use of<br />

<strong>bredent</strong> bonding agent or visio.link.<br />

Filling the bridge body<br />

The key is <strong>fixed</strong> on the model after the model<br />

has been insulated. The bridge body is filled<br />

with breformance and polymerized in the<br />

pressure pot.<br />

breformance Liquid<strong>Co</strong>ldCuring exhibits special<br />

elasticity, fractural strength and color stability.<br />

breformance Liquid<strong>Co</strong>ldCuring<br />

Finishing the bridge<br />

The silicone tubes can be easily removed. The<br />

screw of the coping <strong>fixed</strong> in the bridge body<br />

is loosened and the bridge is removed.<br />

Then the bridge is finished and the occlusion<br />

is checked in the articulator.<br />

The space for the prosthetic copings - to ensure<br />

passive fit in situ - is enlarged using the <strong>bredent</strong><br />

location matrix drill.<br />

Location matrix drill<br />

27


Temporary restoration<br />

Insertion - Preparation in the laboratory<br />

Preparation for the patient<br />

The integrated prosthetic coping ensures<br />

fixation of the bridge. The space created by the<br />

spacers allows stress-free fixation in situ. To<br />

facilitate fixation in the mouth, lateral grooves<br />

are ground at the prosthetic copings.<br />

After finishing the bridge, all parts are cleaned,<br />

disinfected and <strong>fast</strong>ened on the model again.<br />

Qu-resin is a quick-setting, self-curing denture<br />

repair resin available in two colors (pink/dentin).<br />

It is suitable for direct and indirect use.<br />

Qu-resin<br />

Before the restoration is <strong>fixed</strong> in the mouth,<br />

Qu-connector is applied and light cured.<br />

Qu-resin will only bond to the bridge in areas<br />

to which Qu-connector has been applied; as<br />

a result, excess resin can be easily removed.<br />

Qu-connector<br />

Tips from users:<br />

It is recommended to use new screws for the insertion.<br />

<strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> screw M 1.4 for prosthetic coping <strong>SKY</strong> FFSPK.<br />

28<br />

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<strong>fast</strong> & <strong>fixed</strong><br />

Insertion - Practice<br />

Screwing on the prosthetic copings<br />

The impression copings or the gingiva formers<br />

are replaced by the prosthetic copings. The<br />

position of the prosthetic coping already<br />

integrated in the bridge remains empty.<br />

Fastening of the bridge<br />

The bridge is placed on and screwed down with<br />

the integrated prosthetic coping. <strong>Co</strong>ntact of the<br />

bridge body with prosthetic copings that have<br />

not been <strong>fixed</strong> yet must be avoided.<br />

The gingiva must not be squeezed.<br />

Fixation with Qu-resin<br />

Thanks to the lateral grooves, Qu-resin can be<br />

very easily applied. After a short hardening time,<br />

the occlusion can be checked and the bridge<br />

can be removed for final polishing.<br />

Qu-resin<br />

Polishing<br />

<strong>Co</strong>nvex design of the base and high luster<br />

polishing must be ensured!<br />

29


Temporary restoration<br />

Inserting the temporary bridge<br />

The temporary restoration is screwed in at a<br />

torque of 20 Ncm. The temporary resin bridge<br />

offers excellent wearing comfort. Pressure<br />

spots or unfavorable loading of the implants are<br />

avoided. A small gap formed by the shrinking<br />

mucosa after swelling does not create any<br />

problems for patients; rebasing is normally not<br />

required.<br />

<strong>SKY</strong> f & f<br />

prosthetic coping, titanium<br />

Treatment of the patient immediately after<br />

implant insertion. Only a single appointment is<br />

required for the patient.<br />

<strong>SKY</strong> f & f abutment 0°<br />

20 Ncm<br />

The implants were positioned in accordance<br />

with the bone quantity available.<br />

The fabrication of the temporary bridge<br />

immediately after implant insertion avoids<br />

time-consuming reworking. The harmoniously<br />

matched materials enable swift working. Design<br />

of the bridge featuring high stability ensures<br />

successful treatment.<br />

Oral situation when entering<br />

the practice<br />

Patient upon leaving the practice on the<br />

same dry<br />

Extraction<br />

Implantation<br />

Fixed bridge<br />

Tips from users:<br />

In the event of fracture of the bridge, the patient needs to be advised to visit the dental practice immediately to<br />

avoid implant overloading.<br />

30<br />

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Temporary restoration<br />

Advantages<br />

• good long-term prognosis since augmentation procedures<br />

which involve risks can be avoided<br />

• extended period until the fabrication of the definitive restoration<br />

• all options for the definitive restoration are offered<br />

• satisfied patients = increased publicity/high reputation<br />

Advantages for the dentist/implantologist<br />

• making optimal use of the local bone<br />

• excellent distribution of loads on the restoration<br />

thanks to posterior support<br />

• no investment costs for material/tools<br />

• high-quality and accurate temporary restoration reduces<br />

the amount of work for the practice<br />

Advantages for the patient<br />

• patient will leave the practice with a <strong>fixed</strong> restoration<br />

• palate-free restoration, also for the temporary<br />

• no pressure spots caused by the temporary<br />

• no second (follow-up) surgery required<br />

• clearly defined costs – <strong>fixed</strong> price<br />

An overview of our training program and <strong>SKY</strong><br />

<strong>fast</strong> & <strong>fixed</strong> courses/workshops and additional<br />

interesting topics including details of the content of<br />

the courses can be found at www.<strong>bredent</strong>-<strong>medical</strong>.com<br />

31


Free-hand implant placement - LJ<br />

Surgical procedure<br />

Initial situation:<br />

Residual teeth not worth being preserved.<br />

Inflammatory tissue is thoroughly removed, equal bone<br />

level (height) is prepared.<br />

Exposure of the mandibular nerve<br />

Determination of the mid-line and the position of the first<br />

implant with the pilot drill<br />

Position of the vertical implants<br />

32<br />

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<strong>fast</strong> & <strong>fixed</strong><br />

Final drilling in the anterior region<br />

35° pilot drilling using the Twistdrill (Ø 2.25 mm)<br />

b<br />

a<br />

a ~ b<br />

Posterior implants have almost the same<br />

distance as anterior ones<br />

b<br />

a<br />

b<br />

a ~ b<br />

Drilling the implant cavity - pay<br />

attention to the mandibular nerve<br />

33


Case description - LJ<br />

Surgical procedure<br />

Implant insertion<br />

The implant is removed with the placement instrument<br />

for the contra-angle or the ratchet and safely<br />

held thanks to the conical Torx®.<br />

We recommend not to exceed a torque of 30 Ncm<br />

to ensure primary stability of the implant. If the<br />

adjusted torque is reached too soon, further drilling<br />

with the XL-drill should be carried out since half a<br />

turn of the implant will increase the torque by more<br />

than 10 Ncm.<br />

blue<strong>SKY</strong> abutments with a diameter of 4 mm and<br />

lengths of 14 or 16 mm are recommended for implants<br />

placed in angular positions.<br />

The mesial edge of the implant should be at<br />

bone level.<br />

Insertion of the abutments<br />

The abutments are <strong>fast</strong>ened with a torque of<br />

25 Ncm.<br />

<strong>SKY</strong> f & f<br />

abutment 0°<br />

DH 2 mm<br />

<strong>SKY</strong> f & f<br />

abutment 17.5°<br />

DH 3 mm<br />

The straight abutments with integrated screw<br />

are put on the screwdriver and can be safely<br />

inserted. The abutments are not protected<br />

against rotation.<br />

<strong>SKY</strong> f & f<br />

abutment 35°<br />

DH 4 mm<br />

25 Ncm<br />

The angled abutments are placed into the<br />

implant and the position is checked. If parallel<br />

alignment can not be achieved despite six<br />

possible positions, it is recommended to align<br />

the implant with the placement instrument.<br />

Then the abutment is <strong>fast</strong>ened with the blue<br />

standard screw.<br />

34<br />

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<strong>fast</strong> & <strong>fixed</strong><br />

Impression and bite taking<br />

<strong>SKY</strong> f & f<br />

impression coping<br />

with integrated screw<br />

Screwing on the impression copings<br />

Prior to closing the wound with a suture, the<br />

impression copings with integrated screw are<br />

screwed on manually for the closed impression<br />

at abutment level.<br />

Preparation for insertion in the patient‘s mouth<br />

Inserting the temporary bridge<br />

Qu-resin is used for oral fixation. After<br />

loosening the four fixation screws, the bridge<br />

is removed and handed over to the dental<br />

technician for final polishing. The torque ratchet<br />

is set to 20 Ncm for final fixation with screws.<br />

35


Definitive restoration<br />

Metal-reinforced resin bridge on <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> abutments<br />

If it is intended to fabricate occlusal screw-retained<br />

structures such as bridges or bars, the <strong>SKY</strong><br />

<strong>fast</strong> & <strong>fixed</strong> abutments can also be used for the<br />

definitive restoration.<br />

A metal-reinfored resin bridge on <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong><br />

abutments is a favorably-priced restoration.<br />

The definitive restoration is completed on the<br />

<strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> abutment level of the temporary<br />

restoration. This way the costs for prosthetic<br />

accessories can be reduced. The gingiva<br />

is not harmed since it is not required to remove<br />

the <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> abutments.<br />

Removal of the temporary bridge<br />

In this case the definitive restoration is prepared 16 weeks<br />

after inserting the immediate restoration. Healthy and irritation-free<br />

gingiva conditions can be recognized after screwing<br />

off the temporary bridge.<br />

Impression<br />

<strong>SKY</strong> f & f Impression coping<br />

open tray<br />

10 Ncm<br />

For the definitive restoration, the <strong>SKY</strong><br />

<strong>fast</strong> & <strong>fixed</strong> impression copings for the<br />

open impression are screwed on.<br />

Model fabrication<br />

Independent of the angulation of the <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong><br />

abutments used in the patient, only the straight<br />

<strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> laboratory analog is used thanks to<br />

processing at the abutment level in the laboratory.<br />

The <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> system is intended for primary<br />

splinted structures and does not provide any protection<br />

against rotation in the individual positions.<br />

<strong>SKY</strong> f & f<br />

laboratory analog<br />

Even if the models of the immediate restoration<br />

are still available, impression must be taken<br />

and bite registration must be carried out again<br />

because of the change in the gingiva conditions.<br />

Impression taking at abutment level is required for a combination with <strong>SKY</strong> abutments that are protected against<br />

rotation. Detailed description in the following case.<br />

36<br />

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<strong>fast</strong> & <strong>fixed</strong><br />

Setup - bite registration<br />

If <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> prosthetic copings are integrated<br />

into a resin base, it can be screwed when<br />

it is tried in the mouth. Unlike with conventional<br />

techniques, this technique allows<br />

accurate control of bite registration. Basically,<br />

a bone-anchored base is obtained.<br />

It depends on the individual way of working of<br />

the dental team, whether first bite registration<br />

is carried out and then teeth are fully set up or<br />

a combination of both is completed in a single<br />

session (as shown in the photo).<br />

The method of fabrication and selection of the<br />

material of the bridge framework depend on<br />

the specific patient and the procedure that the<br />

prosthetic team prefers. In this example a cast<br />

non-precious framework was chosen, which is<br />

geared to economic efficiency.<br />

The framework was modelled around the <strong>SKY</strong><br />

<strong>fast</strong> & <strong>fixed</strong> prosthetic copings (for the adhesive<br />

technique). The gap can be clearly recognized.<br />

Adhesive bonding can be carried out in vitro or<br />

in vivo just like in this example.<br />

<strong>SKY</strong> f & f<br />

prosthetic coping, titanium<br />

20 Ncm<br />

Veneering<br />

For the definitive bridge with a metal substructure,<br />

the visio.lign veneers are bonded to the<br />

substructure using the dual-curing combo.lign<br />

material. The final shape is achieved using various<br />

shades of dentin, transparent and pink crea.lign<br />

materials.<br />

More information about visio.lign can be found<br />

in the internet at www.<strong>bredent</strong> com. The visio.lign<br />

film is recommended.<br />

Insertion of the bridge<br />

After removing the temporary, the definitive<br />

metal-reinforced resin bridge is inserted. The<br />

four fixation screws are tightened with a torque<br />

of approx. 20 Ncm. In addition to checking the<br />

occlusion and articulation, the cleanability is<br />

checked with a small brush and Superfloss and<br />

the patient receives instructions how to clean<br />

the restoration.<br />

37


<strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> definitive restoration<br />

Impression of <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> for the definitive restoration in combination with <strong>SKY</strong> abutments<br />

Generally it is possible to combine <strong>SKY</strong> abutments and<br />

<strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> abutments for the definitive restoration<br />

on implants placed at an angle of 35°.<br />

This procedure has consequences on the impression and<br />

the fabrication of the model.<br />

The <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> 35° abutments are not removed and<br />

the impression is taken at the abutment level.<br />

The <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> 0° or 17.5° abutments are removed<br />

and work is continued at the implant level.<br />

The 0° abutments are screwed off after<br />

removing the temporary bridge.<br />

Impression abutment<br />

incl. screw<br />

Open impression<br />

The <strong>SKY</strong> impression abutment for the open<br />

impression ensures transfer of the exact position<br />

of the Torx®.<br />

<strong>SKY</strong> f & f Impression coping<br />

open tray<br />

The <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> impression copings<br />

for the open impression are screwed on the<br />

35° abutments. The <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> system<br />

is intended for primary splinted structures<br />

and does not provide any protection against<br />

rotation.<br />

Impression copings for the closed impression<br />

are available for the <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> system.<br />

The <strong>SKY</strong> implant system includes impression<br />

abutments for the closed impression The<br />

<strong>SKY</strong> implant system also includes impression<br />

abutments for the closed impression to permit<br />

safe repositioning in the impression.<br />

Depending on the planned design, the<br />

corresponding <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> prosthetic<br />

copings without protection against rotation and<br />

<strong>SKY</strong> abutments with Torx® rotational protection<br />

are selected.<br />

38<br />

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<strong>fast</strong> & <strong>fixed</strong><br />

Perfect prosthetic solutions with just a few components<br />

Titanium abutments<br />

R<br />

R<br />

Titanium abutments esthetic line<br />

R<br />

Zirconium abutments<br />

Individual abutments<br />

UVE<br />

0° 15°<br />

Bar abutments<br />

39


Definitive restoration<br />

Partially removable bridge with individual lateral screw retention<br />

NPM substructure, visio.lign veneers<br />

Initial model<br />

Bite registration and the individual tray are<br />

prepared using an initial model based on an<br />

alginate impression.<br />

Bite registration<br />

A resin base plate is <strong>fixed</strong> at the two terminal<br />

<strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> abutments. This way bone<br />

support is achieved and mucosa support is<br />

avoided.<br />

A set-up in the anterior region provides a first<br />

impression of the esthetic appearance.<br />

Open impression<br />

The <strong>SKY</strong> impression abutments and the <strong>SKY</strong><br />

<strong>fast</strong> & <strong>fixed</strong> impression copings are already<br />

connected with a plastic lock in the laboratory<br />

and separated again. Position numbers help to<br />

avoid mixups.<br />

Once undesired contacts were checked (dental<br />

floss), the individual elements are connected.<br />

The open impression is taken using a customized<br />

breciform D tray or an individual tray<br />

prepared in the laboratory.<br />

The <strong>SKY</strong> impression abutments and the <strong>SKY</strong><br />

<strong>fast</strong> & <strong>fixed</strong> impression copings are <strong>fixed</strong> in<br />

the impression.<br />

40<br />

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<strong>fast</strong> & <strong>fixed</strong><br />

Model fabrication<br />

While they are screwed on, analogs should<br />

always be held with forceps to avoid rotation<br />

of the impression abutments in the impression.<br />

The choice whether to prepare a hard or soft<br />

gingiva mask for the planned restoration and<br />

procedure is left to the technician. In this case<br />

Exakto Form model resin (<strong>bredent</strong>) was used for<br />

a removable hard gingiva mask. In the anterior<br />

area the four <strong>SKY</strong> implant analogs indicate the<br />

implant level and the terminal <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong><br />

analogs indicate the abutment level.<br />

Set-up<br />

visio.lign veneers are used for the set-up.<br />

A visio.lign esthetic try-in shows the patient the<br />

final result of hiw new <strong>fixed</strong> bridge restoration.<br />

Key<br />

Hard silicone materials are particularly suited<br />

for keys. A two-phase silicone key is prepared to<br />

maintain the interdental spaces and to achieve<br />

enhanced retention of the veneers in the key. A<br />

very precise soft silicone (55 Shore) is used for the<br />

first layer applied directly from the mixing gun<br />

to the set-up. Haptosil (90 Shore) is used for the<br />

second layer to add the required stability to the<br />

key.<br />

Haptosil D<br />

Selection of abutments<br />

For this visio.lign bridge with NPM substructure,<br />

esthetic line abutments are used in the<br />

anterior region. The key shows the dimensions<br />

of the bridge and determines the selection of<br />

abutments.<br />

41


Definitive restoration<br />

Partially removable bridge with individual lateral screw retention,<br />

NPM substructure, visio.lign veneers<br />

Selection of abutments<br />

The occlusal view shows parallel alignment of<br />

the 15° esthetic line abutments. The divergence<br />

of the <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> prosthetic coping is<br />

compensated by the 17.5° outer cone.<br />

<strong>SKY</strong> esthetic abutment<br />

M 15°<br />

with screw 2.2<br />

Individual screw retention<br />

The <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> prosthetic copings permit<br />

two occlusal screw-retained designs. Two<br />

screws were placed in the front using the tool<br />

set for individual screw retentions.<br />

Tool set<br />

for individual screw<br />

retentions M 1.4<br />

Wax-up<br />

A key is used for constant control of the wax-up.<br />

Investing and casting<br />

Spruing, investing and casting are based on<br />

the procedure of the <strong>bredent</strong> casting technique<br />

according to Sabath.<br />

Loose leaf folder<br />

<strong>bredent</strong> casting technique<br />

230 pages<br />

42<br />

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<strong>fast</strong> & <strong>fixed</strong><br />

Finishing the substructure<br />

Stress-free fit of the substructure on the abutments<br />

must be ensured after finishing As a<br />

result the lateral screws can be easily handtightened.<br />

visio.lign veneer<br />

The substructure is conditioned and opaque is<br />

applied. After cleaning, the visio.lign veneers<br />

are sandblasted (110 my) at 2.5 bar and abrasive<br />

dust is removed using oil-free compressed air.<br />

Steam blasting results in moisture and affects<br />

bonding! The application of visio.link bonding<br />

agent is mandatory. The veneers are <strong>fast</strong>ened<br />

to the bridge substructure using dual-curing<br />

combo.lign.<br />

The final shape is achieved using various shades<br />

of dentin, transparent and pink crea.lign materials.<br />

More information about visio.lign can be found<br />

in the internet at www.<strong>bredent</strong>.com<br />

The visio.lign film is recommended.<br />

Inserting the restoration<br />

The battery powered CPS (<strong>Co</strong>rdless Prostodontic<br />

Screwdriver) facilitates screwing of the abutment<br />

screws.<br />

The abutment screws are tightened with<br />

25 Ncm. The lateral screws are handtightened.<br />

In addition to the occlusion and articulation, it<br />

is checked whether the restoration can be properly<br />

cleaned with a small brush and Superfloss<br />

and the patient is instructed how to clean the<br />

restoration.<br />

Mounter for contra-angle<br />

25 Ncm<br />

The visio.lign veneers enable economic restorations with predictable esthetic results.<br />

Perfect occlusion is also advantageous for restorations with a reduced number of implants.<br />

The risk of chipping is almost eliminated. Problems can be easily solved or requests of the patient for subsequent<br />

changes can be easily fulfilled.<br />

43


Definitive restoration „Landsberger Brücke“<br />

Partially removable zirconium bridge with prefabricated horizontal screw retention, UVE abutment,<br />

zirconium dioxide substructure, ceramic veneering in the front, posterior visio.lign veneer<br />

UVE<br />

UVE (Universal <strong>Co</strong>nnector Element)<br />

UVE is a prefabricated abutment system with integrated<br />

horizontal screw retention in a titanium<br />

coping with a function comparable to that of<br />

electroplated copings. Industrially prefabricated<br />

components facilitate and accelerate working and<br />

ensure high precision. Thanks to the defined adhesive<br />

gap of 0.15 mm even large-sized bridges can be<br />

integrated whilst ensuring passive fit.<br />

25 Ncm<br />

Zirconium dioxide substructure<br />

Large-volume cast substructures were frequently<br />

difficult to fabricate and to veneer especially for<br />

implant restorations involving considerable loss<br />

of substance. Zironium dioxide has proved to be<br />

an alternative substructure material - both in the<br />

CAD/CAM technique or with the copy milling system<br />

5-motions-mill.<br />

The admission for adhesion with the UVE copings<br />

can be clearly recognized.<br />

Ceramic veneer<br />

At the patient‘s request, the anterior region was<br />

veneered with ceramic. To extend the length of<br />

the crown, pink „gingiva“ material was additionally<br />

applied.<br />

Visio.lign veneerss<br />

The use of the visio.lign veneers in the posterior<br />

region also reduces the costs of the restoration,<br />

but it was chosen to ensure gentle occlusion<br />

since an implant-supported restoration had<br />

already been integrated in the opposing jaw.<br />

44<br />

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<strong>Co</strong>mpletion of the bridge<br />

The visio.lign veneers are <strong>fixed</strong> (bonded) in<br />

accordance with the visio.lign protocol.<br />

The photo shows the transition from the<br />

ceramic to the visio.lign veneer. A full-ceramic,<br />

veneered pink base could also be prepared.<br />

Bonding of the UVE abutments<br />

After conditioning, the UVE abutments are<br />

bonded in the zirconium dioxide substructure<br />

whilst avoiding any stress. The horizontal screws<br />

are located in the titanium coping.<br />

Insertion of the restoration<br />

The abutment screws are tightened with<br />

a torque of 25 Ncm. The lateral screws are<br />

handtightened. In addition to checking the<br />

occlusion and articulation, the cleanability<br />

is checked with a small brush and Superfloss<br />

and the patient receives instructions how to<br />

clean the restoration.<br />

The combination of new materials and treatment<br />

concepts allows to obtain favorably priced and<br />

esthetic restorations. Risks are minimized or<br />

completely avoided.<br />

The detailed desciption of the case has been published in Quintessenz Zahntechnik 6/2009; 730-738. A special<br />

print is available from <strong>bredent</strong> (REF 331 0D).<br />

45


Definitive restoration with <strong>SKY</strong> abutments<br />

Individual milled bar with removable bridge<br />

Generally, patients alwas prefer to have a <strong>fixed</strong> bridge. However, in case of considerable loss of substance, a ceramic bridge<br />

may not be suitable to achieve adequate support for the lip and cheek areas. In such cases, an individual bar with locks or<br />

attachments is a favorable alternative. This case shows a palate-free upper restoration in the dimensions of a bridge.<br />

The <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> abutments have been designed for primary splinted structures and are suitable for bar restorations -<br />

also in combination with the <strong>SKY</strong> bar system.<br />

Working at implant level with the <strong>SKY</strong> bar system<br />

In this case the rehabilitation team selected<br />

primary splinting with a milled bar.<br />

Situation after three months of trouble-free<br />

wearing of the temporary <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong><br />

bridge. The bridge and <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> abutments<br />

were removed.<br />

The photo shows the implant level. The implantabutment<br />

connection with the star-shaped<br />

Torx® of the three implants in the anterior<br />

region can be clearly recognized.<br />

Generally, <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> abutments are also<br />

suitable for bar restorations. The procedure correspond<br />

to the example of a bridge restoration<br />

above.<br />

Spacer sleeves<br />

<strong>SKY</strong> bar system<br />

The <strong>SKY</strong> bar system is based on spacer sleeves in<br />

heights of 2 and 6 mm for various mucosa thicknesses.<br />

Three bar elements made of plastic, HSL or titanium<br />

allow individual processing.<br />

Possibility of oral bonded structures with screw<br />

retentions for perfect „passive fit“.<br />

The spacer sleeves are at the level of the<br />

mucosa or up to 1 mm above it.<br />

46<br />

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<strong>fast</strong> & <strong>fixed</strong><br />

<br />

<br />

<br />

The <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> prosthetic copings and the<br />

bar elements serve as a base for bonding of the<br />

bar.<br />

Thanks to outer cones of the <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong><br />

Abutments and the inner conical design of the<br />

space sleeves, divergences of the bar structure<br />

can be easily compensated.<br />

Screw retained bar with„passive fit“<br />

Oral bonding ensures stress-free fit. The screw<br />

retention allows easy removal of the partially<br />

removable bar structure.<br />

A palate-free upper restoration in the dimensions<br />

of a bridge.<br />

Individual milled telescopic bar (non-precious<br />

metal) with terminal Vario-Soft bar attachments<br />

in various friction levels.<br />

The range of locks and attachments from <strong>bredent</strong><br />

is suitable for numerous applications. The prosthetic<br />

rehabilitation team is enabled to select the<br />

perfect restoration for each patient with snap or<br />

lock function.<br />

47


Information<br />

Master copy for referring dentists/implantologists<br />

<strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> rules for patients<br />

• eat only soft food during the first few weeks<br />

• avoid maximum masticatory stress during the first six weeks<br />

• consult your dentist immediately in the event of loosening or fracture of the<br />

restoration<br />

• rinse with antiseptic mouthwash until the suture is removed<br />

• after removal of the suture - conventional cleaning with toothbrush, interdental<br />

brush and Superfloss<br />

Important information for <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> cases<br />

The <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> system was used for an immediate restoration.<br />

To avoid complex surgery, implants were placed at a large angle.<br />

The 35° abutments that were screwed on must not be removed when fabricating and inserting the definitive<br />

restoration and are located in position ………………......................(please enter position).<br />

Only the 35° abutment must remain screwed in place. When using 0° abutments, the regular <strong>SKY</strong> abutment<br />

system should be selected since it provides better options for definitive prosthetic restorations.<br />

<strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> abutments and standard abutments of the <strong>SKY</strong> systems can be combined without any<br />

problems.<br />

The <strong>SKY</strong> implant system has only a prosthetic platform to simplify the selection of the abutment and the<br />

prosthetic restoration.<br />

The <strong>SKY</strong> implant system includes a single screw connection (Torx® T6) for all occlusal screws. The abutments<br />

can be quickly screwed in using a single screwdriver without changing the instrument.<br />

Additional information can be found in the <strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong> manual and in the brochure „<strong>SKY</strong> - Presentation<br />

of the system“.<br />

<strong>bredent</strong> <strong>medical</strong> will gladly provide further advice and assistance. To request a catalog or to be visited by<br />

a dental advisor, please call <strong>bredent</strong> <strong>medical</strong> - phone (+49) 73 09 / 8 72-6 00 or send a fax to<br />

(+49) 73 09 / 8 72-6 35.<br />

48<br />

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Order Form<br />

Fax (+49) 0 73 09 / 8 72-4 44<br />

<strong>fast</strong> & <strong>fixed</strong><br />

Temporary restoration<br />

Abutments and copings<br />

Product<br />

REF<br />

Quantity<br />

Alternative<br />

<strong>SKY</strong> f & f abutment 35°<br />

DH 4 mm with screw 2.2<br />

<strong>SKY</strong> f & f abutment 35°<br />

DH 5 mm with screw 2.2<br />

<strong>SKY</strong>FF354<br />

<strong>SKY</strong>FF355<br />

2 pieces<br />

2 pieces<br />

<strong>SKY</strong> f & f abutment 17.5°<br />

DH 3 mm with screw 2.2<br />

<strong>SKY</strong>FF173<br />

Alternative<br />

<strong>SKY</strong> f & f abutment 17.5°<br />

DH 5 mm with screw 2.2<br />

<strong>SKY</strong>FF175<br />

2 pieces<br />

4 pieces<br />

<strong>SKY</strong> f & f abutment 0°<br />

DH 2 mm with integrated screw<br />

<strong>SKY</strong>FF002<br />

<strong>SKY</strong> f & f prosthetic coping<br />

titanium with screw M 1.4 and silicone tube<br />

<strong>SKY</strong>FFPKT<br />

4 pieces<br />

6 pieces<br />

Impression and model fabrication<br />

<strong>SKY</strong> f & f impression coping<br />

with integrated screw<br />

<strong>SKY</strong>FF0AK<br />

4 pieces<br />

6 pieces<br />

<strong>SKY</strong> f & f laboratory analog <strong>SKY</strong>FF0LA 4 pieces<br />

6 pieces<br />

<strong>SKY</strong> f & f gingiva former <strong>SKY</strong>FFGF2 4 pieces 6 pieces<br />

Implants<br />

blue<strong>SKY</strong> titanium implants, coronally structured with osseo connect (ocs®) surface<br />

Ø 3.5<br />

Order<br />

quantity<br />

Ø 4.0<br />

Order<br />

quantity<br />

Ø 4.5<br />

Order<br />

quantity<br />

L 08 L 10<br />

b<strong>SKY</strong> 3510<br />

L 12<br />

b<strong>SKY</strong> 3512<br />

L 14<br />

b<strong>SKY</strong> 3514<br />

L 16<br />

b<strong>SKY</strong> 3516<br />

b<strong>SKY</strong> 4008 b<strong>SKY</strong> 4010 b<strong>SKY</strong> 4012 b<strong>SKY</strong> 4014 b<strong>SKY</strong> 4016<br />

b<strong>SKY</strong> 4508 b<strong>SKY</strong> 4510 b<strong>SKY</strong> 4512 b<strong>SKY</strong> 4514 b<strong>SKY</strong> 4016<br />

Accessories for definitive restorations<br />

<strong>SKY</strong> <strong>fast</strong> & <strong>fixed</strong><br />

<strong>SKY</strong> f & f Impression coping<br />

open tray<br />

REF <strong>SKY</strong>FFAOL<br />

<strong>SKY</strong> f & f Prosthetic coping<br />

Resin burn-out<br />

with screw M 1.4<br />

REF <strong>SKY</strong>FFPKK<br />

<strong>SKY</strong> f & f Prosthetic coping<br />

with screw M 1.4<br />

HSL cast-on<br />

REF <strong>SKY</strong>FFPKH<br />

<strong>SKY</strong> f & f Screw<br />

M 1.4 for Prosthetic coping<br />

REF <strong>SKY</strong>FFSPK<br />

Name and address<br />

Stamp of practice<br />

Customer Number<br />

✂<br />

Date / Signature<br />

<strong>bredent</strong> <strong>medical</strong> <strong>GmbH</strong> & <strong>Co</strong>.<strong>KG</strong> | Weissenhorner Str. 2 | 89250 Senden | Germany<br />

Tel. (+49) 0 73 09 / 8 72-4 40 | Fax (+49) 0 73 09 / 8 72-4 44 | www.<strong>bredent</strong>-<strong>medical</strong>.com | e-mail info-<strong>medical</strong>@<strong>bredent</strong>.com<br />

49


Order Form<br />

Bestellschein<br />

Fax (+49) 0 73 09 / 8 72-4 44<br />

<strong>fast</strong> & <strong>fixed</strong><br />

For simple and precise fabrication of temporary prosthetic restorations, <strong>bredent</strong> <strong>medical</strong> recommends the following<br />

products which are perfectly matched with each other and produce accurate top-quality results.<br />

Product<br />

REF<br />

<strong>Co</strong>ntent of package<br />

Quantity<br />

Assortment - breciform D<br />

impression trays - disposable<br />

LJ/UJ: S, M, L, XL<br />

580 UOTS S Assortment, 100 parts<br />

10 pcs impression trays each<br />

10 pcs occlusal triangular stops<br />

10 pcs occlusal bar-shaped stops<br />

brecision implant heavy<br />

Impression material, blue<br />

580 BH38 0<br />

1 x 380 ml<br />

5 x dynamic mixers<br />

1 x bayonet ring, blue<br />

brecision Putty soft<br />

kneading silicone for<br />

oral use<br />

kneadable base material<br />

580 0002 4<br />

Set, 3 parts<br />

250 ml base, grey<br />

250 ml catalyst, white<br />

2 measuring spoons<br />

Thixo-Rock<br />

special super-hard stone<br />

class IV, grey<br />

570 00G5 2<br />

570 00G5 1<br />

570 00G5 0<br />

1 x 2 kg<br />

5 x 2 kg<br />

10 x 2 kg<br />

haptosil D<br />

kneading silicone for the laboratory<br />

components A + B<br />

components A + B<br />

540 0118 0<br />

540 0119 0<br />

2 x 1.300 g<br />

2 x 7.500 g<br />

Matrix drill<br />

330 0078 0<br />

1 piece<br />

Qu-resin<br />

Quick-setting, self-curing<br />

denture repair resin<br />

540 0116 2<br />

50 ml<br />

Qu-connector<br />

breformance C + B material<br />

dentine material A2<br />

dentine material A3<br />

incisal material Enamel 1<br />

540 0116 3<br />

540 0109 6<br />

540 0109 7<br />

540 0110 2<br />

10 ml<br />

25 g<br />

25 g<br />

25 g<br />

Set-up wax<br />

assortment<br />

ASW 3, 4, 5<br />

430 0149 0<br />

220 g<br />

novo.lign veneers<br />

Please request our „Designs“<br />

brochure.<br />

000202 0D 1<br />

Name and address<br />

Stamp of practice<br />

Customer number<br />

Date / Signature<br />

50<br />

<strong>bredent</strong> <strong>medical</strong> <strong>GmbH</strong> & <strong>Co</strong>.<strong>KG</strong> | Weissenhorner Str. 2 | 89250 Senden | Germany<br />

Tel. (+49) 0 73 09 / 8 72-4 40 | Fax (+49) 0 73 09 / 8 72-4 44 | www.<strong>bredent</strong>-<strong>medical</strong>.com | e-mail info-<strong>medical</strong>@<strong>bredent</strong>.com


Internet<br />

<strong>bredent</strong> <strong>medical</strong> in the internet<br />

Since August 2006 <strong>bredent</strong> <strong>medical</strong> has had a new<br />

website in the internet. Clearly structured and easily<br />

understandable information on products and ordering<br />

for our entire product range is provided at<br />

www.<strong>bredent</strong>-<strong>medical</strong>.com.<br />

As a special service we have integrated the<br />

„training“ section with the possibility of<br />

direct registration.<br />

Interested dentists are enabled to<br />

inform themselves about the course/<br />

workshop of their choice and<br />

can immediately register if they intend<br />

to participate in this training event.<br />

In addition to the content, there is<br />

also a short introduction of the<br />

lecturers of our training seminars.<br />

In the press section new products and therapies<br />

are presented and already published dental articles<br />

of renowned users of our products can<br />

be downloaded.<br />

The „Information on ordering“ section<br />

includes all the relevant information<br />

for placing orders. Currently, an online shop<br />

is being created.<br />

51


Please request brochures with detailed information!<br />

&<br />

<br />

<br />

&<br />

<br />

<br />

<br />

&<br />

<br />

<br />

Brochure Patient Information Published Papers on<br />

REF 000 200 GB REF 000 342 GB REF 000 327 EX<br />

<br />

<br />

<br />

<br />

Catalog<br />

Products for the dental<br />

practice<br />

REF 00I 105 GB<br />

Catalog<br />

Implant Prosthetics<br />

REF 000 348 GB<br />

The guide to modern implant prosthetics<br />

A comprehensive guide on the rapid development<br />

of implant prosthetics with numerous patient cases<br />

- also with contributions of guest authors - and<br />

a fascinating overview for beginners in the<br />

field of dental implantology under the motto:<br />

„KISS“ - keep it simple and successful.<br />

Author: Manfred Lang<br />

Published by: Spitta Verlag, Balingen<br />

ISBN: 978-3-938509-98-2<br />

424 pages, 1.030 photos, incl. DVD<br />

in English and German<br />

<strong>bredent</strong> <strong>medical</strong> <strong>GmbH</strong> & <strong>Co</strong>.<strong>KG</strong><br />

Weissenhorner Str. 2 | 89250 Senden | Germany<br />

Tel. (+49) 0 73 09 / 8 72-4 40<br />

Fax (+49) 0 73 09 / 8 72-4 44<br />

www.<strong>bredent</strong>-<strong>medical</strong>.com<br />

e-mail info-<strong>medical</strong>@<strong>bredent</strong>.com<br />

06/10 244 GB 5 Subject to changes

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