[1]

CERAMIC AND

IMPLANT DESIGN

November 2009

DISCOVER ATLANTIS™ ABUTMENTSAre you looking for the best solution for cement-retained implant prosthetics? Atlantis™ patient specific abutments are the answer. By utilising the unique Atlantis VAD™ (Virtual Abutment Design) software, the abutments are individually designed from the final tooth shape. The result is an abutment with outstanding function and esthetics. • Outstanding function and esthetics –

as close to natural prepped teeth as you can get.

• Available in zirconia, titanium and GoldHue titanium.

• Platform independent so they will work with the majority of systems on the market.

Atlantis was launched at the recent AOS conference at the Friday Breakfast session by Jim Sheridan MD, of Astra Tech Australia. Mark Cotter and Dr David Roberts presented their experience with the system from laboratory and clinical perspectives. Many new features which set Atlantis apart from all other systems were presented. This included the guarantee which not only covers the abutment but also the fixture, no matter the implant system used, the fact that a 45º cut off angle, from the fixture, is no longer an issue and the unique Virtual Abutment Design or “Crown Down” (as Dr Roberts described it) where a virtual tooth is placed in the implant space and the abutment is designed according to this ensuring the best emergence profile and the most aesthetic result!

During the pre-release of the Atlantis abutments, we found them to be very accommodating to all angulations and pos i t ions. As one o f our c l ients commented ‘if they are always this good then I can’t see myself using any other system!’ In all of these pre-release cases we cemented Lava Zirconia or PFG crowns over them. The system does not yet allow us to add support to the abutment so we can directly bond porcelain to them, in the case of zirconia. This will be available in the near future.Available in the traditional titanium and zirconia which are offered by so many others. The Atlantis is also available in GoldHue, a titanium nitrate coating giving it a gold colour and thus giving us the advantage of warmth under the tissues, reducing the ‘greying’ and offering all the strength of titanium.While the majority of implants we restored were Astra Tech, we also restored some complicated 3I and Nobel Replace cases with abutments not available elsewhere. Atlantis Patient Specific Abutments are available for many of the major implant systems on the market today and this portfolio continues to grow. Included with this newsletter is the range of systems and platforms currently available.

Please see over for case presentations.

‘if they are always this good, i can’t

imagine using any other system’

Φ

Welcome to the second edition of the CID Newsletter. From the feedback received, I have made some alterations and included more up to date topics from the dental world this year. As I said in the first edition I welcome your feedback not on ly for th is newsletter but also so we can continue to improve our service to you generally.

In this edition we will “Discover A t l a n t i s ” p a t i e n t s p e c i f i c abutments - the abutment system for all implant systems, launched at the AOS Conference earlier this month. We will overview the AOS Conference and EAO 2009 held in September, Christmas closing times amongst some other items.

I hope you enjoy this edition of CID News, and as usual if you have any other ideas or questions p lease contact the Lab on 92519251

Mark Cotter

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Case 1:

In this case Teeth 11 & 21 were lost due to periodontal disease. 11 & 21 replaced with Astra 4.5mm implants and restored with Atlantis 4.5/5mm Zr abutments and LAVA™ Zr crowns. In addition to this, the 15, 25 and 35 were replaced with screw retained PFG implant crowns using Astra CastDesign abutments. A gold onlay was placed on the 46.

Implant Surgeon - Dr Alistair Stevenson Prosthodontist - Dr Jim IronsideTechnician - Mr Mark Cotter

If you require more information about Atlantis abutments please contact the Lab on 02 92519251.

Case 2:

Here a baby tooth stayed in place 12 years after it was supposed to fall out. The underlying eye tooth was impacted and had to be extracted. An implant was used to support a LAVA™ zirconia crown. Careful implant placement, abutment selection and crown construction resulted in an undetectable restoration.

Implant Surgeon - Dr Luke VillataProsthodontist - Dr Stephen TravisTechnician - Mr Mark Cotter

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Manufacturer Implant Screwdriver type

Astra Tech InternalOsseoSpeed 3.0 - YellowOsseoSpeed 3.5, 4.0 - AquaOsseoSpeed 4.5, 5.0 - LilacOsseoSpeed 4.0 - Blue (Previous)

xxxx

xxxx

xx

xx

0.050” Hex screwdriver

BioHorizons InternalInternal 3.5, 4.5, 5.7ExternalExternal Implant 3.5External Implant 4.0, 5.0

x

xx

x

xx

x

x

x

x

1.25 mm Hex screwdriver

0.050” Hex screwdriver

Biomet 3i InternalCertain 3.25, 4.0, 5.0, 6.0 Certain Prevail 3/4/3, 4/5/4, 5/6/5Certain Prevail 4/3, 5/4, 6/5Certain XP 4/5, 5/6ExternalMicroMiniplant 3.25/3.4 Miniplant 3.25 3.75, 4.0 Standard 5.0, 6.0 WideOsseotite XP 3/4 Expanded Platform MiniplantOsseotite XP 4/5, 5/6 Expanded Platform

xxxx

xxxxxx

xxxx

xxxxxx

xxxx

xxxxx

xxxx

xxxxx

0.048” Hex screwdriver

0.048” Hex screwdriver

Keystone Dental ExternalRestore Small Diameter 3.3, 3.4Restore Regular Diameter 3.75, 4.0Restore Wide Diameter 5.0, 5.5, 6.0

xxx

xxx

x x0.050” Hex screwdriver

Nobel Biocare InternalNobelReplace NP 3.5NobelReplace RP 4NobelReplace WP 5NobelReplace 6

ExternalBrånemark System NP 3.3 Brånemark System RP 3.75, 4.0 Brånemark System WP 5.0, 5.5

SteriOss Replace 3.1, 3.5, 4.3, 5.0, 6.0SteriOss HL 3.25, 3.8, 4.5, 5.0, 6.0

xxxx

xxx

xx

xxxx

xxx

xx

xxxx

xx

xxxx

xx

Nobel Biocare Unigrip

Nobel Biocare Unigrip

0.050” Hex screwdriver

Straumann InternalStandard/Standard Plus 4.8 RN (Regular Neck)Bone Level 3.3 NC (Narrow CrossFit )Bone Level 4.1, 4.8 RC (Regular CrossFit )

ExternalStandard Plus 3.3 NN (Narrow Neck)

xxx

x

xxx

x

x x

Straumann screwdriver compatible

Straumann screwdriver compatible

Sybron Implant Solutions

ExternalEndopore External Hex Connection 3.5, 4.1, 5.0Entegra External Hex Connection 3.5, 4.1, 5.0

xx

xx

0.050” Hex screwdriver

Zimmer Dental InternalTapered Screw-Vent 3.5, 4.5, 5.7SwissPlus 4.8

xx

xx

x x 1.25 mm Hex screwdriver

Tita

nium

Gol

d-sh

aded

titan

ium

Zirc

onia

—sh

aded

Zirc

onia

—w

hite

Implant compatibility chart

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European Association of Osseointergration - 18th Annual Scientific MeetingIn late September Mark headed to France and the EAO meeting in

Monaco. The conference took place from 30th September to 3rd

October. The main reason for Mark to attend was to meet with

representatives of Astra Tech, go over the current position of

the Atlantis Abutment and the progress in Europe and the

USA. With the launch of the system in Australia at AOS it

was important to be completely up-to-date with how the

system was being accepted in Europe and also to highlight

some of the issues which have come to light during the pre-

release phase in Australia.

With so many great and respected presenters to see, it was an

inspiring conference, with only approximately 10 attending from

Australia, Mark being the only technician. “It was great to be part of a

conference which presented so many highlights” Mark said.

Many new concepts were discussed with just as many tried and

tested techniques. Comments or statements such as “ load vs

resistance” remind us we have to respect the natural biology and not

push too hard to get a result at the cost of other complications. It was

demonstrated that whilst peri-implantitis is still a major issue, we will

have to deal with it a lot more into the future. The forces in regards to

overloading of implants still need to be considered, as this still causes

many implants to be lost.

This was covered in many of the presentations but in particular

the presentation on Friday 2nd October by Franck Renouard of France.

His presentation ‘Prosthetic complications: biomechanical

considerations’ was a particularly interesting one. Dr Renouard

highlighted the concept of Load vs Resistance and how this can affect

successful implant treatment. He showed in a very easy to understand

way how load related to occlusal forces and how resistance to these

forces is affected by the number of implants, the position of them, the

bone type and the type and length of the implants.

For Mark the highlight was the satellite industry symposia

held on the Friday night, hosted by Astra Tech. This

event titled ‘A Good Evening with Astra Tech - The

prerequisites for implant treatment success’ covered

the topics ‘management of soft and hard tissues in the

aesthetic zone’, ‘Atlantis - Functional aesthetics through

patient specific solutions’, ‘Prevention of biological

complications in implant therapy’ and ‘Success and Failure of

oral implants with particular reference to marginal bone loss’. All these

presentations were of great interest but the last two presented by Prof

Tord Berglundh and Prof Tomas Albrektsson respectively were fantastic,

both presenters coming from opposing stand points and driving their

points home to leave the audience with a lot of thinking to do. The

evening was wrapped up by a closing discussion between Moderator

Prof Jan Lindhe and Prof Tomas Albrektsson, where again the common

theme from these two great thinkers, one with a periodontal

background and one with a bio-materials background was to perhaps

to agree to disagree, as they have done so many times before.

All in all, the 2009 EAO Conference was excellent, with so many of

the great thinkers and researchers of the dental industry present in one

place, all expressing their own views based on research. It made you

walk away not only thinking but also knowing that by not knowing all

the answers now it makes us all strive to find out more and therefore

obtain better results.

Think!!

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Australian Osseointergration Society 7th Biennial Conference - Gold CoastFrom the 4th - 7th November, we closed the Lab and headed to

the ASO Conference at the Gold Coast Convention Centre. With so

many interesting topics covered from the most advanced maxilo-facial

surgery to general lab processes, there was indeed something for all.

We attended the pre conference work shop put on by Biomet

3i ‘New Technologies vs. Old Techniques’, and it was a great

opening to the Conference. It highlighted many of the things

we now take for granted and showed how things have

improved over time with better knowledge and techniques.

The opening session was chaired by Saso Ivanovski

and the presentations from both Prof. Jan Lindhe and Prof.

Joseph Kan were very thought provoking and set the scene for

a challenging conference where not all agreed but all presented

valid points, concerns and techniques for obtaining the very best

results. We believe, by being pushed to ‘think’ by others, we all improve

our methods and give our patients a better result.

A highlight for all of us was the launch of Atlantis - Patient Specific

Abutments, at the breakfast session on Friday morning, introduced by

Jim Sheridan and then presented from a technical and clinical

perspective by Mark Cotter and David Roberts.

Another highlight was the presentation ‘Platform Shifting: Science

vs Hype’ moderated by Dr Tony Rotondo and with Panelists Dr Michael

Norton, Prof Joseph Kan and Dr Ueli Grunder. Opinions were

challenged and points of view were very strongly put! What was the

consensus? Well generally we still have a lot to learn, but it is

not any one factor which leads to retention of bone, but

rather a number of factors, including platform shifting,

surface technology, micro leakage and bio-mechanics

that combine to give us the best chance of optimum

healing and osseointergration.

The closing session was again very interesting with Dr

Norton, Prof Lindhe, Prof Kan and Prof Niklaus Lang,

covering most of what had been presented over the preceding

4 days and once again thinking outside the normal constraints and

driving for better techniques and results for all.

I hope all who attended enjoyed it as much as we did, and also

had some time to enjoy the Gold Coast and the social events. As the

saying goes “what go on tour, stays on tour!”

For those who couldn’t make it I look forward to seeing you over

the coming months and sharing what we learnt.

“Platform Switching - Science vs

Hype”

AOS CONFERENCE

STAYING BETWEEN THE FLAGS

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In September we assisted in the first of what is likely to become many education programs in Fiji

From the 16th to the 20th of September this year Matt attended the Fiji School of Medicine - Oral Health Department, for an education program which proved to be both a giving and learning process. In early September, Ceramic and Implant Design was contacted by the Fiji School of Medicine and Dr Geoffrey Borlase to attend the Dental School and assist in the training and education of both the dental students and the technicians.

We accepted the offer and on Wednesday 16th September Matt flew to Fiji, on what was a learning experience for all. We forget, or at least take for granted, how good the system in Australia is and going to places like Fiji not only prove this but also make us want to do more to improve our skills as dental technicians.

With 20 dental students and only two technicians to do all of the work things are on a different time frame in Fiji. Jobs basically get delivered to the patient when the work is done. this can mean a single unit PFM can take up to

five weeks to be cemented. The majority of work done by the dental students and dentists at the Dental School still consists of extractions and both partial and full dentures. They also do a number of full gold crowns and some PFM work.

The main focus was to both assist and train the technicians in the production of crown and bridge work. Their denture work is fairly good and whilst they have been producing crown and bridge work for some time, the assistance they received from Matt was greatly appreciated. Matt not only showed them the skills but also offered suggestions on how to arrange and organize the lab to ensure the flow of work is done more efficiently. Matt said “their enthusiasm is inspiring, but without some of the basic items such as job boxes things just get lost or mixed up. They have some new equipment but are still using some very old products including VMK95!” While the experience was a challenge, “Iʼd definitely like to go back to help them again” Matt said. “Next time Iʼll take more things with me to assist them. Theyʼre really up against it in Fiji, but they are good people trying to help their community and if we can make it easier for them, then they can help more people”.

GIVING AND LEARNING

IN FIJI

C.I.D ANNUAL SKI TRIP

As part of our commitment to

delivering the quality you all expect, we

believe it is beneficial to have a good

working relationship and a happy working

environment. As part of this, we try to

spend some time outside the Lab enjoying

other activities and building the friendly

environment which contributes to this.

In late July we all headed to Thredbo

to spend the weekend socialising and

enjoying the mountains. This is the third

year we have travelled and whilst we all ski

at different levels it is a great way to get

out of the Lab but still discuss and look at

ways we might be able to improve the

service we are all committed to.

Going in with the North Bondi SLSC

annual ski trip, we were ensured a good

weekend with

65 others

filling the

House of

U l l r i n

Thredbo.

Seasons Greetings!!We would like to thank you for supporting Ceramic and Implant Design during 2009.

We have now been in the Bridge Street Lab for one year and hope it has been convenient for both you and your patients. From the feed back received it has been a positive move.

We wish you a happy, safe and prosperous Christmas and New Year and look forward to even bigger things in 2010

The Lab will be closed from 12pm Wednesday 23 Dec and reopen on Monday 11 Jan 2010

Cresco™ As one of only two Cresco™ Precision Laboratories in

Australia we offer you not only the unique ability to straighten

angulations, ensuring you get the best angle for screw access, but

also a passive fit.

With the unique Cresco™ precision method we can offer

optimal screw-retained bridges with perfect fit every time, available

for all implant systems and offering us the ability to use different

alloys for our frameworks (titanium, precious and non-precious

alloys)

The Cresco API™ Kit is a simple yet revolutionary concept that

helps streamline the process. Everything needed to carry out the complete

prosthetic solution comes in one standardized kit per implant. This helps to reduce

stock and simplifies the ordering procedure.

For those of you who have used this system you know how easy it is, and for those

who haven’t please let us know if you would like more information. It is really a completely

unique system offering yet another option to

obtain the best result. Whilst not always possible

to use Cresco™ it offers another ‘string to our

bow’ to ensure your patients are getting the best

option for their individual case.

ΦCERAMIC AND

IMPLANT DESIGN

Lava™ Authentication CertificatesFrom mid-November you will all be receiving one of the certificates below. The idea from which authentication comes from is primarily a U.S decision. There was a problem in their marketplace where substitution was taking place and dentists werenʼt getting what they paid for. So along with your warranty cards you will also receive one of these so you know we are producing genuine LAVA™. We have requested the 2 certificates be made one but for now you can be assured that Ceramic and Implant Design is providing you with genuine Lava™ Crowns and Bridges and that 3M and Lava are taking steps to ensure the quality remains

PATIENT NAME