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4. 6.

Step-by-Step Step-by-Step

Cemented Cemented Bridge Bridge Using CPK Abutments Using Abutments Internal InternalHex. Hex.Implant ImplantSystem System


Š MIS Corporation. All rights reserved.

MIS reserves the right to modify the products described in this manual as well as to revise this publication at any time and without informing any person of such revision or change. All rights reserved. No part of this publication may be reproduced, transcribed, stored in an electronic retrieval system translated to any language or computer language, or be transmitted in any form whatsoever without the written consent of the publisher.

Note: This guide is specified for educational use only.


ÂŽ

Committed to your success, MIS provides comprehensive product information, manuals and training courses. The following step-by-step guide aims to guide you through the fabrication of fixed multiple unit restorations for internal hexagon implants using MIS’ Complete Prosthetic Kit.

Contact us at: service@mis-implants.com or visit: www.mis-implants.com.


A Cemented Bridge on Multiple Implants The fabrication of an implant-retained cemented bridge is a staged process. The secure placement of a bridge may be obtained either by using screws or by cementation. This guide relates to cemented bridges, specifying each and every stage using a closed tray impression technique. The suggested impression technique and choice of materials should be considered as recommendations only.

The cemented bridge method is characterized by both advantages and weaknesses: Advantages Use of prefabricated abutments ■ Optimal esthetic occlusal surface ■ Reduction of cost and simple laboratory procedures ■ Passive fit is achieved between the bridge and abutments Weaknesses Not suitable for limited interocclusal conditions ■ Cement excess must be totally removed ■ Difficult to remove after cementation ■ Implants must be parallel ■ Prefabricated abutments are not suitable for all clinical conditions. Custom-made abutments are required occasionally

General Information 1. Since the procedure is prosthetic oriented, an initial planning involving all relevant professionals is critical. The dentist performing the prosthetic stage should be an active participant, together with the surgeon, in the decisions affecting the choice of implants, the type of prosthesis (cemented or screw retained) and of the three dimensional positioning of the implants. 2. Parallel insertion and accurate spacing between implants is essential for proper and easy bridge reconstruction.


Restorative Components - Recommended Indications Table

Location

Crown/ Implant Inclination Ratio

Gingival Height

Catalog Number

Abutment description

Anterior Maxilla

Anterior Mandible

Premolars and Molars

Canine, Premolars and Molars

15° or 25°

15° or 25°

Up to 2.5°

Up to 3.5°

Up to 2mm buccal Up to 4mm palatal

Up to 4mm buccal Up to 6mm palatal

Adjustable, based on abutment preparation

Up to 2mm buccal Up to 4mm lingual/palatal

Up to 2mm buccal Up to 6mm lingual/palatal

Adjustable, based on abutment preparation

Adjustable, based on abutment preparation

MD-A1510 MD-A2510

MD-P1530 MD-P2530

MD-CTP10

MD-CR010

MD-A0010 MD-P0030

MD-MAC10 MD-WMAC1

Esthetic angulated abutment

Esthetic angulated abutment

Conical post abutment

Zircon - Zro2 esthetic abutment

Esthetic abutment

Standard post abutment

Up to 3.5°

15° or 25°

Up to 4°

Up to 2mm

Up to 2mm buccal Up to 4mm lingual

According to gingival height available in heights of 1,2,3,4mm

MD-MACF1

MD-GPC10 MD-GP010

MD-AN151 MD-AN251

MD-CPK41 MD-CPK42 MD-CPK43 MD-CPK44 MD-CPK61 MD-CPK62

Friction fit post platform switching

Screw-retained gold-plastic abutments

Angulated abutment

Anatomic transgingival abutment

MD-CPK63 MD-CPK64 MD-CPK81 MD-CPK82 MD-CPK83 MD-CPK84


The CPK System (Complete Prosthetic Kit)

MIS’ CPK system is designed for the restoration of a single implant or multiple parallel implants. Comprising ready-made components for the entire cemented restoration procedure, the Complete Prosthetic Kit simplifies impression and transfer

methods. The kit contains all the required restorative components: Abutment, plastic healing cap, two burnout sleeves and an analog. CPK Kits are available in two abutment heights and in a variety of gingival heights.

CPK components (cutaway view)


Anatomic cementing transgingival abutment

Burnout anti-rotation plastic cap

MD-CPK61

MD-ICH40

Burnout plastic cap

Abutment analog MD-RSM60

Impression coping plastic cap MD-IC800

Plastic healing cap MM-CHC60

MD-IC040


MK-NPK41

Kit options table

NARROW PLATFORM

Option

1.

MN-CPK41

MN-RSM40

MN-CHC40

MN-ICH40

MN-IC040

MN-IC600

MK-NPK61

Option

2.

MN-CPK61

MN -RSM60

MN-CHC60

MN-ICH40

MN-IC040

MN-IC600

MK-NPK42

Option

3.

MN-CPK42

MN-RSM40

MN-CHC40

MN-ICH40

MN-IC040

MN-IC600

MK-NPK62

Option

4.

MN-CPK62

MN-RSM60

MN-CHC60

MN-ICH40

MN-IC040

MN-IC600


MK-NPK43

Option MN-CPK43

MN-RSM40

MN-CHC40

MN-ICH40

MN-IC040

MN-IC600

5. Anatomic transgingival abutment dimensions:

MK-NPK63

4ยบ

Option MN-CPK63

MN-RSM60

MN-CHC60

MN-ICH40

MN-IC040

MN-IC600

6. L= 4,6mm

H=1,2,3,4mm

MK-NPK44

Option MN-CPK44

MN-RSM40

MN-CHC40

MN-ICH40

MN-IC040

MN-IC600

ร˜4mm

7.

2.10

MK-NPK64

Option MN-CPK64

MN-RSM60

MN-CHC60

MN-ICH40

MN-IC040

MN-IC600

8.

L - crown height H - gingival height


MK-CPK41

Kit options table

STANDARD PLATFORM

Option

1.

MD-CPK41

MD-RSM40

MD-CHC40

MD-ICH40

MD-IC040

MD-IC800

MK-CPK61

Option

2.

MD-CPK61

MD-RSM60

MD-CHC60

MD-ICH40

MD-IC040

MD-IC800

MK-CPK81

Option

3.

MD-CPK81

MD-RSM80

MD-CHC80

MD-ICH40

MD-IC040

MD-IC800

MK-CPK42

Option

4.

MD-CPK42

MD-RSM40

MD-CHC40

MD-ICH40

MD-IC040

MD-IC800

MK-CPK62

Option

5.

MD-CPK62

MD-RSM60

MD-CHC60

MD-ICH40

MD-IC040

MD-IC800

MK-CPK82

Option

6.

MD-CPK82

MD-RSM80

MD-CHC80

MD-ICH40

MD-IC040

MD-IC800


MK-CPK43

Option MD-CPK43

MD-RSM40

MD-CHC40

MD-ICH40

MD-IC040

MD-IC800

7.

MK-CPK63

Option MD-CPK63

MD-RSM60

MD-CHC60

MD-ICH40

MD-IC040

MD-IC800

Anatomic transgingival abutment dimensions:

8.

4.8ยบ

MK-CPK83

Option MD-CPK83

MD-RSM80

MD-CHC80

MD-ICH40

MD-IC040

MD-IC800

L= 4,6,8mm

9.

MK-CPK44 H=1,2,3,4mm

Option MD-CPK44

MD-RSM40

MD-CHC40

MD-ICH40

MD-IC040

MD-IC800

10. ร˜4.8mm

MK-CPK64

Option MD-CPK64

MD-RSM60

MD-CHC60

MD-ICH40

MD-IC040

MD-IC800

11.

MK-CPK84

2.45

Option MD-CPK84

MD-RSM80

MD-CHC80

MD-ICH40

MD-IC040

MD-IC800

12.

L - crown height H - gingival height


MK-WPK41

Kit options table

WIDE PLATFORM

Option

1.

MW-CPK41

MW-RSM40

MW-CHC40

MW-ICH40

MW-IC040

MW-IC800

MK-WPK61

Option

2.

MW-CPK61

MW-RSM60

MW-CHC60

MW-ICH40

MW-IC040

MW-IC800

MK-WPK81

Option

3.

MW-CPK81

MW-RSM80

MW-CHC80

MW-ICH40

MW-IC040

MW-IC800

MK-WPK42

Option

4.

MW-CPK42

MW-RSM40

MW-CHC40

MW-ICH40

MW-IC040

MW-IC800

MK-WPK62

Option

5.

MW-CPK62

MW-RSM60

MW-CHC60

MW-ICH40

MW-IC040

MW-IC800

MK-WPK82

Option

6.

MW-CPK82

MW-RSM80

MW-CHC80

MW-ICH40

MW-IC040

MW-IC800


MK-WPK43

Option MW-CPK43

MW-RSM40

MW-CHC40

MW-ICH40

MW-IC040

MW-IC800

7.

MK-WPK63

Option MW-CPK63

MW-RSM60

MW-CHC60

MW-ICH40

MW-IC040

MW-IC800

Anatomic transgingival abutment dimensions:

8.

4.8ยบ

MK-WPK83

Option MW-CPK83

MW-RSM80

MW-CHC80

MW-ICH40

MW-IC040

MW-IC800

L= 4,6,8mm

9.

MK-WPK44 H=1,2,3,4mm

Option MW-CPK44

MW-RSM40

MW-CHC40

MW-ICH40

MW-IC040

MW-IC800

10. ร˜5.5mm

MK-WPK64

Option MW-CPK64

MW-RSM60

MW-CHC60

MW-ICH40

MW-IC040

MW-IC800

11.

MK-WPK84

2.45

Option MW-CPK84

MW-RSM80

MW-CHC80

MW-ICH40

MW-IC040

MW-IC800

12.

L - crown height H - gingival height


Step 1.

A.

B.

Implant exposure

Abutment placement

Components:

Implant MF7-11375

Anatomic cementing transgingival abutment MD-CPK61

Prosthetic screw MD-S0220 Long hex. driver 0.05’’ MT-HDL30

Exposed implants

Based on the loading protocol, remove healing caps to expose the implants.

Placement of anatomic cementing transgingival abutments

Torque wrench MT-RI050

Place anatomic cementing transgingival abutments on the implants according to tissue depth. Abutments are available in four transgingival heights of 1, 2, 3 and 4mm. The anatomic cementing transgingival abutment is attached by screwingon prosthetic screw using a long hex. driver and a torque wrench to tighten the abutment to 30 Ncm afterwards.


Step 1 www.mis-implants.com


Step 2.

A.

B.

Impression coping plastic caps (transfer coping) for closed tray technique

Taking the impression

Indication of the correct location of the impression coping plastic cap on the abutment. The plastic caps should snap into position.

Closed tray impression

For closed tray impression technique, adapt the impression coping plastic caps (MD-IC800) to the anatomic cementing transgingival abutments (MD-CPK61).

For best results, copings must be completely covered by impression material and the tray fully seated. It is recommended to inject low-viscosity impression material into the retention grooves and around the plastic sleeves prior to seating of the tray with a heavier impression material.

Components:

Implant MF7-11375

Anatomic cementing transgingival abutment MD-CPK61

Impression coping plastic cap MD-IC800

To ensure correct placement, the impression copings should be placed so that the groove on top of the plastic sleeve faces the flat surface of the abutment. Correct location is indicated by stable seating of the plastic (snap engagement).


Step 2 www.mis-implants.com


Step 3.

A. (Option A)

B. (Option B)

Plastic healing caps

Connecting standard or anatomic healing caps

Components:

Implant MF7-11375

Anatomic cementing transgingival abutment MD-CPK61 Standard or anatomic healing caps can also be used Plastic healing cap MM-CHC60

Healing cap MH-03375

Plastic healing caps in place

Anatomic Healing cap MH-53375

Long hand screwdriver for 0.05’’ hex. MT-HHR13

After impression taking, three options are available: 1) delivery of a temporary restoration; 2) covering the abutments with plastic healing caps; 3) removing the abutments and replacing them with titanium healing caps. Temporary plastic healing caps (MM-CHC60) can be temporarily cemented to protect the abutments, prevent creeping of the gingiva on top of the abutment margins and, to prevent inconvenience to the patient. This procedure avoids re-seating and retightening of the abutments, as required when using the titanium healing caps.

In order to connect titanium healing caps, it is necessary to remove the anatomic cementing transgingival abutments from the implants. Healing caps are made of titanium alloy and are available in several heights*. Standard and anatomic caps, Ø4mm for standard caps and Ø5.5mm for anatomic caps (SP). The titanium healing caps should extend at least 1mm above the gingiva.

Note: * Narrow Platform: 2,3,4,5,6, 8mm (Anatomic 2,3,4,5,6mm) Standard Platform: 3,4,5, 6mm (Anatomic 3,4,5,6mm) Wide Platform: 3, 4, 5mm (Anatomic 3, 4, 5mm)


Step 3 www.mis-implants.com


Step 4.

A.

B.

Impression evaluation

Abutment analogs

Impression plastic caps

Abutment analogs attached to the impression caps

Components:

Impression coping plastic cap MD-IC800

Abutment analog MD-RSM60

The impression plastic caps are clearly visible in the impression. It is important to confirm proper seating of the impression copings in the impression material. If the copings are not completely stable in the impression, it is recommended that a new impression be taken.

Abutment analogs (MD-RSM60) should be attached to the impression plastic caps. Proper insertion and alignment of the analog in the copings is critical. No gaps or misalignment should be evident (snap engagement).

Note: Please align the flat surface of each abutment analog to the corresponding surface in the impression caps prior to seating of the analog into place.


C.

Step 4

Simulation of gingiva

Use of gingival simulation material

Use gingival simulation material around the neck of the analogs. The material facilitates access to the analogs for laboratory work.

Note: It is recommended to isolate the impression material from the simulated gingiva with a special isolation material, in order to avoid bonding between the two materials.

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Step 5.

A.

Stone model with abutment analogs and simulated gingiva

Components:

Abutment analog MD-RSM60

Stone model with abutment analogs

The final working model is ready for the next step.


Step 5 www.mis-implants.com


Step 6.

A.

B.

Diagnostic wax-up

Silicone index

Components:

Abutment analog MD-RSM60

The diagnostic bridge

A diagnostic wax up is built directly on the analogs.

Silicone index

Prepare an indicative silicone key to be used as a negative replica of the missing teeth.


Step 6 www.mis-implants.com


Step 7.

A.

B.

Burnout plastic caps

Occlusal adjustment of burnout plastic caps

Placement of burnout plastic caps on analogs

Adjustment of burnout plastic caps

Place the burnout plastic caps tightly onto analogs.

Adjust burnout plastic sleeve by simply cutting excess height with a hot surgical blade.

Components:

Abutment analog MD-RSM60

Burnout plastic cap MD-IC040

Optional Burnout anti-rotation plastic cap MD-ICH40

The CPK system includes an anti-rotation burnout plastic cap for single unit cemented restorations.


D.

Verifying spacing

Burnout wax on plastic caps.

Verifying proper space between burnout plastic caps and silicone index.

Block adjusted burnout plastic cap window with burnout wax or burnout resin.

Use the silicone index to verify correct height of the burnout plastic caps.

Step 7

C.

Block burnout plastic cap


Step 8.

A.

B.

Wax carving

Silicone index with wax-up

Wax carving

Silicone index with wax-up

Use wax or burnout resin to carve desired framwork.

Use silicone index to verify that the space left is adequate for porcelain.

Components:

Abutment analog MD-RSM60

Burnout plastic cap MD-IC040


Step 8 www.mis-implants.com


Step 9.

A.

B.

Snap mechanism

Removal of “snap” rim ring

Components:

Shoulder reamer MT-CS450

Guide Pin MT-GP450 Pre-casting

Follow manufacturer instructions and fabricate metal framework based on conventional metal casting techniques.

The “snap” rim ring

The plastic copings for CPK abutment are fitted utilizing a “snap mechanism”. The “snap mechanism” is a ring that fits onto an undercut groove on the abutment. This allows the abutment to be perfectly positioned and fixed on the analog. To ensure accurate seating of the cast framework on the prosthetic abutments, it is essential to grind and remove the metal “snap mechanism”. For best results, use MIS shoulder reamer (MT-CS450).


C.

D.

Shoulder reamer

Grinding with the shoulder reamer

1

2

3

Careful use of shoulder reamer

The shoulder reamer (MT-CS450) assembly

Step 9

The shoulder reamer is composed of three elements: the guide pin(1), the shoulder reamer itself(2) and the prosthetic holder MT-MSD20(3).

Use the shoulder reamer as the last step, after making standard framework adjustments, to remove “snap mechanism�.

Note: MT-MDS20 is also available within MK-0001 Abutment holding system kit.


E.

F.

Metal framework try-in on a stone model

Metal framework try-in in patient’s mouth

Metal framework try-in in the mouth

Metal framework try-in on model

Try-in and adapt metal framework following conventional laboratory techniques. The technician must verify passive fit of the framework.

It is critical that the metal framework fits the abutments passively. “Passive fit� means that the framework can be seated all the way with no pressure on the abutments. Standard metal framework evaluation and adjustments procedures should be used to verify correct seating of the framework.


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Step 10.

A.

B.

Porcelain build-up

Porcelain try-in

Components:

Implant MF7-11375

Anatomic cementing transgingival abutment MD-CPK61 Porcelain try-in on model Abutment analog MD-RSM60

Once the appropriate shade is selected, porcelain is baked following standard procedures and adjustments.

Porcelain try-in in the mouth

Prior to placing the bridge, remove the temporary plastic healing caps from the patient’s mouth. Crown set

MK-0022

Proximal and occlusal contacts should be adjusted before cementation. “Crown Set” (MIS cement) is recommended for cementation of PFM bridges and crowns. Ensure removal of excess material.


Step 10

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Restorative procedure

NARROW PLATFORM

Prosthetic options Healing caps Standard

M4 Ø 3.30mm

Anatomic

Ø4mm H-3,4,5,6

Ø5.5mm H-2,3,4,5,6

MH-N2330 MH-N3330 MH-N4330 MH-N5330 MH-N6330

MH-52330 MH-53330 MH-54330 MH-55330 MH-56330

Impression copings

MN-I0330

Analog

MN-RSM10

Anatomic transgingival abutments

MN-CPK41 MN-CPK42 MN-CPK43 MN-CPK44

Angulated abutments

Plastic cylinders

MN-MAC10

MN-AN020

MN-CPH13

MN-CP013 MN-IT100

MN-ICH40

(Anti-rotation)

MN-PF330

SEVEN Ø 3.30mm

MN-CPK61 MN-CPK62 MN-CPK63 MN-CPK64

Cementing posts

MN-IC600

MN-IT300

MN-IC040

Screw

Screw

MN-S0160

MN-S0160


Restorative procedure

STANDARD PLATFORM

Prosthetic options Healing caps Standard

M4 Ø 3.75mm Ø 4.20mm

Anatomic

Ø4mm H-3,4,5,6

Ø5.5mm H-3,4,5,6

MH-03375 MH-04375 MH-05375 MH-06375

MH-53375 MH-54375 MH-55375 MH-56375

Impression copings

MD-I0375

Analog

MD-RSM10

Anatomic transgingival abutments

Cementing posts

Esthetic abutments

Angulated abutments

MD-CPK41 MD-CPK42 MD-CPK43 MD-CPK44 MD-CPK61 MD-CPK62

MD-CTP10 MD-MAC10 MD-WMAC1

MD-A0010 MD-P0030

MD-AN151

MD-MACF1

MD-CR010

MD-AN251

MD-CPK63 MD-CPK64 MD-CPK81 MD-CPK82 MD-CPK83 MD-CPK84

MD-IT100

MD-ICH40

(Anti-rotation)

MD-PF375

Screw

Plastic cylinders

Gold plastic cylinders

MD-A1510 MD-A2510

MD-CPH13

MD-GPC10

MD-P1530 MD-P2530

MD-CPH50

MD-GP010

Esthetic angulated abutments

MD-IC040

Screw

Screw MD-CP013

SEVEN Ø 3.75mm Ø 4.20mm

MD-IC800

MD-S0200 MD-S0220 MD-S0222 MD-S0224

MD-S0200 MD-S0220 MD-S0222 MD-S0224

MD-S0200 MD-S0220

MD-CP050 MD-IT300 MD-G0220

MD-G0220


Restorative procedure

WIDE PLATFORM

Prosthetic options Healing caps Standard

M4 Ø 5mm Ø6mm

Anatomic

Ø5mm H-3,4,5

Ø6.30mm H-3,4,5

MH-W3500 MH-W4500 MH-W5500

MH-W3630 MH-W4630 MH-W5630

Impression copings

Analog

MW-I0470

MW-RSM10

Anatomic transgingival abutments

Cementing posts

Esthetic abutment

Angulated abutment

Esthetic angulated abutment

Plastic cylinders

Gold plastic cylinders

MW-CPK41 MW-CPK42 MW-CPK43 MW-CPK44 MW-CPK61 MW-CPK62

MW-CTP10 MW-MAC10

MW-P0010

MW-AN151

MW-P1510

MW-CPH13

MW-GPC10

MW-CPH60

MW-GP010

MW-CPK63 MW-CPK64 MW-CPK81 MW-CPK82 MW-CPK83 MW-CPK84

MW-IT100

MW-WMAC1 MW-ICH40

(Anti-rotation)

Screw

MW-IC040

Screw

Screw

MW-PF550 MW-CP013 SEVEN Ø 5mm Ø6mm MW-IC800

MD-S0200 MD-S0220 MD-S0222 MD-S0224

MD-S0200 MD-S0220 MD-S0222 MD-S0224

MD-S0200 MD-S0220

MW-CP060 MW-IT300

MD-G0220

MD-G0220


All rights reserved. No part of this publication may be reproduced, transcribed, stored in an electronic retrieval system, translated into any language or computer language, or be transmitted in any form whatsoever, without the prior written consent of the publisher. Warning: MIS’ products referred to in this publication should be used by licensed dentists only.


MC-PMU06 Rev.4

www.mis-implants.com

®

MIS’ Quality System complies with international quality standards: ISO 13485:2003 - Quality Management System for Medical Devices, ISO 9001: 2008 – Quality Management System and CE Directive for Medical Devices 93/42/EEC. MIS’ products are cleared for marketing in the USA and are CE approved.

© MIS Corporation. All right reserved

Cemented Bridge Using CPK Abutments Step-by-Step  

The fabrication of an implant-retained cemented bridge is a staged process. The secure placement of a bridge may be obtained either by using...

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