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