BASIC INFORMATION ON THE - Straumann · General InformatIon 3 2.1 ®Restorative options with the Straumann ... The Straumann ® CARES Wax-up kit includes all wax-up sleeve holders

BASIC INFORMATION ON THEStraumann® CarES® Implant- bornE proSthEtIC proCEdurES

1. IntroductIon 2

2. General InformatIon 32.1 Restorative options with the Straumann® CARES® Portfolio 4

2.2 Technical requirements 5

2.3 System overview 6

2.4 Compatibility chart for CADCAM systems 8

3. PreParatIon for careS® VISual 93.1 Fabrication of the master cast 9

3.2 Planning / Wax-up sleeves 10

3.2.1 Straumann® CARES® Wax-up kit 10

3.2.2 Step-by-step instructions for use 11

3.3 Straumann® Scanbodies 14

3.3.1 Straumann® CARES® Mono Scanbody 14

3.3.2 Straumann® Scanbody 15

3.4 Scanning with the desktop scanner 16

4. reStoratIonS, deSIGnInG and fInIShInG 174.1 Restoration: CARES® Abutment 17

4.1.1 Designing CARES® Workflow 18

4.1.2 Finishing (Straumann® CARES® Abutments – Completion at the dental laboratory) 18

4.1.3 Insertion (dentist’s office) 19

4.2 Restoration: CARES® Variobase™ Abutments 20


4.2.2 Finishing 21

4.2.3 Insertion (dentist’s office) 24

4.3 Restoration: CARES® Variobase™ coping 25


4.3.2 Finishing (Straumann® CARES® Abutments – Completion at the dental laboratory) 26

4.4 Restoration: CARES® Screw-retained bridges and bars (SRBB) 27

4.4.1 Straumann CARES® Screw-retained bridge 29

4.4.2 CARES® Bars 33

5. auxIlIarIeS and InStrumentS 395.1 SCS Screwdriver 39

5.2 Ratchet 39

5.3 Polishing aids and analog holder 39

5.4 Auxiliaries for bar matrices 40

5.5 Wax-up kits 40

6. aPPendIx 416.1 Related documentation 41

7. ImPortant GuIdelIneS 42

CONTENTS

The ITI (International Team for Implantology) is academic partner of Institut Straumann AG in the areas of research and education.

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1. INTRODuCTION 2. GENERAl INFORMATION

PurPoSe of thIS GuIdeThis guide was created for dental technicians working with the Straumann® CARES® Visual software for designing customized abutments, copings, bars and screw-retained bridges. It provides complementary information regarding the conven-tional working steps in the dental laboratory when working with the Straumann® CARES® CADCAM system, e.g. the correct handling of the scanbodies, wax-up sleeves, etc.

Additional brochures are Basic Information on Tooth-borne Prosthetic Procedures, Straumann® CARES® Visual – Software Manual and Straumann® CARES® System.

All of the described devices are CAD-derived and CAM-man-ufactured. Straumann® CARES® Visual supports you designing the devices within indication-related conditions.

Instructions provided are insufficient to serve as the only means for processing and placing Straumann® CARES® implant-borne prosthetics related components. Only those dental profession-als thoroughly trained in dental restorations should be pro-cessing and placing these devices. Processing and placing Straumann® CARES® implant-borne prosthetics and related components without proper training may lead to failure of the restoration. Restoration failure may lead to restoration removal or other complications.

Failure to follow the procedures outlined in these instructions may harm the patient and/or lead to any or all of the following complications:

p Aspiration or swallowing of a component p Breakage p Infection

note p Implant-borne superstructures require optimal oral hygiene on the part of the patient. This must be considered by all involved parties when planning and designing the restoration.

p Consult the brochure Basic Information on the Surgical Proce-dures for information on indications and contraindications of Straumann® Dental implants, such as the required minimum number of implants, implant type, diameter and loading pro-tocols.

careS® ProSthetIcS IncorPoratInG State-of-the-art technoloGy The Straumann® CARES® implant-borne prosthetics provide you with customized solutions for single-tooth gaps, multiple-tooth gaps and fully edentulous jaws.Different materials and kinds of restorations are available to give you flexibility in the way you restore the implants.

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1 2 31 2 3 4

1 2 3 4

Screw-retained cement-retained

1 CARES® Abutment, ZrO2

2 CARES® Variobase™ Abutment3 CARES® Variobase™ Coping


2 CARES® Variobase™ Abutment3 CARES® Abutment, Ti4 CARES® Variobase™ Coping

CARES® Screw-retained bridge


2 CARES® Variobase™ Abutment3 CARES® Abutment, Ti4 CARES® Variobase™ Coping

Screw-retained for removable overdentures

CARES® Screw-retained bridge CARES® Bar

2.2 technIcal requIrementS

There are many ways to a CARES® restoration, which makes different “combinations” of infrastructure possible. Those com-binations are required for designing and ordering Straumann®

CARES® restorations:

deSktoP ScannerThe patient situation can be taken with a conventional impres-sion tray. The dental laboratory will scan the fabricated master model (preferably with removable segments) with a Straumann-approved desktop scanner (e.g. Straumann® CARES® Scan CS2).

SoftwareThe restoration is designed with a Straumann-approved soft-ware (e.g. Straumann® CARES® Visual), which is engineered to ensure that the restoration dimension complies with the Straumann manufacturing capabilities.

Intraoral ScannerS (Incl. rePoSItIonable ImPlant analoGS)The patient situation can be scanned with a Straumann-ap-proved intraoral scanner (e.g. iTero™ or 3M™ lava™ Chair-side Oral Scanner C. O. S.). The data can be imported in the Straumann-approved software (e.g. Straumann® CARES® Visual version 5.IO or higher).

Straumann® CARES® Solution WS (working station) is a solution for customers who do not require scanning the physical master cast and therefore do not have to invest in a desktop scanner.For detailed information on intraoral scanning, refer to the bro-chure: iTero™ Intra-Oral Scanner for Digital Impressions.

Scan & ShaPe SerVIceIf the dental laboratory does not have a Straumann-approved desktop scanner but wishes to order a Straumann® CARES® Abutment, they can send in their master model or wax-up abut-ment to Straumann® CARES® Scan & Shape service*.

2.1 reStoratIVe oPtIonS wIth the Straumann® careS® PortfolIo

es1-Scanner

Straumann® CARES® Visual

iTero™

CARES® Scan CS2

* CARES® Scan & Shape service is not available in all countries, please check with your local sales representative for further information. Additional information about the CARES® Scan & Shape service can be found in the brochures “The Way To Straumann® CARES® Abutments” and “Straumann® CARES® Scan & Shape Process Guide”.

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2.3 SyStem oVerVIew

nn nnc rn

transfer parts

048.167 048.067 048.087 048.087-04

048.132 048.130

048.173 048.137 048.137V4

048.087-04

048.168 048.068 048.088 048.088-04

048.129 048.108 048.124

temporary restorations2)

titanium abutments / bridges (titanium grade 4 / cobalt chromium)2)

1) 1)

ceramic restorations2)

1) 1)

careS® bars (titanium grade 4 / cobalt chromium)2)

accessories screws

048.353 049.177 048.313048.354

ZrO2

048.356 SRBB3)/Ti/Variobase™

bar matrices

wn nc rc

048.169 048.069 048.089 048.089-04

048.172 048.171

025.2915 025.2905 025.2903 025.2903-04

025.2102 025.2101

025.4915 025.4905 025.4903 025.4903-04

025.4102 025.4101

1) 1) 1)

1) 1)

048.356 SRBB3)/Ti/Variobase™

025.2906 ZrO2

025.2900 Ti/Variobase™

025.2926 SRBB3)

025.4906 ZrO2

025.4900 Ti/Variobase™

025.2926 SRBB3)

ackermann®

A female part E (posterior): 05050010

B female part E (anterior): 05050011 (spacer is included)

Important: the following matrices are available only from your local cendres + méteaux representative: ackermann®, mP-clip®, round bar.

Important: the dolder® bar matrix is available through Straumann.

mP-clip®

Retention elements: – yellow, standard retention G: 200004363 – white, medium retention G: 200004365 – red, extra retention X: 200004365 Spacer with sleeve X: 200004367dolder®

Regular: 048.414 Mini: 048.413

round bar

Female part E: 050527

Spacer 50×0.6 mm: 052082

1) Straumann® CARES® abutments can be ordered via the Straumann® CARES® Visual software or at http://cares.straumann.com2) Manufactured at the Straumann CADCAM production center.3) SRBB is the abbreviation for Screw-Retained Bridge & Bar.

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Pre-condItIonS p The tooth shade has been identified and noted (via color chart or digital measuring device). p Impression has been taken.

Both, shade information and impression have been sent to the dental lab.

Fabricate the master cast using standard methods and type-4 dental stone (ISO 6873). To ensure high-quality restorations, the following requirements must be considered:

p Only use new, undamaged and original Straumann implant analogs.

p The implant analogs must be embedded in the stone and must not move in the model.

p A gingival mask should always be used to ensure the emer-gence profile is optimally contoured.

p For CARES® SRBB1 a large-range removable gingival mask is necessary to enable Straumann to conduct a fit check.

p Preferably use scannable material for the gingival mask.

1 SRBB is the abbreviation for Screw-Retained Bridge & Bar.

3. PREPARATION FOR CARES® VISuAl

3.1 fabrIcatIon of the maSter caSt

2.4 comPatIbIlIty chart for cadcam SyStemS

es1 Scanner CARES® Scan CS2 Intraoral scanners1 Scan & Shape2

Software Version 5.0 5.IO 6.0 6.2 7.0 8.0 4.2 n/a

acc

esso

ries

Straumann® CARES® Mono Scanbody 1 1 1 n/a

Straumann® Scanbody 1 1 1 1 1 1 n/a

Straumann® Wax-up sleeves 1 1 1 1 1 n/a 1

care

S® r

esto

ratio

ns

CARES® Abutments 1 1 1 1 1 1

CARES® Variobase™ Copings 1 1

CARES® Variobase™ Abutments 1

CA

RES®

SRB

B3 p Tissue level 1 1

p Bone level 1

p Bone level / Tissue level mix 1

CA

RES®

Bar

p Dolder® Egg-shape (regular) 1 1

p Dolder® Egg-shape (mini) 1

p Dolder® u-shape (regular and mini) 1

p MP-Clip® Bar 1

p Ackermann-Bar® 1

p Round-Bar 1

1 “iTero™ Partner Lab Software 4.2”/3M™ Lava™ Chairside Oral Scanner C. O. S. is in preparation

2 CARES® Scan & Shape service is not available in all countries, please check with your local sales representative for further information.


noteEnsure that the planning is executed with the corresponding software version. Be aware not to mix the Straumann® CARES® Mono Scanbody and Straumann® Scanbody in the same scan-ning process.

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For optimal esthetic planning, especially in the labial region, design a fully anatomic wax-up and confirm the size and position intraorally. For CARES® abutments the wax-up can be scanned with the wax-up sleeve holder and ordered, as an alternative to designing it in CARES® Visual. (see brochure Basic Procedure Straumann® CARES® System for more information).

For CARES® screw-retained bridges the wax-up can be scanned and used as reference when designing the restoration in CARES® Visual.

Wax-up sleeves are used for waxing up the abutment.

noteThe wax-up sleeves are designed for single use only. If the sleeves are used more than once, an accurate reproduction of the abutment’s position with reference to the implant position cannot be guaranteed and the milling results may be inaccurate.

3.2.1 Straumann® careS® wax-uP kIt

The Straumann® CARES® Wax-up kit includes all wax-up sleeve holders which are required for placing the wax-up sleeves in the desktop scanner. They are required for correct scanning of the customized abutment.

article number p 019.0063 – Straumann® CARES® Wax-up kit (used for Straumann® Abutments) p 019.0050 – Straumann® CARES® Wax-up kit for Camlog (used for Variobase™ Copings for Camlog® Abutments)

p 019.0051 – Straumann® CARES® Wax-up kit for NobelReplace™ (used for Variobase™ Copings for NobelReplace™ Abutments)

3.2 PlannInG / wax-uP SleeVeS 3.2.2 SteP-by-SteP InStructIonS for uSe

3.2.2.a ShortenInG wax-uP SleeVeS In General

p The section above the implant shoulder represents the mini-mum body, and must not be ground (displayed red in the graphic to the right).

p Only in the upper section the wax-up sleeve can be shortened (displayed green in the graphic to the right).

p Do not wax below the basal margin of the wax-up sleeve (red arrow).

p Sharp-edged modeling must be avoided.

3.2.2.b ShortenInG wax-uP SleeVeS for VarIobaSe™ abutmentS

The wax-up abutment must have a minimal height due to the Variobase™ Abutment height. The section above the implant shoulder represents the minimum body and must not be ground (displayed red in the graphic to the left). Only in the upper sec-tion the wax-up sleeve can be shortened (displayed green in the graphic to the right). Do not wax below the basal margin of the wax-up sleeve (red arrow).

Insert a wax-up sleeve into the master cast.

nnc nn rn wn nc rc

nc rc wn rn nnc

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3.2.2.c waxInG uP the abutment / Screw-retaIned brIdGe

3.2.2.d maxImum Geometry for ProductIon of careS® abutmentS

use only scannable wax to ensure an accurate scan (e.g. CopyCAD Wax from Straumann). If no scannable wax is used, apply scan spray.

noteTo ensure stability, it is recommended to make a frame with modeling resin with low shrinkage when waxing up bridges.

The projecting part of the wax-up sleeve must always be cut off before scanning, oth-erwise this section will also be scanned and therefore milled.

noteThe angulation of the wax-up must not exceed 30°.

oPtIon a: full anatomIc deSIGn (VarIobaSe™ temPorary abutment)

oPtIon b: reduced anatomIc deSIGn (VarIobaSe™ temPorary abutment, VarIobaSe™ abutment, careS® abutmentS, careS® Screw-retaIned brIdGeS)

A full anatomic wax-up should be prepared for optimal es-thetic planning. use the wax-up sleeve to model the shape of the full anatomic temporary abutment.

A full anatomic wax-up should be prepared for optimal esthetic planning.

Prepare a silicone key over the full wax-up to determine the optimal shape of the restoration.

use the wax-up sleeve to model the shape of the reduced ana-tomic restoration.

Check the wax-up with the silicone key.

Implant Platform nc rc nn rn wn

wax-up sleeve article number 025.2903 025.4903 048.087 048.088 048.089

Zirconium dioxide (ZrO2)

CARES® ZrO2 Abutment article number

027.2650 027.4650 040.679 040.688

Titanium (Ti)

CARES® Ti Abutment article number

027.2620 027.4620 040.693 040.689 040.694

8 mm 10 mm 6 mm

8 mm10 mm 12 mm 14 mm 12 mm

8 mm

8 mm10 mm

10 mm 12 mm 14 mm 14 mm 11 mm

8 mm 10 mm12 mm

1

3

2

4

1312

3.3 Straumann® ScanbodIeS

Product deScrIPtIonThe Straumann® Scanbodies represent the position and orientation of the respective dental implant or analog in CADCAM scanning procedures. This helps the CADCAM software to correctly align the subsequent CADCAM restorations.

Product oVerVIewStraumann offers two different types of scanbodies which differ in handling and scan-ner compatibility:

p Straumann® CARES® Mono Scanbody p Straumann® Scanbody

Make sure to select the correct Straumann® Scanbody according to the software ver-sion (see compatibility chart on page 8).

noteThe Straumann® Scanbodies and all components are intended for single use only. Multiple use of a scanbody can lead to inaccurate results. Make sure the stability of the dental implant is sufficient for supporting the screwing/unscrewing operations of the scanbodies. Scan spray is not required at any time.

3.3.1 Straumann® careS® mono Scanbody

3.3.1.a Product ProPertIeS and benefItS In brIef

Improved handling p Single component incl. self-retaining screw

Improved functionality p Optimized geometry for the Straumann® CARES® Scan CS2 scanner and iTero™ p Optimized system configuration for multi-unit restorations

well-accepted material p PEEK for excellent scanning results

3.3.1.b SteP-by-SteP InStructIonS for uSe

3.3.2 Straumann® Scanbody

assemblingCheck proper fit of the scanbody in the analog and hand-tighten the self-retaining screw (maximum 15 Ncm). Only use the Straumann® SCS Screwdriver to fix the post in the analog. Check again for proper fit and for any rotational or vertical looseness. If a single-tooth restoration is planned, orient the angled surface of the scanbody buccally (not adjacent to the approximal tooth). Avoid any contact of the scanbody to the approximal teeth.

3.3.2.a Product ProPertIeS and benefItS In brIef

two-component scanbody p Contains scan post, scan cap and fixation screw

for single-tooth restorations p Scanbody geometry to meet requirements of scanner etkon™ es1 and iTero™

well-accepted material p PEEK for excellent scanning results

3.3.2.b SteP-by-SteP InStructIon for uSe

assemblingBefore placing the scanbody in the master cast, ensure that all components are clean and undamaged (neither scratches, deformations nor discolorations). Check proper fit of the scan post in the analog, insert the fixation screw and hand-tighten (maximum 15 Ncm). Only use the SCS Screwdriver to fix the post in the analog. Check again for proper fit to prevent any rotational or vertical looseness.Place the scan cap on the scan post. Ensure that the flat parts in the connection area of the scan cap and the scan post are aligned to one another. The flat parts are the rotational security feature between scan cap and scan post. If correctly placed, the cap clicks on the post. Slightly press down with your fingertip to avoid any gaps be-tween cap and post.

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Please refer to the brochure Basic Procedure Straumann® CARES® System for detailed information regarding the scanning process of the wax-up sleeves and the master model.

3.4 ScannInG wIth the deSktoP Scanner

BASIC PROCEDURESTRAUMANN® CARES® SYSTEM

Intended uSe p Cement-retained crowns p Cement-retained bridges via mesostructure p Screw-retained, directly veneerable crowns (CARES® abutments, ZrO2 only)

materIal p Titanium grade 4 p Zirconium dioxide

contraIndIcatIon p Allergies to materials used, which may include any or all of the following: zirco-nium dioxide (ZrO2), yttrium oxide Y2O2, aluminum oxide Al2O3, hafnium dioxide HfO2, titanium (Ti), titanium alloy (Ti6Al7Nb titanium, niobium, aluminum or TAN).

characterIStIcS p CARES® abutment ZrO2 is the abutment of choice in the anterior region and for patients with thin gingiva

p Anatomic emergence profile p A patient-specific emergence profile supports soft tissue management and an es-thetic outcome

p Straumann Guarantee for Straumann® CARES® abutments

4.1 reStoratIon: careS® abutment

4. RESTORATIONS, DESIGNING AND FINISHING

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SteP 1 – PreParatIon for careS® VISualFollow the preparation requirements according to chapter 3.

SteP 2 – deSIGnInG wIth careS® VISualDesign the restoration according the Straumann® CARES® Visual – Software Manual or watch the CARES® Tutorial videos online for further guidance. www.straumann-cares-digital-solutions.com > my StraumannCARESDesktop > Products & Service > Education

oPtIon a: Screw-retaIned crown

Straumann® careS® ceramic abutment p Fabricate a screw-retained crown with a ceramic that is synchronized to the thermal expansion coefficient of zirconium dioxide.

p Straumann® CARES® Ceramic Abutments made of zirconium dioxide have a thermal expansion coefficient of 10.5 × 10−6/K (25 °C – 500 °C, 77 °F – 932 °F).

noteParticular attention must be given to an even layer thickness of the porcelain veneered on the abutment.

oPtIon b: cement-retaIned crown

p Mount the Straumann® CARES® Ceramic Abutment on the implant analog.

p use a standard procedure to fabricate the cement-retained single crown.

p Veneer the structure.

4.1.1 deSIGnInG careS® workflow

4.1.2 fInIShInG (Straumann® careS® abutmentS – comPletIon at the dental laboratory)

Straumann® careS® abutment – ProSthetIc Procedure

The final restoration is fixed on the master cast before it is delivered to the doctor’s office.

SteP 1 – PreParatIon p Remove the healing cap or temporary restoration. p Remove the superstructure from the master cast and unscrew the abutment from the analog.

p Clean and dry the interior of the implant and the abutment thoroughly.

noteuse transfer aids if the model contains more than one abutment. Never use cement when the abutment is inserted into the implant. Straumann® CARES® abutments made from zirconium dioxide are not autoclavable and must not be cleaned by steam blasting.

SteP 2 – fInal InSertIon Straumann® careS® ceramIc abutment

option a: Screw-retained crown p Position the cleaned Straumann® CARES® Ceramic Abutment in the implant. Tighten the screw to 35 Ncm using the SCS Screwdriver along with the ratchet and the torque control device.

p Close the SCS configuration of the screw with cotton and sealing compound (e.g. gutta-percha). This allows a later removal of the customized abutment in case a crown replacement is required.

option b: cement-retained crown p Position the cleaned Straumann® CARES® Ceramic Abutment in the implant. Tighten the screw to 35 Ncm using the SCS Screwdriver along with the ratchet and the torque control device.

p Close the SCS configuration of the screw with cotton and sealing compound (e.g. gutta-percha). This allows a later removal of the customized abutment in case a crown replacement is required.

p Cement the superstructure to the abutment. p Remove superfluous cement.

noteuse only the special basal screws provided for the Straumann® CARES® Ceramic Abutment.

4.1.3 InSertIon (dentISt’S offIce)

1

2A

2B

1918

4.2 reStoratIon: careS® VarIobaSe™ abutmentS

Intended uSe p Screw-retained or cement-retained crowns p Cement-retained bridges via mesostructure

materIal p zerion® (zirconium dioxide) p polycon® ae (PMMA)

contraIndIcatIon p Allergies or hypersensitivity to chemical ingredients of the zirconium dioxide material (zirconium dioxide (ZrO2), yttrium oxide (Y2O3), hafnium dioxide (HfO2), aluminum oxide (Al2O3)),titanium alloy (Ti6Al7Nb, titanium, aluminum, niobium or TAN) or PMMA (polymethyl methacrylate).

characterIStIcS p Customized shape and emergence profile, and ideal for the replacement of big teeth

p Straumann logo indicating that it is an original component p zerion® and polycon® ae are available in various tooth shades p polycon® ae copings are intended for a usage of up to 180 days p Straumann Guarantee for Straumann® CARES® abutments



SteP 2 – deSIGnInG wIth careS® VISualDesign the restoration according to the Straumann® CARES® Visual – Software Manual or watch the CARES® Tutorial videos online for further guidance. www.straumann-cares-digital-solutions.com > myStraumannCARESDesktop > Products & Service > Education

4.2.2 fInIShInG

SteP 1 – fabrIcatIon of the crown

option a: Screw-retained final restorationFabricate a screw-retained crown with a ceramic that is synchro-nized to the thermal expansion coefficient of zirconium dioxide.

note p CARES® Variobase™ copings must not be sandblasted or ground.

p All commercially available veneering ceramics that are intended for veneering of this material and that are suitable for a CTE value of 10x10-6/K can be used.

After reception, unpack the Straumann® CARES® Vario base™ abutment.

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Particular attention must be given to an even layer thickness of the porcelain veneered on the abutment.

Possible veneering ceramics: p VITA VM® 9 p GC® Initial Zr p VINTAGE® Zr

The processing instructions of the veneering material manufacturers apply!

option b: cement-retained final restoration Directly proceed to Step 2 – Bonding process, described below.

SteP 2 – bondInG Fix the Variobase™ abutment to the implant analog with a screw (hand-tight). Seal the screw channel with wax.

noteIt is not necessary to sandblast the Variobase™ abutment.

Apply self-adhesive dental cement on the Variobase™ abutment. Follow the cement manufacturer’s instructions. Bond the coping to the Variobase™ abutment.

noteImmediately remove excess cement from the abutment and polish the lower margin of the coping after the cement has dried.

p Always use a polishing aid to protect the abutment’s prosthetic connection. p Do not fire the abutment after bonding.

SteP 3 – Product comPletIon at the dental laboratory

option a: Screw-retained final restorationDirectly proceed to Step 4 – The use of transfer aids.

option b: cement-retained final restoration p Mount the Straumann® CARES® Variobase™ abutment on the implant analog.

p use standard procedure to fabricate the cement-retained restoration.

p Veneer the structure.

SteP 4 – the uSe of tranSfer aIdSTo ensure correct transfer of the abutment position from the mas-ter cast to the patient, an individual index can be fabricated on the master cast using acrylic. The index is secured with support from the adjacent teeth.

noteThe occlusal screw opening must not be covered with acrylic. Ensure that no acrylic gets into the interior of the abutment, otherwise it might not be possible to loosen the basal screw.

2322

4.2.3 InSertIon (dentISt’S offIce)

SteP 2 – fInal InSertIon

option a: Screw-retained final restoration p Position the sterilized Straumann® CARES® Variobase™ abutment in the implant. Tighten the screw to 35 Ncm using the SCS Screwdriver along with the ratchet and the torque control device.

p Close the SCS screw channel with cotton and sealing compound (i.e. gutta-percha). This allows for later removal of the Straumann® CARES® Variobase™ abutment in case a crown replacement is required.

option b: cement-retained final restoration p Position the sterilized Straumann® CARES® Variobase™ abutment in the implant. Tighten the screw to 35 Ncm using the SCS Screwdriver along with the ratchet and the torque control device.

p Close the SCS screw channel with cotton and sealing compound (i.e. gutta-percha). This allows for later removal of the Straumann® CARES® Variobase™ abutment in case a crown replacement is required.

p Cement the superstructure to the abutment. p Remove excess cement.

The final restoration is fixed on the master cast before it is deliv-ered to the doctor’s office.

SteP 1 – PreParatIon p Remove the healing cap or temporary restoration. p Remove the superstructure from the master cast and unscrew the abutment from the analog.

p Clean and dry the interior of the implant and the abutment thoroughly.

note p Always ensure that surfaces of threads and screw heads are clean and that a new screw is used for the final restoration.

p Straumann® CARES® Variobase™ abutments, zerion® can be sterilized with moist heat (134°C/273°F, 5 min).

4.3 reStoratIon: careS® VarIobaSe™ coPInG

Intended uSe p Screw-retained or cement-retained crowns on competitor abutments p Cement-retained bridges (via mesostructure) on competitor abutments

materIal p zerion® (zirconium dioxide) p polycon® ae (PMMA)

contraIndIcatIon p Allergies or hypersensitivity to chemical ingredients of the zirconium dioxide material (zirconium dioxide (ZrO2), yttrium oxide (Y2O3), hafnium dioxide (HfO2), aluminum oxide (Al2O3), titanium alloy (Ti6Al7Nb titanium, aluminum, niobium or TAN) or PMMA (polymethyl methacrylate).

characterIStIcS p zerion® and polycon® ae are available in various tooth shades p Customized shape and emergence profile p Straumann precision fit of coping to bonding base

Polycon® ae copings are intended for a usage of up to 180 days.

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Only use bonding bases or abutments of original implant system manufacturers and follow the corresponding instructions for use. Protect the abutment connection with a polishing aid during sandblasting. use scan spray or sandblast the abutment surface with aluminum oxide (50 µm with max. 2 bar) to ensure proper digitization of the bonding base.

SteP 2 – deSIGnInG wIth careS® VISualRegister the wax-up sleeve holder in the CARES® Visual software and then design the restoration according to the Straumann® CARES® Visual – Software Manual. Or you can also watch the CARES® Tutorial videos online for further guidance. www.straumann-cares-digital-solutions.com > myStraumannCARESDesktop > Products & Service > Education

noteScrew hole diameters for Straumann® Variobase™ Abutments are:NNC = 2.2 mm, RN = 2.75 mm, WN = 2.75 mm, NC = 2.2 mm, RC = 2.3 mm

4.3.2 fInIShInG (Straumann® careS® abutmentS – comPletIon at the dental laboratory)

Please follow steps described in chapter 4.2.2.

4.4 reStoratIon: careS® Screw-retaIned brIdGeS and barS (Srbb1)

Intended uSe Straumann® CARES® SRBB are prosthetic mesostructures directly screwed to the endos-seous dental implant intended as an aid in prosthetic rehabilitations for multiple tooth replacement or fully edentulous patients.

materIal p Titanium grade 4 p Cobalt-chromium alloy (coron®)

contraIndIcatIonAllergies or hypersensitivity to chemical ingredients of the following materials used: coron® (cobalt-chromium alloy): cobalt (Co), chromium (Cr), tungsten (W), silicon (Si), manganese (Mn), niobium (Nb), commercially pure titanium grade 4 (Ti)TAN (titanium alloy Ti-6Al-7Nb): titanium (Ti), aluminum (Al), niobium (Nb).



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note p The Straumann® Repositionable Implant Analogs are not intended to be used for Straumann® CARES® SRBB. Please consider the model preparation instructions described in chapter 3.1. Straumann may return the order if the requirements are not fulfilled.

p The screws delivered together with the CARES® SRBB are meant for use in the pa-tient’s mouth. For additional screws in case of loss or for use in the lab, only use the screws listed in the chart above.

characterIStIcS

Straumann® careS® Srbb conditions

careS® Srbb are available on following Straumann® Implants

Implant divergence compensation between any two implants Screws for Straumann®

careS® SrbbOnly Tl Only Bl Mixed Tl and Bl

Straumann® Soft Tissue level implants

Regular Neck (RN)36° –

24°

synOcta® Basal screw 048.356

Wide Neck (WN)

Straumann® Bone level implants

Regular CrossFit® (RC)– 24°

NC / RC SRBB Bl screw 025.2926

Narrow CrossFit® (NC)

4.4.1 Straumann careS® Screw-retaIned brIdGe

Intended uSeStraumann® CARES® screw-retained bridge is a framework which is intended for direct veneering with appropriate techniques in dental technology or for wrapping with acryl-ics in combination with pre-fabricated teeth, to treat partially or fully edentulous cases.

characterIStIcS p 2 to 16 units p Placement on 2 to 16 implants

– Straumann Soft Tissue level (RN, WN), Bone level (NC, RC) and Bl / Tl mixed implant platforms

p Maximum number of anterior pontics: 4 (only possible between the canines)

p Maximum number of posterior pontics: 3 p Maximum number of free-ends: 1 per end p Straumann Guarantee for Straumann® CARES® screw-retained bridges and bars

noteFor 4 pontic span bridges more than two NC implants are required.

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4.4.1.1 deSIGnInG: careS® workflow


noteFor optimal esthetic planning, especially in the labial region, model a fully anatomic wax-up and confirm the size and position intraorally. The wax-up can be scanned and used as reference when designing the restoration in CARES® Visual.


SteP 3 – order ProceSS for careS® SrbbOrder the restoration according to the process described in the brochure Straumann® CARES® Screw-retained Bridge and CARES® Bar – Service and Process.

4.4.1.2 fInIShInG

SteP 1Delivery of the bridge and screws for use in the patient’s mouth from Straumann: use the included patient label for patient re-cords in the laboratory. The bridge can be directly placed on the implant analogs and implants, no additional processing, grinding or adjustments is needed.

SteP 2Check the tension-free fit on the master cast (e.g. Sheffield test) and also check the occlusal situation with an antagonist model.

SteP 3 (oPtIonal)To further check the fit, send the bridge to the dentist for an ad-ditional try-on in the patient’s mouth. Make sure the screws used are not damaged. Insert the screws with the SCS Screwdriver. The friction fit secures the screws to the instrument during inser-tion and ensures safe handling.

SteP 4Prepare and process the bridge according to the instructions from the manufacturer of the veneering material.

SteP 5use appropriate veneering techniques of dental technology to veneer the framework. Be sure to follow the instructions for use of the veneering material of your choice, which must be appro-priate for the framework material.

noteConsider anatomical guidelines when veneering. The “freedom in centric” concept should be used for the occlusion.

SteP 6Send the master cast, the bridge together with new screws, the IFu leaflet and patient labels to the restorativedentist.

noteThe IFu must be sent together with the restoration to the dentist.

1

2

3

5

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4.4.1.3 InSertIon (dentISt’S offIce)

The final restoration is fixed on the master cast before it is de-livered to the dentist’s office together with new screws, IFu and patient labels.

SteP 1Remove the healing abutment or temporary restoration.

SteP 2Clean and dry the interior of the implants. Ensure that the screws and the bridgework are cleaned thoroughly before insertion (cleaning, disinfection and sterilization according to the bro-chure Guideline for Cleaning, Disinfection and Sterilization.

SteP 3Check the fit of the bridge before fixing it in the patient’s mouth. Do not attach the bridge if the fit appears to be unsatisfactory (e.g. when performing a Sheffield test).

SteP 4Position the cleaned bridge on the implants and insert the screws. Tighten the screws to 35 Ncm using the SCS Screw-driver with the ratchet and the torque control device.

noteThe friction fit secures the screws to the instrument during inser-tion and ensures a safe handling.

SteP 5Close the screw channels with cotton and sealing compound (e.g. gutta-percha or composite). This allows a later removal of the bridge if maintenance is needed.

SteP 6Polish the filling material.

noteIf additional screws are needed, consult the table “CARES® SRBB conditions” in chapter 4.4 for the corresponding article numbers.

4.4.2 careS® barS

Intended uSeStraumann® CARES® bars are retentive elements to be combined with an overdenture to treat edentulous cases.

characterIStIcS p Placement on 2 to 10 implants

– Straumann Soft Tissue level (RN, WN), Bone level (NC, RC) and Bl / Tl mixed implant

p Free-end extensions possible p large bar design variety:

– Dolder® u-shape (regular and mini) – Dolder® egg-shape (regular and mini) – Dolder® mix (e.g. egg-shaped anterior,

u-shaped free-end extensions) – MP-Clip® Bar – Ackermann-Bar®

– Round Bar p Straumann Guarantee for Straumann® CARES® screw-retained bridges and bars

3332

bar PoSItIonInGTo ensure optimal force distribution, position the bar in parallel to the occlusal plane and place it physiologically optimal over the alveolar ridge. Consider the path of inser-tion of the coverdenture when designing the bar. To avoid horizontal forces, design the bar in parallel to the occlusal plane. (Wirz, 1994)1

4.4.2.1 deSIGnInG: careS® workflow


noteFor optimal esthetic planning of the bar, make a setup of the overdenture in wax and check its fit intraorally. The setup can be scanned and used as reference when design-ing the bar in CARES® Visual.


SteP 3 – order ProceSS for careS® SrbbOrder the restoration according to the process described in the brochure Straumann®

CARES® Screw-retained Bridge and CARES® Bar – Service and Process.

dolder® u-shape bar dolder® egg-shape bar

p u-shaped cross section p Rigid and stable combination of bar and matrix

p Egg-shaped cross section p Vertical translation and rotation possible

ackermann-bar® round bar mP-clip® bar

p Round-section bar p 2 rider concepts for space saving mounting p Bar diameter 1.8 mm

p Round-section bar p Bar diameter 1.9 mm

p Economical alternative to prefabricated metal matrixes

p Retention intensity can easily be adjusted by exchanging the retention inserts

p Bar diameter 1.8 mm

1 Jager, K., Wirz J. unterkiefer-Hybridprothesen mir vier Implantaten. Eine In-vitro-Spannungs-analyse. Schweiz. Monatsschr. Zahnmed., 104, 1489-1494 (1994).

Straumann® careS® barS PortfolIo

3534

4.4.2.2 fInIShInG

SteP 1Delivery of the bridge and screws for use in the patient’s mouth from Straumann: use the included patient label for patient re-cords in the laboratory. The bar can be directly placed on the implant analogs and implants, no additional processing, grind-ing or adjustments is needed.

noteBe advised that changing the shape or the cross section of the bar might have a negative impact on the fit of the matrices on the bars. Do not alter/weaken the connection interface be-tween bar and bar copings.

SteP 2 Check the tension-free fit on the master cast (e.g. Sheffield test).

SteP 3 (oPtIonal)To further check the tension-free fit, send the bar to the dentist for an additional try-on in the patient’s mouth. Make sure the screws used are not damaged. Insert the screws with the SCS Screwdriver. The friction fit secures the screws to the instrument during insertion and ensures safe handling.

SteP 4Fabricate the final prosthesis and fixate the matrices according to the instructions on the following page. For optimal fit and best performance of the Straumann® CARES® bar, it is recommended to combine the device only with the corresponding original matrices of the CARES® System.

mP-clIP® bar p Attach the spacer with the sleeve on the bar and make sure that it fits perfectly. p Cut the sleeve back according to the height of the bar and block out the space between the sleeve and gingiva as well as the implant caps with wax.

p Finalize the denture according to the standard dental technique. Remove the bar from the denture and strip the spacer from the sleeve. use the insert positioner to place the retention insert in the metal sleeve.

ackermann®, dolder® and round bar matrIxAckermann®: use the Ackermann® Bar Matrix A in the posterior and Matrix B in the anterior region. Dolder® Bar: Shorten the matrix according to the length of the bar. To ensure a secure fixation in the denture, the matrix should be at least 5 mm long.Ackermann®, Dolder® and Round Bar: Place the matrix on the bar. Place the accord-ing spacer between the bar and the matrix during polymerization. Ackermann® and Round Bar: To prevent the matrices from premature wear and to achieve a consistent insertion axis of the denture, position the matrices in parallel to each other (Fig. 1). Block out the space between matrix / bar and gingiva as well as the implant caps with wax (Fig. 2). Ensure that the lamellae of the matrix is blocked out adequately to enable deflection when the denture is inserted or removed. Dolder® Bar: Block out half of the height of the Dolder® Matrix (Fig. 3).Ackermann®, Dolder® and Round Bar: Finalize the denture according to the standard dental technique.

noteTo avoid unwanted loading of the implants during chewing, always use the according spacer between the bar and the matrix when polymerizing. This also ensures the verti-cal translation of the prosthesis to the bar.

VaryInG the retentIon force of the bar matrIxOnly the appropriate activator/deactivator may be used for activating/deactivating the bar matrix.

p To activate the matrix, press its walls together with the activator. p To deactivate the matrix, push its walls apart with the deactivator.

SteP 5Send the master cast, the bar, the prosthesis, new screws, the IFu and the patient labels to the restorative dentist.

noteThe IFu must be sent together with the restoration to the dentist.

2

3

1

1

3736

4.4.2.3 InSertIon (dentISt’S offIce)

The final restoration is fixed on the master cast before it is de-livered to the dentist’s office together with new screws, IFu and patient labels.

SteP 1Remove the temporary restoration.

SteP 2Clean and dry the interior of the implants. Ensure that the screws and the bar are cleaned thoroughly before insertion (cleaning, disinfection and sterilization according the brochure Guideline for Cleaning, Disinfection and Sterilization.

SteP 3Check the fit of the bar before fixing it in the patient’s mouth. Do not attach the bar if the fit appears to be unsatisfactory (e.g. when performing a Sheffield test).

SteP 4Position the cleaned bar on the implants and insert the patient screws. Tighten the screws to 35 Ncm using the SCS Screw-driver with the ratchet and the torque control device.

noteThe friction fit secures the screws to the instrument during inser-tion and ensure safe handling. If additional screws are needed, consult the table “Straumann® CARES® SRBB conditions” in chapter 4.4 for the according article numbers.

SteP 5Attach the final prosthesis.

5. AuXIlIARIES AND INSTRuMENTS

5.1 ScS ScrewdrIVerS

5.2 ratchet

5.3 PolIShInG aIdS and analoG holder

art. no. article dimensions material

046.400SCS Screwdriver for ratchet, extra short

length 15 mm Cronidur® 30

046.401SCS Screwdriver for ratchet, short


046.402SCS Screwdriver for ratchet, long



046.119Ratchet includes service instrument

length 84 mm Stainless steel


046.245Polishing protector for RN synOcta® Copings, transocclusal screw-retained


025.2920 025.2920-04

NC Polishing aid length 16 mm Stainless steel

025.4920 025.4920-04

RC Polishing aid length 16 mm Stainless steel

046.239 Analog holder length 105 mm Al/Steel

3938

5.4 auxIlIarIeS for bar matrIceS

5.5 wax-uP kItS


046.150Activator set for all bar matrices, three-part


046.151Deactivator for Dolder® Bar matrices, mini

length 66 mm Grilon BS/Brass

046.152Deactivator for Dolder® Bar matrices, regular

length 66 mm Grilon BS/Brass


019.0063

Straumann® CARES® Wax-up kit contains wax-up sleeve holders for Strau-mann® Dental restorations on Straumann® Implant

019.0050

Straumann® CARES® Wax-up kit for Camlog® contains wax-up sleeve holders for Straumann® Dental restorations on Camlog® Implants

019.0051

Straumann® CARES® Wax-up kit for NobelReplace™ contains wax-up sleeve holders for Straumann® Dental restorations on NobelReplace™ Implants

6. APPENDIX

6.1 related documentatIon

p Basic Procedure Straumann® CARES® System p Instructions for use Straumann® CARES® Mono Scanbody p Instructions for use for Straumann® Scanbody p Basic Informationon Straumann® CARES® Tooth-borne Prosthetic Procedures p Basic Information on the Surgical Procedures – Straumann® Dental Implant System p Guideline for Cleaning, Disinfection and Sterilization p Straumann® CARES® System p Basic Procedure Straumann® CARES® System p Straumann® CARES® Visual Software Manual p Straumann® CARES® Screw-retained Bridge and CARES® Bar – Service and Process p The Way to Straumann® CARES® Abutments p Straumann® CARES® Scan & Shape Process Guide p iTero™ Intra-Oral Scanner for Digital Impressions p www.straumann-cares-digital-solutions.com > myStraumannCARESDesktop > Products & Service > Education

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7. IMPORTANT GuIDElINES

Please notePractitioners must have appropriate knowledge and instruction in the handling of the Straumann CADCAM products or other Straumann products (“Straumann Products”) for using the Straumann Products safely and properly in accordance with the instructions for use.

The Straumann Product must be used in accordance with the instructions for use provided by the manufacturer. It is the practitioner’s responsibility to use the device in accordance with these instructions for use and to determine, if the device fits to the individual patient situation.

The Straumann Products are part of an overall concept and must be used only in conjunction with the corresponding original components and instruments distributed by Institut Straumann AG, its ultimate parent company and all affiliates or subsidiaries of such parent company (“Straumann”), except if stated otherwise in this document or in the instructions for use for the respective Straumann Product. If use of products made by third parties is not recommended by Straumann in this document or in the respective instructions for use, any such use will void any warranty or other obligation, express or implied, of Straumann.

AvailabilitySome of the Straumann Products listed in this document may not be available in all countries.

Caution In addition to the caution notes in this document, our products must be secured against aspiration when used intraorally.

ValidityUpon publication of this document, all previous versions are superseded.

Documentation For detailed instructions on the Straumann Products contact your Straumann representative.

Copyright and trademarksStraumann® documents may not be reprinted or published, in whole or in part, without the written authorization of Straumann. Straumann® and/or other trademarks and logos from Straumann® mentioned herein are the trademarks or registered trademarks of Straumann Holding AG and/or its affiliates.

Explanation of the symbols on labels and instruction leaflets

IMPorTAnT GUIDELInES

Batch code

Catalogue number

Sterilized using irradiation

…min.

Lower limit of temperature

…max.

Upper limit of temperature

…max.

…min.

Temperature limitation

Caution: Federal law restricts this device to sale by or on the order of a dental professional.

Do not re-use

non-sterile

Caution, consult accompanying documents

Use by

Keep away from sunlight

Straumann Products with the CE mark fulfill the requirements of the Medical Devices Directive 93/42 EEC

0123

Consult instructions for use

NOTES

BAR Trademarks C+M:

Dolder® is a registered trademark from Prof. Eugen Dolder, former

director, School of Dentistry of Zürich

Ackermann-Bar® is a registered trademark of Cendres+Métaux Hold-

ing SA, Switzerland.

MP-Clip® is a registered trademark of Cendres+Métaux Holding SA,

Switzerland.

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International headquartersInstitut Straumann AG Peter Merian-Weg 12CH-4002 Basel, SwitzerlandPhone +41 (0)61 965 11 11Fax +41 (0)61 965 11 01

www.straumann.comSt

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CE

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Dolder® is a registered trademark from Prof. Eugen Dolder, former director, School of Dentistry of ZürichAckermann-Bar® is a registered trademark of Cendres + Métaux Holding SA, Switzerland.MP-Clip® is a registered trademark of Cendres + Métaux Holding SA, Switzerland.

© Institut Straumann AG, 2013. All rights reserved. Straumann® and/or other trademarks and logos from Straumann® mentioned herein are the trademarks or registered trademarks of Straumann Holding AG and/or its affiliates. All rights reserved.

Documents

BASIC INFORMATION ON THE - Straumann · General InformatIon 3 2.1 ®Restorative options with the Straumann ... The Straumann ® CARES Wax-up kit includes all wax-up sleeve holders